On 21 January, a huge fire broke out in the under-construction building of the Serum Institute of India, Pune. Five workers were killed. A compensation of Rs 25 lakhs each was announced by the owners of India’s premier vaccine-maker. Within hours of the incident, the Prime Minister of India tweeted about it and expressed anguish over the loss of lives. The Chief Minister of Maharashtra is expected to visit the site of the fire and assess the situation. The extraordinary media coverage that this tragic accident received was because the Serum Institute is one of the two companies in India manufacturing the highly awaited vaccine that will finally act as an antidote to the deadly coronavirus that has claimed more than 2 million lives worldwide.
The Government of India and health authorities have sanctioned two vaccines, Covishield by the Serum Institute of India, Pune, and Covaxin by Bharat Biotech Ltd, Hyderabad. Covishield is the locally manufactured version of the Oxford-AstraZeneca vaccine (a collaboration between the University of Oxford and the British-Swedish pharmaceutical AstraZeneca), while Covaxin is completely indigenously researched and prepared in India.
Vaccinating a country of 1.3 billion is no mean task. The logistics, the costs, the management and the unenviable task of ensuring a just distribution in a country, as diverse as India with extreme income disparity and levels of poverty and affluence, pose a humungous challenge for our nation. Add to this colossal project is the fear and trepidation among people regarding the efficacy and safety of the vaccine. Can we measure up to this truly gigantic task? Let us explore some of the pitfalls we should avoid and learn from the best practices followed by other nations.
THE NUMBERS
India’s cumulative testing has crossed 190 million. We have more than 10 million people who were tested positive with around 1.5 lakh deaths. The vaccination in India started on 16 January 2021 (nearly 40 days after the first Covid-19 vaccine was administered in the UK) and after 6 days, it has reached the 1 million mark. According to media reports quoting government sources, in phase 1 to be completed by July 2021, 10 million health workers and 20 million frontline workers will be receiving the vaccine. In phase 2 those above the age of 50 (about 250 million) would be targeted. In terms of numbers, we have inoculated 10% of our caseload and around 1% of our population. Stated another way, we require 60 crore doses for 30 crore people in Phase 1. From a global perspective the data (cumulative doses) is as per the table below:
| USA | China | UK | Israel | UAE | Germany | Italy | Turkey | Spain | India | |
| Vaccinations | 17.55 | 15 | 5.85 | 3.36 | 2.34 | 1.5 | 1.31 | 1.2 | 1.17 | 1.04 |
| as % of cases | 65.6 | 16891.1 | 153.4 | 550.4 | 840.4 | 66.5 | 52.8 | 46.4 | 43.1 | 9.8 |
| as % of population | 5.0 | 1.0 | 8.0 | 34.9 | 22.6 | 1.7 | 2.1 | 1.3 | 2.4 | 0.1 |
(Source – ourworldindata.org as of 21 Jan 2021, vaccination numbers are in million)
VACCINE HESITANCY
Multiple cases of people dying suddenly after taking the vaccine are reported from the states of Haryana, Rajasthan, Uttar Pradesh, Karnataka and Telangana. Health officials have denied any link between their deaths and the vaccine in all cases and suggested that the deaths were due to their inherent health condition and the diseases they were suffering from. According to an editorial in The Hindu (dated 11 January 2021) – “The vaccination begins under a cloud. Covaxin belongs to a league of vaccines that have been approved without establishing its efficacy, namely, the extent to which vaccination protects from COVID-19.” This kind of damaging information available in the public domain, combined with the huge “trust deficit” that exists between people and the government has led to a situation where even health workers have expressed their reluctance to take the vaccine.
This diffidence has reached such proportions that the Government of India has come out with various messages and advertisements to counter this reluctance to accept the Covid-19 immunisation. Communicating with the media, India’s health minister, Dr Harshvardhan said: “All eminent doctors of well-known hospitals have taken the vaccine and praised the exercise for its desired end. It is only a handful of vested political interests who are interested in spreading rumours and encouraging vaccine hesitancy among the vulnerable to such propaganda in the population. The paradox is that countries across the globe are asking us for access to the vaccines while a section of our own is fomenting misinformation and doubt for narrow political ends.”
Despite such assurances and an advertising campaign launched by the MoH (Ministry of Health) to dispel any doubts regarding the safety of the vaccine, there is a large section of the populace, which is hesitating to take the jab.
AN EGALITARIAN ROLLOUT
According to the Director of AIIMS, Dr Randeep Guleria, the Government of India is going to bear the entire cost of the vaccine rollout. According to him, this will be reflected in the upcoming budget. Media reports suggest that the cost of the vaccine rollout is Rs 60,000 crore. There is a chance that the government may adopt the “cess route” to fund this bill given our fiscal situation and the miniscule budgetary allocation to the health sector. However, it is also important for us to have an egalitarian rollout. This means that there should not be any discrimination while implementing the rollout.
Vaccination drives may have different strategies like 1) protecting those at greater risk, 2) saving the most lives possible, and 3) ensuring societal benefit. India is a country of extreme disparity. There is rampant discrimination at all levels of power and governance. Some of the various divides that challenge the fundamental constitutional guarantee of equality include the urban-rural divide, rich-poor divide, and ghettoization of minorities, posh area-slum area divide in cities and metros and the divide that exists between the educated and uneducated. These well-entrenched divides will test how equal and classless a vaccination rollout we can achieve.
We do not know the exact contours of the Phase 2-vaccination. It should not be the case that those who can afford the vaccine will get it easily in a convenient manner by paying premium charges while the remaining public will have to stand in long queues to get their shot from government clinics and hospitals. At the heart of an egalitarian society lies the concept of humanity and the dignity of the individual that we believe in.
The Prophet Muhammad ﷺ said: “O mankind, your Lord is One and your father is one. You all descended from Adam, and Adam was created from the earth. He is most honoured among you in the sight of God who is the most upright.” (Tirmidhi) Let us hope the vaccination process in our country is both efficacious and ethical. As the maxim goes – It is not what you do; it is how you do it. It is not what you see; it is how you look at it. It is not how your life is; it is how you live it.