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Recommend Vaccination for all People 18 years of Age and Above and Reside in the 130 Red Districts from April 15th Onwards

Broad overview:

Purpose of the paper: India is currently in the middle of a race with the covid-19 pandemic second wave growing rapidly on one hand and a rapid effort to vaccinate people to contain the impact of the second wave on the other. In this paper, data has been analyzed using advanced epidemiological and supply chain models to provide TCS-NITIE point of view to achieve the best outcomes given the conflicting dilemmas the Nation is facing.

Pandemic Characteristics: The current increase in coronavirus cases noticed in mid-Feb’21 continues unabated. Now, there are roughly 60,000+ new cases every day and the second wave is expected to have its own distinct characteristics with respect to transmission, demographic impact, and intensity of infection. Below we have compared the unfolding of the pandemic in India across the two waves.

Characteristics of the first wave of pandemic:

Pandemic wave 1 started in Mar’20 and went on till Oct’20, 130 districts were identified as red zone by the government due to higher number of covid-19 cases, and this wave had the following characteristics:

  • The wave started in India predominantly due to international travelers from China, Europe, Arabic states, and the US traveling to India for personal and professional reasons
  • The virus spread quickly in densely populated geographic areas
    A higher proportion of deaths recorded amongst older people having comorbidities
  • States better at enforcing lockdown and efficient at contact tracing were able to reign in the rate of spread.
  • Behavior of the virus and treatment protocols were not well understood

Likely Characteristics of the second wave:

The second wave, is expected to have distinctly different characteristics than the first:

  • The emergence of mutations of the virus and their transmission in the population

  • Increase in positivity rate due to gradual easing of restrictions and poor adherence to preventive measures.

  • New clusters of cases can emerge in known and hitherto unknown locations

  • New restrictions on travel and increased emphasis on tracking and tracing of people’s movements

  • Partial reinforcement of lockdown in areas with higher cases causing disruption in business activities and loss of economic output.

But fortunately, there are several positives compared to the first wave:

  • Two vaccines are available in India and approved for emergency use authorization.

  • There is no longer any stigma attached to covid-19 infection making it easier to identify, trace and contain.

  • Treatment protocols are better understood, and hospitals are better prepared

  • Increased testing in states with higher positivity rates.

The second wave has brought new tools at disposal to the government to implement its policies specially vaccination, and treatment protocols.

COVID 19 vaccination drive:

The government has done a commendable job in rolling out the covid-19 vaccination program in India. The government targeted frontline healthcare workers in phase 1 of the ongoing vaccination drive, which was expanded, to include people above 60 years and people with comorbid conditions in the age-group of 45 to 60 years, in phase 2.

So far, India has vaccinated around 9 million people with 2 required doses per person, and around 65 million people have received at least one dose of the vaccine, since the national vaccination program started on 16th Jan’21.

Covid-19 vaccines are produced by two manufacturers in India viz, Serum Institute of India and Bharat Biotech with capacity of ~100 million and ~10 million doses per month respectively and both the companies are making significant investments to ramp up the production. The government has allowed private participation for administering the vaccines and as a result India’s covid-19 vaccination rate has approached nearly 2.5 million vaccinations per day.

Impact of vaccine on pandemic progression:

Following approach is used to understand the impact of vaccination in arresting the growth of wave 2:

  • Standard SEIR epidemiological model [8] is considered for wave 2 forecast.

  • Additional parameters are added in the model to analyze the impact of vaccination on epidemiological wave 2 forecast

The epidemiological model and impact of vaccination is illustrated below with an example of Mumbai Suburban district with a population of 10 million and an infected population of 20,000, four different vaccination rates varying from no vaccination to 80,000 per day vaccination are considered for the analysis.

Authors

TCS

Dr. Syama Sunkara, Vinay Sharma, Pawan Singh, Ahish Bindumadhavan, & Ashutosh Sinha

NITIE

Dr. Manoj Tiwari & Dr. Hema Date  

Picture

Figure 4: Impact of varying vaccination rates [Ref: TCS insights]

It is observed that when there is no vaccination then wave two will likely follow the red curve with peak cases of 70,000 and the tail end would likely start in 140 days. On the other extreme with vaccination rate of 80,000 vaccinations per day, peak will be shifted to 20,000 cases and tail would likely start after 60 days.

Clearly, rapid vaccination will not only reduce the peak cases but will significantly arrest the growth of disease. Taking the simulated results into account we believe that increase in the vaccination rate will help in arresting the second wave of covid-19 in India as well as to reduce the impact of the third wave.

Key observations:

  • India should prioritize and accelerate the vaccination for 130 districts, which were identified as red zones in wave 1.

  • Once the vaccination is opened for everyone above 18 years around 230 million people (assuming 80% coverage) need to be vaccinated at the rate of 2.5 million per day across these 130 districts.

  • Beyond these 130 districts, to cover remaining population of around 490 million people above 18 years (assuming 80% coverage), it will take 6 to 7 months to vaccinate the people at the rate of 2.5 million per day.

  • India needs to open all delivery channels e.g. 24/7 vaccination centres, vaccinating through non-Ayushman Bharat hospitals and clinics, pharmacies which have reliable capacity and capability.

Key recommendations:

  • Focus vaccination efforts immediately (15th April’21 onwards) to cover 80% of the people aged 18 and above in next three months in the 130 districts identified as red zone in wave 1.

  • Focus vaccination efforts immediately (1st Apri’21 onwards) to cover 80% of people aged 45 & above across the country, beyond the 130 districts, over the next 6 months.

  • Provide separate queuing to prioritize senior citizens, and people above 45 years of age at the vaccination centers.

  • Target cohorts of people based on area, work locations, type of jobs etc to achieve rapid vaccination.

  • Encourage walk-ins with appropriate arrangements for capturing required data at the vaccination centers.

  • Vaccination centers to be expanded beyond government and Ayushman Bharat hospitals to include smaller hospitals, clinics, and pharmacies.

  • Co-WIN platform to be strengthened to provide availability, scalability, and real-time information including vaccination time.

  • Overcome logistics and Supply cold chain constraints by collaborating with private sector

Authors

TCS

Dr. Syama Sunkara, Vinay Sharma, Pawan Singh, Ahish Bindumadhavan, & Ashutosh Sinha

NITIE

Dr. Manoj Tiwari & Dr. Hema Date