FAQ: Can We Start Vaccinating Those Above 50 by March?

On Friday, 5 February, the Ministry of Health and Family Welfare said that India has vaccinated more than 5 million people against COVID-19 since the launch of the vaccination drive on 16 January.

Health Minister Harsh Vardhan announced in the Lok Sabha that the third phase of vaccinations - for those above 50 and those younger but with morbidities - will likely begin in March.

He said that there might be an initial preference for those above 60 first. The government plans to vaccinate three crore healthcare workers and frontline workers by April, followed by the other priority population group of those above 50 or younger with severe co-morbidities. Since India has enough vaccine supplies, it may be possible to cover separate priority groups at the same time.

But Can We Begin Phase 3 in March?

In an earlier FIT report, virologist Dr Shahid Jameel said that our bottleneck is not the shortage of vaccines but that we don’t have enough centres and people to administer the vaccine.

“We have 3000 centres to give the vaccines across the country. Each of these can administer one shot to 100 people a day, which becomes 3 lakh a year. In a 30 crore priority group, this will take roughly 3 years.”

Dr Jameel also says he did not account for holidays and only accounted for one dose when you need two, so the reality of this timeline will be longer.

“We need to work on increasing our capacity,” says Dr Jameel. FIT talks to experts to see if we can achieve this goal by April and what our vaccination timeline looks like.

“The plan to inoculate the elderly and those under 50 with co-morbidities by March is doable.”

Anant Bhan

“Yes, it will be challenging,” he adds, “because there is a much larger population we have to reach out to, but with enough resources and planning it is doable.”

What Do We Need to Start Phase 3 of the Vaccination Plan?

Dr Bhan and Dr Jameel concurred that we need to increase our capacity to be able to meet the ambitious March timeline. So for now, we need answers to the following questions:

1. How Are We Reaching the Population?

We either need to increase our vaccination centres or outreach immunisation centres. “Healthcare workers were vaccinated mostly in their facilities so reaching them and coordinating was easy, but with a larger population we need to figure out delivery points, will we be going out into communities and immunizing like for children - this may be challenging but will increase uptake. Will they have to come in? We need to train people accordingly,” says Dr Bhan, agreeing that it will take a lot of financial and human resources and planning.

2. Who Will be Eligible?

For healthcare workers, eligibility was easily determined based on profession and a medical check, but we need to do a lot of groundwork to see who is eligible in this larger category. “We need more transparency. For the elderly, it may be easy with age proof but for those with co-morbidities we need more clarity. Which co-morbidities? How severe do they have to be? How will this data be collected, what certificates are needed and can this be self-reported? A lot of people may be missed out as they may not be diagnosed yet,” asks Dr Bhan.

As per a report in The Times of India, those with severe co-morbidities need to procure a medical certificate certified by a general physician to qualify. The protocol to qualify will include doctors scoring the patient as per a set criterion, and often new tests to verify may be needed. These medical certificates need to uploaded on the Co-WIN IT platform. As per the report the following co-morbidities to receive the vaccine on priority are:

• diabetes
• heart disorders
• respiratory diseases
• kidney diseases
• any type of cancer
• people with disabilities - although which ones aren't mentioned,
• neurological disorders like Parkinson's or those that can result in higher chances of severe pneumonia
• people who are on immunosuppressant drugs will also be eligible, although which ones were not mentioned. It seems like the criteria will look at the severity of the disease and its impact on increasing mortality from infection or lowering the immune system so a person with severe diabetes for more than 10 years will get priority over someone younger with diabetes who has the problem under semi-control.

3. How Will We Manage This?

We need to increase our capacities in building centres, training human resources, tracking and planning the logistics. “If the government is paying for this then it should be possible,” says Dr Bhan. This can be done by tapping into the COVID relief fund.

The health ministry added that till date total hospitalisations post the vaccination is just 27, which amounts to 0.0005 per cent. Meanwhile, 28 people have died post receiving the shot, although there has been no clear link between deaths and the vaccine. As per the Ministry, no death or even severe or serious case has been linked to Adverse Effect Following Immunisation (AEFI).

Still, there is a fear of ‘vaccine hesitancy’ from a lack of transparency about the vaccine or a lack of awareness (usually in the lay public). We are already seeing this in healthcare workers, with the low uptake of only 28,000 across the country on Sunday, 7 February. “We would need robust awareness programmes to increase uptake otherwise this plan would not work.” This again would need training, planning, financial and human resources.

Be Ready for Complications

Dr Bhan said that we are nearly done with the majority of healthcare workers, and then as we move to the larger population of frontline workers we will face challenges too. Similarly, for the next group, we will face bumps in the road.

“For vaccinations to be useful, the process needs to be fast. We cannot wait for several years before the people who need the vaccine get it as that defeats the purpose of a vaccine in a pandemic.”

Anant Bhan

“It will be a complex exercise for sure,” he adds.

What About Simultaneous ‘Vaccine Diplomacy’?

India has strength in manufacturing vaccines and has been deploying vaccines to the rest of the world before COVID-19 as well. “We have the capacities and vaccine diplomacy is important in balance with distributing it within our population. It depends on domestic and international demand, accordingly the manufacturing companies will ramp up production to ensure there is minimal wastage,” says Dr Bhan.

“We have enough supply,” he adds and so India can afford to help out neighbouring countries and improve foreign relations in the process.

The health ministry asserted that India had the fasted global vaccination pace as the country has vaccinated 5.2 million beneficiaries in 21 days, while the US took 24, the UK 43 and Israel took 45 days to reach the five million milestone.

Global public-private vaccine alliance Gavi has collaborated with the Serum Institute of India (manufacturer of Covishield, the Oxford-AstraZenenca vaccine in India) and the Bill and Melinda Gates Foundation to deliver up to an additional 100 million doses of vaccines to low- and middle-income countries, as part of the Gavi-COVAX Advance Market Commitment, reported Hindustan Times. This is to ensure developing countries don’t get left behind in the vaccine race.

As per The Print, Bharat Biotech's Covaxin will be sent free of cost to Mongolia, Oman, Myanmar, Philippines, Bahrain, Maldives and Mauritius, while Covishield will be sent to Bhutan, Afghanistan, Nepal, Bangladesh, and Seychelles. On 18 January, the government said that we have around 5 crore available in stock of which 2.5 crore will be exported.