As India crossed the 300,000 mark of daily cases in April 2021, there was a political tussle between the central government and some states over the shortage of vaccines. This is raising a series of setbacks in India’s bid with Kovid. Many state health ministers have been accused of limiting supplies to their states. This problem is most relevant due to the lack of transparency at a time when India needs vaccine allocations based on an effective and efficient scientific principle. The current principle of vaccine distribution in the states is not clear. It is important to use scientific calculations that are transparent and take into account Kovid severity. To this end, we have identified six ict presents of disease severity and developed a comprehensive formula that assigns an equal weightage to each.
The need and allocation of vaccines in the states depends on their population size, exposure and outbreak risk. We used a set of six indicators, which had three dimensions: population, severity of the current wave, and risk of infection. These three are given equal weights to calculate the total score, which is none other than the proposed share of vaccines to be provided to a state or central territory (UT).
Population size measurements are measured by the proportion of states and UTs in the population of India that are 45 or older. Its severity factor will be covered by the distribution of the total number of confirmed cases and mortality rates in the two weeks to April 22, but the vulnerability is estimated based on three indicators: the proportion of rural population not covered by community health centers (CHCs) with multiple morbidities in the population aged 45 and over. And distribution of Indian urban population in states and UTs.
The extensive literature suggests that, along with the lack of access to quality health care, a high proportion of urban dwellers and the elderly with multiple-morbid conditions increase the vulnerability to infections and deaths caused by SARS-COV-2. Data for the first five indicators were obtained from Population Projections for India, Longitudinal Aging in India Study and National Family Health Survey Reports. The rural population found by the CHCs is calculated based on the criteria set by the National Health Mission (NHM) by obtaining state-wise CHCs from the 2019-20 Rural Health Statistics Report and the rural population as a whole for India and states report from population estimates. According to NHM regulations, a CHC will serve 120,000 people in the plains and 80,000 in hilly / tribal areas. For states with a significant combination of plains and hill / tribal areas, we intend to bring 100,000 people under CHC. If a rural population exceeds the number of CHCs and the output of the standard population by the CHC, it is defined as a rural population not covered by the CHCs.
According to the proposed formula, the top five states where vaccination is required are Maharashtra, Uttar Pradesh, Karnataka, Bihar and West Bengal. In total, these five states should receive 50% of the total vaccines in India, as these states have high vulnerability; However, the latest statistics of the first vaccine dose indicate that they received only 37% of the total. This indicates inequality in distribution, and the increasing number of deaths does not result in an error with each passing day.
Going to the individual states, Delhi Delhi and Maharashtra are getting only 56% and 57% of the proposed share, indicating a huge deficit in vaccine coverage. Similarly, according to our formula, the coverage deficit in Tamil Nadu, Uttar Pradesh, Punjab and Bihar is 30%. On the other hand, Karnataka, Chhattisgarh, Jharkhand, Andhra Pradesh, Telangana and West Bengal are receiving ideal shares to ensure adequate vaccine coverage. Vaccination is most prevalent in Madhya Pradesh, Meghalaya, Nagaland, Haryana, Kerala, Uttarakhand, Jammu and Kashmir and Gujarat. In contrast, large states like Odisha and Rajasthan and smaller states like Himachal Pradesh, Mizoram, Arunachal Pradesh, Tripura and Sikkim are receiving much higher doses, with a share of 200% or more.
Distribution across states can also be calculated using similar criteria, estimating the prevalence and severity of the epidemic in different cities, and vaccinating accordingly. It may be noted here that the proposed formula assigns vaccines based on the severity of the epidemic in the two weeks prior to April 22 in a particular state. These values should be updated weekly and the vaccine allocation should be changed accordingly.
Also, if the allowances for minors are taken into account, the population factor can be modified to obtain the corresponding values.
Finally, vaccines should be used to their maximum potential without any wastage. In Italy, positive behavior was seen in the first stage of aggression and fear; However, its inhabitants have developed hesitation and doubts about the vaccine over time. Therefore, looking at the current Kovid surge in India, it is very necessary to have a fine system that has a large population with as high a dose as possible. The government needs to develop a sharp strategy for its immunization program so as to encourage more people to get sick, especially the most harmful and the least wasted.
Akancha Singh & Nand Lal Mishra Doctoral Fellows at the International Institute for Population Sciences, Mumbai
Alka Chauhan and Bishwajit Besra, research graduates from IIPS, contributed to this column.