India's national government has inappropriately prioritised people for covid-19 vaccination
Current approach is causing huge numbers of avertable deaths, warn experts
India's national government has inappropriately prioritised people for covid-19 vaccination, argue doctors and researchers in The BMJ today.
Peter Lloyd-Sherlock and colleagues warn that the government's current approach to vaccination - focusing on younger age groups - "is causing huge numbers of avertable deaths and is deeply inequitable."
From 3 May to 5 June 2021, more first doses were administered to people under 45 than over 60, even though at least 77 million people aged 60 remain unvaccinated, they say.
As such, they urge the government to take a more targeted approach and reallocate available doses to older people, especially in more deprived areas.
They explain that in January 2021, India's vaccination programme began with health professionals and "frontline workers." In March, it was extended to people aged 60 or over and those aged 45 or over with comorbidities, and in April to anyone aged 45 or over. From 1 May, vaccine entitlement was extended to all people aged 18 or over, although people under 45 had to pay.
Earlier this week, the government announced that vaccines would now also be free for people aged 18-45, which the authors suggest is likely to increase the focus of vaccination on people in this age group, rather than those aged 45 or over.
In practice, they say access to covid-19 vaccination is mainly determined by socioeconomic status, with very low coverage in rural areas and among disadvantaged urban populations.
As a result, Indians of all ages are increasingly resorting to private purchases, and the country's minimal pension system makes this especially unaffordable for older people.
What's more, no special provision has been made to facilitate vaccine access for adults with impaired mobility, they add, and older people tend to be less familiar with the digital technology required to make a booking.
They note that some Indian states have now reallocated available doses to older people and they urge the national government to do the same until all older people in India have received at least one dose.
"Its current approach to vaccination is causing huge numbers of avertable deaths and is deeply inequitable, both between age groups and within them," they conclude.
Externally peer reviewed? No Evidence type: Letter; Opinion Subject: Covid-19 vaccination in India