In the first year of the covid-19 pandemic, India’s management of the spread, testing, tracing, and treatment of covid-19 was globally regarded as relatively well managed. But complacency set in and during the second phase of the pandemic, India experienced a devastating rise in the number of covid-19 cases and deaths. In 2020, India recorded 10.28 million cases and 149,018 deaths. In the first six months of 2021, India recorded another 20.26 million cases, which was more than double the cases in 2020. Deaths also increased at a much higher rate with 253,015 deaths recorded in the first six months of 2021. Just before the second wave started, India’s covid-19 vaccine rollout began. The total vaccination doses delivered as on 9 August 2021 is 508 million, with 112 million people fully vaccinated (8.27% of the population). While India has been successful in vaccinating large numbers of people, it only ranks 94th in the world based on percentage of population vaccinated.

Despite being the pharmacy of the world, India has failed to increase the pace of its vaccination coverage. As of 6 July 2021, India ranked 128 among all countries that have administered the vaccine, even for all doses as a proportion to its population, and an even lower rank of 135 for the number of fully vaccinated people. This suggests that India is not producing or receiving enough vaccines. It is not that there is dearth of vaccine manufacturing facilities, but the production is restricted to the patent holders of the two vaccine makers in India: the Serum Institute of India for the Oxford-Astra Zeneca vaccine (Covishield) and Bharat Biotech for the National Institute of Virology (ICMR) Bharat Biotech vaccine (Covaxin). About half the initial batches of these vaccines were either exported or given away as aid to a number of African, Asian, and Latin American countries. By the end of 2020, the Indian government was well aware that the vaccine rollout would happen soon, but it had failed to plan for ramping up production.

The failures of India’s vaccine policy have led to huge vaccine shortages across the country and because of this India’s vaccine policy has been wavering around who should get the vaccine or who should not. There have been shifts each month as to which age groups and/or vulnerable groups can get vaccinated. This has caused huge disruptions in the rollout across Indian states. The vaccine shortages also resulted in discriminatory supply chains wherein states that are not under BJP-NDA rule received vaccine supplies which were not commensurate to their population size or the prevalence rate in their states. Chief ministers of these states have been complaining to the Union Government about this discrimination and the disruptions it has led to in the rollout of vaccinations in their states, but to little avail. The government’s decision to open up the delivery of covid-19 vaccines to the private health sector, for paid vaccinations at a price which is higher than the original price at which the government obtained the vaccines, has caused further chaos. Given that the regulation of private healthcare in India is very poor, it has resulted in huge frauds in vaccine administration across the country.

At clinics where vaccines are administered, the erratic supply of vaccines has disrupted schedules and appointments via the digital platform. People can register on the website easily, but because of erratic vaccine supplies to districts and municipal governments, scheduling the appointments is very difficult. It is a game of the fastest first as the scheduled slots are taken within less than a minute of being uploaded. The middle classes, who have good digital access, have a clear advantage in booking appointments, but the vast majority of the population have to struggle to go to the closest health centres to try and get registered and then get an appointment. This also leads to discrimination in access. Kerala has had some success in involving ASHA (Accredited Social Health Activists) workers to assist in this process. Once you register on the vaccination website or at the health centre, a health worker in your local area calls you on phone or at your home and schedules your appointment. I don’t see why this is not the protocol in other states.

My own personal experience of getting the first jab has been difficult. I was registered in the first week of April 2021, but getting a scheduled slot took nearly three months until I finally made it on 21 June—the day India delivered its highest ever number of vaccinations in a single day with over 8 million doses administered. Having made it to the vaccine centre, which was a school and where social distancing and masking were well maintained, getting the vaccine had its hitches. The staff found it challenging to check the registration data as they were using personal mobile phones with poor connectivity instead of having dedicated computer systems to work on. Once you cleared the registration process, you got the vaccine dose, but there were clear problems with that too. The syringes were prefilled and not filled in one’s presence so how does one know if protocols have not been compromised. This was in a metropolitan city. It seems likely that the scenario in smaller towns and rural areas is even more challenging.

Ravi Duggal is a sociologist who has done wide-ranging research on public health issues in non-government health research institutions in India and globally.

Competing interests: none declared.