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A brief history 'Atma Nirbhar' Bharat's vaccination drive... Or rather lack of it

By Koko Singh*

From the very onset of the Covid pandemic, it was apparent to all and sundry that the only sustainable check would be vaccine-induced protection. As early as July 2020, vaccine R&D went into overdrive globally, with Phase 1&2 trials being conducted in tandem. Even a covid idiot like Donald Trump committed millions for development and speculative production.
In India, however, the single largest vaccine producer in the world (Serum Institute of India) got no assistance from the Government of India (GoI), but despite that it went ahead with AstraZeneca vaccine production on a speculative basis, with only part of the cost being met by international funding. The GoI, through the Indian Council of Medical Research, also started the development of a vaccine with Hyderabad-based company, Bharat Biotech. They, however, only had a manufacturing capacity of under 5 million (50 lakh) vaccines a month, whereas India’s demand, at 100% coverage of the 18+ population, works out to be two billion (200 crore) shots.
In August 2020, in this race to produce a vaccine, the Russians made it to the finishing line, attempting to repeat their space race triumph of 1957 (when they put the first unmanned satellite into orbit). The launch of the Sputnik V vaccine was announced by their Alexander Putin. The efficacy of Sputnik V was not accepted by most as Phase 3 trials had not been completed!
At this time, globally, close to 130 vaccines were being developed and by November/December 2020, vaccines from Moderna and Pfizer, based on the new mRNA science, had passed scientific scrutiny and applied for 'emergency use' in the USA and Europe. After its significant contribution to unleashing the virus globally, China also announced the development of two vaccines but even today their efficacy is in doubt. In early December, the vaccination drive started in both the USA and UK, initially with the Pfizer vaccine.
Switch now to the prevailing scene in Bharat with the yet-to-be-titled ‘Vishwa Guru’, the Supreme Leader (‘SL’ in short), at the helm. In the first week of December 2020, both Pfizer and AstraZeneca (Covishield), applied for emergency use approvals. Pfizer’s application was discarded rather hastily and with scant in-depth consideration, because there had been no trials conducted in India. The fact that millions of people in other parts of the world were going to receive this vaccine was not good enough for us, the babu and our SL had it in for the ‘white man’ for getting ahead!
From then on, we have moved at elephantine speed with numerous big stumbles along the way. Serum Institute announced that they had stockpiled enough vaccine raw material to produce 50-60 million (5-6 crore) doses and could produce 50 million per month. This indicated we could have started our vaccination drive by mid-December 2020. But, there was a deafening silence till January 1.
When, as a New Year gift to us, emergency approval was granted to Covishield. The reason for this inordinate delay became apparent the very next day. In a masterstroke by Atma Nirbhar Bharat, approval was given to Bharat Biotech’s Covaxin vaccine, despite only Phase1&2 trials having been completed on it.
Inoculations for frontline workers (approximately 30 million) were then scheduled to start from January 16. However, till January 11 no orders or price finalization was in place. Finally, Serum Institute received an order for 11 million doses of Covishield and in early February another order for 10 million doses. For various reasons, including vaccine hesitancy, only 50% of the identified frontline workers could be covered in the first 6 weeks.
Within the first ten days of the vaccination drive, the slow trend was evident but instead of expanding the scope of coverage, the SL and his cohorts decided to open vaccination to an extremely limited part of the general public (aged 60+ and 45+ with co-morbidities) from March 1. An app called Cowin was introduced and it was mandatory to first register on it and then seek a date and time slot for the vaccine shot.
At this stage, there was a convergence of several factors that resulted in the ‘perfect storm’. On Janaury 21, the SL announced at no less a forum than the World Economic Forum at Davos that we had defeated Covid! Barely 3 weeks later, the BJP national executive passed resolutions extolling not only the defeat of Covid under the able, sensitive, committed and visionary leadership of the SL but also attempted to infuse in its citizens the confidence to build an ‘Atma Nirbhar Bharat’.
In early March, the Union Health Minister, a doctor himself, declared that ‘we are in the endgame of the COVID-19 pandemic in India’. Simultaneous to all this macho ‘56” chest beating’, our SL decided it was the ideal time to substitute hugaloo diplomacy with Vaccine Maitri (friendship). Serum Institute had in stock around 100 million doses ready for use and shortsightedly keeping only the current consumption of under 15 million doses in mind, 66 million doses were exported and 90 countries received this friendly jab from us.
Some time in February, research from the inventors of Covishield indicated that there would be a significant increase in efficacy if the duration between the two-dose regimens was increased from 4-6 weeks to 10-12 weeks. Studies also indicated that even one dose was generating significantly improved immunity.
The wider gap formula was adopted in England but our masterminds declared that this was just a ploy to make up for vaccine supply constraints in the UK and that we had more than enough capacity to meet our needs and would stay with the 4-6 week gap recommendation. With the opening up of the eligibility criterion, the number of people covered by the first dose rose to just over 55 million, by March-end.
This implied that even with opening up, our pace was around 1.5 million per day. A simple calculation shows that at this rate it would take till August end to fully inoculate the 300 million (30 crore) people in the 45+ category for whom slots were opened from April 1. Unfortunately, the fault lay not in the stars but the shortsighted, rigid protocols imposed. To cite an example, walk-ins were discouraged at vaccination centres and the number of shots per centre was restricted to 100 although one has subsequently seen that 250 people can be vaccinated in a day.
Unfortunately for us, dark clouds were visible, at least to those that wanted to see. In parts of the country, particularly the North, the fast-spreading UK variant started showing up and a local ‘Atma Nirbhar’ variant (B.1.617) reared its head in Maharashtra. The SL and his loyal fans were still in a state of euphoria over the great ‘victory’ so all energy was spent on politicking, promoting large scale religious gatherings instead of gearing up production of the vaccine and the vaccination drive.
Belatedly in April, the government decided to increase the gap between Covishield shots to 6-8 weeks but this was left to individual discretion. In mid-March, both vaccine producers asked for funding to ramp up production but this was sanctioned only at the end of April in the form of an advance against orders slated for May, June and July. Serum Institute is on record stating that in the absence of large orders they were forced to limit their vision to produce around 50 million a month.
Even today, with a painfully slow vaccination drive that needs to be dramatically ramped up, the SL and his babus have placed orders for 160 million (16 crore) doses to be supplied over three months. Why not five times this amount so that the manufacturers start expediting production? GoI has now also removed the condition which they used to throw out Pfizer in December and are open to importing/producing vaccines that have not passed the great Indian field trial. Sputnik 5 vaccines have landed and been deployed as of May 16 at Rs 1,000 per dose.
A masterstroke was announced by SL around mid-April. By mid-April, the Indian variant (B.1.617), had spread exponentially in the country leaving a devastating trail of deaths. There was an inexcusable collapse of medical facilities and supplies in most major urban centres and a huge groundswell of anger and desperation built up in the country leading to many more people now seeking and accepting the vaccine as a necessary protection.
In early April, with the 45+ now eligible, the daily vaccination rate went up to 3.5 million (35 lakh) per day. For a person with any intelligence, it would be apparent that if one just followed this current rate the demand would be 50% more than supply. And with the existing panic and increased demand, the requirement would be enhanced. So, under these circumstances, what do the genie-asses in charge of our programme announcement? The opening up of vaccinations to all 18+ citizens!
Free vaccination was to be limited to 45+ even though the budgetary allocation of Rs 35,000 crore would leave a surplus of Rs 9000 crore (if all 900 million, were covered at the declared GoI rate of 150 per dose).
Furthermore, with the future in mind, the Centre decides that each State has to buy/procure their requirements directly from the manufacturers at whatever price they can negotiate as they compete with each other. Vaccine manufacturers are directed to supply 50% of their production to private entities/States at a price to be determined by them.
Also, they decided to remove the condition of testing in India for allowing ‘foreign’ vaccines to be used on our great Atma Nirbhar populace. However, not unsurprisingly, there are almost no vaccines available in quantity till the end of the year! So now, the powers-that-be (specifically the SL and his Home Minister), did what they do best under pressure... perform the famous indigenous disappearing rope trick! The States have been left to take the flak for the mayhem to follow.
Both Serum Institute and Bharat Biotech announced prices considerably higher than the rate they were happily supplying to the GoI. Expectedly, the mighty SL asked for a reduction which was given within hours. So in less than ten days private hospitals and the States were supposed to tie up supplies (at a rate of Rs 300 per dose for the States and Rs 650 for private hospitals). The time-line for supply however remains the same and now the States and private hospitals are in the unenviable position of competing with each other to get doses for the 18-45 age group which is roughly 67% of the total population.
The author

Both manufacturers may be honorable men, but as entrepreneurs, if you have ordered at different price points and quantities, you have the power to pick and choose. All private sector orders would get preference and after that, they can ‘play god’ with the States.
Another act in this theatre of the absurd was a dictat for all private hospitals to return their stock of the vaccines leftover as of April 30. Some wise babus probably figured that the hospitals would make a huge profit on the stocks with them and so instead of listening to “let it be” as good folk should in troubled times they indulged in usual red tape, slowing things down.
“Mayday! Mayday!” is the universal distress call and that’s what we have been hearing for real this May in our country. Confusion has been further confounded by directions to the States to concentrate on coverage of the 45+ (only 30% for the 18-45 group). This has been followed by the ‘advice’ that now the gap between Covishield shots must be 12-16 weeks and that those who have had Covid should wait six months before getting the vaccination. This is an indication that, sooner rather than later, second shots will be denied till the beginning of July for those who got their first shot in March.
I leave you to draw your conclusions, but the above is not hearsay, it is based on facts.

The Way forward

  • Remove all officials/politicians who have been associated with this botched mission, particularly all those responsible for the lack of oxygen and other medical facilities.
  • Immediately reverse the decision which has forced States to attempt procurement in competition with each other. We are a Federal Government for a reason.
  • Reprioritize the vaccination drive. Complete the 45+ group, with the gap, increased to 10-12 weeks. Assess whether this gap is okay for those with co-morbidities and modify if necessary. Evaluation is necessary as this may be another Himalayan Blunder in the making as the UK, after evaluating the B.1.617 variant has reduced the gap from 12 to 8 weeks.
  • A new priority list must include all postal and bank employees, shopkeepers, drivers, salespersons, delivery staff, domestic workers and all others whose work involves public contact. This group should get preference until there is a substantial increase in vaccine availability.
  • GoI must procure and distribute the vaccine free to all States. Even if Serum Institute is paid 50% more than the current rate of Rs150/- per dose, the outlay will be only Rs 5,000 crore above the budgeted figure (maybe the SL can shrink his new home in the making!) Sputnik 5 has landed and this and others are priced at 1000/- a dose, for those who want the privilege of a private institute.
  • Immediately revamp the entire process of administering the vaccination. The Cowin app is completely elitist and not suitable for at least 70% of our people who do not have a smartphone and are not net-savvy. To add insult to injury the app is in English only. To be Atma Nirbhar, it has to be available in at least eight regional languages. Cowin figures indicate that only 210 million (21cr) citizens have registered so far which is a far cry from the eligible 900 million (90cr).
Two simple measures will solve the problem:
  • Set up facilitation camps and allow 1000 registrations per mobile number instead of the current four. This will allow a single person to assist a whole community
  • Simultaneously allow on-the-spot registration at the vaccination centre based on the documents required.
I am sure that at some stage the babu will want the vaccination certificate for travel, stay, entering a place of worship and anything else that comes to his brilliant mind. Physical copies, (preferably without the grim visage of the SL!), of the vaccination certificate needs to be provided to us at the vaccination centre or by post.
Currently we have a supply problem but anecdotal evidence from slum dwellers and rural people in the hinterland indicate that awareness of the vaccine is low, and many are afraid to take the shot because of rumours of even fatal side effects. An intensive communication campaign to allay fears and emphasize the benefits needs to be launched in the next 4-6 weeks so that the marginalised communities are not left out once again. The suggested facilitation camps could do motivational work besides assisting in the registrations.
It is also evident that a booster shot will be required more sooner than later, either to protect against newer variants or boost immunity which is expected to decline over a yet undetermined period.
Pfizer has started vaccination of the 12+ age group in the USA. We need to plan for the approximately 400 million 2+-year-old children of our nation so that we are not caught completely exposed and vulnerable a second time around.
---
*Associated with Atmashakti Trust, an NGO working with marginalised communities in Odisha. Views are the author’s own

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