Adjusted for population, India has distributed more vaccinations in rural districts. However, at a state level, there are severe disparities
When India rolled out covid-19 vaccines, there were concerns that the coverage would be biased towards urban centres with better medical infrastructure. However, data shows India has managed superior coverage in rural districts than in urban ones, albeit with significant state-level variations.
Overall, rural districts have received 489 doses per 1,000 population as of Wednesday, as against 451 in urban districts.
Kerala, which leads the coverage among large states, has given 1,008 doses per 1,000 population in rural districts, compared to 827 in urban ones. Jammu and Kashmir, Uttarakhand, and West Bengal also have a significant surplus in favour of rural districts.
Major exceptions are Maharashtra, Manipur, Nagaland, and Telangana, where the urban vaccine coverage is at least two times more than in rural districts. Uttar Pradesh and Andhra Pradesh have an almost equal distribution, while Himachal Pradesh and Rajasthan have only a marginal urban-rural divide, though in favour of the rural sector.
Interestingly, many states with lower population share in rural districts have done better in providing vaccines in these districts.
This analysis considers districts with fewer than 400 persons per sq km as rural districts, drawing from the multi-tiered 2011 census definition of urban units. Such districts typically have weaker medical infrastructure. This classification may not reflect the actual rural-urban population share.
India's vaccination coverage grew 7.8% last week to 663 million doses, earning it the second slot among the 10 most populous countries in terms of the highest weekly increase in vaccination. It administered 12.9 million doses on 30 August, a record. South Asian peers—Bangladesh, Indonesia, and Philippines—have also ramped up vaccination in the last two weeks after facing supply constraints in the previous few months.
Recent Delta variant outbreaks have strained healthcare facilities in Indonesia and the Philippines. In the Indonesian capital Jakarta, deaths have been three times more among the unvaccinated, according to official data. While more than half the population in Jakarta have been vaccinated, the share is less than 10% in rural provinces. To aid the drive, Indonesia approved the Sputnik-V vaccine for emergency use last week. The Philippines accelerated its vaccination, partly due to the 3 million Moderna vaccines it received from the US earlier in August, the largest ever donation of vaccines by a single country.
India’s top 10 districts with the highest caseload in the last week were all from Kerala, as Onam festivities were followed by a renewed explosion in infections. The state constituted 69% of all new cases in India. In the top five districts—Thrissur, Ernakulam, Kozhikode, Malappuram and Kollam—weekly cases jumped over 1.5 times, with the highest in Kollam, where infections doubled to 17,937 cases. The other four are also the only districts in India to have reported more than 20,000 weekly cases.
Maharashtra came a distant second with a sixth of Kerala’s caseload. Even though cases declined in the north-east, Mizoram continued to be the state of concern: six of its 11 districts witnessed a rise in cases. In Mamit, Lunglei, and Champhai districts, cases rose at least 1.8 times. The capital district, Aizawl, continues to register around 3,000 cases.
Weekly deaths continued to fall for the ninth week. The toll this week was 3,163, down from 3,317 in the preceding week. In Kerala, the toll increased to 989 from 923, replacing Maharashtra as the state with the highest weekly toll. Two districts from Kerala—Thrissur and Palakkad—were among the top five with most deaths.
Maharashtra’s toll dropped 20% this week to 925. Among districts, Pune saw the most deaths this week (214), though this number dropped by 28%. Cuttack in Odisha was second (144), where deaths have been on a steady rise since the last week of July, when it had reported just 7 deaths. Punjab also saw a fivefold rise in the toll due to a reconciliation exercise.
As the vaccination coverage expands, the number of deaths is expected to come down, even if there were to be a third wave. But the rural-urban divide may need to be addressed: rural districts are at risk due to weak facilities, and urban areas due to high population density. Both need attention.