As COVID Cases Surge Once Again, Are Vaccinations Dipping?

Why are vaccine turnouts dipping? What lesson can other states learn from Maharashtra? 

Is the recent dip in vaccination concerning?

Cases of COVID infections in the country have once again been on the rise.

Maharashtra continues to be the worst-hit state in the country, accounting for over 60 percent of the new cases recorded in India.

As we brace ourselves for a full-blown ‘second wave’, the COVID-19 vaccination drive—that was first launched in January— would seem like our obvious defence that could minimise the impact of the virus this time around.

However, as the number of fresh cases in the country goes up, there seems to have been a dip in the number of people taking the vaccine.

Maharashtra alone saw a 32 percent drop in the number of people getting vaccinated between 22 and 23 March, reported Times of India.

The number of people getting vaccinated in Mumbai has also been declining steadily in the past few days with the count of elderly getting vaccinated fell below 20,000 on Wednesday, 24 March - the lowest since the drive began.

Why is there a dip in vaccine takers in Maharashtra? Is it a cause for concern? FIT speaks to Dr R R Gangakhedkar, former head of Epidemiology and Communicable diseases at ICMR, to find out.

What Does This Drop in Numbers Mean?

Although Maharashtra has been doing better than other states, there has been a dip in the number of vaccinations. But according to Dr Gangakhedkar, the dip is most likely a temporary one.

He talks about three main reasons for this development.

One deterrent to ramping up the vaccination drive has been infrastructure.“Specifically, in the case of Maharashtra, there are a number of hospitals that are yet to be approved to provide vaccines. There is also a lack of public-private partnership when it comes to administering the vaccine.”

Second is the discrepancies in data entry being a cause fluctuation in the numbers.

“We have to remember that short term dips could also be partly due to local circumstances and how data has been entered. There could be some delays in uploading the data, especially ones coming from in rural areas.”
Dr RR Gangakhedkar, former head of Epidemiology and Communicable diseases at ICMR

Thirdly, Dr Gangakhedkar says, “There is definitely some hesitation that has developed in people.”

So Why the Vaccine Hesitancy?

Dr Gangakhedkar explains how a lot of vaccine hesitancy stems from the recent change in the guidelines extending the gap between doses of Covishield.

"The temporary dip you are seeing could be because of uncertainty because of change in guidelines, because they are unable to understand it, and also if it applies to Covaxin or not,” he says.

Another major factor contributing to people's vaccine hesitancy could be the controversy surrounding the AstraZeneca Vaccine and questions that have arisen about its safety, and efficacy.

“There is also the repeated new controversies coming up with respect to efficacy data. So, there will naturally be some amount of hesitancy.”
Dr RR Gangakhedkar, former head of Epidemiology and Communicable diseases at ICMR

Dr V K Paul, NITI Aayog member (Health), said in a press conference on 24 March, “We would like to assure you that there are no risks of blood clotting-related complications (from Covishield) that were noticed in some nations.”

But Dr Gangakhedkar thinks that the problem of vaccine hesitancy can be dealt with well if we spread awareness and address people's concerns.

He also talks about how we're likely to see the number of vaccine takers rising in the near future because of the recent surge in COVID cases, saying.

Can Vaccination Be Our Defense Against the Second Wave?

Only if we ramp it up now, says Dr Gangakhedkar.

“Ideally we could have used the interval between decline of first wave and the onset of the second wave a little more efficiently.”
Dr RR Gangakhedkar, former head of Epidemiology and Communicable diseases at ICMR

“But that is the past, ” he adds. “Now, although with an increase in cases, people are likely to come forward (to get vaccinated), in settings where the incidents are high it may not be as impactful.”

He goes on to say that this is something that other states can still implement while their numbers are not very high, “so that they can mitigate the risk of mortality to a larger extent among older individuals and those that have chronic morbidities.”

“This message has to go clearly to other states”, he says.

“Because even if we increase the rate of vaccination now, the situation is so volatile, it may not be able to protect as well as we would hope. It takes time to develop the protective antibodies.” 
Dr RR Gangakhedkar, former head of Epidemiology and Communicable diseases at ICMR

Speaking to FIT earlier in the week, Dr Swapneil Parikh, Internal medicine specialist, also emphasised the importance of “ scaling up vaccination a few weeks before the peak,” in light of the incoming ‘second wave’ of covid cases in the country.

“Even if we start scaling (vaccination) today, the people to be vaccinated today will not have protection for another 3 weeks. And in 3 weeks we might be facing a disaster.”
Dr Swapneil Parikh, Internal medicine specialist

Would It Help to Remove the Eligibility Caps?

In a bid to speed things up, the government on Tuesday, 23 March announced that everyone above the age of 45 would be eligible to receive the vaccine irrespective of comorbidities, starting 1 April.

While this is a welcome move that is likely to create some momentum, Dr Gangakhedkar says that it would be impractical to open it up for all.

“The vaccine is good at reducing deaths but not so much at reducing transmission. So, given these circumstances, since we know that people who are older, and those with comorbidities have a higher risk of severe COVID and even death, it would be prudent to ensure they are protected.”
Dr RR Gangakhedkar, former head of Epidemiology and Communicable diseases at ICMR

Providing it to younger people may not really help in curbing the surge, as it won’t guarantee reduced transmission.

Moreover, opening vaccines up completely could prove counterproductive. “You might find that those places are more likely to become super-spreading events because of the rush. It would also be difficult to ensure COVID appropriate behaviour.” he says.

For this reason, Dr Gangakhedkar suggests a balanced approach.

Optimising Our Approach to Vaccination

“Perhaps it would be good to decentralise the approach of providing vaccines, and strengthening the public-private partnership. If the local self-government bodies were able to connect as well as the central government in terms of acquiring and distributing, perhaps it might help,” says Dr Gangakhedkar.

“If they could also make entries in COWIN,” he goes on to add, “perhaps that could give them a better handle on increasing vaccinations.”

Meanwhile, India’s Serum Institute has also temporarily halted the export of its Oxford AstraZeneca vaccine in order to meet domestic demands, reported Reuters.

The surge in cases and the demand for vaccines within the country can lead domino effect disrupting the supply chain of vaccines across the world.

(Written with inputs from Times of India.)

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