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.
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.
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