India’s move to vaccinate all adults at once may be a bad idea.

Hope the govt has solid plans to take care of the issues that may arise.

Photo by Firos nv on Unsplash

The union govt of India announced that from May 1st, 2021 all above the age of 18 years can get vaccinated. While indeed it is the recommendation of experts that vaccination be opened up for all, there are good reasons why India should not do it now.

Right now India is going through a Covid surge. It may be due to new variants in the country which have a higher R-naught (rate of transmission) than previous variants. At the same time, looking at the data, I feel the death rate due to this variant is much less. My ballpark calculations show it at 0.8% compared to 1.3% for the first Covid-19 wave.

This surge, again by my ballpark estimation, should last for a month and a half. That is by mid-June we will see case numbers drop to less than 50k a day from the current 250k a day. This is because I believe the current infection rate is at least 5–10x the numbers being tested positive. So herd immunity will be achieved in less than 45 days in most severely affected cities.

For example, if a city like Mumbai posts 25k positive cases a day, then probably 125-250k are actually getting infected. Mumbai already has 30% prevalence rate of Covid antibodies from the first wave. So with a population of 20 million, 6 million are already carrying anti-bodies. And at 150k infections a day, in 30 days Mumbai will have 4.5 million Covid positive cases.

So more than 50% of Mumbai, or 10.5 million will have anti-bodies in a month’s time. Which means they will reach herd immunity in just 40–45 days paving the way for a drastic reduction in cases. By June, we will see case numbers dropping as fast as it is rising now. Let’s call this “Bringing Covid Under Control” and remember how it actually happened.

Now coming to vaccinations, India has a current capacity to produce about 100 million vaccines a month. And it is doing almost 3 million vaccinations a day. That’s in 30 days India will use up all the vaccines it produces including wastage at the current rate of vaccination. So technically how do we vaccinate the under 45 population which makes up 70% of India’s demographic?

While I agree that opening up vaccination for all is great, it works only if we have unlimited supply of vaccines. But we don’t. We have limited capacity to produce vaccines and even that too can get sabotaged, or face hiccups. Fires can break out, production can halt, and many other issues can happen slowing production.

We are also reliant on the US for some of the raw materials that go into our vaccines. Which are being tightly controlled and their exports limited by them. So even if we can immediately ramp up manufacturing capacity, we still won’t be having adequate raw materials for producing the vaccines in the numbers required.

The numbers required are going to be huge. If at present, for the above 45 age group, 3 million are turning up for vaccination, then we can expect twice that to turn up for all above 18. How’s India going to produce 150–200 million vaccines a month? And we have not even counted those who will turn up for their second dose!

It’s simply not possible even with Sputnik V imports, as Russia can at most send us a few million doses. Our local manufacturing of Sputnik V will take months to get going. So it may have been very wise of the govt to not buckle under media and “experts” pressure to open up vaccination for all from May.

The “vaccination for all” is going to cause many problems and this is what I foresee:

1. Mad rush: Given the Covid surge happening and the scare mongering by media, there’s going to a mad rush by youngsters to get their vaccines. They are by far the most active age group. They will rush for the vaccines and soon we will hear of reports of overcrowding and long queues.
2. Severe vaccine shortages: At current capacity and with what’s in stock, the vaccination needs of 5–7 million a day who turn up can be met for a week at most. After that, it’s going to be a vaccine shortage and that’s going to add to more confusion, mad rush, and crowding. This will come at a time when the current surge peaks in 2nd week of May.
3. Profiteering and high prices: Middle men and local agents will get involved by procuring, hoarding, and distributing vaccines. Prices will go much higher than the regulated Rs. 250 per dose in private hospitals. While public hospitals and health centers may be chronically short of vaccines for the poor.
4. Fake vaccines: This is my biggest concern. Already adversaries are looking to sabotage India’s vaccination efforts to cause harm to us politically, economically, and strategically. This presents the best opportunity for such adversaries as well as local criminal elements to introduce fake vaccines. It will make a big dent in India’s vaccination efforts and increase vaccine hesitancy.
5. Media onslaught: All the above will be cooked up into juicy stories and shows by the media to scare the people and bully the govt. India will lose credibility internationally while the govt will lose its credibility locally. People’s trust on the govt is very important during a crisis and that may be eroded.

I feel it may have been better for the govt to limit the increase in eligibility in stages of age groups, or offer these vaccines to all only in current Covid-19 hot spot areas. Am unable to understand why they would be pushed to take such a decision that’s bound to create a lot of issues.

Unless… remember the “Bringing Covid Under Control” event? The govt is cognizant of the fact that millions are naturally being vaccinated by acquiring Covid-19. And know well that by June the surge will abate. Hence they can change their policy in June by claiming their vaccination opening up is what brought it under control. Also, they can throw their hands up and blame the states for all issues in the meantime.

Updates (10/May/2021):

1. Mad rush has been on and people aren’t getting vaccines.

2. Severe vaccine shortages slow India’s vaccination drive.

3. Vaccines prices have gone 5–6x officially. Covaxin now costs Rs. 1250 per dose. It cost only Rs. 250 initially. Covisheild too has more than doubled in price. Still there are no reports yet of hoarding or black marketing as distribution seems to be tightly controlled.

4. (18/08/2021) Fake vaccines have been reported and flagged by WHO as a serious concern. https://www.bbc.com/news/world-asia-india-58253488