India May Not Have Enough Doses To Meet Its COVID Vaccination Targets, Data Show

On April 8, Union health minister Harsh Vardhan said that India has 24 million vaccine doses in stock and 19 million doses in the pipeline. At the rate of 3.5 million doses per day that India has averaged in April, the doses in stock would not last more than a week from April 8 and those in the pipeline would help sustain for another five days.

If the momentum continues, India would be able to vaccinate 40% of its population by December 2021 and 60% of the population by May 2022. But the availability of vaccines may scuttle the pace. To vaccinate three in five Indians, which the World Health Organization (WHO) estimates will be needed to reach herd immunity, the country needs 1.45 billion doses of vaccine by May 2022. India currently has the capacity to manufacture 1-1.3 billion doses per year, as per a Rajya Sabha committee report.

The central government's scientific panel that examines drug approvals on April 12 approved the Russian COVID-19 vaccine, Sputnik V. But it is not yet clear how soon these vaccines will reach vaccination centres; as of these vaccines need another level of government approval.

On April 12, India surpassed Brazil to become the country with the second highest number of COVID-19 cases and it has the fourth highest death toll in the world. The first phase of COVID vaccination in India began on January 16, 2021, targeting 300 million people. These include nearly 10 million healthcare workers, 20 million frontline workers and 270 million people above the age of 50 and/or with comorbidities.

Three months into the vaccination drive and one week after the criteria were broadened to include everyone above the age of 45, at least 10 states in India have reported a vaccine shortage and many vaccine centres have been reported shut.

This is happening at a time when India has been reporting over 100,000 COVID-19 cases and 725 deaths per day, on average, over the last week. If the country wants to make a dent in mortality, it needs to cover the vulnerable population in the next two-three months and increase its pace of vaccination to 10 million doses per day, epidemiologist Giridhar R. Babu told IndiaSpend.

But India may not have enough vaccine doses to do this, our analysis has found.

Vaccine capacity and shortage

India was vaccinating at an average rate of 300,000 doses per day till February 28. In March, this increased four-fold to reach 1.6 million doses per day. In April, after the criteria were expanded again, the average daily doses administered reached 3.5 million. Nearly 35% of the total 10.4 million doses were administered in the first 10 days of April.

India's current capacity for manufacturing COVID-19 vaccines is 83-113 million doses per month.

India must maintain this pace to meet its August target of vaccinating 300 million people. But vaccinating 300 million people or 23% of the population may not be enough to bring down COVID-19 cases or deaths.

At least two state governments--Delhi and Maharashtra--have requested the central government to expand vaccination coverage to younger people, as they make up for the majority of the COVID-19 cases.

While the level of herd immunity for COVID-19 is yet to be determined, the WHO estimates that at least 60% to 70% of the population needs to have immunity to break the chain of transmission. In at least three countries--Israel, Seychelles and United Arab Emirates--the COVID-19 curve has flattened or declined after 40% of the population was vaccinated. Herd immunity is not absolute and depends on human behaviour and interaction, experts have pointed out.

At the current pace, India will take close to eight months to vaccinate 40% of its population and 13 months to vaccinate 60%. These milestones would be met by December 2021 and May 2022, respectively.

However, as of now, India does not have enough doses in the pipeline to meet the demand of 105 million doses per month that is required to meet these timelines. This could change as new vaccines get approval for import, manufacture and use.

Currently, two vaccines are being produced and utilised in India--Oxford AstraZeneca's vaccine Covishield, produced by Serum Institute of India (SII), and Bharat Biotech's Covaxin. As per a Rajya Sabha committee report, the estimated manufacturing capacity for Covishield is 70-100 million per month and that for Covaxin is 12.5 million per month. This makes for a cumulative 83-113 million doses per month.

In addition to the initial stock of 50 million doses, around 50-60 million doses of Covishield--which makes for 91% of the total doses administered--are being produced every month since January. Around nine million doses of Covaxin have been administered in the country.

However, as per data released by the government, nearly 115 million doses have been either administered or are in stock, and 64.7 million doses have been exported.

With Russia's Sputnik V nearing emergency-use approval, it could be the third vaccine to be used in India's vaccination drive.

Vaccine supply to the states

Nearly three months into India's vaccination drive and one week after the criteria were expanded to include all above the age of 45, at least 10 state governments have reported a shortage of vaccines. These states include those that are reporting the most number of COVID-19 cases such as Maharashtra, Chhattisgarh and the National Capital Territory of Delhi.

In Maharashtra, which accounts for half the active cases in the country, several vaccination centres have been closed due to the shortage. Health Minister Rajesh Tope said that as of April 8, the state has only 1.2 million doses left and requires a supply of four million doses per week. The state also accounts for nearly 10% of the total doses administered in the country.

The central government has said that Maharashtra and Rajasthan--among the states that have raised shortage concerns--have received the most number of vaccine doses. While the government has not released the latest data for all the states, it has said that Maharashtra, Rajasthan and Gujarat each have received around 10 million doses until April 8.

This is not proportionate to the population of eligible beneficiaries in the state or to the number of COVID-19 cases or deaths, an IndiaSpend analysis of Census 2011 data on people above the age of 45 and healthcare workers shows. State-wise data on frontline workers were not available. Maharashtra, with 26 million eligible people, received as many doses as Gujarat, which has 13 million eligible people.

While the data released on April 8 had only mentioned three states, the government had released data for all states on March 17. Since the month-old data may not be accurate in absolute terms, we analysed the data on vaccine supply to states to assess whether supply has been proportionate to states' eligible populations. We also cross-checked with recent data published by The Times of India and found that the proportions have stayed nearly the same, except for a margin of two percentage points.

Uttar Pradesh, India's most populous state, has around 36 million eligible people--10 million more than Maharashtra--and has received nearly as many doses as Maharashtra. Andhra Pradesh, which has nearly 20 million eligible beneficiaries, was allocated half as many doses as Maharashtra.

IndiaSpend requested the Ministry of Health and Family Welfare for updated data and the criteria for distribution of vaccines to states. This report will be updated when we receive a response.

Vaccine wastage and utilisation

Another response from the central government to the states reporting vaccine shortage was highlighting the wastage of vaccines. Union cabinet minister Prakash Javadekar said that Maharashtra has wasted 6% of the vaccines it was supplied.

Vaccine wastage is a routine part of any immunisation programme and wastage rates are a key input in planning and forecasting of doses required. India's COVID-19 vaccination programme also considers this factor--its operational guidelines include wastage rates (which are not specified, but should be "minimal") while estimating the number of doses a state, district or block requires per month.

The national average of vaccine wastage was 6.5%, as per data released by the health ministry on March 17. Five states--Telangana, Andhra Pradesh, Uttar Pradesh, Karnataka and Jammu and Kashmir--reported higher proportions of vaccine wastage than the national average.

Among the 15 states for which data were released, Himachal Pradesh, Uttarakhand and Tripura had reported the lowest vaccine wastage.

Update: Since this story was published, the DCGI has approved the Sputnik V vaccine for emergency use

(Shreya Khaitan, writer and editor, Shreehari Paliath, analyst, and Utkarsh Shamkuwar, an intern with IndiaSpend, contributed to this report.)

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