A doctor’s perspective: After a billion jab feat, what’s the next Covid challenge for India?

India has surpassed the one billion vaccination mark, which is a spectacular achievement for the Indian government and the people. Not so long ago this seemed a far-fetched dream, with one report in April this year saying it would take the country eight years to vaccinate 70 percent of the population and thus achieve herd immunity. And 12 years to vaccinate the entire population! Six months down the line, India has already vaccinated more than a billion people, with over 75 per cent of the country’s all eligible adult population getting at least the first Covid-19 vaccine dose, while 31 per cent receiving both the doses. India was able to achieve this feat in face of several hurdles, such as supply shortage, distribution problems, and vaccine hesitancy among the people. The vaccination programme in India was initiated on 16 January 2021. Initially, it was given to healthcare workers, corona warriors, people who were 60 years and above, and to 45 years and above people with chronic diseases like diabetes, hypertension, etc. From 1 May 2021, the vaccination was opened for everyone above 18 years of age. The actual breakthrough was made when from 21 June 2021, vaccination was made free for everyone of age 18 and above. The government targets the entire adult population in the country to be fully vaccinated by the end of this year. With the daily doses of successful vaccination, it may seem difficult but definitely not impossible. What’s next? The third phase of trials for vaccination of children below 18 years of age are set to finish and may get approval for emergency use in the country within the next two weeks. One needs to keep an eye on how effective this will be in the long run. As of now many people who were vaccinated at the beginning of the drive are about to reach the 9th or 10th month of their post-vaccination status. As per studies, in order to maintain Covid antibody levels in the body, a booster dose of vaccine is recommended. The need for a booster dose in India, however, is not immediate. We have the challenge to vaccinate a large population where almost 75% are still single vaccinated. A significant percentage of the population has been exposed to the disease which gives them some degree of naturally acquired immunity. A third dose seems unnecessary at the moment. We should be focused on how the huge vaccination gap of not vaccinated, single vaccinated and double vaccinated populations can be reduced. The same has been brought up by scientists at the Indian Council of Medical Research (ICMR) who have not yet approved a booster dose in India. “For India, a booster dose is not the central theme at the moment and getting two doses remains the major priority,” ICMR Director General Balram Bhargava said recently. First, we need to immunise everyone before starting the booster dose. Having said that, we can explore possibilities of the third dose in truly vulnerable minority groups. The World Health Organization (WHO) has already recommended a third dose for immune-compromised people like transplant patients, chemotherapy patients, HIV positive persons, etc. Many countries like the US, the UK and France have already rolled out Covid booster doses. India still needs to weigh the need for a third dose as very little data is available right now. People from the first phase of vaccination may require a booster dose, but that doesn’t mean they do not have any protection. Naturally acquired immunity may still be able to protect them from severe illness. Coronavirus vaccines “are all highly effective in reducing the risk of severe disease, hospitalisation, and death, even in the midst of the widely circulating Delta variant”, Dr Rochelle P Walensky, director of the Centers for Disease Control and Prevention, said in a statement recently. There is a further requirement of study with various population groups and work on different data to suggest the use and initiation of a booster dose in India. But that is the area the country will have to keep an eye on, besides vaccinating the rest of the population. Be that as it may, the fact is that India has already shown the world how to fight a pandemic despite such a large population and the challenges associated with it. The writer is a Delhi-based doctor. Views expressed are personal.​