The government needs to prioritise vaccine distribution through careful examination of persons at real risks, instead of perceived risks, writes GYAN PATHAK.
The people who are most at risk should get COVID-19 vaccine before those who are running a lower risk of the contagion. This is the principle of priority – seemingly very simple, but very difficult to implement.
India, undergoing the process, is now faced with several impediments in the way, including the danger of falling in the trap created by an error in application of mind due to several reasons.
The tasks at hand are to not only ensure distribution of COVID-19 vaccines on priority and equitable basis, but also ascertain if the vaccines are safe, effective and affordable.
India is the top country to have ordered the largest number of vaccines, with 1.6 billion dozes, followed by European Union with 1.58 billion dozes and US with 1.1 billion, as on November 30.
In the midst of the COVID-19 pandemic, several countries of the world including India have been racing to develop and deploy safe and effective vaccines. There are currently over 50 vaccine candidates in trial, and several manufacturers have applied for emergency use approval for their vaccines, which they claimed effective. India is the top country to have ordered the largest number of vaccines, with 1.6 billion dozes, followed by European Union with 1.58 billion dozes and US with 1.1 billion, as on November 30.
However, India had to reduce the number of dozes ordered to 1.5 billion on December 11, indicating the difficulties the county is facing in acquiring a sufficient number of dozes for its 1.38 billion people.
Since every person requires several dozes of the vaccine, there is a great shortfall. It is here that India needs prioritization in the deployment of vaccines.
Presently, the five manufacturers of COVID-19 vaccines are Oxford- Astrazeneca, Pfizer- BioNTech, Moderna, Novavax, and Gamaleya (Sputnik).
It is an error, similar to the one that India committed in its order of complete lockdown on March 24, followed by several ad hoc orders on containment measures.
Though India is almost ready with its vaccination plan, only about 30 crore people can be vaccinated in phase one, which is only 21.7 per cent of the population. The population to receive this vaccine in the first phase include one crore health care workers, two crore frontline workers, and 26 crore persons above 50 years of age. The people below the age of 50 years suffering from chronic critical illness, which are about one crore, will be provided vaccines after completion of the first phase.
It goes without saying that the plan of distribution of vaccine on priority basis is simplistic while the situation is complex.
It is an error, similar to the one that India committed in its order of complete lockdown on March 24, followed by several ad hoc orders on containment measures.
The lockdown orders were simplistic and lacked careful application of mind. Lockdown and containment measures were required only for those areas where there were infections, not for those areas where there was no infection.
The mistake was realized only after a great damage done to economy and thousands of lives were lost, both on account of diseases and several other reasons such as chaos among migrant labours. We had locked even those areas and regions where there were no infections. Only with Unlock-1 on June 1, we could come to terms with our own error, and started giving relaxation to the areas without any infection.
The lockdown orders were simplistic and lacked careful application of mind. Lockdown and containment measures were required only for those areas where there were infections, not for those areas where there was no infection.
There are many areas in the country where there is no corona infection, and subsequently no risk of the contagion. Why should we then insist on giving vaccine to them when they are not at all at risk?
Similarly, while ascertaining priority, government should not adopt simplistic logic that people above 50 years of age are most vulnerable to corona. After careful application of mind one can easily find error in this attitude. There are many areas in the country where there is no corona infection, and subsequently no risk of the contagion. Why should we then insist on giving vaccine to them when they are not at all at risk?
If government implements its present plan, several states with lower risk of contagion and less population would receive more doses of vaccine than the states running higher risks on the ground with higher population. It would be due to demographical differences. To avoid this, we must assess the actual risks on the ground, not the age.
Since records for all the states are not available, the country needs to collect them first to assess the real situation in each state.
We do have 50+ population records for all the states but do not have records for high blood sugar or on medication for high blood sugar, and also high blood pressure or on medication for blood pressure population for 11 major states – Uttar Pradesh, Tamil Nadu, Madhya Pradesh, Rajasthan, Odisha, Punjab, Jharkhand, Haryana, Chhattisgarh, Delhi, and Uttarakhand.
Additionally, it should be taken into consideration there could be millions of people in the country suffering from high blood sugar and high blood pressure who are undetected in several regions, due to carelessness and lack of medical facilities. In due course of time number of newly detected persons with these ailments could sharply increase.
Since records for all the states are not available, the country needs to collect them first to assess the real situation in each state.
If we look at state wise demography of the country with 50+ population, and the population with high blood sugar and high blood pressure below and above 50 may alter the present priority of the government. It would be a wrong decision only to go on 50+ population basis and ignore the cases of comorbidity in the first phase. People with actual higher risks must get the vaccine first irrespective of their age.
The records of the patients with high blood sugar and high blood pressure are available only for 11 major states – many of them have very high level of corona infection. These states are Maharashtra, West Bengal, Bihar, Karnataka, Gujarat, Andhra Pradesh, Kerala, Telangana, Assam, Jammu and Kashmir, and Himachal Pradesh. Maharashtra and West Bengal have the highest number of people with hypertension and diabetes respectively, while almost one third of Kerala’s population is 50+ with high prevalence of these diseases.
It is a very sorry state of affair that the present strategy of prioritization ignores even 6.5 per cent of adults below 50 years of age having diabetes and hence running the risks more than others without such ailment.
Uttar Pradesh has highest 50+ population followed by Maharashtra, West Bengal, Tamil Nadu, and Bihar. It is a very sorry state of affair that the present strategy of prioritization ignores even 6.5 per cent of adults below 50 years of age having diabetes and hence running the risks more than others without such ailment. This is only an example to show the error in the present strategy that need more thought to reach the people that are actually running highest risks.
Acquiring the safest vaccine at an affordable price along with their deployment within the shortest possible time is also a challenging task- due to maladministration breeding corruption and lack of infrastructure and medical personnel.
Vaccination at the rate of only 100 people per session at each site per day needs to be substantially increased. Government has declared to increase the number to 200 if logistics allow, indicating how tough the task is going to be. (IPA)
(Gyan Pathak is a senior journalist. Views are personal.)
