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India opens up COVID-19 vaccinations for all adults, despite supply issues

India opened COVID-19 vaccinations to all adults on Saturday, launching a huge inoculation effort that is sure to tax the limits of the federal government and the country's vaccine factories, as well as the patience of its 1.4 billion people.

Vaccines aren't so easy to access for all people, in all parts of the country

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In hopes of taming a monstrous spike in COVID-19 infections, India opened vaccinations to all adults on Saturday, launching a huge inoculation effort that is sure to tax the limits of the federal government and the country's vaccine factories, as well as the patience of its 1.4 billion people.

The world's largest maker of vaccines was still short of critical supplies — a result of lagging manufacturing and raw material shortages that delayed the rollout in several states.

Even in places where the shots were in stock, India's wide economic disparities made access to the vaccine inconsistent.

The country's ambitious effort was also partly overshadowed on Saturday by a fire in a COVID-19 ward in western India that killed 18 patients and the death of 12 COVID-19 patients at a hospital in New Delhi after the facility ran out of oxygen for 80 minutes.

A health-care worker gives a dose of the COVID-19 vaccine to a man at a hospital in New Delhi on Saturday. Just two per cent of India's population has been fully vaccinated so far against COVID-19 — and about 10 per cent has received a single dose of the vaccine. (Adnan Abidi/Reuters)

Private vaccines pricey for many

Only a fraction of India's population will be able to afford the prices charged by private hospitals for the shot, experts said, meaning states will be saddled with immunizing the 600 million Indian adults younger than 45, while the federal government gives shots to 300 million health-care and front-line workers and people older than 45.

So far, government vaccines have been free, and private hospitals have been permitted to sell shots at a price capped at 250 rupees, or just over $4 Cdn.

A mask-wearing woman holds her child as she sits along a street in New Delhi on Saturday, as the Indian capital continues a lockdown amid the COVID-19 pandemic. (Tauseef Mustafa/AFP/Getty Images)

That practice will now change: Prices for state governments and private hospitals will be determined by vaccine companies.

Some states might not be able to provide vaccines for free since they are paying twice as much as the federal government for the same shot, and prices at private hospitals could rise.

Since state governments and private players compete for shots in the same marketplace, and states pay less for the doses, vaccine makers can reap more profit by selling to the private sector, said Dr. Chandrakant Lahariya, an epidemiologist and health policy expert.

That cost can then be passed on to people receiving the shots, increasing inequity.

"There is no logic that two different governments should be paying two prices," he said.

Just 2 per cent fully vaccinated

Concerns that pricing issues could deepen inequities are only the most recent hitch in India's sluggish immunization efforts.

Less than two per cent of the population has been fully immunized against COVID-19, and about 10 per cent has received a single dose. Immunization rates have also fallen.

People line up in Prayagraj, India, on Saturday, awaiting their chance to be vaccinated at a local medical facility. (Rajesh Kumar Singh/The Associated Press)

The average number of shots per day dipped from more than 3.6 million in early April to less than 2.5 million currently.

In the worst-hit state of Maharashtra, the health minister promised free vaccines for those aged 18 to 44, but he also acknowledged that the shortage of doses meant immunization would not start as planned on Saturday.

States say the paucity of shots is one reason why immunizations have declined.

In a positive development, the country on Saturday received its first batch of Sputnik V vaccines, which it is importing from Russia. Moscow has signed a deal with an Indian pharmaceutical company to distribute 125 million doses.

WATCH | Hospitals grapple with oxygen shortages:

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Mounting challenges

India thought the worst was over when cases ebbed in September. But mass gatherings such as political rallies and religious events were allowed to continue, and relaxed attitudes on the risks fuelled a major humanitarian crisis, according to health experts. New variants of COVID-19 have partly led the surge.

The country's shortage of shots has global implications because, in addition to its own inoculation efforts, India has promised to ship vaccines abroad as part of a United Nations vaccine-sharing program that is dependent on its supply.

A man wearing a face shield and mask receives a dose of a COVID-19 vaccine at a vaccination centre in Mumbai on Saturday. (Francis Mascarenhas/Reuters)

Some experts warned that conducting a massive inoculation effort now could worsen the surge in a country that is second only to the United States in its number of infections.

"There's ample evidence that having people wait in a long, crowded, disorderly queue could itself be a source of infection," said Dr. Bharat Pankhania, a senior clinical lecturer specializing in infectious diseases at the University of Exeter Medical School in England.

He urged India to first stop the circulation of the virus by imposing "a long, sustained, strictly enforced lockdown."

Pankhania cautioned that immunization efforts alone would not help immediately stem the current spike of COVID-19, since shots "only start to bear fruit in about three months' time."

Vaccination would help prevent future waves of infection, he said.

A health worker posts a notice in Srinagar, India, on Friday, about a lack of availability of vaccines at a health centre. (Mukhtar Khan/The Associated Press)

Given the urgent need for vaccines, some experts said rationing available doses is critical.

"Vaccines need to be delivered to the areas with the most intense transmission," said Ravi Gupta, a professor of clinical microbiology at Cambridge University, explaining that vaccines should be used as "emergency control measures" in specific regions of India.

Pankhania said the widely seen images of Indian virus patients gasping for air and smoke billowing from makeshift funeral pyres should spur rich countries to share their vaccines more freely.

He criticized the approach taken by many Western countries that are attempting to vaccinate all citizens, including younger people at low risk, before sharing any doses.

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