Grasping the challenges in India’s booster rollout
Even if future waves of Covid-19 are mild, a rapid spread of infections – as seen in the case of the Omicron-led surge – can put a large number of workers and businesses out of action or halt in-person school education. This is not a desirable outcome when the economy has not fully recovered from the losses suffered in two years of the pandemic, and learning outcomes have suffered on account of school closures.
Fully vaccinating the entire population, and boosting (administering boosters) to adults is the best way to avoid this outcome. But numbers suggest that the vaccination drive in India is now flagging. This is because the current pace of vaccination is low even if one allows for the gap requirement of nine months for boosters, and the fact that most adults have been fully vaccinated. Here are four charts that explain the problem India is facing.
Eligible people are not taking even first doses
The seven-day average of total doses administered in India was 1.98 million per day on April 28, according to data from the Co-WIN dashboard. This is an improvement over the average of 1.37 million doses on April 21, but far below the pace seen as recently as mid-February, when the third and biggest wave of Covid-19 cases was subsiding in India. From late July last year to mid-February this year, the seven-day average of daily doses was rarely below four million. After February 17, the pace has fallen below that number and consistently declined.
Is the pace falling because most people have been vaccinated? The dose-wise breakup for different age groups is not available from the Co-WIN dashboard, but is available in press releases of the health ministry, whose numbers also capture a small fraction of doses administered outside the Co-WIN system. These numbers show that while the first dose coverage for adults is widespread (and near complete; as is the second), it is not so for teenagers who became eligible for doses during the Omicron wave this year. Poor performance on this metric is the first sign of a flagging vaccination drive. Only around 40% of people in the 12-15 years age group and 79% of those in the 15-18 years age group has received theirfirst doses (they became eligible for them on March 16 and January 3 respectively). Although it has not been long since the drive began, these groups also have a relatively smaller population compared to all adults: together, just around 15% of the adult population in India. The pace of vaccinations for these individual groups has also fallen compared to the early days of the drive.
3/4th eligible people are late on boosters
The required gap between the second and booster dose can be a matter of debate. However, there is no mathematical reason for people to miss their booster doses if they are eligible. All adults who received a second dose nine months ago are now eligible for boosters. The number of such eligible people on April 28 – on the basis of people fully vaccinated by July 28 last year – was 96.6 million. However, only 26.4 million people had received boosters by April 28, meaning 70.2 million people or almost three-fourths of eligible people are late on boosters. While there is a wide variation across states, in no state or Union territory was the share of people late on boosters less than 40% on April 28. Among big states, the share of people who have delayed their boosters ranges from around 59% in Andhra Pradesh to 83% in Haryana. And only some of these can be explained by recent infections or re-infections.
Fewer vaccination sites and priced booster doses could be discouraging people from taking doses
The numbers above might suggest that people have become complacent. While that is possible, it is not the only issue. The number of vaccination sites have dwindled over time, almost in tandem with the pace of vaccination; and, in many states, people between the ages of 18 and 60, who are eligible for boosters, have to pay for them. Indeed, this may be the main reason for the reluctance -- and some states and union territories have started providing booster doses free to address the problem. The last peak in vaccination was in early January (see Chart 1 above). This is also the time when the number of vaccination sites in the country reached its all-time high: a seven-day average of 102,670 on January 9. Currently, their number is hovering between 40,000 and 50,000 -- a level last seen around August and September last year. Such reduction in vaccination sites, and the absence of free doses can discourage people.
Uptick in cases since mid-April
Improving the current state of the vaccination drive can also not be a long-term goal. This is because there has been a gradual uptick in cases since mid-April although it is early to say that a wave is underway.
The seven-day average of cases was 996 on April 15. It grew to 2,912 by April 28. This uptick can be seen even if one excludes Kerala from the analysis, which released a bulletin on only one day between April 14 and April 19. To be sure, there has been no appreciable increase in hospitalisations.