Achieving vaccine equity by making comorbidities redundant for those above 45 years

As vaccines are a tool to promote health equity, all attempts should be made to remove any artificial barriers in accessing them particularly during the pandemic and more so when several States are witnessing a surge in cases.

Just three weeks after India rolled out the second phase of the mass COVID-19 vaccination programme to cover people above the age 60 years and those above 45 years with comorbidities, India has undertaken a much-needed course correction to vaccinate anyone above 45 years immaterial of comorbidity status from April 1 onwards.

By following the U.K. model of vaccinating people based on age bands rather than focussing on comorbidities, millions of people would become eligible to receive the vaccine and be fully protected from severe disease and death.

Highly restrictive list

Indeed, people with comorbidities are at greater risk of becoming critically ill and even dying. However, the list of comorbidities that made a person eligible for a vaccine was not only highly restrictive but also focussed on multiple comorbidities, and that too of severe nature. Also, the need for a medical certificate meant that vaccinating as many people as quickly as possible was unachievable.

Since a vast majority of people, particularly the poor and those in rural areas, are ignorant of their underlying disease, the decision, though belated, to make comorbidities redundant for a vaccine is highly commendable.

As vaccines are a tool to promote health equity, all attempts should be made to remove any artificial barriers in accessing them particularly during the pandemic and more so when several States are witnessing a surge in cases.

Uptake slowly increasing

While hesitancy towards the two available vaccines was partly responsible for low uptake initially, there is now increasing willingness to get vaccinated; each vaccinated person becomes an influencer in his/her immediate circle thus increasing vaccine confidence and, in turn, uptake.

While 0.8 million doses administered on February 25 was the highest before the second phase of vaccination began, the numbers have been increasing steadily since March 1; increasing the gap between two Covishield doses partly addresses vaccine shortage. Yet, the seven-day rolling average crossed two million doses per day only in the last couple of days; only about 50.23 million doses have been administered as on March 24, which is less than four doses per 100 people.

The vaccination programme has been witnessing lukewarm participation by private medical facilities, belying expectations that they would help kick up the daily vaccination numbers. The reasons for this, including slow pace of expansion in some States, needs to be investigated and fixed quickly.

Lack of political will

Though the COVID-19 vaccination, which targets adults, is vastly different from the universal immunisation programme, India has the wherewithal to sharply accelerate daily vaccination rate. What is largely missing is the political will to achieve that, which is reflected in absent targets and awareness building exercises on several fronts, including vaccine safety, vaccination sites and permissibility of walk-ins.

Also, unlike the immunisation programme, overreliance on the CoWIN platform has made COVID-19 vaccination into a largely passive, facility-based exercise rather than a public-health initiative. Lack of microplanning and outreach activities is further impacting vaccine uptake. Clearly, there is a cases for reaching out to people to quickly increase vaccine uptake.

Published in The Hindu on March 26, 2021