The Who, What, When Of Vaccination In India: BQ Explains

Who is eligible for a vaccine in India, what will it cost, who will provide it and by when: Explained.

A Covid-19 vaccination center set up at the Delhi Municipal Corp. Public Health Center. (Photographer: Sumit Dayal/Bloomberg)
A Covid-19 vaccination center set up at the Delhi Municipal Corp. Public Health Center. (Photographer: Sumit Dayal/Bloomberg)

This explainer seeks to clarify key aspects of India’s vaccination policy. Namely, who is eligible for a vaccine, what will it cost, who will provide it and by when.

All the information is from official government statements as on May 4, 2021.

Who Is In Charge Of India’s Covid Vaccination Policy?

The central government has formulated the national Covid-19 vaccination strategy. A task force was constituted last year in August—National Expert Group on Vaccine Administration for Covid-19—under the chairmanship of VK Paul, member (health) of Niti Aayog, to determine various aspects ranging from conceptualisation to last-mile delivery. Its recommendations, if any, aren’t publicly available. Annoucements regarding the vaccine policy have been made either by Prime minister Narendra Modi or via statements from the ministry of health and family welfare.

On Jan. 16, 2021, India began vaccinating healthcare and frontline workers.

On March 1, vaccinations were extended to those above 60 years and those above 45 years with comorbidities.

Starting April 1, all above 45 years were eligible to be vaccinated.

The latest iteration of the vaccination policy was decided in a meeting chaired by Prime Minister Narendra Modi. Starting May 1, the eligible age for vaccination has been lowered to 18 years.

Will The Central Government Vaccinate All Indians?

No. The central government has been and will continue to vaccinate only those above 45 years of age and all healthcare and frontline workers. It procures the vaccines and allocates them to states to administer. As has been ongoing, vaccinations for 45+, health care and frontline workers will be free at government hospitals. Those due for their second dose will be prioritised.

Starting May 1, states bear the responsibility to vaccinate those between 18-44 years. They were informed on April 19, when the new vaccine policy was announced by the federal government. They’ve had 11 days to prepare and procure vaccines for this age group. Many states have begun vaccination for those aged between 18 and 44 years but in limited numbers owing to scarcity of vaccines.

States are free to charge for vaccinations but most have announced they will be provided free.

As per the new vaccine policy, private hospitals and other private entities can also purchase vaccines in the open market and provide vaccinations.

Who Supplies Vaccines To India?

There are two domestic producers—Serum Institute of India and Bharat Biotech. So far, all vaccine supplies have been from them. Over 90% of vaccines administered have been Covishield, supplied by Serum Institute. Covaxin, by Bharat Biotech, constitutes the rest.

Current Capacity

  • Serum Institute: 6 crore doses a month.
  • Bharat Biotech: 5.8 crore doses a month

Capacity Addition

  • Serum intends to expand to over 10 crore by July.
  • Bharat Biotech will receive a government grant of Rs 65 crore to expand to 10 crore doses by September.

Soon more vaccines will be available.

Russian vaccine Sputnik V has been cleared for use in India and Dr. Reddy’s Laboratories Ltd. has begun importing it.

Other vaccines that have received regulatory clearance in their home countries, such as vaccines from Pfizer, Moderna, J&J etc., can be imported once they clear the fast-track approval process in India. This fast-track process was announced only in mid-April. Till then India sought additional clinical tests on these vaccines for local use. As yet, none of these vaccines have cleared the fast-track approval process.

Cadila has its own vaccine, ZyCov-D, awaiting regulatory clearance.

Serum Institute has also stockpiled Novovax, which has yet to pass regulatory muster overseas.

It is not known how long it will take for the supply of Covishield and Covaxin to be augmented by these other vaccines.

What Does Vaccination Cost?

The answer to that comes in two parts.

1. From January to May, only the central government had the power to procure and distribute vaccines. States were only doing the last-mile delivery. At that time, the central government was purchasing vaccines from Serum Institute and Bharat Biotech at Rs 150 per dose, exclusive of GST. The vaccines were provided for free at government hospitals and at Rs 250 per dose in private hospitals. Of that fee, the hospital kept Rs 100 towards its costs and the central government was given Rs 150.

2. As mentioned earlier, the new vaccine policy allows states and private entities to also procure and distribute vaccines. From them, Serum Institute and Bharat Biotech are charging a higher price;

Serum Institute - Covishield
Central government: Rs 150 per dose
States: Rs 300 per dose
Private Hospitals: Rs 600 per dose

Bharat Biotech - Covaxin
Centre: Rs 150 per dose
States: Rs 400 per dose
Private Hospitals: Rs 1,200 per dose

Almost all states have publicly stated they will provide free vaccination for those 18-44 years.

Some private hospitals such as Apollo, Fortis and Max are providing vaccinations at between Rs 800-1,300 per dose.

Okay, Too Confusing - Can I Get Free Vaccination?

Yes. Irrespective of age you can get vaccinated for free but it’s not clear how long that would take.

If you’re aged above 45 years, the central government will provide the vaccine and the state will administer it at your nearby government/private hospital.

If you’re between 18 and 44 years of age, the state will procure and provide the vaccine at a nearby government/private hospital.

If you’re willing to pay then you can check if a private hospital near you is providing its own supply of vaccines.

How Long Will It Take For All Eligible Indians To Get Vaccinated

First, the good news. 16.04 crore doses have been administered across India as on May 4, according to the government’s daily update. Of those, 3.04 are second doses. That means between January 16 to May 4, 3.04 crore Indians have been fully vaccinated.

The bad news—that’s about 3% of the eligible population. As many as 164 crore doses have yet to be administered for all 90 crore Indians above 18 years of age to be vaccinated (two doses each).

India is in short supply of vaccines. All through April the pace of vaccination slowed across the country and it has dipped further in May.

Since May 1, the pace of vaccinating those above 45 years of age has slowed further as the two producers make vaccines available to states for the younger cohort.

Between May 1-4, 6.62 lakh people in the 18-44 years category across 12 states and union territories have received vaccinations.

If India can more than double the pace of vaccination—from the current average 20 lakh daily doses to 50 lakh—then 50% of the population could be vaccinated by the year-end, estimates HSBC. This is a highly optimistic forecast and depends on a significant increase in vaccine supplies.

The Who, What, When Of Vaccination In India: BQ Explains

Why Is The Vaccine Rollout Slow?

In the absence of any clear explanation or data from the government the answer to that question can only be derived from other sources of information.

For instance, Serum Institute recently said it had so far received orders from the central government for 26 crore doses. Of which, 15 crore doses had been provided and another 11 crore doses would be delivered over the next few months.

After the new vaccine policy was announced, states and private hospitals have ordered 11 crore Covishield doses which will also be delivered over the next few months.

Bharat Biotech hasn’t made any production or order data available. But a government statement recently said the last order placed with the vaccine maker was for 2 crore doses and another 5 crore doses will be delivered over May, June and July.

It’s not clear why the central government has been placing orders in small quantities so far. It’s also not clear why advance payments or grants were not provided to the two producers well in advance so that they may scale up manufacture. For the orders due in the next three months though, the government paid the two producers on April 28. Maybe that will help them fund additional capacity.