4 min read.Updated: 29 Apr 2021, 06:08 AM ISTAkancha Singh,Nand Lal Mishra
Calculations that account for how exposed people are to covid risks show our distribution of jabs has been highly lopsided
As India surpassed the 300,000 mark of daily cases in April 2021, a political brawl broke out between the Union government and some states over an alleged shortage of vaccines. This is adding to a series of setbacks in India’s tryst with covid. Health ministers of several states have accused the Centre of limiting supplies to their states. The issue is especially pertinent because of a lack of transparency at a time India needs vaccine allocations based on an effective and efficient scientific formula. The current formula of vaccine distribution among states is not clear. It is crucial to use scientific calculations that are transparent and take covid severity into account. To that end, we have worked out an integrated formula that acknowledges six predictors of disease severity and assigns equal weightage to each.
The need and allocation of vaccines across states depend on their population size, exposure and vulnerability to the pandemic. We have used a set of six indicators, covering three dimensions: demography, severity of the current wave, and vulnerability to infection. All three are given equal weights in order to compute an aggregate score that is nothing but a proposed share of vaccines to be provided to a state or Union territory (UTs).
The demographic dimension is measured by the proportion of India’s population aged 45 or above across states and UTs. The severity aspect of it is covered by the percentage distribution of total confirmed cases and deaths attributed to covid over the two weeks till 22 April, while vulnerability is estimated on the basis of three indicators: share of the population aged 45 and above with multi-morbid conditions, proportion of the rural population not covered by community health centres (CHCs), and the percentage distribution of India’s urban population across states and UTs.
A wide range of literature suggests that a higher share of urban dwellers and older people with multi-morbidity conditions, combined with lack of access to quality healthcare, tends to increase the vulnerability of infections and deaths attributed to Sars-CoV-2. Data for the first five indicators was obtained from Population Projections for India, Longitudinal Ageing in India Study and National Family Health Survey reports. The rural population uncovered by CHCs is calculated based on standards prescribed by the National Health Mission (NHM), by obtaining the state-wise number of CHCs from the Rural Health Statistics report of 2019-20, and the rural population total from the Population Projections for India and States report. As per NHM norms, one CHC is supposed to serve 120,000 people in the plains and 80,000 people in hilly/tribal areas. For states with a significant combination of plains and hilly/tribal areas, we have considered a threshold of 100,000 people to be covered by a CHC. If a rural population exceeds the product of the number of CHCs and standard population covered by a CHC, it is defined as a rural population not covered by CHCs.
According to this proposed formula, the top five states that seem to be in dire need of vaccines are Maharashtra, Uttar Pradesh, Karnataka, Bihar and West Bengal. As an aggregate, these five states should be receiving 50% of India’s total vaccines, given the high vulnerability in these states; however, the latest figures of first vaccine dosage indicate that they have received only about 37% of the total. This points to inequality in distribution, and the rising fatality count each passing day leaves no room for error.
Moving on to individual states, Delhi and Maharashtra are getting only 56% and 57% of the proposed share, indicative of a massive deficit in vaccination coverage. Likewise, Tamil Nadu, Uttar Pradesh, Punjab and Bihar have a coverage deficit of 30% by our formula. On the other hand, Karnataka, Chhattisgarh, Jharkhand, Andhra Pradesh, Telangana and West Bengal are receiving ideal shares to ensure appropriate vaccine coverage. Madhya Pradesh, Meghalaya, Nagaland, Haryana, Kerala, Uttarakhand, Jammu and Kashmir and Gujarat have had a relatively higher share of vaccination. In contrast, larger states such as Odisha and Rajasthan and smaller states like Himachal Pradesh, Mizoram, Arunachal Pradesh, Tripura and Sikkim are receiving a far greater proportion of doses, 200% or more of their proposed share.
Distribution within states can also be computed using similar criteria, assessing the spread and severity of the pandemic in various cities, to administer vaccines accordingly. It may be noted that the proposed formula here allocates vaccines based on the severity of the pandemic over the two weeks before 22 April in a particular state. These values need to be updated every week and the allocation of vaccines changed accordingly.
Also, considering the allowances for younger age groups, the demographic factor can be modified accordingly to get respective values.
Lastly, vaccines must be utilized to their maximum capacity without any wastage. In Italy, positive behaviour vis-a-vis vaccines was seen during its first phase of heightened risk and fear; however, its residents developed hesitancy and doubts about vaccination over time. Hence, given the current covid surge in India, it is essential to have a well-equipped system covering as much of the population with doses as possible. The government needs to devise a sharper strategy for its immunization programme so that it encourages more people to get jabs, especially the most vulnerable, and results in minimum wastage.
Akancha Singh & Nand Lal Mishra are doctoral fellows at International Institute for Population Sciences, Mumbai
Alka Chauhan and Bishwajeet Besra, research graduates from IIPS, contributed to this column.