The decision to open up about 20,000 private hospitals across India from March 1 — in addition to about 10,000 government sites — to vaccinate people older than 60 years and those above 45 years with comorbidities will at once increase the number of vaccination sites. Roping in the private sector to support the government programme of vaccinating about 270 million people belonging to the two high-risk priority groups can surely speed up vaccination coverage. At 13 million at the end of six weeks since the vaccination programme began, only a little over a third of health-care and frontline workers have been covered. With the average uptake per session only about 35%, beginning the second phase of the programme could increase this percentage. Even if CoWIN platform glitches and a decline in daily cases are partly responsible for low uptake, the hesitancy to available vaccines among health-care workers, who are one of the most informed and also at greater risk of infection, cannot be overlooked. Whether the elderly and those above 45 with comorbidities will behave strikingly different or take a cue from health-care workers and prefer to wait before queuing up for a vaccine remains to be seen.
Crucial to increasing vaccine uptake in private hospitals will be the cost of vaccination, especially when it is available for free at government sites. At a time when vaccine uptake has been low even when offered for free, the only way to increase coverage is by making it easy for people desiring to get vaccinated to have one. While the intent to quickly protect people with comorbidities above 45 years who are at greater risk of progressing to a severe form of the disease or even death is commendable, the insistence on documentary evidence for vaccination should be reviewed if the uptake remains below the desired level. One in three adults in India has hypertension but only about half are even aware of it. It is one in 10 in the case of diabetes; awareness is about 50%. The trend is the same for a few other diseases that make a person eligible for a vaccine. With just over 21% of the population above 45 as per the 2011 Census data, the government can consider vaccinating anyone above that age who comes to a site. Similarly, insisting on prior registration on the CoWIN platform will further worsen inequities; vaccinating people who walk in without registration must be allowed. That less than 10% of people have opted for Covaxin nationally is proof that vaccine uptake is directly related to availability of trial data. The government can still win back trust and improve vaccine coverage by quickly making all vaccine trial data public. Also, timely resolution by the national committee, of serious adverse events and deaths following vaccination and sharing the details will surely inspire public confidence in the vaccines.
