Vaccinate all above 45 years to avoid vaccine inequities

While the intent of the government to quickly protect people with comorbidities above the age of 45 years who are at greater risk of progressing to severe form of disease or even death is commendable, any insistence on documentary evidence for vaccination will be hugely counterproductive. Similarly, insisting on prior registration on the CoWIN platform will further worsen inequities.

In addition to about 10,000 government sites, the decision to open up about 20,000 private hospitals across the country from March 1 to vaccinate people older than 60 years and those above 45 years with comorbidities will at once increase the number of sites where people can get vaccinated.

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 in nearly seven weeks since the vaccination programme began, only a little over one-third of health-care and frontline workers have been covered. The average uptake per session has been only about 35%, so beginning the second phase of the programme is likely to increase in vaccine uptake per session.

Hesitancy to available vaccines 

Even if glitches in the CoWIN platform and decline in daily cases are partly responsible for low uptake, hesitancy to available vaccines amongst 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 years with comorbidities will behave strikingly different or take a cue from health-care workers and prefer to wait for some more time 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 across the country even when offered for free, the only way to increase vaccination coverage is by making it easy for people desiring to get vaccinated to have one.

Exacerbating health inequities

While the intent of the government to quickly protect people with comorbidities above the age of 45 years who are at greater risk of progressing to severe form of disease or even death is commendable, any insistence on documentary evidence for vaccination will be hugely counterproductive.

One in three adults in India have 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 the age of 45 years 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 uptake of COVID-19 vaccine is directly related to availability of trial data. The government can still win back people’s trust and improve vaccine coverage by quickly making all trial data of vaccines public.

Also, timely resolution of serious adverse events and deaths following vaccination by the national committee and sharing the details will surely inspire public confidence in the vaccines. 

Published in The Hindu on February 26, 2021