India takes up the challenge to vaccinate 300 million people in the initial stage of COVID-19 immunisation programme. Sanjeet Bagcchi reports.
As of Feb 8, more than 6 million people have been vaccinated in the world's largest COVID-19 vaccination campaign that started on Jan 16 in India. The first vaccine was administered to a sanitation worker at the All India Institute of Medical Sciences, New Delhi, and then the campaign picked up its speed. According to statement released on Feb 8 by the government's Press Information Bureau, “India has become the fastest country to vaccinate 6 million beneficiaries countrywide. This feat was achieved in just 24 days”.
With a population of 1·38 billion, in the initial phase of the COVID-19 vaccination programme, India aimed at vaccinating 300 million people by August 2021, including 30 million health workers and frontline workers (eg, police, soldiers), and 270 million elderly people (ie, aged over 50 years) and people with co-morbidities. According to the Press Information Bureau, COVID-19 vaccination in India has been initiated with two types of vaccines: Covishield (by Serum Institute of India Ltd) and Covaxin (by Bharat Biotech International Ltd).
The Indian government will bear the cost of COVID-19 vaccination for health and frontline workers (ie, 30 million). However, clarifications have yet to come regarding whether the vaccination would be free for the rest of the targeted population and when vaccines will be available in Indian pharmacies (and at what price). The Press Information Bureau unveiled the government's procurements of 11 million doses of Covishield at a cost per dose (excluding taxes) of 200 Indian rupees [approximately $2·75], and 5·5 million doses of Covaxin at an average cost per dose (excluding taxes) of 206 Indian rupees [approximately $2·83].
With respect to India's COVID-19 vaccination initiative, Bruce Y Lee (CUNY Graduate School of Public Health and Health Policy, NY, USA) told The Lancet Infectious Diseases that, “India has the world's second largest population and over one-seventh of all the people in the world. Therefore, getting high coverage of India's population with the COVID-19 vaccine will be important in controlling the global spread of SARS-CoV-2”. According to Brian Wahl (Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA), India's strong domestic vaccine sector has enabled the country to launch one of the largest and fastest COVID-19 vaccination campaigns in the world. He said that “India's vaccine sector will likely play a critical role in providing affordable COVID-19 [vaccines] to countries that might not have access [to the vaccine] otherwise”.
India has previous experience in carrying out large and targeted vaccination campaigns against diseases, such as, for example, measles, tetanus, and diphtheria, under the country's Universal Immunization Program, which targets 26·7 million newborns and 29 million pregnant women every year. The country has also eradicated smallpox and polio. For the ongoing COVID-19 vaccination programme, the government has covered—apart from various other places—urban slums, tribal areas, and remote areas. “More than a lakh [ie, 100 000] vaccinators were trained; multiple mock exercises were conducted; a pan-India national exercise was also conducted to hammer out the slightest glitches”, the Indian health minister Harsh Vardhan said.
According to Harish Nair (University of Edinburgh, Edinburgh, UK), immunisation of 300 million people in the next few months is a herculean task. “India does have the experience to conduct mass immunisation programmes at scale”, he said, adding that, “[this] will undoubtedly require participation of not just the public sector, but also the private and voluntary sectors”. He added that “Alongside supply side logistics, the government will need to build public confidence in COVID-19 vaccines”.
Madhukar Pai (McGill University, Montreal, Canada) thinks that the task ahead of India is daunting, but the country has tremendous experience with mass vaccination programmes. Although public participation generally tends to be high in India, public communication and transparency is critical, he pointed out. “So, it will be good to share all vaccine approval data in the public domain and also engage high profile politicians and celebrities to promote the campaign”, he added.
In India, although safety concerns on COVID-19 vaccines were raised, a large number of health workers who underwent vaccination at the initial stages welcomed the programme and dispelled rumors through social and electronic media and various other ways. “I really appreciate the world's largest COVID-19 vaccine drive in India. I feel proud”, said Madhu Gupta (Post Graduate Institute of Medical Education and Research, Chandigarh, India). “I would recommend that more and more people in the priority group should come forward to participate in this [vaccination] drive”, she told The Lancet Infectious Diseases. Sushmita Roy Chowdhury (Fortis Hospital, Kolkata, India) added “I would recommend responsible journalism around [the COVID-19] vaccination. [Also, it should be considered that] high-risk population in India [undergo] mandatory vaccination”.
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