Young, Indian, Unvaccinated

COVID-19 INDIA

Young, Indian, Unvaccinated

How the ‘world’s largest vaccination campaign’ faltered, leaving some 600 million people aged between 18 and 45 years scrambling for COVID-19 shots.

India began an inoculation drive for its 1.38 billion people in earnest in mid-January. Healthcare, frontline workers and the elderly were the first eligible, followed by people aged over 45 in April and then adults aged 18-45 in May. That last extension, covering around 43% of the population, proved to be a crunch point.

Population

Vaccine doses

Est. 2020

18-44

45-59

60+

Scarce appointments

Following a surge in COVID-19 infections across the country in April, Prime Minister Narendra Modi accelerated plans to broaden the programme and opened up vaccinations from May 1 for people aged between 18 and 45 years. The decision led to a rush by people in that age group, who account for 600 million of the population, to sign up to the government’s CoWIN vaccination website. Critically, there was no corresponding increase in vaccine supplies.

18+ Registrations

10.5 million

Registered on the CoWIN portal as it opens up for 18-44 year olds on April 28

10M

8M

6M

4M

2M

0

18+ Vaccinations

0.2 million

Doses given to 18-44 year olds

2M

0

May 1

May 28

May 14

18+ Registrations

10.5 million

Registered on the CoWIN portal as it opens up for 18-44 year olds on April 28

10M

8M

6M

4M

2M

0

18+ Vaccinations

0.2 million

Doses given to 18-44 year olds

2M

0

May 1

May 7

May 14

May 21

May 28

June 4

18+ Registrations

10.5 million

Registered on the CoWIN portal as it opens up for 18-44 year olds on April 28

10M

8M

6M

4M

2M

0

18+ Vaccinations

0.2 million

Doses given to 18-44 year olds

2M

0

May 1

May 7

May 14

May 21

May 28

June 4

Hospitals faced huge shortages and some immunisation centers closed down as vaccine supplies dried up. India’s tech experts, meanwhile, made software and websites to help people book scarce vaccination appointments, giving the middle-class an advantage over the poor.

18+ Vaccination sessions

in states with 10M+ population

Sessions per district

1

30

May

29

June

1

June

4

Uttar Pr.

More

people

Bihar

Maharashtra

Nearly 31 sessions per district for 18-44 group

West Bengal

Madhya Pr.

Rajasthan

Tamil Nadu

Karnataka

Gujarat

Less than 1 session per district

Andhra Pr.

Odisha

Jharkhand

Telangana

Kerala

Assam

No sessions

Punjab

Chhattisgarh

Haryana

Delhi

Less

people

J&K

Uttarakhand

18+ Vaccination sessions

in states with 10M+ population

Sessions per district

May

29

June

1

June

4

1

30

Uttar Pradesh

Bihar

Maharashtra

Nearly 31 sessions per district for 18-44 group

West Bengal

Madhya Pradesh

Rajasthan

Tamil Nadu

Karnataka

Gujarat

More people

Less than 1 session per district

Andhra Pradesh

Odisha

Less people

Jharkhand

Telangana

Kerala

Assam

No sessions

Punjab

Chhattisgarh

Haryana

Delhi

Jammu and Kashmir

Uttarakhand

18+ Vaccination sessions

in states with 10M+ population

Sessions per district

May

29

June

1

June

4

1

30

Uttar Pradesh

Bihar

Maharashtra

Nearly 31 sessions per district for 18-44 group

West Bengal

Madhya Pradesh

Rajasthan

Tamil Nadu

Karnataka

Gujarat

More people

Less than 1 session per district

Andhra Pradesh

Odisha

Less people

Jharkhand

Telangana

Kerala

Assam

No sessions

Punjab

Chhattisgarh

Haryana

Delhi

Jammu and Kashmir

Uttarakhand

By June 4, India had provided at least one dose to roughly 50 million people aged between 18 and 44, representing just 8% of that population group.

A privilege gap

Adding to the difficulties, a privilege gap emerged in the vaccination rollout, with hospitals charging different prices for the same vaccine since May. Some hospitals in affluent areas have sold the Covishield shot, manufactured in India, for 1,800 rupees ($25) a dose, almost double the 950 rupees charged elsewhere. Data from CoWIN shows that even in poorer regions, the price ranged from 200 to 1,500 rupees. The domestically developed Covaxin shot is costlier than Covishield across the country.

Vaccination fees at private centers (in rupees)

0

400

800

1,200

1,600

2,000

Delhi

Uttar Pr.

Andhra Pr.

A shot of

Covishield or Covaxin can cost as much as ₹1,800 in the capital

Gujarat

Punjab

West Bengal

Karnataka

J&K

Maharashtra

Telangana

Tamil Nadu

Assam

Goa

Haryana

Kerala

Madhya Pr.

Rajasthan

Chhattisgarh

Uttarakhand

Jharkhand

Odisha

Chandigarh

Himachal Pr.

Meghalaya

Lakshadweep

0

400

800

1,200

1,600

2,000

Vaccination fees at private centers (in rupees)

0

400

800

1,200

1,600

2,000

Delhi

Uttar Pr.

Andhra Pr.

A shot of

Covishield or Covaxin can cost as much as ₹1,800 in the capital

Gujarat

Punjab

West Bengal

Karnataka

J&K

Maharashtra

Telangana

Tamil Nadu

Assam

Goa

Haryana

Kerala

Madhya Pr.

Rajasthan

Chhattisgarh

Uttarakhand

Jharkhand

Odisha

Chandigarh

Himachal Pr.

Meghalaya

Lakshadweep

0

400

800

1,200

1,600

2,000

Vaccination fees at private centers (in rupees)

0

400

800

1,200

1,600

2,000

Delhi

Uttar Pr.

Andhra Pr.

A shot of

Covishield or Covaxin

can cost as much as

₹1,800 in the capital

Gujarat

Punjab

West Bengal

Karnataka

J&K

Maharashtra

Telangana

Tamil Nadu

Assam

Goa

Haryana

Kerala

Madhya Pr.

Rajasthan

Chhattisgarh

Uttarakhand

Jharkhand

Odisha

Chandigarh

Himachal Pr.

Meghalaya

Lakshadweep

0

400

800

1,200

1,600

2,000

Urban Indians have received shots faster than those living in the countryside. In 114 of India’s least developed districts - home to about 176 million people - authorities have administered 23 million doses in total, a Reuters analysis showed earlier this month. That means vaccines remain unavailable to a large part of the population that cannot afford it or has little or no access to private hospitals.

Modi’s government offered vaccines free of cost to the elderly and frontline workers, but initially left it to state governments and private hospitals to administer doses to adults under 45. After much criticism, Modi reversed that policy on June 7 and said the federal government would offer free COVID-19 shots to all adults from June 21. Private hospitals would still get a quarter of total supplies, which they can sell for 150 rupees over the wholesale cost of a dose.

Vaccine shortages

India - the world’s biggest producer of vaccines for polio, diphtheria and other diseases - sold or donated more than 66 million COVID-19 vaccine shots to 95 countries until the middle of April. But as infections started rising from around mid-March in India, the clamour for vaccines at home also increased. India has now started importing vaccines and also expecting donations from the United States.

Compared to many Western countries, India was late in procuring vaccines. Modi’s government placed the first advance order for an unapproved vaccine only this month, after being criticised for being slow. Countries including the United States and Britain signed orders last year.

Vaccines purchased, doses per person

8 doses

UK

EU

6

Israel

4

US

18+

Phase 3

2

Phase 2

Vaccination

begins

India

0

May

Sep

Jan

May

2020

2021

Note: Chart shows cumulative share of doses based on deals through May 2021. Data do not reflect dates of deliveries or vaccinations. Some vaccines require two doses, others just one.

Vaccines purchased, doses per person

8 doses

UK

EU

6

Israel

4

US

18+

Phase 3

2

Phase 2

Vaccination

begins

India

0

May

July

Sep

Nov

Jan

Mar

May

2020

2021

Note: Chart shows cumulative share of doses based on deals through May 2021. Data do not reflect dates of deliveries or vaccinations. Some vaccines require two doses, others just one.

Vaccines purchased, doses per person

8 doses

UK

EU

6

Israel

4

US

18+

Phase 3

2

Phase 2

Vaccination

begins

India

0

May

July

Sep

Nov

Jan

Mar

May

2020

2021

Note: Chart shows cumulative share of doses based on deals through May 2021. Data do not reflect dates of deliveries or vaccinations. Some vaccines require two doses, others just one.

The government expects vaccine supplies to improve substantially from June. It is expecting to produce enough shots by December to inoculate all of its estimated 950 million adults, though those between 18 and 45 years will be the last on the priority list.

Outpaced by the pandemic

Several states in India have begun to gradually lift restrictions on travel and businesses, after a fall in cases in recent weeks. However, health experts have warned that cases could surge again once most states re-open, and have called for vaccinations to be sped up.

As of June 8, less than 4% of India’s adult population had been given the required two vaccine doses. Nearly 14% received at least one dose and, of that group, less than one-tenth of 18-45 year olds have been inoculated.

Daily vaccinations, per million people

In thousands

0

5

20

21,400 per million people

2021

Jan

Mar

May

Israel

US

EU

UK

India

Jan 16: Vaccination

campaign begins

2,500 per million people

Daily vaccinations, per million people

In thousands

0

5

20

21,400 per million people

2021

Jan

Feb

Mar

Apr

May

June

Israel

US

EU

UK

India

Jan. 16: Vaccination campaign begins

2,500 per million people

Daily vaccinations, per million people

In thousands

0

5

20

21,400 per million people

2021

Jan

Feb

Mar

Apr

May

June

Israel

US

EU

UK

India

Jan. 16: Vaccination campaign begins

2,500 per million people

The State Bank of India warned in a report last week that a third wave of infections could be as bad as the second. Government health officials and independent health experts have said daily vaccinations must jump to keep another surge at bay.

Note

Data as of June 9, 2021.

Methodology

Doses administered are from weekly estimates published on the CoWIN dashboard and may differ from daily snapshots. Covishield and Covaxin are the only vaccinations currently available. Both require two doses to be fully vaccinated.

For vaccine prices and appointments Reuters analysed publicly available data from CoWIN for more than 58 thousand centres across 36 states and union territories in the week of May 29 - June 4.

Sources

India’s CoWIN Portal; Press Information Bureau, Government of India; Duke University’s Global Health Innovation Center; Our World in Data; United Nations Population Division

Photos

Cover: Adnan Abidi
Vaccine centers: Francis Mascarenhas and Niharika Kulkarni

Editing by

Sarah Slobin, Krishna Das and Jane Wardell