COVID: Will India be able to meet its vaccination target?

Despite an uptick in the pace of vaccinations, production and supply problems continue to be a hurdle. The Indian government is still hopeful of vaccinating the entire adult population by the end of the year.

Over 450 million Indians have received one jab of a coronavirus vaccine and 98 million have received both shots — that means just over 7.2% of the country's 1.3 billion populationis vaccinated.

Based on available data, statisticians say India needs to accelerate its vaccination drive six-fold to achieve its target of immunizing its entire adult population of 940 million by the end of 2021.

Government exudes optimism

India's vaccination drive began on January 16. It has been marred by a shortage of vaccines, differential pricing and a bitter struggle between states and the federal government over supply.

Yet the government seems confident of meeting its vaccination target despite these major obstructions.

Last week, Health Minister Bharati Pravin Pawar told parliament that 1.35 billion vaccines would likely be made available across the country between August and December, and that advance payments had already been made to manufacturers.

However, Pawar was quick to point out that while "no fixed timeline" could be implemented in light of the evolving nature of the pandemic, those over the age of 18 would be vaccinated by December 2021.

N K Arora, who heads the National Expert Group on Vaccine Administration, also expressed confidence the government would be able to meet its target. This is based on a vaccine supply boost expected over the coming months.

"There has been a gradual increase in the availability of vaccines," Arora told India's NDTV television channel, adding that the country needs to add between 75,000 and 100,000 immunization centers to meet its deadline.

The government's new vaccination policy came into effect on June 21. It shifted to centralized procurement of vaccines after several states faced difficulties in acquiring and managing the funding of vaccines. The pace of immunizations has since picked up again.

In June, India administered 118 million doses and is likely to administer 124 million doses by the end of this month. Roughly 4 million people a day are being vaccinated, according to government data.

An unfeasible proposition

Critics say it is not clear how and when the vaccines will be obtained. 

"If 1.35 billion vaccines are to be procured, it would mean 270 million doses every month or 8.8 million doses per day on average," Vikas Bajpai, a social medicine and community health expert, told DW.

Administering 124 million doses a month of the vaccine has proved to be India's best performance so far, but scaling up to 270 million doses is going to be an arduous task, says Bajpai.

"Vaccinations do not happen on demand. Has the production capacity increased or have the manufacturers been asked to ramp up?" queries Bajpai.

India's national network of civil society organizations and health rights activists slammed the deadline as unrealistic.

They point to the government's failure to involve local communities in their vaccine policy, which has seriously impaired trust among sections of the population and influenced the way they view vaccinations.

"There are huge problems of transparency in the vaccine policy, apart from logistical issues. Huge swathes of the population both in rural and urban areas have trust issues. It is not going to be easy," Vandana Prasad, a community pediatrician and public health professional, told DW.

Prasad, who has been involved for over two decades in the Public Health Resource Network, said vaccine hesitancy is becoming more of a problem despite the government's promise it would provide states with free vaccines for everyone above the age of 18.

"The questionable basis for emergency authorization approvals and the lack of a robust mechanism to address possible adverse effects will push the deadline," said Prasad.

Government remains hopeful

Not all experts are on the same page as to whether India is on course to complete its vaccination process by the end of the year.

"Although India's vaccination rollout has been hampered by supply chain constraints, the government is confidently asserting that supplies will improve by August," Srinath Reddy from the Public Health Foundation of India told DW.

Reddy said that the government's new-found belief was based on scaled up production and the likely regulatory approval of several new vaccines in advanced stages of clinical trials.

W Shally Awathi, a pediatric pulmonologist from Lucknow, says the goal is "doable."

"I am hopeful we will be able to meet this target if production is ramped up and we move on a war-footing to inoculate the beneficiaries that are in the cohort group," Awathi told DW. 

Where are the vaccines coming from?

It quickly became clear that the two vaccine manufacturers, the Serum Institute of India (SII) — which produces Covishield — and the Hyderabad-based Bharat Biotech — which produces Covaxin — were not going to be able to meet the demand.

SII officials told DW that the monthly production capacity for Covishield is approximately between 110 and 120 million doses, with no plans to increase it further. Bharat Biotech is also not expected to increase production to expected levels. The company is still producing around 20-25 million doses a month.

The Russian vaccine, Sputnik V, has not been greenlit for everyone, although the government says it plans to produce more than 300 million doses a year. The government is yet to announce when that target might be achieved.

If approved, the Zydus Cadila-developed jab will become India's second homemade COVID vaccine. The company has reportedly submitted additional data related to immunogenicity and safety of the vaccine to the Drugs Controller General of India.

Supplies of foreign-made vaccines such as Moderna and BioNTech-Pfizer are still facing legal hurdles over the manufacturers' desire for indemnity protection.

"Unless we know where the vaccines are coming from, how can the government be so confident of meeting a deadline that is so far-fetched? All this will obviously have an impact," said Bajpai.

With a third wave predicted for India any time between August and December, vaccine protection remains the only way forward against severe infections and hospitalizations, he added.