As the total Covid-19 vaccine rollout in India approaches the 250 million dose milestone, a massive gap has begun to emerge between its major urban centers—which have managed to receive the lion’s share of the inoculations—and its poorer rural districts, leaving large swathes of the country’s population vulnerable to the deadly coronavirus.
According to an analysis carried out by Reuters, 114 of India’s least developed districts—home to a collective population of 176 million people—have administered only 23 million doses of the Covid-19 vaccines so far.
In contrast, almost the same number of vaccines have been doled out across India’s nine major cities—New Delhi, Mumbai, Kolkata, Chennai, Bengaluru, Hyderabad, Pune, Thane and Nagpur—whose combined population is less than half of the least developed districts.
The disparity only got worse in May as the private sale of vaccines were allowed, leading to the nine cities combining to administer 5.75 million shots compared to the 4.95 million shots given out by the 114 districts, the Reuters’ analysis added, citing the Indian government’s vaccination dashboard.
According to The Hindu, by mid-May, 30.3% of India’s urban population had received at least one dose of the vaccine compared to 19.2% in semi-urban areas, 15.1% in semi-rural areas and just 12.7% in rural areas.
The divide is also visible in India’s private market vaccine rollout—which starting last month accounts for 25% of all doses manufactured in the country—as nine major hospital chains managed to corner 50% of all privately sold doses accessible in the country.
Beyond unequal access, India’s rural vaccination rollout appears too hampered by growing vaccine hesitancy fueled by misinformation and rumors on social media and messaging platforms like WhatsApp.
65.5%. That’s the percentage of India’s population that resides in rural areas, according to World Bank Data. Inoculating this sizable majority of the country’s 1.4 billion people will be key to preventing a third wave of the pandemic that could quickly overwhelm rural India’s limited health infrastructure.
Several quirks have emerged within the vaccine rollout in private hospitals as the government has decided not to cap the pricing of these doses. The private hospitals can acquire the AstraZeneca vaccine from manufacturer Serum Institute of India at $8.2 (Rs 600) per dose and the indigenous Covaxin at $16.5 (Rs 1,200 per) dose. However, the out-of-pocket cost faced by vaccine recipients appears to vary between around $7 (Rs 650) and about $25 (Rs 1800) per dose, according to a report by The Ken.
Starting May, India’s government began implementing its so-called “liberalized” vaccine procurement and allocation policy. Under this policy, the federal government will procure 50% of the total vaccines manufactured in the country and then distribute them to the states for free. Of the remaining 50% doses, states will be allowed to directly negotiate and acquire 25% of the vaccines while the remaining 25% will be sold to private hospitals. The split procurement process has led to vaccine manufacturers setting up a tiered pricing system, where states have to pay the manufacturers more than double what the federal government pays and private hospitals pay even higher. This has been criticized by public health experts who have called for a centralized acquisition process and free vaccines for everyone to ensure fair and equal access. In addition to this, people are also required to sign up and book their vaccination appointment online, resulting in the exclusion of those who may not have access to internet devices.
Last week, India’s Supreme Court slammed the federal government’s “liberalized” vaccine policy, saying: “The present system of allowing only digital registration and booking of appointments on CoWIN (India’s online vaccine enrollment platform), coupled with the current scarcity of vaccines, will ultimately ensure that initially all vaccines, whether free or paid, are first availed by the economically privileged sections of the society.”