Just three weeks after it rolled out the second phase of the mass vaccination programme for people above 60 years and those above 45 years with comorbidities, India has now undertaken course correction — to vaccinate anyone above 45 years immaterial of comorbidity status from April 1. By following the U.K. model of vaccination based on age bands rather than on comorbidities, millions would become eligible to receive the vaccine and be fully protected. Indeed, people with comorbidities are at greater risk of becoming critically ill and even dying. However, the list of comorbidities that made a person eligible for a vaccine was not only highly restrictive but also focused on multiple comorbidities, and that too of severe nature. Also, the need for a medical certificate meant that vaccinating as many people as quickly as possible was unachievable. Since a vast majority, particularly the poor and those in rural areas, are ignorant of their underlying disease, the decision, though belated, to make comorbidities redundant for a vaccine is commendable. As vaccines are a tool to promote health equity, all attempts should be made to remove any artificial barriers, more so when several States are witnessing a surge in cases.
While hesitancy towards the two available vaccines was partly responsible for the low uptake initially, there is now increasing willingness to get vaccinated. While 0.8 million doses administered on February 25 was the highest before the second phase began, the numbers have been rising steadily thereafter; increasing the gap between two Covishield doses partly addresses vaccine shortage. Yet, the seven-day rolling average crossed two million doses per day only in the last couple of days; only about 50.23 million doses have been administered as on March 24, or less than four doses per 100 people. The vaccination programme has also been witnessing lukewarm participation by private medical facilities. The reasons for this, besides the slow pace of expansion in some States, need to be fixed. Though the COVID-19 vaccination, which targets adults, is vastly different from the universal immunisation programme, India has the wherewithal to accelerate the daily vaccination rate. What is missing is the political will to achieve that, reflected in absent targets and awareness building exercises, including vaccine safety, vaccine sites and permissibility of walk-ins. Also, unlike the immunisation programme, overreliance on the CoWIN platform has made vaccination into a largely passive, facility-based exercise rather than a public-health initiative. Lack of microplanning and outreach activities are further impacting uptake. Clearly, there is a case for reaching out to people to quickly increase vaccine uptake.