India Needs to Address Intra-State Inequities in COVID-19 Vaccination Coverage

The reasons for uneven vaccination coverage include pockets of vaccine hesitancy, complacency and vaccine fatigue

Medchal-Malkajgiri, a district on the fringes of Hyderabad, Telangana is one of the best performing districts in the country with 79 percent of its population fully vaccinated against COVID-19 as per the India COVID-19 Vaccine Tracker for Districts and Parliamentary Constituencies of India which visualises data from the CoWIN Dashboard.

Meanwhile, Vikarabad, another district adjoining Hyderabad has fully vaccinated only 26 percent of its population. Similarly, in the NCT of Delhi, while the East Delhi district has fully immunised over 90 percent of the population, the district of North Delhi is lagging behind considerably with a complete vaccination coverage of 38 percent.

As India embarks on vaccinating teenagers and administering precautionary doses to vulnerable adults over the age of 60 years, it is imperative that the prevailing inter-state and intra-state inequities in the primary vaccination program are addressed.

What Do States Need to Do?

While remoteness of terrain, percentage of tribal population, and levels of poverty are variables which are typically correlated with poor vaccine coverage, even well-performing states need to rework their vaccination strategies and accelerate implementation in less developed districts.

For instance, while in states like Bihar, Chhattisgarh and Nagaland, vaccination needs to be ramped up across most districts, even Andhra Pradesh and Telangana, which have achieved considerable success in terms of overall vaccination numbers, need to address the significant variations between districts in their respective states.

There are challenges associated with reaching out to remote districts, and costs too, however, terrain is not the only reason for uneven implementation.

Every state, including the best performing one, has districts that drag India’s overall vaccination coverage rates down.

Therefore, it is critical to adopt a targeted approach for these districts. In the same way the government transitioned from imposing city-wide curfews to zeroing down strategically on smaller containment zones within cities, focusing on blind spots offers a path ahead for India’s COVID vaccination drive too.

By the end of December 2021, around 90 percent of India’s adult population had received at least one dose of the COVID vaccine, while 65 percent of the country’s adult population was fully vaccinated.

This is no small feat considering the enormous logistical challenges faced by the drive when it was first initiated just under a year ago on 16 January, 2021.

Over 11 states and Union territories have achieved 100 per cent coverage of the first dose of the vaccine, while 3 states and UTs have achieved 100 percent full vaccination coverage against COVID-19.

Last Mile Challenges

Under the nationwide COVID-19 vaccination programme, the 'Har Ghar Dastak' campaign was launched on 3 November 2021 to create awareness and mobilise eligible beneficiaries who have been missed or have dropped out of the immunisation drive for various reasons. As the vaccination coverage plateaus out in several districts across the country, reaching the last mile is emerging as the predominant challenge.

The reasons for uneven coverage include pockets of vaccine hesitancy, complacency and vaccine fatigue. In some areas, for instance, low levels of knowledge mean that people believe that one dose is sufficient to offer protection from the virus.

There are also certain myths and misconceptions about the safety of vaccines as well as inadequate understanding of vaccine related adverse events which contribute to hesitancy. These challenges are further exacerbated by relatively weaker health infrastructure and resource limitations in poor districts, which in turn, contribute to suboptimal implementation.

The 'Har Ghar Dastak' campaign is a step in the right direction, especially for combating hesitancy and reaching out to underserved groups.

Access to Diverse COVID-19 Vaccines

Another far-reaching and potentially game-changing step by the government is the authorisation of additional vaccines such as Corbevax by Biological E and Covovax by the Serum Institute for restricted use in an emergency situation.

Diversifying the vaccine mix will contribute to India’s progress towards its goal of achieving 100 percent vaccination coverage.

It is crucial for the Centre and states to collectively plug the gaps in the vaccination program by using district-level data to identify implementation blind spots and intensify efforts in these areas.

Further disaggregating the vaccination coverage data by geography (urban versus rural), gender as well as socio-economic status (e.g., mainstream versus marginalised groups like tribals) can pave the way for design of targeted strategies that address the micro-level obstacles to ensuring universal vaccination coverage in the country.

(Urvashi Prasad and Adhiraj Parthasarathy are Directors, Development Monitoring & Evaluation Office, NITI Aayog. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)