Experts say India is unlikely to reach its goal of fully vaccinating all adults by year's end due to limited supply. India is the world's biggest vaccine manufacturer.
India offered shots to all adults in May. But the campaign faltered in villages due to vaccine hesitancy and misinformation. This began to change in mid-July. Nearly 70% of the 120 million shots given in the last three weeks were in India's villages, up from the half that was administered in May.
Despite the positive signs of increased vaccination acceptance in rural areas, India's pandemic remains far from over. The 46,000 new infections reported Saturday, after weeks of steady decline, was the highest number in nearly two months.
India's large population is only 11% fully vaccinated. Half of Indian adults have had at least one shot, and 35% of India's total population has received it. Large swathes remain susceptible to the virus despite this.
Numerous countries, including Israel and the U.S., offer or plan to provide booster shots to their citizens, increasing global vaccine inequity. India was once expected to be a major producer of vaccines to immunize the entire world. However, exports were stopped after an epidemic of infections. To resolve supply problems, India was expected to receive 1.35 billion shots over the last five months of 2021. However, global concerns will arise about whether Indian vaccine manufacturers can increase production to meet India’s demands.
"Currently, India has more demand than supply...the current supply of vaccines in use is lower that the projections made just a few months back." These two situations are constraining the availability of vaccines in India," stated Dr. Chandrakant Lahariya (a vaccine policy expert).
India is not unfamiliar with mass vaccinations. But this is the first time shots have been given to adults at this scale. Officials have combined strategies that worked in the past with more recent, localized innovations.
Kamalawati (65), a retired government accountant, lined up to take a shot at Nizampur outside New Delhi. People were initially concerned about side effects, but now they aren't.
Her village has won this contest, which awards a trophy and plaque to the village that has the highest number of vaccinated residents. To encourage others to get vaccinated, stickers are placed on homes. Saumya Sharma, district administrator, said that the campaign is built on the pride and sense of community residents feel in their village. "This is our village. We are determined to make it the No. She said.
Paramedic Ravi Sharma stated that Juggar is home to many thousand people living in rural areas of India's Uttar Pradesh. Others were only able to receive the vaccine after their family members and health workers had seen them.
Millions of people migrate to the Middle East every year from eastern Bihar, India's most rural state. International travel is impossible without proof of full vaccination. Dr. R.K. Chaudhary who runs a rural health centre in Phulwari Sharif village said that more people are signing up to get jabs.
These strategies are based on proven methods from past vaccination campaigns. To emphasize the importance of the shot, traditional-dressed performers are seen marching to Indian villages with drums. Numerous states have set up mobile vaccination centers where shots can be given in highly visible locations on village squares. To help people book vaccine appointments, the government also uses WhatsApp, which is a ubiquitous Indian app.
Experts in public health say that the increase in vaccinations in rural areas is crucial because of fragile health care systems in rural villages. In rural India, thousands died from the deadly epidemic of infections that swept through hospitals in January. Lahariya said that migrants from villages migrate to cities to work, and outbreaks, as well as the possibility of a new, dangerous variant, cannot be ignored.
He said that India has the infrastructure necessary to vaccinate between 5 million to 6 million people per day.
Nearly 90% of vaccines have been administered using AstraZeneca shots from the Serum Institute of India. The government hopes to solve the supply constraints that have hamstrung the vaccination effort with new production lines as well as the approval of a new homemade vaccine and another in the pipeline.
India hopes Bharat Biotech can produce around a third the required 1.3 billion shots. The company has had difficulty scaling up, and although a new facility capable of producing 10 million shots per month began production last week the company is now looking for international manufacturing partners.
Indian regulators gave the green light to the Russian-made Sputnik V vaccination in April. However, it accounts for less that 1% of all vaccines. The company has reached agreements with several Indian vaccine manufacturers to begin making shots locally, possibly by the end of this month.
India is expected to receive 100 million Sputnik V shots, and 50 million shots from Zydus Cadila, an Indian drugmaker, in the coming months.
Other than this, Moderna's COVID-19 vaccination was approved by the regulator in June. The single-dose Johnson & Johnson shot was approved in August. It is not clear when they will be administered.
Moderna and Pfizer had been meeting for several weeks to discuss the possibility of India's signing indemnity waivers. Lahariya said that India does not have an indemnity system for those who are affected by rare side effects, unlike other countries and the U.N.-backed COVAX initiative. These discussions are an opportunity to review accountability and create a system that protects people, he said.
Lahariya cautioned that, even though supply is expected to increase, it was unlikely that India will have enough vaccines to immunize all citizens by the end. He said, "No matter what."