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Sunday, July 25, 2021

The big gap between jab & arm: What has led to this severe shortfall among high priority groups?


Five months after India embarked on its vaccination drive against the Covid-19 pandemic, a vast number of people belonging to the two critical priority groups of healthcare workers (HCWs) and frontline workers (FLWs) are still queuing up for their first dose.

On June 15, Day 151 of the vaccination drive, as high as 67,879 people from these two groups were still receiving their first dose, according to data of the Union Ministry for Health & Family Welfare (MoHFW), raising an obvious question — why has the process of immunising India’s high priority groups not wound up yet? Covering about 3 crore people (2 crore FLWs and 1 crore HCWs) should have been a relatively easy task, considering most of them are on government payrolls and there was sufficient supply of vaccines for them in the first three months of the rollout.

But as of June 15, according to MoHFW data, only 69 lakh healthcare workers and 89 lakh frontline workers have been fully vaccinated – which comes to only 1.58 crore, a little over 50% of the original target. What explains this shortfall? The Government of India (GoI) had initially proposed to complete the first dose of vaccination for HCWs by February 25, 2021, and for FLWs by March 6, according to a letter issued by Union health secretary Rajesh Bhushan, dated April 3, reminding the states of the deadline. To find an answer to this question, ET spoke to a number of government officials, police officers, senior doctors and hospital owners; some came on record while others preferred to remain anonymous. The findings are worrying.

“There is a difference between the original estimate and the actual figures. For example, we estimated that Chhattisgarh had about 2.64 lakh healthcare workers. But many more registered later. The number has now risen to 3.5 lakh””

— TS Singh Deo Health Minister, Chhattisgarh

Hesitancy, myths and superstitions prevail over a section of the security personnel and healthcare professionals, including doctors and nurses in elite hospitals in metros — a reason why India has witnessed several spells of disinclination towards vaccination since January 16 — the day the nationwide inoculation programme was launched, initially for HCWs, which was later extended to FLWs from February 2. Chairman of Medanta Hospital Dr Naresh Trehan concedes that vaccine hesitancy is a reality although as it has receded after the devastating second wave of the pandemic in April-May that saw 4,000-plus daily deaths for several weeks. “Vaccine hesitancy was seen mostly among female nurses because of misgivings that it would affect their fertility.Some of them are still reluctant. But overall, such hesitancy has gone down after the pandemic’s second wave when many people lost their friends or family members,” Dr Trehan told ET, adding that only about 5% of those vaccinated fully in India have got Covid, and their symptoms have been mild.

According to an Indian Medical Association (IMA) report, over 700 doctors have died across the country during the second wave. The reluctance of several doctors in New Delhi’s premier medical institute, AIIMS, to get themselves vaccinated in the initial months of the rollout was widely reported.

“Initially vaccine hesitancy was very high, but many came forward for the jabs later. About 2% of my police personnel are still unwilling to get the shot because of some superstitions. Some are citing health issues. Look, we can only persuade them, not force them””

— Bhaskar Jyoti Mahanta Director General of Police, Assam

Even today, about 2% of the workforce in have refused to get vaccinated, according to a senior executive of the company, requesting anonymity. It is not just healthcare professionals. Myths and misgivings hamper vaccination among security personnel, too, although many police chiefs are unwilling to talk about the matter publicly. Assam’s Director General of Police Bhaskar Jyoti Mahanta candidly says that about 2% of his cops (about 1,300) are still hesitant to get the jab although his team is persuading them to go and get vaccinated. “Initially, vaccine hesitancy was very high, but many came forward later. About 2% of my police personnel are still unwilling to get the shot because of some superstitions. Some are citing health issues. Look, we can only persuade them, not force them,” he says, adding that 92% of the police personnel in the state have taken both the doses. As on June 15, according to MoHFW data, 1 crore HCWs and 1.7 crore FLWs have got their first dose. On June 2, it pointed to 1st dose coverage of 81% HCWs and 84% FLWs.

Target vs RealityAgencies

There was no mention of the completion of second dose. It has not released vaccination in terms of percentage of the target, which makes it difficult to capture the exact status of full inoculation since the target has gone beyond the original number of 3 crore people due to subsequent registrations. States also maintain their own numbers. In Telangana, for example, 66% HCWs and 71% FLWs took the first jab as on June 15. Also, these statistics capture the data of only those people who have disclosed their professions as falling under priority groups. Some government officials argue that the number of those vaccinated in the two priority groups could indeed be slightly higher. “If a healthcare worker takes vaccines in a different category, for instance in the 18-44-year cohort, and prefers not to disclose her profession, there is no way CoWIN will capture that data separately.

“If a healthcare worker takes vaccine in any category, for instance in the 18-44 year cohort, and prefers not to disclose her profession, there is no way CoWIN will capture that data separately. So I suspect many healthcare workers are getting vaccinated in open categories and, hence, their actual number could be more””

— RS Sharma, Chairman, Empowered Group on Vaccine Administration

So I suspect, many healthcare workers are getting vaccinated in open categories and, hence, their actual number could be more,” says RS Sharma, chairman of the empowered group on vaccine administration that oversees the digital platform, CoWIN. Chhattisgarh Health Minister TS Singh Deo says one cannot go by the original target of HCWs: “Yes, there has been a difference between the original estimate and the actual numbers. For example, we estimated that Chhattisgarh had about 2.64 lakh healthcare workers. But many more registered later. The number has now risen to 3.5 lakh,” he says, adding that the state has covered 90% of the target in HCW category.

Jabs Across GroupsAgencies

ZEROING IN ON PRIORITY GROUPS

To understand how GoI has decided on priority groups, one needs to return to a video conference held on November 24, 2020, when Prime Minister Narendra Modi interacted with select chief ministers and officials on how to roll out a nationwide vaccination programme. It was during that virtual meet that NITI Aayog member (health) VK Paul repeatedly highlighted a “30 crore number” in a presentation on the roadmap of inoculation, an official who attended the meeting had told ET then. Later, the government disclosed that it would initially immunise 30 crore Indians, including 1 crore HCWs, 2 crore FLWs and 26 crore people over the age of 50 years and another 1 crore with comorbidity.

But when the programme was actually launched, GoI chose to define the elderly as 60 years-plus, not 50-plus. As the very grouping got altered, a comparison between the original target of 30 crore in priority groups and today’s achievement of 17 crore (with only one dose of vaccine, across all categories) would be misleading. But monthly trends of vaccination (between January 16 and June 12) among the first two priority groups — HCWs and FLWs— suggest that a big chunk of people did not make the effort to procure a vaccination slot in the first 2-3 months. Fifty-eight lakh people got the first dose only during the crest of the second wave (April-May) and another 12 lakh in June (till June 12), indicating that they were either reluctant or laidback about vaccination earlier.

“Vaccine hesitancy was seen mostly among female nurses because of misgivings that it would affect their fertility. Some of them are still reluctant. But overall, such hesitancy has gone down after the pandemic’s second wave when many people lost their friends or family members””

— Dr Naresh Trehan Chairman, Medanta Hospital

After all, there was no major supply constraint till then, and GoI had allowed the cohort of 45-59 years to get vaccinated from April 1 because a large number of slots were going empty. Since only about 1.58 crore individuals belonging to both the priory groups have got fully vaccinated (two doses) as on June 15, and even if we assume the original target of 3 crore is unchanged, the score will still be a modest 53%. Says CoWIN’s Sharma: “For some time (in March-April) we stopped the window for healthcare and frontline workers because there was very little demand.

Month-wise breakupAgencies

We suspected the system could be misused by people of other categories (not eligible then). But as many genuine healthcare and frontline workers were still left out, we reopened that window,” he adds. Reopening the window for priority categories turned out to be crucial, as over 70 lakh people took the first dose after April 1. But vaccination of India’s highly prioritised and critical workforce should speed up. Every doctor, nurse and soldier should get their shot at the earliest.



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