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 Table of Contents  
Year : 2021  |  Volume : 6  |  Issue : 5  |  Page : 98-101

Vaccine distribution for COVID-19 and equity issues in India

Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission07-Aug-2021
Date of Decision15-Sep-2021
Date of Acceptance22-Sep-2021
Date of Web Publication19-Nov-2021

Correspondence Address:
Dr. J S Thakur
Department of Community Medicine, School of Public Health, PGIMER; President, World Noncommunicable Disease (NCD) Federation, Chandigarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2468-8827.330658

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India, being the biggest producer of drugs including vaccines, emerged as a major supplier of the coronavirus vaccines for most of the countries across the world during the COVID-19 pandemic. Two vaccines, Covishield and Covaxin, were given emergency use authorization by India's drugs regulator during initial phases. Under the guidance of the National Expert Group on Vaccine Administration for COVID-19, India started its national vaccination program against SARS-CoV-2 on January 16, 2021. CoWIN (COVID-19 Vaccine Intelligence Network) is playing a vital role in real-time monitoring of COVID-19 vaccination. Having a robust Universal Immunization Program and experience of the previous immunization campaigns are advantages for India's COVID-19 vaccination program. Under Vaccine Maitri initiative, India is providing vaccines to nations across the world to ensure vaccine equity. In India, vaccination is being done in a phased manner where priority is given to the health and other frontline workers, people with age >50 years and people with comorbidities and above 18 years. As per the current policy, center government is responsible for buying 75% of all vaccines made for use in India and will distribute it to states based on their populations, disease burdens, and number of people to be vaccinated. Remaining 25% vaccines are available to be procured by private hospitals. However, existing facilities seem to be unable to meet the increased demand, and the government is considering approval for other vaccines to be imported. The world, including India, is still fighting against COVID-19 and vaccine equity is very important to win against this pandemic.

Keywords: Advocacy, capacity building, Covaxin, Covishield, vaccination, vaccine demand, vaccine equity

How to cite this article:
Thakur J S, Kaur H. Vaccine distribution for COVID-19 and equity issues in India. Int J Non-Commun Dis 2021;6, Suppl S1:98-101

How to cite this URL:
Thakur J S, Kaur H. Vaccine distribution for COVID-19 and equity issues in India. Int J Non-Commun Dis [serial online] 2021 [cited 2023 Mar 26];6, Suppl S1:98-101. Available from: https://www.ijncd.org/text.asp?2021/6/5/98/330658

Having vast experience and strong knowledge in pharmaceuticals, India is being called as the pharmacy of the world during the COVID-19 pandemic. India is one of the world's biggest drug producers including vaccines, so during this pandemic, an increasing number of countries are approaching it for procuring coronavirus vaccines.[1]

During the initial phases, India's drugs regulator gave emergency use authorization to Covishield, being produced by Pune-based Serum Institute of India after securing license from British pharma company AstraZeneca, and Covaxin indigenously developed jointly by Hyderabad-based Bharat Biotech and Indian Council of Medical Research.[2]

India started its national vaccination program against SARS-CoV-2 on January 16, 2021. National Expert Group on Vaccine Administration for COVID-19 guides all aspects of the COVID-19 vaccine introduction in India by coordinating with various ministries and departments at state, district, and block levels. This think tank is involved in the selection of suitable vaccines, their procurement, roll out plan of vaccine delivery, phase-wise delivery of vaccine, prioritization of groups, cold chain requirement, etc.[3]

Under intersectoral convergence, medical college representatives, professional bodies, developmental partners including WHO, UNICEF, UNDP, BMGF, voluntary organizations, nongovernment organizations, and Information and Broadcasting (I and B) department are given various roles to play to speed up the process of vaccination and awareness generation among public for vaccination.[2]

Investment of India in digital infrastructure has proven invaluable particularly in the current challenging times of pandemic. Digital technology has played a great role whether it was for human resource training through virtual mode or use of CoWin for vaccination. India already had an existing electronic Vaccine Intelligence Network (eVIN) module, a comprehensive cloud-based IT solution for planning, implementation, monitoring, and evaluation of vaccination in India. CoWIN has been developed as an extension of eVIN for COVID-19 vaccination. This is an online portal for preregistration, appointment confirmation, record maintenance, generation of certificate following vaccination, and reporting of adverse events following vaccination. It keeps track vials in cold storage real-time monitoring.[2]

Already having structure in place, with cold chains and deliveries, vaccination centers and trained staff of robust Universal Immunization Program is an advantage for the country. Further, countries can also rely on a built-in network of hospitals and clinics as hubs for vaccine delivery. Before rolling out the vaccination drive, India performed dry runs to test the logistics of delivering doses and the technology used to track and monitor vaccine appointments – the exercise covered seven districts in four states and exposed crucial areas that need improvement well in time. Having experience of the previous immunization campaigns (MI/IMI/MR) at large scale is another advantage, based on which five strategies are guiding the introduction of COVID-19 vaccine at the National and State level. These are Advocacy and Capacity Building, Media Engagement and social media, Social Mobilization and Community Engagement, Crisis Communication including AEFI and Robust AEFI surveillance system.[2]

India is directly helping to address the issue of vaccine equity at a time when the entire world is dealing with the crippling coronavirus pandemic. This is because the country recognizes that this health crisis can be solved only if everybody is vaccinated. Under India's Vaccine Maitri' initiative, which translates into Vaccine Friendship, the country is providing vaccines to nations across the world and is a significant source of supply to the COVAX facility. From its immediate neighbors to countries in Latin America and Africa, India has shipped about 66 million vaccine doses to over 90 countries.[4]

Within the country, the Government of India prioritized health and other frontline workers for vaccination in the first phase. As the risk of COVID-19 infection and deaths were reported to be higher in patients with comorbidities such as hypertension, diabetes, lung diseases, coronary artery disease, and chronic kidney disease, priority was given to the people with comorbidities and of age >50 years in the next phase of the vaccination.[5],[6],[7],[8] In the third phase, which in operation included the people >18 years of age. Lactating and pregnant mothers are also being covered, but children and adolescents <18 years of age were not included in the priority list due to unavailability of vaccine efficacy data in these groups. The health ministry's vaccine campaign is aiming for 300 million people to be vaccinated in its initial phase.[9]

In the initial phases, the central government procured the entire quantity of vaccines from the manufacturers, Serum Institute of India (Covishield) and Bharat Biotech (Covaxin) and distributed it to states. The states distributed the stock to government vaccination centers, which administered the vaccine free of cost, and to private hospitals that charged recipients Rs. 250 ($4.2 CAD) per dose. However, from May 1, 2021, it was decided to divide the supply into two baskets: 50% for the center and 50% for the open market which includes nongovernment channels, state governments, private hospitals, and industries that have facilities to administer the vaccine. These all were supposed to be able to procure doses directly from manufacturers which would be used to vaccinate those above the age of 18 years. Vaccines procured by the Government of India were to be available at all vaccination centers and to be provided free of cost vaccination to health-care workers, frontline workers, and those above 45 years. The center had to allocate its 50% share to states based on the extent of infection (active cases) and performance (speed of administration). The states were receiving vaccine doses according to demand (number of registrations and walk-in vaccinations).[10]

However, in the month of June, India changed its vaccination policy as the decided plan did not work because the states had never bought vaccines before, and a limited supply meant that they were competing with one another as well as with private hospitals. They were forced to pay higher prices than the federal government could have negotiated, that essentially made it inefficient. Furthermore, the private hospitals passed that cost on to people, and amid shortages at government centers, people had to either pay for a vaccine or not get a shot.[11]

Both Covishield and Covaxin are being given for free at government vaccination centers, while at private hospitals, the charges have been capped at Rs. 780 ($13.24 CAD) for Covishield and Rs. 1410 ($23.91 CAD) for Covaxin. The price announced for Dr. Reddy's, the distributor of Russian Sputnik V is Rs. 1145 ($ 19.43 CAD).[12]

Till July 21, 2021, 415 million doses (either first or both doses of the vaccination) have been administered.[13] As India was facing a second wave of COVID-19 and the daily cases were increasing, vaccination of its population at a faster pace seemed to be the only solution and main priority for the country. Existing facilities, Serum Institute of India, and Bharat Biotech seem to be unable to meet the increased demand, and the government is considering other options as well. Now, the central government has decided to buy a larger portion of vaccines. Furthermore, on April 12, 2021, Russia's Sputnik V vaccine was approved by the Government of India.

According to the current policy, it is decided that the center will buy 75% of all vaccines made for use in India and these shots will be given to states and will continue to be distributed for free. Private hospitals can buy the remaining 25% at prices that have been capped and can charge a maximum of Rs. 150 ($ 2.55 CAD) per dose as service charges. The states will receive vaccines based on their populations, disease burdens and how many people have been vaccinated. But still, the supply remains a challenge. India has placed orders for vaccines still in development, but for the moment, it will continue to rely on existing, overstretched suppliers such as the Serum Institute of India. Hyderabad-based Dr. Reddy's Laboratories will become a manufacturing hub for Sputnik, producing 1 billion doses, with 250 million marked for local use. The Russian Direct Investment Fund is also in talks with other Indian manufacturers.[14] On April 13, 2021, the government also allowed the use of all vaccines certified by the U.S., the EU, and Japanese regulators.[15],[16] Furthermore, another vaccine from Zydus Cadila, an Ahmedabad-based firm, may be next to get an approval.

There is much to admire about India's efforts. The country's microplanning, intersectoral coordination, infrastructure, training and preparedness, advocacy, communication, social mobilization, and parallel initiatives to support in vaccine development activities through DBT are some of the lessons that other countries can learn for rolling out vaccination programs. India has managed to scale its medical manufacturing efforts to global proportions and earn the title of pharmacy of the world. Postpandemic, India's pharmaceutical industry will be further strengthened due to the efforts being taken now. However, right now, India is nowhere near declaring victory. Even if India fully vaccinates 300 million citizens by July, that's just about one third of the total adult population. There is a long way to go. Meanwhile, the pandemic is raging unabated, sparing not even younger people. For now, India is still fighting against COVID-19 and so is the world. During these times, an important thing we should be aware is that “vaccine nationalism” is not only detrimental for global public health but also for the global economy. If countries with large numbers of cases lag in their access to vaccines, the threat of transmission remains strong. Hence, vaccine equity is very crucial if we want to win against this evil.

Ethical approval statement

As this is a perspective paper and not an original study, it is not necessary to seek ethical approval.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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Ministry of External Affairs. COVID-19 Updates-Vaccine Supply. Available from: https://www.mea.gov.in/vaccine-supply.htm. [Last updated on 2020 Dec 28; Last accessed on 2021 Jul 10].  Back to cited text no. 4
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Kumar VM, Pandi-Perumal SR, Trakht I, Thyagarajan SP. Strategy for COVID-19 vaccination in India: The country with the second highest population and number of cases. NPJ Vaccines 2021;6:1-7.  Back to cited text no. 9
Ministry of Health and Family Welfare. PIB'S Bulletin on COVID-19. Available from:https://pib.gov.in/PressReleasePage.aspx?PRID=1712710. [Last updated on 2021 Apr 21; Last accessed on 2021 Jul 10].  Back to cited text no. 10
Ghosal A. How India, a Key Supplier of Vaccines, is Changing Its Plan Amid the Country's Shortages. Los Angles Times. Available from: https://www.latimes.com/world-nation/story/2021-06-18/how-india-a-key-supplier-of-vaccines-is-changing-its-plan-amid-the-countrys-shortages. [Last updated on 2021 Jun 18; Last accessed on 2021 Jul 10].  Back to cited text no. 11
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Ministry of Health and Family Welfare. Centre Fast Tracks Emergency Approvals for Foreign Produced COVID-19 Vaccines that have been Granted EUA in Other Countries to Expand the Basket of Vaccines for Domestic Use and Hasten the Pace and Coverage of Vaccination. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1711381. [Last updated on 2021 Apr 13; Last accessed on 2021 Jul 10].  Back to cited text no. 15
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