Vaccination Progress in India I
Summary and Progress to Date
As the second wave of COVID is beginning to ebb, many in India are worrying about a future third wave. The best way we know to protect against the next wave is to vaccinate the population. In this post we explore (1) the progress being made to vaccinate India. In the next two posts, we examine two topics: (2) the supply of vaccines to the Centre and then states and (3) the administration of vaccine doses, including the problem of wastage of doses.
Our main take-aways are that
India is vaccinating at a daily rate that is short of what would be required to meet its stated goal of vaccinating 20% of the population by July.
There is a lot of variation in how different states are performing. Interestingly, some Southern states that are typically higher performing lag behind other states.
India does not appear to have enough planned supply through July to meet its vaccination target.
The supply of vaccines from the Centre to states is mainly a function of their population. It does not appear to be affected by political circumstances.
Even though supplies are constrained, states with greater demand seem to administer a greater share of the doses they are provisioned.
States with greater demand have also have less wastage via expiration of doses. Interestingly, we find evidence that administration of Covaxin is associated with greater wastage, consistent with news stories that the larger 20-dose vials of Covaxin increase the risk of doses going unused before the vial expires.
This leaves us with the following three recommendations.
India should increase the production or procurement of vaccinations. If this is not feasible, it should explore whether solutions, like de-prioritizing those people who already have anti-COVID antibodies and fractional dosing, would be effective at increasing the value of limited vaccine doses.
There may be value in switching from allocation to states in proportion to population to allocation to states (or even districts) in proportion to future risk-based so that we allocate limited doses as impactfully as possible.
Even though supply is constrained, efforts to encourage demand (via marketing or lotteries) will reduce the risk of wastage. India may also want to consider making it easier to access doses by increasing the number of vaccination sessions it holds at each clinic.
The government should focus on improving rural distribution chains and building more durable adult vaccine infrastructure. Because the risk of future mutation may require future shots with reformulated vaccines, overcoming these logistical challenges should be viewed as a long-term investment in public health.
Going forward, we will work to keep people abreast of vaccination progress through our Twitter bot @covidmetrics.
I. Progress to date
India had ambitious plans to vaccinate almost 20% of the population by July (Ministry of Health and Family Welfare, 2020). Despite administering more than 230 million doses, it has fallen short of its stated plans. In order to meet the July target, India would have needed to vaccinate 3.1 million persons a day. However, India's current vaccination rate of 2.4 million people a day1 (IDFC Institute, 2021) have been considerably short of that target. To catch up and meet the original July target, India will need to vaccinate 6.5 million persons per day.2 (On Monday, June 7, the Centre announced plans to take back the limited vaccine procurement allocated to the states. This does not change the analysis below.)
In aggregate, 12.6% of the population received 1 dose and 3.4% received 2 doses of vaccine by 27 May, 2021. In terms of eligible population (greater than 18 years), this translates to 20% for the first dose and 5.5% for the second dose. However, there is dramatic variation across states in the share of eligible population vaccinated (Figure 1).
Figure 1: Share of Eligible Population Vaccinated, by States
Source: Co-WIN Dashboard and Census 2011
Smaller states are doing notably better. This is likely a product of the fact that logistics of distribution are easier in a smaller state. What is more surprising to us is that some states that traditionally have high public health capacity -- Telangana, Andhra Pradesh, and Tamil Nadu -- lag behind other states, including adjacent states such as Karnataka, Kerala, and Maharashtra.
Some of the performance of lagging states is a product of variation in supply from the centre. To be fair, much of the supply from the centre is driven by population. As Figure 2 shows, supply from the centre to each state (blue dots) is largely in a tight range between 0.1 to 0.3 doses per capita. However, if one gives only 1 does per person, this variation can explain 20 percentage points of variation across states.
However, the gaps between supply to states and doses administered (green dots) suggest that local distribution is also a serious problem. Contrast, for example, the large gap in Andhra Pradesh versus the smaller gaps in Telangana and Tamil Nadu.
Figure 2: Vaccine Supply and Consumption Per Capita, by States
Source: Ministry of Health and Family Welfare, Press Release and Census 2011
It is possible that some gap between supply to states and distribution by states is driven by individuals being vaccinated without certification. But it seems unlikely this explains gaps as large as those observed in Andhra. Nor do we have indirect data to support this explanation. Moreover, it indicates that the states may not be conforming with their stated prioritization plans.
Speaking of prioritization, it is heartening to see that vaccination is prioritizing higher age populations across the country (Figure 3). Even in the lagging states, this is true. This is important because the infection fatality rate from COVID increases exponentially in age. The only problem highlighted by the figure below is that, if we were to do the prioritization right, those who are above 60 should hit 100% vaccination before those 45-60 are vaccinated, and so on. This would maximize the number of lives saved. It is possible this is not being followed because some elderly persons cannot be reached or do not want vaccination. However, we believe that this deviation is likely in places like Meghalaya, where vaccination rates of 60 and above are only at 50% and 45-60 year olds are vaccinated at rates equal to 50 to 75% of 60 and older rates. (One thing that might confuse people about Figure 3 is that the percentage of the population is above 100%. This is partly due to the fact that our population numbers are from the 2011 census and the population has grown since then.)
Figure 3: Share of Population Vaccinated, by States and age group
Source: Co-WIN Dashboard and Census 2011
One red flag for India’s vaccination drive is wastage of doses. This captures doses that expire before being administered. Any wastage is bad, especially when supply is limited. But some states perform much worse than others on this front. According to Figure 4, 8 states waste more than 4% of the doses they received.
Figure 4: Wastage of vaccines, by State
Source: Ministry of Health and Family Welfare, Press Release
Asher , S., Lunt , T., Matsuura , R., & Novosad, P. (2021). DDL COVID India. Retrieved from Data Development Lab: http://www.devdatalab.org/
covid19india.org. (2021). Retrieved from covid19india.org
Government of India. (2021). Co-WIn. Retrieved from Dashboard: https://dashboard.cowin.gov.in
IDFC Institute. (2021). The Indian OVID-19 Alliance, TICA. Retrieved from https://www.idfcinstitute.org/projects/state-capacity/the-indian-covid-19-alliance-tica/
Ministry of Health and Family Welfare. (2020, October). Press Release: Dr Harsh Vardhan interacts with social media users during Sunday Samvaad-4. New Delhi.
Ministry of Health and Family Welfare. (2021, May 11). More than 18 crore vaccine doses provided to States/UTs Free of Cost by Govt. of India, so far. Delhi.
Ministry of Health and Family Welfare. (2021, May 17). More than 20 crore vaccine doses provided to States/UTs Free of Cost by Govt. of India, so far . Delhi.
Office of the Registrar General & Census Commissioner, India. (n.d.). 2011 Census Data. Retrieved from Census India: https://censusindia.gov.in/2011-common/censusdata2011.html
7 Day Moving Average as of May 27, 2021.
Based on estimation of total doses; target till July 31, 2021: 600 million, current status as of June 2, 2021: 216.8 million; required rate = (600-216.8 million)/ 59 days