But as India celebrated the passing of the moment on Thursday, some experts warned that the pandemic threat was not over – in a nation of 1.3 billion, millions of people would still not receive any doses at all.
Experts fear that interstate travel and the possibility of new variants could lead to a third increase in infection – leaving unvaccinated people and children at greater risk.
“Difficultly difficult to predict because global experience shows that things can get worse at any point of time,” said Dr Anant Bhan, a global health and policy expert from the central Indian city of Bhopal. “But the trend in India is now very encouraging. The number of vaccines administered is high and there is no increase in cases.”
Up to 8 million doses are being administered on a typical day, but the Indian Medical Association is calling on the government to stop exports until more people are vaccinated at home.
The second wave of Covid beat the vaccines
India had two waves of Covid-19-one last year before vaccines became available, and the second that started just a few weeks into the country’s ambitious vaccination program earlier this year.
The first doses began to appear in January for vulnerable citizens and front-line workers, part of a priority group of 300 million people – almost as many as the entire American population.
“We faced absolutely hiccups at first,” Dr JA Jayalal, president of the Indian Medical Association, told CNN. “We were not able to meet our huge demand and there was a lot of hesitation, especially among our rural population.”
Vaccination rates were still very low as the second Covid wave was built in early March, and by the end of the month, the government had halted vaccine exports to give preference to Indians.
The rise of Covid cases brought panic and despair as millions tried to navigate the collapse of the country’s healthcare system. Some posted desperately for help on social media, hoping to secure a hospital bed or medical oxygen.
Several districts in the western state of Maharashtra had to temporarily suspend vaccination, including more than 70 centers in the financial capital Mumbai, according to state health minister Rajesh Tope.
On September 17, Modi’s birthday, India set a one-day vaccination record by administering more than 25 million vaccines. That week, the country passed a major breakthrough by delivering at least one dose to more than 60% of its qualified adult population.
But like many countries, India’s vaccination rates are not evenly distributed. In rural areas, more than 64% of people have received at least one dose of the vaccine. In urban India, where people live in cities and more crowded cities, the figure is close to 35%, according to data from the Ministry of Health.
India’s challenge is to improve rates across the country – and most importantly, to vaccinate its children.
Children in line
Since the onset of the pandemic, less than 1% of Covid-19 deaths in India have been children under 15, according to the country’s Ministry of Health. But some states are taking extra precautions and preparing for a worst-case scenario if the third wave hits.
Hospitals are stockpiling medical oxygen and several states — including Maharashtra, Tamil Nadu and Karnataka — are building Covid-19 treatment facilities, especially for children.
“We do not know how the virus will behave, but we can not afford to be unprepared this time,” said Suhas Prabhu, head of the Pediatric Task Force in the western state of Maharashtra, according to Reuters.
“No mother should run to look for the hospital bed when her child is sick.”
The first vaccine available to Indian children over the age of 12-ZyCov-D, developed by Gujarat-based Cadila Healthcare Ltd-was granted the Emergency Use Authorization (EUA) in August.
“Our priority now is to continue exploring options for children and teens for sure, but our goal is to cover the adult population for which there is no longer a shortage of vaccines,” he said.
Another vaccine, Covaxin India, developed by Bharat Biotech and the Indian Medical Research Council, is expected to be given soon to the EUA for children aged 2 to 18 years.
However, the World Health Organization has not yet approved it for adults or children.
The US-made Johnson & Johnson & Moderna vaccines are also expected to be released in India this year, although the timing is not known — nor have they been approved for use in children in India.
Concern about exports
Delivery of 1 billion doses of Covid vaccine is a milestone for India, but experts say it needs to do much more to achieve its vaccination target of its entire adult population by the end of the year.
Jayalal from IMA says the country should aim to vaccinate at least 10 million people a day.
Then there is the issue of supplies. IMA worries that by resuming vaccine exports, India could find itself in a similar position to last year – when demand far exceeded supply.
“Personally, we are not supporting exports,” Jayalal said. “We are emphasizing that our entire population should receive the first dose at least before exports resume.”
About 1 million shots of Covaxin were sent to Iran last week, the Indian embassy in Tehran confirmed on Twitter. Nepal, Bangladesh and Myanmar also received vaccines produced by India in October, according to Indian officials. Exports are expected to rise sharply in the coming months as domestic stocks rise and most of India’s population will be inoculated with the first dose, officials said on October 14th.
Dr Bhan, the global health and policy expert, said that while India plays an important role in the supply of vaccines in the world, a balance needs to be struck.
“We, of course, have to offer a part of that supply to other countries, especially those where there has been a small supply,” he said. “We have increased production and coverage of local vaccines is increasing. But perhaps this is the time for us to increase production in a way that supports domestic and export needs.”
A spokesman from Bharat Biotech, which manufactures Covaxin, said it is not facing any challenges in shock production, and is working towards making 1 billion doses in India this year by expanding its production capacity at many facilities in the country.
SII, which produces Covishield, will produce 200 million doses in October, up from 160 million in September, according to the company, after improving access to raw materials required for vaccine production.
CNN addressed the Ministry of Health, but received no response.
K. Srinath Reddy, president of the India Public Health Foundation, said the country may not achieve full vaccination by the end of the year, but increased authorities are “comforted” by antibody surveys showing high positivity rates in it all over the country, that is, there is a protection against the virus.
“This is being taken as an indicator of protective immunity acquired either during the second wave run by Delta or through vaccination even from a single dose,” he said.
Indian authorities will hope – even without both doses – that protective immunity offers Indians some security as the long festival season begins.
The government has not announced a ban on religious gatherings and interstate movements, but is urging the public to remain vigilant and avoid non-essential travel.
“We have started to get back on our feet, but we can not afford to be complacent,” said Jayalal, IMA president.
“We are urging the government not to allow mass rallies. It is definitely a chance for a third wave to come, and we need to be ready for it.”
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