NEW DELHI – India has dramatically increased COVID-19 vaccination rates in its vast rural hinterland, home to about 65% of the country’s nearly 1.4 billion people. But supply constraints remain for the world’s largest vaccine maker, and experts say India is unlikely to meet its target of vaccinating all adults by the end of the year.
India opened injections to all adults in May. But the campaign failed in villages due to vaccine reluctance and misinformation. That started to change in mid-July and of the nearly 120 million beatings administered in the past three weeks, around 70% were in Indian villages, up from around half in the first weeks of May.
While increased acceptance of vaccines in rural areas is promising, the pandemic is far from over in India: after weeks of steadily declining, the 46,000 new infections reported on Saturday were at their highest in nearly two month.
Only about 11% of the vast Indian population is fully vaccinated. Half of all adults and about 35% of the total population have received at least one injection. This has left large swathes of people still susceptible to the virus.
Several countries, including the United States and Israel, are offering or planning to offer booster vaccines to people, exacerbating global vaccine inequalities. India was supposed to be a major producer of vaccines to immunize the world, but halted exports after an explosion of infections. And while India expected to obtain 1.35 billion vaccines in the last five months of 2021 to resolve its supply constraints, the question of whether Indian vaccine makers can increase production to meet the India’s needs will have global implications.
“Currently in India, demand is greater than available supply … the supply of vaccines currently in use is lower than projections made a few months ago. These two situations therefore place constraints on the availability of vaccines in the country, ”said Dr Chandrakant Lahariya, expert in vaccine policy.
India is no stranger to mass vaccinations, but it is the first time that vaccines have been administered on this scale, and to adults. Managers have mixed strategies that have been successful in the past with newer, more localized innovations.
Kamalawati, 65, a retired government accountant who bears only her first name, lined up for a shot in Nizampur, a village outside of New Delhi. She said people initially feared there would be harmful side effects, but “people are no longer afraid.”
What has worked for her village and others is a competition in which the local government awards a trophy to the village with the most vaccinated people and a plaque declaring the village the winner. Stickers are also put on houses where people are fully immunized to encourage neighbors to do the same. District administrator Saumya Sharma said the campaign built on the sense of community and pride of the people in their village. “That this is our village. And we are going to make it number 1,” she said.
In Juggar, home to several thousand of the more than 155 million people who live in rural parts of the Indian state of Uttar Pradesh, villagers refused the vaccine when health officials arrived there, said paramedic Ravi Sharma. It was only after family members of health workers were vaccinated in public that others began to be vaccinated.
Millions of people from eastern Bihar state, one of the least urbanized in India, migrate to the Middle East for work. With international travel impossible without full vaccination certificates, more and more people are signing up for vaccines, said Dr RK Chaudhary, manager of a rural health center in the village of Phulwari Sharif.
These strategies are based on methods that have worked in previous vaccination campaigns. Performers with drums and dressed in traditional clothing are deployed in Indian villages to emphasize the importance of being photographed. Several states have organized mobile vaccination centers, where vaccines are administered in highly visible places in village squares. The government has also used WhatsApp, which is ubiquitous in India, to help people make appointments for vaccines.
Public health experts say the rise in rural vaccinations is significant because health care systems in villages are fragile. The deadly wave of infections that engulfed hospitals earlier this year has ravaged rural India and thousands have died. Moreover, migrants from villages move to cities to work and until everyone is vaccinated, epidemics and even the possibility of a dangerous new variant cannot be ruled out, Lahariya said.
India has the infrastructure to vaccinate up to 10 million people per day, but on average between 5 and 6 million, he said.
So far, almost 90% of the vaccines given have been AstraZeneca injections given by the Serum Institute of India. The government hopes to resolve the supply constraints that have crippled the vaccination effort with new production lines as well as the approval of a new home-made vaccine and one in preparation.
India expects Bharat Biotech to take about a third of the 1.3 billion snapshots it needs. The company has struggled to grow so far and as a new facility, capable of making 10 million shots per month, began production last week, the company is looking for international manufacturing partners.
The Russian-made Sputnik V vaccine was approved by Indian regulators in April, but represents less than 1% of total vaccinations. The company has made arrangements with several Indian vaccine makers to start injecting locally, hopefully later this month.
India expects 100 million shots of Sputnik V and 50 million shots of the newly enlightened COVID-19 vaccine by Indian drug maker Zydus Cadila later this year.
Apart from that, the regulator approved Moderna’s COVID-19 vaccine in June and the Johnson & Johnson single-dose vaccine in August. But it is not known when they will be administered.
Meanwhile, Moderna and Pfizer have been discussing signing compensation waivers for their vaccines with the Indian federal government for weeks. Unlike other countries and the UN-backed COVAX initiative, India has not put in place a mechanism for people with rare side effects to seek compensation, Lahariya said. He said these talks were an opportunity to re-examine accountability and create a system where people are protected.
Lahariya warned that although he expected the supply to improve, India was unlikely to have enough vaccines to vaccinate all adults by the end of the year. “It doesn’t matter what,” he said.
PA journalists Rishi Lekhi in New Delhi, Biswajeet Banerjee in Lucknow, India, and Indrajit Singh in Patna, India contributed to this report.
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