Vaccines : Waste not! Refuse not!
The battle against Covid-19 in India may now appear to be about the availability of vaccines, who should get it first and who should get later and at what price.
But, as the magnitude of the outbreak of the second wave of the pandemic gains a monstrous proportion, we can see that our engagement to exterminate the coronavirus needs to be bolstered at all levels.
Of course, the authorities have been forced to revise their strategy frequently, which has brought some confusion but also hope that, eventually, everyone who wishes to take the vaccine will be offered an opportunity.
On its part, the Centre has promised availability of 216 crore vaccines by December so that all adults can be vaccinated. Yes, it may sound very ambitious when the memories of the scenes of shortages of oxygen, patients desperate for hospital beds and medicines and the panic over getting even the first jab have disheartened many people.
In a bid to boost the supply of vaccines in the market, the Centre proposed a 50/50 model– where half of the supply of Covaxin and Covishield will go directly to its pool of vaccines, and, which in turn, would be allotted to the states.
The other half of vaccines from private manufacturers will be available in the open market to private hospitals and state governments but at a price– different from the rate at which they would be sold to the Central government.
By having different prices, the Centre has hoped that the new mechanism will bring in efficiency and scale and incentivise production by private companies.
Even as the debate rages over the soundness of this vaccine procurement policy, the issue of vaccine shortage has bedevilled the state governments. They think that they have been forced to go for global tenders–when it is not easy to procure vaccines from anywhere at short notice.
Added to this scenario are instances of diversion from eligible beneficiaries to ineligible ones. After the announcement that all citizens of the country between the age of 18-44 years can get vaccinated from May 1, there has been a very huge rush of young people to take the jab even before 45 plus persons could be fully covered by vaccination.
So much so, the states have naturally ran out of stock and stopped the vaccination drive.
Could this confusion andrush have been avoided? Perhaps, because everyone knew that the supplies of vaccines were not ready as yet.
It did not begin this way when the vaccination programme started from January 16. It was rather very smooth– as it started with health care workers, followed by frontline workers and then senior citizens above 60 years and those above 45 years with co-morbidity. It was later extended to all citizens above 45 years.
Suddenly, when the vaccination had covered 18 crore people (including 4 crore second doses), the Centre thought it must be ready to allow the next age band– to take the jab. So vaccination was opened for 52 crore more Indians overnight –without checking on the availability of vaccines.
Apparently, the Centre appeared to have come under severe pressure–because of the fear of the second wave.
There was clamour that everything should be opened up and every age group must get access.
True, a massive capacity build-up of vaccine supply was announced simultaneously. We are set to see the current capacity of nearly 8 crore vaccines per month go up to 15 crore by July and more than 60 crore by end of this year.
By the second half of the year, 200 crore vaccines may be available on demand.
To ease the current shortage, the Centre has also widened the gap between two shots for Covishield (to 12-16 weeks) and extended the period for vaccination after Covid infection to six months.
However, what is very disturbing is that, even with the current level of supplies, many states failed to prevent loss of these vaccines–because of either careless handling or not finding enough people to vaccinate when vials are opened.
On the issue of vaccine wastage, Prime Minister Narendra Modi did not mince words recently. “Wasting even a single dose means not being able to give shield to a life. It is important to stop vaccine wastage,” he said.
Statistically speaking, India has wasted 4.6 million doses so far since the drive to vaccinate the population kicked off in January, according to data shared by the Ministry of Health and Family Welfare. This is a huge number.
The Centre has been drumming into the ears of the states to keep wastage below 1%. But, as Modi pointed out earlier this month, over 10% of covid-19 vaccines in Telangana, Andhra Pradesh and Uttar Pradesh are being wasted. Among the major states, Tamil Nadu reports wastage of the vaccines at 8.83%, followed by Assam (7.7%), Manipur (7.44%) and Haryana (5.72%).
Significantly, eight states have acted to the contrary. Kerala, West Bengal, Himachal Pradesh, Mizoram, Goa, Daman and Diu, Andaman and Nicobar Islands as well as Lakshadweep have reported ‘zero wastage’.
After private hospitals were roped into the vaccination drive, wastage appears to be higher in private hospitals than in public hospitals– because they have a ready channel for the wastage. Persons below 45 years who want to get the vaccine and are willing to pay for it are tapped. That is, if wastage is actually 5%, it is shown as 15% and 10% is sold to these people in the hospitals.
Therefore, vaccine shortage in our cities have dominated the narrative, along with reports of vaccine wastage and hesitancy to take the jab–apart from horror stories about patients dying for want of hospital beds or oxygen.
Whether it is rural Uttar Pradesh, Madhya Pradesh, Maharashtra, Rajasthan, Bihar, Gujarat, Tamil Nadu or Haryana, many villages have definitely witnessed a surge in cases.
In 2020, rural India had largely remained unaffected. That is why the reports of the spread of the coronavirus in its second avatar has set the alarm bells ringing. India, after all, lives in its villages.
But the challenges are much more stupendous –not just because of the number of people living in villages. There is a huge problem of hesitancy to undergo even tests for the fear of being stigmatised, which also extends to even taking the jab.
There is even strong physical resistance from villagers to visiting health teams as many stupidly believe that Covid is an urban phenomenon. Some even think 5G towers (which are currently experimenting with the new spectrum technology) are causing Covid-19!
This resistance for testing and taking the vaccine compounds the fact these areas do not even have the necessary medical infrastructure to take care of those who get infected.
That is why the Centre’s claim that 216 crore doses of vaccine will be available by December does not inspire much confidence among the medical experts.
We cannot be sure whether the hesitancy over taking the jab among a large section of people, including even among the literate, can be overcome so easily. There are many people in India who still say openly that the Corona vaccine is a ‘death vaccine.’
In Tamil Nadu, at many places, local villagers have refused to take the jab, citing the death of popular comedian-actor Vivek who died of cardiac arrest two days after he took the vaccine. Ironically, Vivek had given publicity to his jab in a bid to urge everyone to take the vaccine. So his death came as a huge shock and dampener for the vaccination drive though doctors were at pains to explain his death was not linked to vaccination.
In Kesarpura village, 14 km from Rajasthan’s Ajmer city, 15 people died of Covid-19. The state government rushed a team with vaccine vials to the village consisting of 1,300 residents– but not a single villager took the vaccine. Only a health worker took the jab.
In Bihar, villagers have thrashed health workers who went to vaccinate them. These health workers have been consistently pleading with villagers to take the vaccine, but none agreed.
The tribal population living in Maharashtra’s Shahapur, Bhiwandi, Palghar and Thane are still very hesitant to take the vaccine. In a bid to avoid the jab, some people had even recently fled to jungles in Gondia district.
In these places, there is no dearth of testing kits or vaccine vials. The vaccine centres wait the whole day for at least ten persons to show up to open each vial.
Karnataka has had a similar experience when tribals from Mysuru, Kodagu, and Chamarajanagar districts refused to take the jab. These districts have also reported instances of people escaping from isolation centres without completing the mandatory 14-day isolation period.
How do we overcome the crisis caused by hesitancy to take the jab or undertake tests? Maybe, a more concerted campaign is necessary to remove the stigma associated with the disease.
Until this issue is tackled effectively, the demand for COVID-19 vaccines may not be witnessed in rural areas.
Vaccine hesitant people may have genuine anxiety and fears over safety concerns, or they might belong to a community that has mistrusted the medical establishment. But there is only one solution. We, all Indians, must resolve and shout aloud: Waste not vaccines! Refuse not vaccines!
By Shekhar Iyer