Why India’s Vaccination Policy is an Exercise in Exclusion : India is desperately in need of a vaccination initiative to control the spread of Covid-19 pandemic that has brought our country down to its knees.
If you grew up in the 90s and early aughts, there is little chance that you don’t remember getting Oral Polio Vaccine (OPV) either administered at home through a door to door campaign or at a local (permanent or makeshift) neighbourhood healthcare centre. I still remember the taste of the ‘Polio drops’ as they were called - sweet when it touches the tongue with a bitter aftertaste.
Twice a year on designated Polio Ravivar, the aanganwadi (childcare centre) would turn into a vaccine centre where all the kids under the age of five in the neighbourhood were hauled to get their Do Boond Zindagi Ki - Pulse Polio campaign tagline which loosely translates to two drops of life - and there would be a follow up by the healthcare workers for upto five days to make sure no child was left behind.
Pulse Polio Initiative was rolled out on 2nd October 1994 when India accounted for more than 60 percent of polio cases. The initiative which is still running is one of the largest immunisation programs in the world which helped India achieve Polio Free status by the World Health Organisation in 2014 after reporting no cases of wild Polio for over five years.
The success of the program can be attributed to its overt reach making the vaccine doses available to the most deprived and vulnerable, simple and clever messaging to reinforce the need and safety of the vaccine and relentless follow up on ground.
Today, India is desperately in need of a vaccination initiative to control the spread of COVID-19 pandemic that has brought our country down to its knees. Official death toll stands at 2.58 lakhs and we all know that the actual number would be much higher. After the gruesome partition that left millions dead and displaced, this is the first time we are witnessing a tragedy of this enormous scale. And guess, we have no Radcliffe to blame but our own government who still haven't shown any signs of acting in the favour of its suffering population.
Why India’s Vaccination Policy is an Exercise in Exclusion
Scientists, epidemiologists, public health officials, doctors and everyone who remotely understands anything about fast spreading diseases have repeatedly stressed on vaccinating people as the only long term effective measure in curbing the spread of COVID-19. Countries like the USA and UK who were dealing with devastating second waves at the start of 2021 are now slowly reopening their public lives and economies on the back of robust vaccination programs. In England alone, 95 percent of people aged above 50 and 66 percent of people between 18-50 have received their first dose of the vaccine.
In comparison, India has administered the first dose of the vaccine to about 10 percent of the population. I understand that we are the world’s second most populated country and the fact that we have administered more doses in terms of absolute numbers. However, that argument doesn't hold much weight against the claims made by our Prime Minister Narendra Modi on 7th March 2021 when he lauded his government for turning India into ‘World’s Pharmacy’ during the pandemic.
India’s vaccination policy is so ill-thought out that I wonder if it should be called a policy at all. The time when the second wave was raging through western countries was the time Indian government could have easily ramped up vaccination production and administration if it had listened to experts that pandemics are known to have second and third waves. Even though the experts also did not predict the ferocity of this second wave, it was no excuse to not prepare at all.
India launched mobile based application, CoWIN on January 16th this year when the government began the vaccination drive that would include all the frontline workers in the first two phases. The app was being developed to track vaccination when it would be rolled out for the general public - though there was no clarity on when this would happen. Dr. Dilip Patil, a Maharashtra Immunisation officer reportedly said,"considering the time it would take to administer the vaccine to healthcare workers, frontline staff and people with comorbid conditions, it would take a minimum of six to seven months for the vaccine to reach the general public,"
The third phase to inoculate those above 60 and those above 45 with comorbidities began in March and was then extended to everyone over 45 in April. Second wave had already started intensifying in parts of Maharashtra by then. However, the central government continued to ignore these warning signs and left the responsibility of firefighting with state and district level administration without making any changes in its vaccine policy and distribution. Even as the second wave reached other parts of the country, the government was busy winning (read: miserably trying and yet failing) elections.
After repeated requests and nudging from medical experts and scientists, the central government finally opened the vaccination program to everyone in the 18-45 age group. However, the government had an exclusive condition for who they considered ‘everyone’ - access to the internet and a smartphone.
According to the guidelines under “Liberalised and Accelerated Phase 3 Strategy of Covid-19 Vaccination”, mandatory prior online registration on the CoWIN portal is required for everyone in the 18-44 age group. It doesn’t take an expert to point out this very flawed and inequitable guideline where just over 50 percent of the population have access to smartphones and the internet.
Mumbai - where I currently reside - has the highest number of internet users in the country estimated at 12 million which roughly amounts to 60 per cent of the total population. And yet, I have repeatedly failed to secure a vaccine slot despite having access to a laptop, a smartphone and a stable internet connection owing to limited supply of vaccine doses in the city. However, many of the Mumbaikars have taken advantage of having internet connections to book vaccine slots in nearby rural districts, leaving the locals vulnerable.
Instead of taking upon itself the task for vaccinating each and every individual of the country, the Narendra Modi led BJP government has absolved itself of all responsibility and left the state governments to fend for its citizens? It is important to note that the central government did not allocate any funds for procurement of vaccines in the fiscal budget of 2021-22 but allocated 35000 crores as loans/grants to states for the same. However, who will get a loan versus who will get a grant wasn’t specified.
Instead of equitably distributing the allocated amount from the fiscal budget to all the states, the Central Government came up with the bizarre policy of differential pricing of vaccines which allowed the manufacturers to sell the vaccine to state governments at double the price of what the central government itself paid for. In a country where all the states are not on the same financial footing, the move will make people living in rural and remote regions of the country much longer when even the most industrial states like Maharashtra and Tamil Nadu are unable to procure enough vaccines for their populations.
The confusion and frustrations around COVID-19 vaccination policy in a country that implemented one of the most successful immunisation programs to eradicate Polio in the 1990s when there was much less physical and almost no internet connectivity makes one wonder if we have receded much backwards into the past. I am aware that the spiralling COVID-19 situation can’t be compared apples to apples with the Polio endemic in the country where only children under five were inoculated over a course of a few years.
However, the delivery of the Polio vaccination program which reached to villages where electricity was yet to reach is something that Narendra Modi and his men could have learnt from had they not been so adamant about erasing the legacies of the past governments.
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