India Aims to Vaccinate All Adults by 2021, but Do We Have Jabs?

The ambitious plans of the Centre depend on the ability to scale up Covid-19 vaccine production and infrastructure.

India Aims to Vaccinate All Adults by 2021, but Do We Have Jabs?

Under growing criticism of its handling of the pandemic and the Covid-19 vaccination drive, Prime Minister Narendra Modi Monday announced a centralised vaccine policy and asserted that vaccine supply would be increased significantly in the country in the coming days.

This comes after Centre said it plans to vaccinate the entire adult population by the end of 2021.

Last month, the government claimed that over 2 billion doses will be available between August and December, all from domestic production, including vaccines under development.

On Tuesday, it also said India will be in a position to vaccinate 10 million people every day by July or August.

In June, close to 120 million doses will be available for the national vaccination programme, the health ministry said last week.

Are these tall claims by the government? India has a history of large scale effective vaccination programmes. But is the scale of vaccination the Centre is aiming for beyond the capacity of the system?


How Many Vaccines Do We Need?

The estimated size of the adult population is around 900 million out of the country’s total 1.4 billion population.

Most vaccines available in India so far require two doses for full vaccination. Which means, around 1.8 billion doses are needed to vaccinate all those above 18 years.

As of May 5, 227 million vaccines have been administered, according to the Health Ministry. The additional requirement, therefore, is roughly around 1.6 billion.

Based on the Centre's projection, 2 billion doses should be enough to cover India's adult population.

Vaccines Approved and Those in the Pipeline

On Monday, PM Modi claimed, "7 companies in the country are producing different types of vaccines. Trial of three more vaccines is also going in the advanced stage." He said that work on producing an intranasal vaccine for Covid is also underway.

But how did the government arrive at the 2 billion projection? Take a look at the vaccines which are on the way, as stated by Dr Vinod K Paul, member of NITI Aayog, recently.

India Aims to Vaccinate All Adults by 2021, but Do We Have Jabs?

Of the eight vaccines mentioned in the list, only 3 have been approved. The remaining 5 vaccines are still in the pipeline for a green signal.

Biological E and Zydus Cadilla vaccines are undergoing Phase 3 trials, while Bharat Biotech’s nasal vaccine and Gennova’s mRNA-based vaccine are in Phase 1-2 trials.

Covovax, the Indian name of the Novavax vaccine, is currently being manufactured by SII, at its own risk before approvals are acquired, and trials are ongoing in India.

So, let's leave the vaccines which are yet to get approval, out of the 2 billion figure.

Of the 2.16 billion doses, 1.46 are expected to be manufactured by SII, Bharat Biotech and the six companies that manufacture Sputnik vaccine, assuming there would be zero exports and minimal wastage.

This is still short of the 1.6 billion doses needed for the adult population.

Mismatch in Production Estimates

In an affidavit submitted to the Supreme Court on April 29, the Centre said 85 million doses of vaccines were being produced monthly in India.

It said the SII has ramped up its production capacity to 65 million doses a month, while Bharat Biotech to 20 million a month and further increase is expected up to 55 million by July.

The SII also recently promised to scale up its Covishield production to 100 million from August. Bharat Biotech has conveyed that the production of Covaxin would be raised to 33.2 million in July, and to 78.2 million in August which will be maintained in September too.

If the SII is able to deliver on its promise, it would be able to produce 500 million doses from August-December. Similarly, Bharat Biotech would be able to produce around 430 million doses.

The three other companies Covaxin is willing to share the code with would start production only by the end of the year or next year.

Even if we go by the numbers in the affidavit, it does not explain how the government came up with 750 million doses for Covishield and 550 million for Covaxin. The numbers just don't add up.

The manufacturers of Covishield and Covaxin will not be able to meet the government's demand from August till December unless they ramp up production capacity significantly.


Plans for June

Last week, the government informed that nearly 120 million doses will be available in June.

At least 60 million doses will be supplied to the states and Union territories for vaccination of the priority groups of health care workers, frontline workers, and people aged 45 years and above as free supply from the central government.

Apart from this, nearly 59 million doses will be available for direct procurement by the states and private hospitals.

In the affidavit, the government itself said the total production capacity of SII and Bharat Biotech is 85 million doses. The SII’s production will be ramped up only in August and Bharat Biotech’s only in July.

While 3 million doses of Sputnik vaccine arrived in India recently, large production of the Russian vaccine will begin only by August, according to reports.

It is also important to note that often the companies overstate their production capacities significantly.

So, how did the government promise to provide 120 million doses for vaccination in June? The figures are clearly unrealistic.

Vaccination Pace Should Pick Up, but Where Are the Doses?

So far, just about 3.4 per cent of India's population has been fully vaccinated, while 13.7 percent have received at least one dose.

5.53 crore vaccine shots were administered in May, compared to 7.75 crore doses in April.

For India to inoculate the remaining adult population, it needs to administer roughly 1.6 billion doses.

Starting June 5, India has about 200 days to fully vaccinate the rest of the adults. This requires roughly 8 million doses a day achieve the target.

The highest number of doses administered in a single day was a little under 4 million in the second week of April. While the inoculation drive stuttered even as adults were allowed to the get the jab in May, there was some improvement at the end of the month.

In the 10 days, 2.6 million doses were administered on per day on an average, according to data from the CoWIN portal.

India Aims to Vaccinate All Adults by 2021, but Do We Have Jabs?

According to the current production capacity of SII and Bharat Biotech, we can administer just about 2.8 million doses per day in June and in July. This is significantly lower than the required rate of 8 million doses per day.

Even if both the companies ramp up their production by August, we would still fall short of 8 million doses required per day.

The Centre also said India could have as many as 10 million doses available per day in July and August. This is more than thrice the number of average doses available per day or more than twice the highest single day doses administered till date.

It’s not clear where the doses would come from.

The above estimates have been made considering the best case scenario of production and delivery. The ambitious plans, however, depend on the ability to scale up production and infrastructure.

It would also depend on approval of the vaccine candidates and how well they can meet manufacturing timelines.

The Centre's target of inoculating the entire adult population by the end of 2021 is clouded in ambiguity. While it has repeatedly said there is no shortage of vaccines, it's important to remember that similar claims have been made in the past without making realistic assessments and failed to deliver.

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