India’s Vaccination Programme: Is the Government’s Timeline Realistic?

On June 7, Prime Minister Narendra Modi declared that the Centre would be providing free vaccines to all citizens above 18 years from June 21 onwards.

It was a historic announcement, but it came only after the devastating death toll of the second COVID-19 wave. One could argue that the government should have shown more swiftness in carrying out universal vaccination as well as increasing its pace as an efficient means of preventing loss of life.

While one member of the Niti Aayog announced that 2.1 billion doses would be procured before December 2021, there is little evidence to back up the claims. Thus, without clear planning, it cannot be said with certainty that the central government will be able to procure such a large quantity of vaccines and achieve universal vaccination within the stipulated time.

It is particularly important to examine the government’s timeline and issues that might impede the vaccination progress. We begin by first discussing the existing speed of vaccination and the required rate for universal vaccination for different states. This is followed by an analysis of the expected vaccination coverage by the cut-off date based on various speeds.

We also project timelines for states to achieve universal vaccine coverage. For simplicity, we focus only on the number of doses required at the rate of two doses per person for universal vaccination. It is estimated that 938.96 million people of the age of 18 and above are eligible for vaccination, which would require 1877.9 million vaccine doses to be administered.

We show vaccination speeds during recent times and projections thereon with respect to vaccination target completion by end of this year along with a possible timeline of universal vaccination. Our analysis is based on states’ actual average daily doses in millions and we also double this speed for simulated projection purposes. 

Closed Brihanmumbai Municipal Corporation (BMC) vaccination centre due to shortage of vaccine in Mumbai, Thursday, July 1, 2021. Photo: PTI/Shashank Parade

Various vaccination speed and projection dates have been used: ‘May rate’ is from the morning of May 1 to May 31, 2021 (30 days) and projected from June 8, 2021, post the PM’s address. ‘June rate’ (previous phase) is from the morning of June 1 to June 21, 2021 (20 days) and projections from the morning of June 21 before the beginning of new vaccination campaign. The current ‘June rate (new phase)’ is from the morning of June 21 to July 1, 2021 (10 days) and projections made from July 1, 2021, to show the current trend. The required rate in the table below is projected from July 1, 2021, for universal vaccination with a cut-off date of December 31, 2021. (Data is sourced from the website of Ministry of Health and Family Welfare and may be provisional and subject to revision.)

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In Table 1, the average daily doses in May were only 1.94 million. There was some improvement to 3.2 million in the previous phase of June which quickly progressed to as high as 5.57 million in the new phase of June. If the speed of vaccination could suddenly increase in the new vaccination phase, why was the initial speed so low?

More importantly still, the required average daily rate of vaccination for universal vaccination by year end comes out to be 8.38 million for India. The national record for most vaccinations was 8.6 million on June 21. There is a need to keep up the daily vaccination rate around the national record consistently. However, this momentum has not been sustained, and the average has fallen to 5.57 million between June 21 and June 30, 2021, and on June 30, 2021, only 2.7 million vaccinations were administered.

Table 1: Speed of Vaccination and Required Rate (Total Doses) 

Source: Authors calculations

At the same time, we must also look at the performance of different states vis-à-vis their required rates for vaccination. States like Delhi, Himachal Pradesh, Uttarakhand, North-Eastern states, Karnataka, Madhya Pradesh and Chhattisgarh show a promising trend, their present rates of vaccination overtaking their required rates. In Kerala and Gujarat, the current rate is very close to the required rate. It may be assumed that these states will be able to meet the target of universal vaccination soon.

However, the remaining states still need to improve their current average rates of vaccination if they want to meet their required deadlines. Although Uttar Pradesh seems to be performing the best out of all states at an average of 0.57 million vaccinations, it is still a long way in achieving its required rate of 1.43 million. Given the vaccine hesitancy, and the risk of coordination failures in states with a poor health infrastructure, the pace of vaccination may further increase challenges in any case.

It is thus evident that many states will lag behind in achieving full vaccination coverage as they have not yet achieved the required rate. It is relevant to have a perspective of the expected coverage and shortfall expected by the end of the year going by the various vaccination speed.

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In Table 2, we consider first the usual rate of vaccination for the months of May and June (previous and new phases) and also double these rates to see the projected coverage.

If the usual speed seen in May 2021 were continued, only 34% vaccination coverage could have been achieved by end of this year. Double this speed could have raised coverage up to 55%. Going by the usual rate in the previous phase of June, 48% coverage could be achieved in India by the end of December, doubling which could increase coverage to as high as 81%. However, since the speed increased considerably in the new phase of June, the usual speed would be expected to lead to coverage of 70% of total doses. 

Table 2: Percentage of Vaccination Coverage Expected by December 31, 2021, Based on Different Vaccination Speeds (Total Doses) 

Source: Authors calculations. 

At the same time again, projections for each state yields differential outcomes. Delhi is the only state which will be able to achieve the target by the cut-off date, even by the usual May speed. If the June speed (as seen in the new phase) is continued, states such as Himachal Pradesh, North-eastern states, Uttarakhand, Chhattisgarh, Madhya Pradesh and Karnataka will be able to achieve the target of full vaccination cover by end of this year.

If the June (new phase) speed is doubled, most of the remaining states will achieve the target. However, the states of Jharkhand, West Bengal, Punjab, and Uttar Pradesh will only be able to cross 80% vaccination cover of both doses by year-end even with double the speed seen in the new phase of June. Bihar meanwhile, will not able to even reach 70% coverage even at the double of the current rate.

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Given the differential outcomes in the expected coverage by the year end, we also present in Table 3 the dates by which universal vaccination coverage can be achieved by different states. 

Table 3: Timeline of Vaccine Coverage (Total Doses) Based on Different Vaccination Speed

Source: Authors calculations. 

Going by the average May 2021 usual speed, India would only achieve full vaccination coverage by Gandhi Jayanti in 2023 and doubling this speed would only help India reach its target by August 2022. At the usual May speed, only Delhi would be able to achieve the target before the year end. Going by the June speed (previous phase), India would reach its universal vaccination target by November 2022, and even by the current June speed, it is only in April 2022 that India is projected to accomplish universal vaccination.

Uttar Pradesh and Bihar are expected to achieve its target by October 2022 and February 2023 respectively. Even by doubling the speed seen in June (new phase), Uttar Pradesh and Bihar are projected to achieve the target by February and April 2022 respectively.

A woman reacts as a health worker conducts COVID-19 testing before administering a dose of COVID vaccine, outside a bus terminal at Parimpora in Srinagar, Monday, July 5, 2021. Photo: PTI/S. Irfan

We have seen that there is volatility in vaccination speed and sustaining the momentum may emerge as a major issue.  It is only now that the vaccination speed has picked up to around six million doses per day, which again raises questions about the slow vaccination speed seen earlier in May at just around two million doses per day. Was this slow vaccination speed deliberate or due to supply issues? If it were just because of supply issues, wouldn’t it have been prudent to have resolved it earlier?

There are visible supply deficiencies which raise questions about the claims of achieving the target of full vaccination coverage by December 31, 2021.  The challenge of maintaining the vaccination speed is dependent upon uninterrupted supply which necessities scaling-up of the production process. However, most of the private suppliers are not able to scale up and it is very unlikely that they would be in a position to meet the supply requirement within the time frame. There is definitely a lack of production capacity by private suppliers in India. 

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Bharat Biotech, which is expected to produce 550 million doses over five months, has only committed 80 million doses. Its additional plants may take at least six months before they can supply doses. Similarly, Serum is expected to supply 750 million doses between August and December, but producing 150 million doses per month does not seem feasible. Dr. Reddy’s Lab will manufacture, from August to December 2021, 35 to 40 million doses of the Sputnik vaccine. Bio E + Baylor College USA are to manufacture subunit vaccines but their Phase 3 trials, if they succeed, will scale up production only later in 2021.

Moreover, Serum Institute’s Novavax (called Covavax) faces trial and thus manufacturing delays exacerbated by shortage of raw materials. Even Bharat Biotech’s Nasal vaccines have only just completed Phase 1 trials, and there is no certainty it will be ready this year even if trials are successful. Gennova is also planning mRNA vaccine based on a new technology, which however has still not completed trials. Finally, Zydus Cadilla is to manufacture a DNA vaccine, but it is still under trials. As such, there is much uncertainty with respect to private manufacturers.

In the public sector, only Indian Immunologicals has got its wheels turning. Haffkine and BIBCOL will take a significant amount of time to start manufacture. Had Haffkine received bulk from Bharat Biotech as per the initial plans, production of finished doses could have started by June this year. This however did not happen and as a result, officials at Haffkine have asked for at least a year before production can commence.

But the central government has time and again emphasised that there is no shortage of vaccines. The supply side however paints a dismal picture. The only way to make good on the claims of achieving full vaccination coverage by end of this year will be by increasing the speed of vaccination with simultaneous focus on increasing and maintaining a continuous supply of doses. We also have to keep in mind the impending third wave which also necessitates faster vaccination. If some states are able to reach the target early, their excess supply can be used to fill the deficit in laggard states. The key however is to speed up production as well as the speed of vaccination. 

Santosh Mehrotra is Visiting Professor, University of Bath, UK; Rakesh Ranjan Kumar has a Doctorate in Economics from JNU.