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India lags far behind its developing-country rivals in the covid-19 booster vaccination race, even as cases have seen a steady uptick in the past fortnight. The poor show comes even as the country started its ‘precaution’ dose inoculation drive around the same time as some of the other countries, shows a Mint analysis.

For every 1,000 people, India has managed to administer just 32 boosters, i.e. merely 3% of the population. A look at the same figure for comparable emerging markets (EMs) shows the extent of the lag: China (547 doses), Brazil (500 doses), Mexico (408 doses), Indonesia (175 doses) and the Philippines (132 doses) are way ahead of India. Even neighbours Pakistan and Bangladesh have fared better at a time the World Health Organization warned that the pandemic ‘is far from over’, with a fresh spike in new covid cases seen in 110 countries.

Few takers of booster shots in India
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Few takers of booster shots in India

India’s high population isn’t the only reason behind the low per-capita coverage. In absolute numbers, India has given fewer booster doses (45 million) than China, Brazil, Mexico and Indonesia, while Bangladesh and Pakistan have already clocked more than half that count.

“These numbers are nothing to be proud of," said T. Jacob John, a former professor of clinical virology at Christian Medical College, Vellore.

A key point to note here is that most countries that were part of the analysis began their booster campaigns between October and December 2021. However, India administered its first booster shot on 10 January this year and by 10 April, had expanded the eligibility to all adults, who had got their second covid-19 shot at least nine months ago.

Recently, the Centre flagged concerns over the low utilization of booster doses. “People should understand that the precaution dose is essential to build additional cover of protection, particularly in those with comorbidities. In the context of the recent increase in symptomatic cases of covid, this becomes very important," National Technical Advisory Group chairman Dr N.K. Arora told Mint in an interview last month.

Utilization of booster shots among people aged 18-59 years is particularly low (7.3 doses per 1,000), shows official data. As of 3 July, Delhi, Bihar and Haryana led the trend in this age group, with 64, 29 and 26 doses per 1,000, respectively.

Authoritative scientific research has consistently highlighted the importance of getting boosters. India has seen a sharp rise in active case count over the past fortnight. On 29 June, India clocked over 18,000 cases, which was the highest since February this year. Active coronavirus cases stood at 111,711 as of 3 July, which is the third straight day of over 100,000 active numbers in the country.

Where did India falter in its booster rollout policy? Top vaccine experts Mint spoke to said that with vaccine shortage no longer a concern, the low coverage points to a combination of poor official communication in driving home the benefits of a booster, ambiguous policy and the lack of a proper system in place to vaccinate adults and follow-up for adverse reactions. Inertia among the general public due to low health education has also contributed to the low numbers, they added.

“A key issue with the government’s communication has been its inability to refute the perception that vaccines are ‘useless’ because one can get infected even after vaccination," Shahid Jameel, one of India’s top virologists, said in an interview. “While protection from infection is variable for different vaccines and wanes with time, all vaccines have worked well to protect against severe disease," he explained.

Unlike the universal immunization programme for children, there is no established apparatus for adult vaccination. This is leading to information asymmetry around adverse events, feeding into rumours and promoting hesitancy around getting jabbed, said Jacob John. “Imagine somebody offers free ice creams but without the guarantee that it is safe and not contaminated. Will you take it?"

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