India has administered more than 90 million doses of coronavirus vaccines amid a deadly second wave of infections.
The country has been reporting an average of more than 90,000 cases of Covid-19 every day since 1 April.
Everyone above the age of 45 is now eligible for jabs, which are available at vaccination centres and hospitals.
Most of the doses have been given so far to frontline workers and people above the age of 60.
However, the world’s largest vaccination drive appears to be struggling. This week, half a dozen states have reported a shortage of doses even as the federal government insists that there’s enough in stock.
The government claims the “allegations” of vaccine scarcity are “utterly baseless” and it has more than 40 million doses in stock.
The inoculation drive aims to cover 250 million people by July, but experts say the pace needs to pick up further to meet the target.
The third phase – which began on 1 April – opened amid a sharp uptick in Covid-19 cases.
On 4 April, India became the second country after the US to report 100,000 new cases in a single day. More than half of those were confirmed in Maharashtra, which has India’s largest city Mumbai as its capital.
India’s caseload had dropped sharply by the time it began vaccinating people early this year. It was adding under 15,000 infections daily. But cases began to spike again in March, largely driven by poor test-and-trace and lax safety protocols.
Experts say India’s second wave is being fuelled by people being less cautious – and mixed messaging by the government.
Since the pandemic began, India has confirmed more than 12 million cases and over 167,000 deaths. It’s the third-highest number of Covid-19 infections in the world after the United States and Brazil.
How is the rollout going?
India launched its vaccination drive on 16 January, but it was limited to healthcare workers and frontline staff – a sanitation worker became the first Indian to receive the vaccine.
From 1 March, the eligibility criteria was expanded to include people over 60 and those who are between 45 and 59 but have other illnesses.
The third phase of its vaccination drive with everyone above the age of 45 eligible for the jab was launched on 1 April.
The country’s drugs regulator has given the green light to two vaccines – one developed by AstraZeneca with Oxford University (Covishield) and one by Indian firm Bharat Biotech (Covaxin). Several others candidates are at different stages of trials.
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India also wants to scale up the drive quickly to stem the recent spike in cases. So it recently placed a temporary hold on all exports of the Oxford-AstraZeneca coronavirus vaccine, which is being made by India’s largest vaccine manufacturer, the Serum Institute of India (SII).
This week the vaccine maker said its production capacity was “very stressed” and that it was “still short of being able to supply to every Indian”.
Serum says it has been providing 65-70 million doses every month to India, and exported a total of nearly an equal amount of doses since it began production early this year.
The firm was aiming to boost production to 100 million doses a month. Now it says it would not be able to meet the target before the end of June because of time taken to repair damages from a fire at its facilities in the western city of Pune in January.
Experts believe India should ramp up vaccination in areas of high transmission and in five states where elections are being held to prevent the virus from spreading.
Dr Murad Banaji, a mathematician at Middlesex University London who is closely tracking the pandemic, told the BBC that he hoped that vaccinations will play a part in controlling the second wave.
“But at the current pace vaccination is going to have little effect on slowing spread in a month or two. Being targeted at the most vulnerable, it might, however, start reducing hospitalisations and deaths more quickly.”
Bhramar Mukherjee, a biostatistician at the University of Michigan, told the BBC that India needed to administer 10 million shots daily “instead of being complacent with 3 million” doses a day.
“I do feel frustrated that India did not roll out the vaccination drive more aggressively while the curve was in its valley,” Dr Mukherjee said.
“It is much easier to roll out vaccination when the infection is not so high. Now the healthcare capacity is stretched between vaccination and Covid care.”
How many have been vaccinated so far?
India has administered more than 94 million doses of coronavirus vaccines so far.
Over 70 million people have received one dose, and over 10 million people have been fully vaccinated after receiving two doses.
For decades now, India has been running one of the world’s largest immunisation programmes that vaccinates tens of millions, including newborns and pregnant women, against various diseases.
So experts believed India was well-prepared for the challenge. But the uptake has been slow because of vaccine scepticism as well as a lack of awareness among the poor or in rural areas.
Many of the poor have little information on how to register themselves and access the vaccine free of cost. Eligible people can now book their jabs online or walk in and register at vaccination centres.
“There’s very little public health communication for the poor and the working class regarding the vaccines,” says Radha Khan, an independent consultant working in the field of gender, governance and social inclusion.
The government aims to use up to 500 million doses to cover 250 million “priority people” by the end of July.
Interestingly, in some states, more women than men have been vaccinated. The reasons are not clear.
Who is paying for the vaccines?
Vaccination is voluntary. State-run clinics and hospitals are offering free jabs but people can also pay 250 rupees ($3.4; £2.4) a dose at private facilities to get vaccinated.
Starting 11 April, people can get paid jabs at private and state-run workplaces.
The government is spending around $5bn for free doses at state-run clinics, public health centres and hospitals.
It has also bought millions of doses of two approved vaccines and provided funds to states for their vaccination programmes.
Have there been ‘adverse events’ after vaccination?
Vaccines come with side effects for some people.
India has a 34-year-old surveillance programme for monitoring such “adverse events” following immunisation. Experts say a failure to transparently report adverse effects could easily lead to fear-mongering around vaccines.
Until early February, India reported 8,483 “adverse events” after vaccination. Most of these events were “minor” – anxiety, vertigo, giddiness, dizziness, fever, and pain, and all patients had recovered, the government said.
It found the “deaths happened in cases where the person had underlying conditions, including heart problems, high blood pressure and diabetes”.