India may end up wasting millions of COVID-19 vaccine doses if there is no separate queue for second shots

• Nearly 600 million more people in India will become eligible for getting the COVID-19 vaccine on May 1.
• At the time, at least 40 million people will be eligible for their second dose and that number would rise every passing day, adding over 65 million people by the end of May.
• According to government guidelines, the second dose needs to be administered within four to eight weeks of the first dose.

There will be at least 40 million people eligible for the second dose of COVID-19 vaccine on May 1.

According to the Indian government, the interval between the first and second dose should be four to eight weeks. “Most likely, after eight weeks, you should consider your first dose to be a waste of time,” Dr Kunal Sarkar, the chief cardiac surgeon and senior vice chairman of Medica Hospital in Kolkata, told Business Insider.

Dr Sarkar’s view echoes the government guidelines that said that the second dose of Covishield should be administered “not later than stipulated period of 8 weeks.”

While a Lancet study has shown that a longer interval may improve the vaccine’s efficacy, the study itself recommended a 12-week interval between doses. Moreover, the vaccines currently in use are those that have been given emergency approval and it is wise to err on the side of caution especially with new variants of the virus emerging.

“With COVAXIN, they maintain that the interval should be four weeks. With Covishield, as per their trial data, even they said four weeks. Then, based on certain experiences in the UK, it was stretched to six weeks,” said Sarkar. “Now, because of the irregularity in supply, it is anybody's guess… By and large, we are afraid if it stretches beyond eight weeks or so, then will the two-dose concept still remain valid? There is no data.”

In order to ensure that people who already have the first dose do not get pushed behind in the queue, the Indian government should allow for separate counters and dedicated slots for people who are eligible for the second dose. This would be easier said than done given the current shortage of vaccine supply across many states.

Source: Data from the Ministry of Health and Family Welfare (MoHFW)

On May 1, as the country opens up its vaccination drive to everyone above the age of 18 years, 600 million additional people will become eligible. This could lead to another crisis as another 40 million will already be waiting in the queue for the second dose.

And that number will rise with every passing day, as the 65 million people above the age of 45 — who got the first dose after April 1 — complete their stipulated time of four to eight weeks and join the queue for the second dose.

If they don’t get vaccinated in time, they will have to begin the vaccination cycle all over again.

According to Dr Marcus Ranney, founder and chief executive of Human Edge, the need to separate the people coming in for vaccination is also important to avoid the spreading of the virus at the centres. “As the window will open to 18-year-olds, they very clearly need to have centres that are earmarked for different populations. If they try and serve everyone from the same place, it’s just going to create chaos and may even fuel a much larger spread,” he told Business Insider.


One way to stall the chaos is to prioritise those who need the second shot. Another filter that can be used is to ask those who may have been infected by COVID-19 in recent weeks to stay out of the queue.

“What hasn’t been used as well as we could have done is the same methodology used with polio and other types of vaccines, which was more door to door — particularly for the elderly folks,” said Ranney.

All in all, the government needs to come out with clear guidelines to ensure no one is left behind, and not one precious dose goes to waste — especially since India has already wasted 4.6 million doses till April 11.

There is going to be a crazy rush at vaccination centres in the absence of proper guidelines

This has become evident from the response to the opening up of online booking of vaccination slots. The government opened up registrations for people between the ages of 18 to 44 on April 28. And, before things could even take off, registration was delayed from midnight to 4:00 pm.

According to the government, more than 3.5 million people registered within the first hour of the launch. But when it came to being able to book an appointment, they passed the buck onto state governments and private vaccination centers.

When the floodgates opened, the CoWIN app, Aarogya Setu app and UMANG app’s servers crashed. Many of those who got the chance to register via the CoWIN website, never found an open slot.

Even if the government were to take no new bookings, and only focus on those needing second shots at all centres, at the current rate of vaccination, it would take 48 days to just go through that lot. In such a scenario, it is not unimaginable that those who need the second shot never get the slot before their 12-week deadline.

The other challenge will be allocating the limited vaccine supplies

This would not have been a concern if India had enough vaccines to go around for everyone who wants it. However, that’s not the case because the government dragged its feet in placing the orders.

On April 23, the government pledged to increase the monthly production of doses to around 100 million doses by September with the rate of immunisation slowing down amid rising cases.

When the government opened up jabs for those above the age of 45 from May 1, it had expected the imported lot of Russia’s Sputnik V COVID-19 vaccine to arrive by then. While Russia is now sticking to the date, it is not clear how many doses will come in, especially after a brief attempt to delay the supply to the end of May.

Having to repeat the first doses for even one person is a waste of precious resources. Managing a pandemic was never going to be easy. Imagining scenarios and preparing for the possibilities is the only way to keep things from spiraling out of control.

The updated version of the story includes additional opinions from Dr Kunal Sarkar and the Lancet study, which recommended an interval of 12 weeks between two vaccine doses.

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