One billion Covid Vaccines and beyond – Explained, pointwise

Introduction

India has administered more than one billion Covid vaccines since it started its Covid vaccination drive on January 16, 2021. This made India the second nation to achieve such a target, after China.

India celebrated this historic achievement with the launch of a film and song at capital Delhi’s Red Fort by the Union Health Minister. The Archaeological Survey of India, under the Ministry of Culture, participated in the celebrations by illuminating 100 monuments, including the UNESCO world heritage sites, in tricolour.

Leaders from across the world, including Bhutan, Sri Lanka, the US, congratulated India and termed it a huge and extraordinary accomplishment. Given the late start to the vaccination programme and various hiccups related to procurement and delivery, this is a significant achievement. This progress is critical not just for India but for the whole world to end the borderless Pandemic.

About India’s Covid Vaccination programme

India’s Covid vaccine drive is the largest, and one of the fastest, ever. Estimates suggest that more than 75% of India’s adult population has received the first dose and over 31% has received a second dose; more than 48% of whom are women.

According to the health ministry, the first 100 million doses were administered in 85 days, while the last 100 million doses were given in just 24 days.

The 100 crore vaccine is not an easy task, to get a sense of the scale, assume that each vaccination took just two minutes for a healthcare worker. At this rate, it took around 41 lakh man-days or approximately eleven thousand man-years of effort to reach this landmark.

What has led to this extraordinary achievement in Covid vaccination?

Strong political will from top to bottom: Ever since PM’s vision to vaccinate all eligible Indian adults against Covid-19 by December 31, 2021, the state and district leaders have responded with urgency.

High-powered committees set up in 2020 charted road maps for vaccine R&D and manufacturing, and the phased delivery of vaccines across India’s adult population, starting with those most at risk.

India’s lesson from previous vaccination campaigns: India’s Universal Immunisation Programme is one of the world’s most extensive public health programmes. It vaccinates over 27 million newborns with essential primary doses and over 100 million children aged 1-5 years with booster doses every year. Also, over time, India has built close to 27,000 cold chain facilities to deliver health services in the remotest locations.

Further, India’s over 2.3 million ASHA and Anganwadi women frontline workers were trained along with millions of doctors, nurses and auxiliary nurse midwives to ensure that Covid vaccines are delivered equitably, everywhere in the country. India has successfully leveraged its long-standing experience, knowledge and infrastructure to fight Covid-19.

Harnessed India’s expertise in vaccine manufacturing: Before the pandemic, Indian vaccines had already saved millions of lives from infectious diseases like meningitis, pneumonia and diarrhoea. Many Indian manufacturers, including Serum Institute (SII), Bharat Biotech, and BioE have helped make these safe and affordable vaccines available across India and to low- and middle-income countries (LMICs).
Now, indigenously produced vaccines like Covishield and Covaxin, are not only saving Indian lives but also serving the global population through Gavi’s COVAX facility and the Vaccine Maitri initiatives.

India’s IT prowess: India has used its IT prowess to digitally monitor the national vaccination effort. For example, CoWin – an open-source platform created in India – tracks vaccine appointments scheduling, provides verifiable digital vaccine certification and enables analysis of vaccine trends and breakthrough infections.

Awareness campaigns: Both Centre and State governments focussed on mobilising the population. They delivered messages through national and local influencers to address issues of hesitancy, engaged local governments and self-help groups to generate demand, used sophisticated digital strategies to address misinformation and disinformation, and conducted mass media campaigns and vaccine festivals or ‘mahostavs’.

Various state-specific initiatives: Various state governments used their individual innovation in covid vaccination. For instance, the Maharashtra government’s  Teekakaran Maha Abhiyan ensured that no one misses the corona vaccination campaign.

Tracking Adverse Events after vaccination: India had set up an expert panel last year to monitor Adverse Events Following Immunisation (AEFI) at the national level.  Any clinical event or disease that occurs within 28 days of administering a dose of the vaccine is to be reported as AEFI. This reduced vaccine hesitancy.

What are the important points to consider from the Covid vaccination?

Made in India vaccines: Till today, only a handful of countries have developed their own vaccines. India is one of them. At present, four vaccines are manufactured in India — Bharat biotech’s Covaxin, Serum Institute’s Covishield, Cadila Zydus ZycovD vaccine and Russian-developed Sputnik V.

Also, in a few instances, people prefer foreign brands. But when it came to something as crucial as the COVID vaccine, the people of India unanimously trusted ‘Made in India’ vaccines. This is a significant paradigm shift.

Note: During the pandemic, the PLI scheme ensured self-sufficiency in the manufacture of PPE kits and N-95 masks within a year.

Participatory governance: India’s vaccine drive is an example of what India can achieve if the citizens and the Government come together with a common goal in the spirit of Jan Bhagidari (people’s active participation).

Development of Science and Technology: Major investments were made in high-risk projects, a collaboration between academia and industry was proactively encouraged and infrastructure to support vaccine development was bolstered.

Another outstanding achievement has been the development and manufacturing of the first-ever DNA-based Covid-19 vaccine by the Indian pharma company Zydus Cadila.

Equitable distribution of Vaccines: Uttar Pradesh, Maharashtra, West Bengal, Gujarat and Madhya Pradesh led in terms of the number of vaccine doses administered so far. But overall the rural-urban divide in covid vaccine distribution is limited due to centralised procurement. Further, India did not follow any preferential treatment of citizens while delivering vaccines.  The CoWIN platform ensured that the vaccine drive was equitable, scalable, trackable, and transparent.

What challenges will India face in further Covid vaccination?

Shortage of vaccines: Indian government earlier set a target to vaccinate all eligible Indian adults by the end of the year. For fully vaccinating all adults, India requires another 90 crore doses. If one includes children over 2, then India will need around 80 crore more doses. So, India needs a total of 170 crore doses for fully vaccinating the population above 2 years of age.

Even though India administered 1 billion doses in just 279 days, the vaccine manufacturing capacity is not enough to vaccinate to meet the government targets. For instance, the SII capacity to produce 220 million doses of vaccine per month is not enough to meet the target.

Mutation of virus and vaccine efficiency: Covid virus is mutating ever since the beginning (Delta, Mu, Beta, Kappa, etc. are the various variants associated with the virus). At present, there is a global concern on the Delta+ variant, the further evolution of which could combine speedy transmission with Beta variant’s ability to dodge vaccines. Covid cases are again rising in the UK and Singapore despite having fully vaccinated 67% and 80% of the population respectively.

Multiple studies have suggested that vaccine-induced immunity tends to wane over a period of six to nine months. This is significant for India as the under-18 population remains non-vaccinated and also there is no certainty of booster doses in India like Israel. Immunocompromised and older people above the age of 60 may become more susceptible to infection and severe disease.

Endemicity of Covid: Recently, the World Health Organization(WHO)  Chief Scientist has said that India seems to be entering some stage of Covid-19 endemicity, where there is low- to moderate-level transmission. Even if 100% vaccination is achieved, endemicity will cause symptomatic infections within India.

Challenges associated with Covaxin: Although 90% of the Covid vaccines administered are Covishield, Bharat Biotech’s Covaxin is the dominant vaccine in many parts of the country. Further, an expert panel has allowed the use of Covaxin to the 2-18 age group.

But the Scientists are concerned that Covaxin’s full phase III trial data has not been shared. Also, the vaccine is yet to receive approvals from the WHO. This raises questions regarding the administration of Covaxin to adults and children.

What can be done to improve Covid vaccination?

Expand immunisation campaign: With more vaccines like ZyCov-D, Corbevax and Covovax in the pipeline, India’s campaign to immunize everyone needs to expand and gain further pace. The government also has to provide booster shots if the real-world data reveals waning protection over time. For instance, recently, WHO has advocated a booster dose for two Chinese vaccines due to their waning efficiency. If such proofs are available, then India also has to move ahead and start providing booster doses.

Fast pacing the recognition of Covaxin: The government has to fasten the pace of the phase III trials of Covaxin and recognition of same by WHO. This will help not only to improve the covid vaccination drive but also help Indian nationals to move to another country with a recognised vaccine certificate.

Hold-on vaccine for children till proving efficacy and safety: Instead of rushing vaccination drive to children, India has to fully vaccinate its adult population first. Within that time, India has to observe the safety and efficacy of covid vaccines on children from global studies.

More Intellectual Property collaborations: Technology transfer from AstraZeneca-Oxford University, helped India to achieve this remarkable feat. So, India has to work on more such IP transfers, global pharma collaborations and intergovernmental cooperation on raw material sourcing to improve India’s pharma industry.

Fulfil International Commitments: India’s Covid vaccination is guided by the principle of “Vasudhaiva Kutumbakam” (the world is one family). So, India has to fulfil its supply obligations to the rest of the world, for both humanitarian and strategic reasons.

In conclusion, there may be reasons to celebrate the achievement of administering 100 crore vaccines, but the current pace of vaccination should be enhanced. All stakeholders should come together to achieve the vaccination goals sooner than later. Until then, social distancing must continue and masks too should not come off.