Government's not prioritizing second vaccine dose is bad strategy, why?

During March and April this year, a large number of people above 45 years of age and with serious diseases were incentivised to go for vaccination. The central government rightly took the services of private hospitals also in this campaign. 

Towards the end of April, the government shifted its focus to maximizing vaccination for those aged 18 and above. It had already stopped scheduling the second dose and now it almost completely stopped partnering with private hospitals for vaccination to 45+ category. 

Take the example of Gurugram, a part of the National Capital Region. I have selected it because I live here and therefore have first hand information and experience. There were about a dozen private hospitals that were vaccinating for COVID-19 in pre-April period by charging Rs. 250 but there are hardly any now. Government agencies also used to set up vaccination camps. No more. 

A tweet to the District Magistrate of Gurugram seeking information on this resulted in this stock reply: "For 45+ registration is mandatory via Co-win for the first dose only, for 2nd you may walk-in into the nearest PHC without any registration. Please carry a valid Government issued ID preferable, Aadhar."

Why ignoring 45+ population in vaccination will backfire

This well-meaning reply but hopeless arrangement is likely to frustrate government's vaccination program in more ways than one, but the government seems to be oblivious to it. Let me explain why this attitude is likely to backfire.

1. People above 45 years of age whose period of wait before the second dose is nearing or has ended are in panic. They are rushing to government hospitals/ PHCs, and the few private hospitals that are vaccinating them. Being aged or diseased, they are usually accompanied by somebody - so often more than one person visits the hospital for a single vaccine dose. This crowding has the potential to create corona hotspots. 

People who have visited these hospitals share that the hospital staff is perpetually confused. Hospitals are also unable to deal with the rush.

2. Most of these people have one or the other disease, and almost all are aged. If they go to hospitals with crowds - and thus get infected - the number of COVID-induced deaths is likely to go up.

3. A big majority of people in this group are  less resourceful in terms of health, mobility, use of technology, connections, etc. because of their age or diseases or both. The health of such people is likely to deteriorate further due to the anxiety caused by this uncertainty.

4. If people do not get the second dose even after two months (OK, stretch it to three months), they will lose immunity gained through the first dose. They will be in a catch-22 situation: aadhar linkage will not allow them to be in the queue as first-timers, and they will not get the second dose due to the prevalent confusion and rush. Thus, they will have to live with a single dose of vaccine. 

There must already be a large number of such people because in March-April, vaccination was at peak. Those who got their first dose during this period but did not go for the second dose before the last week of April are all suffering due to lack of attention, forget a high priority.

The central government should take note, because it is this government that is, by its own admission, responsible for vaccination of 45+ population. The anger among this age group is bad enough for the government from the perspective of public trust, but this uncaring attitude might also dent the [already low] credibility of the vaccination programme.

The easy way out

The way out is rather easy. 

1. Government must allow the earlier-registered private hospitals to administer vaccines to this group. In fact, the more the government partners with private hospitals, the better (less cost to government, less burden on public resources). Everybody knows this, but why the government is shying away from using private resources is not known.

2. Government hospitals should have a separate window: presently for this group, and later for second dose to any age group.

3. CoWin should allow people to schedule their second dose, starting with 45+ population. Walk-in creates problems for people as well as hospitals. In addition, it does not allow proper planning at any level, be it the hospital or higher-level implementing agencies.

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