India falters in administering the second dose

Even as the daily fresh cases have been on an overall downward trend since it peaked in early May, the pace of vaccination has slowed down sharply since hitting a peak in September. Only 38% have been fully vaccinated though nearly 80% of all eligible adults have received the first dose. Nearly 43% of people aged 45-59 years and over 37% of those above 60 years are yet to receive the second dose. Worse, about 10% of health-care workers are yet to receive the second dose.

Even as a small uptick in daily fresh cases has been reported in November, based on genome sequence data, the Indian SARS-CoV-2 Genomics Consortium (INSACOG) has said no new variants of interest or concern have been seen in India. And variants other than the Delta are now “negligible in sequencing data from India”.

No new variant in India

According to INSACOG, AY4.2, a Delta variant sublineage, which is slowly increasing in proportion to reported cases in the U.K., is “very infrequent” in India. In other words, the Delta variant, which was first reported in India last year and was responsible for the staggering number of daily cases and deaths this year, is still the dominant variant.

According to the WHO weekly epidemiological update of November 9, the Delta variant has become predominant across the world and has “outcompeted other variants” in most countries; 99.6% of genome sequences posted on the global database is of the Delta.

Even as the daily fresh cases have been on an overall downward trend since it peaked in early May, the pace of vaccination has slowed down sharply since hitting a peak in September. The average daily doses administered in November has been just four million, the lowest since mid-July, despite vaccines not being in short-supply.

A wide gap

A greater concern is that only 38% have been fully vaccinated though nearly 80% of all eligible adults have received the first dose. Since full protection from vaccines is achieved only when two doses are administered, State governments need to pull out all the stops to increase the percentage of fully vaccinated people even while relentlessly increasing coverage.

With Covishield accounting for about 90% of vaccines administered, the rate of administration of the second dose after the mandatory gap between two doses has always been very low. Despite people over 60 years and everyone above 45 years being one of the priority groups included way back in March owing to increased risk of progressing to severe disease and even dying, nearly 43% of people aged 45-59 years and over 37% of those above 60 years are yet to receive the second dose. Worse, about 10% of health-care workers are yet to receive the second dose nearly 10 months after the vaccination programme began on January 16.

Complacency the reason?

One reason could be complacency, particularly since the daily fresh cases, hospitalisation and deaths have been continuously dropping since the second wave peaked. The nearly month-long door-to-door vaccination campaign across the country this month to reach out to people who have been unable to access vaccines is, therefore, a welcome step in increasing vaccine uptake.

As proven in the universal immunisation programme for children to deliver polio vaccine, outreach programmes have a greater rate of success immunising the target population and in overcoming hesitancy and complacency.

All proven and innovative methods need to be deployed to drastically increase vaccine uptake if India is serious in vaccinating everyone above 18 years by the end of the year and before a new variant emerges.

Published in The Hindu on November 13, 2021