Will India Be Able to Achieve Its COVID Vaccination Target?
India has to give 3.65 mn shots per day for the remaining 137 days to achieve its target of 250 mn people.
India will need to give 3.65 million shots per day for the remaining 137 days until the end of July, in order to achieve its target of vaccinating 250 million people with two doses.
A small number of adverse events, such as hospitalizations and deaths, have been reported following the vaccinations - 51 people have been hospitalized and 46 people have died after taking COVID-19 vaccination, according to the government on . The government since 16 January, 2021, that, "No case of serious/severe AEFI/Death is attributable to vaccination, till date."
For this second edition of the COVID-19 vaccination update, IndiaSpend visited three vaccination centres-one government and two private - in the national capital, and spoke to practitioners and public health specialists on the current criteria for vaccination.
Preference for govt vaccination centres
Jeevan Hospital and Nursing Home in south-east Delhi is located in the lower-middle class neighbourhood of Sunlight Colony, on a cramped and potholed road. At 9 a.m. on 15 March, when the vaccination drive opened, only three people were waiting inside the building.
In two hours, 13 people had been vaccinated. All of them were senior citizens, aged 60 or older.
"I was not able to register online. But I live close to the hospital, so I came over and registered my mother who has been very enthusiastic to get the vaccine," said Amit Arora.
Outside the hospital, brothers Khajan Singh Saini and Dhyanchand Singh Saini, both aged above 60 years, were getting their shoes polished from a cobbler. They live close by, but said they did not want to get vaccinated there. "We don't trust private hospitals, and my son has registered for us to take the vaccine at Safdarjung Hospital," said Dhyanchand.
In South Delhi’s upmarket East of Kailash area, people wait in the sun for their vaccine shot at the National Heart Institute, a private hospital.
Rajkumar Jaiswal, a senior citizen who works as office staff serving tea and water at a nearby firm, has come to take his vaccination.
Jaiswal said he did not know about the vaccination or how to register, but a woman at his workplace had told him about it and offered to help. “This vaccination centre is close to my house. But I did not know where this place actually is and walked for about an hour trying to find it,”Rajkumar Jaiswal
RML has three vaccination sites at its campus. Many frontline workers were present for their vaccination, especially from the Delhi Police, on 15 March, when IndiaSpend visited. Medical and nursing students were also lined up for their shots.
"Most people don't know where to go for vaccination but assume that RML, being an important government hospital, will definitely be providing the vaccine," said Parmar. "We have so far been able to cater to the inflow of people but it would be good if people went to other vaccination centres also, to decrease the load here."
Expanding the pool of those who can get vaccinated
Up to 73% of India’s COVID-19 deaths are linked with comorbidities including diabetes, hypertension, cardiovascular and respiratory disease, according to June 2020 government data.
Ischaemic heart disease was the leading cause of health-loss in India in 2016, and stroke the fifth. Also, the prevalence of chronic obstructive lung disease increased to 55 million in 2016, from 28 million in 1990.
As of 2019, India had 77 million diabetics--second only to China (116 million)--according to the International Diabetes Federation's . Up to 75% of India's diabetics face higher COVID-19 mortality risk, as IndiaSpend in June 2020.
Hypertension affects nearly three in 10 Indians and is responsible for 17.5% of all deaths and 9.7% of disability-adjusted life years or DALYS in India, IndiaSpend reported in May 2018.
Some comorbidities have to coexist with others for eligibility in this round. For example, those who have had diabetes should also be hypertensive to get vaccinated, and their diabetes should have existed for over 10 years, or should have other complications associated with it.
Given this high prevalence of diabetes and hypertension in India, some health experts are of the view such comorbidities should be sufficient conditions for being on the priority list.
"It needs to expand to include even younger people who also have these chronic diseases," said Misra. "In my practice, I can see that chronic diseases are occurring in younger people too. Some of the cut-offs also don't make sense.
For example, asking that people who have had diabetes for 10 years get the vaccine first. Diabetes, whether one has had it for such a long period or less, remains a risk factor for COVID-19."
, cardiologist and vice president (research and policy) at the Public Health Foundation of India, pointed out that the eligibility list is dynamic and will start to embrace a wide group of comorbidities in the future.
"One can argue that the list should have simply said that anyone with diabetes or hypertension should get the vaccine, but the volume of people would have been staggering for the system to manage it initially," he said.
"As the ability to vaccinate increases, as the availability of vaccines increases, as more vaccines get approved, more people can also be vaccinated and the list of eligible people can increase," said Dorairaj.
How the world is deciding on vaccine eligibility
In November 2020, WHO offered advice on how countries can prioritize vaccine eligibility for COVID-19. If those with all kinds of comorbidities are included in the early months of the vaccination drive, demand could outstrip supply.
The organization also pointed out that those with multiple comorbidities are at a higher risk than others.
WHO asked countries to use local data to figure out their prioritization strategy. As an example, it said, one approach could be "to prioritize individuals who have two or more relevant comorbidities". India's vaccination criteria so far, has been in line with this advice.
NCDs have been on the mind of policy-makers around the world even before the pandemic. In 2011, global leaders met at the United Nations to put together an agenda to tackle disease such as cardiovascular problems, cancer, chronic respiratory disease and diabetes that cause 60% of all deaths globally.
In the UK, the is divided into nine groups, and "will include around 99% of people at risk of dying from the disease". The first group is of residents in care homes for the elderly, the second, of those older than 80 and also frontline health and social workers.
The remaining groups are largely age-based and of those who are "clinically extremely vulnerable".
The US government’s vaccination prioritisation has been divided into phases. In the first, vaccination is being offered to healthcare personnel and residents of long-term care facilities.
In the second, it is opened to frontline workers and those older than 75. In the third phase, it is open to those between 65-74 years of age and also 16 to 64 years of age with underlying medical conditions that increase the risk of severe COVID-19.
What is the status of the vaccines so far?
COVAXIN’s approval was based on interim safety and immunogenicity data from phase 1 and 2 clinical trials, and safety data from phase 3.
COVISHIELD's approval was based on safety, immunogenicity and efficacy data from phase 2 and 3 of clinical trials abroad, and some ongoing data on safety and immunogenicity from the same phases in India.
Currently, several countries including Germany, Italy, France, Sweden and Norway have suspended the AstraZeneca COVID-19 vaccine after reports or recipients experiencing blood clots following the vaccination.
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Anoo Bhuyan reports on healthcare at IndiaSpend. She has also reported on issues of law and justice, technology and society and gender. Before IndiaSpend, she worked at The Wire, Outlook Magazine, BBC News and National Public Radio. In 2018, she won Bournemouth University’s ‘Journalist of Change’ award for her reporting on extra judicial killings in Manipur. She also received a scholarship for her postgraduate degree at the School of Oriental and African Studies, University of London. She can be reached on Twitter at www.twitter.com/AnooBhu.
(This article was originally published on IndiaSpend. Read the original article here.)
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