COVID-19 vaccination in India

On 1 January 2021, the Drug Controller General of India, approved the emergency or conditional use of AstraZeneca’s COVID-19 vaccine AZD1222 (marketed as Covishield).[21] Covishield is developed by the University of Oxford and its spin-out company, Vaccitech.[22] It’s a viral vector vaccine based on replication-deficient Adenovirus that causes cold in Chimpanzees. It can be stored, transported and handled at normal refrigerated conditions (2°C-8°C/ 36°F-46°F). It has a shelf-life of at least six months.

Oxford AstraZeneca vaccine (Indian version) 2021

Covaxin developed by Bharat Biotech

On 2 January 2021, BBV152 (marketed as Covaxin), first indigenous vaccine, developed by Bharat Biotech in association with the Indian Council of Medical Research and National Institute of Virology received approval from the Drug Controller General of India for its emergency or conditional usage.[23] However, this approval was met with some concern as the vaccine had not then completed phase-3 trials.[24] On 3 March 2021, Bharat Biotech announced that interim results of Covaxin showed the 81% efficacy. Trial was conducted on the 25,800 people in India.[25]

All Healthline worker and frontline worker including police, paramilitary forces, sanitation workers & disaster management volunteers.[26]

This phase of vaccination is for citizens above 60 years of age and those aged from 45 years to 60 years and have the following comorbidities. However, any healthcare or front-line worker left out in phase one is also eligible. To augment and simplify the process of registration and vaccination, the Ministry of Health and Family Welfare introduced COWIN 2.0.[38][39][2]

Guidance note for COWIN 2.0

• Heart Failure with hospital admission in past one year
• Post Cardiac Transplant/Left Ventricular Assist Device (LVAD)
• Significant Left ventricular systolic dysfunction (LVEF <40%)
• Moderate or Severe Valvular Heart Disease
• Congenital heart disease with severe PAH or Idiopathic PAH
• Coronary Artery Disease with past CABG/PTCA/MI AND Hypertension/ Diabetes on treatment
• Angina AND Hypertension/ Diabetes on treatment
• CT/MRI documented stroke AND Hypertension/ Diabetes on treatment
• Pulmonary artery hypertension AND Hypertension/ Diabetes on treatment
• Diabetes (> 10 years OR with complications) AND Hypertension on treatment
• Kidney/ Liver/ Haematopoietic stem cell transplant: Recipient/On wait-list
• End Stage Kidney Disease on Haemodialysis/ CAPD
• Current prolonged use of oral corticosteroids/ immunosuppressant medications
• Decompensated cirrhosis
• Severe respiratory disease with hospitalizations in last two years/FEV1 <50%
• Lymphoma/ Leukaemia/ Myeloma
• Diagnosis of any solid cancer on or after 1 July 2020 OR currently on any cancer therapy
• Sickle Cell Disease/ Bone marrow failure/ Aplastic Anaemia/ Thalassemia Major
• Primary Immunodeficiency Diseases/ HIV infection
• Persons with disabilities due to Intellectual disabilities/ Muscular Dystrophy/ Acid attack with involvement of respiratory system/ Persons with disabilities having high support needs/ Multiple disabilities including deaf-blindness

According to the Ministry of Health and Family Welfare, Phase-III of the vaccination program has begun from the 1st of April 2021. All persons above the age of 45 are eligible for the jab.[40]

Andhra Pradesh had received 370,000 doses of Covishield and 20,000 of Covaxin. It was decided that only Covishield would be administered. The state aims to vaccinate 32,000 people a day. However, on the first two days, only 61 and 47.8 per cent of those days' targets could be vaccinated. There were two cases of adverse events, but neither required hospitalization.[42]

Bihar received 569,000 doses of the vaccine. 4,64,160 health workers had registered for the vaccine, and the state expects to vaccinate 30,000 people a day across 300 sites. Some doctors had doubts about the efficacy of Covaxin and refused to take it.[43]

One person was admitted to hospital following complications, but was later discharged.[29]

4,319 health workers were administered the vaccine on the first day, and there were 51 minor and one major cases of adverse effects.[44] By day three, four people had been admitted to hospitals following complications, of which three had been later discharged.[29]

Karnataka Health Minister K. Sudhakar announced on 9 January that the state would be given 13.9 lakh (1.39 million) doses of Covishield in two batches. 6.3 lakh (630,000) health workers had registered for the vaccine.[45] Two people were admitted to hospital following complications; one person was later discharged.[29] A 43-year old vaccine recipient in Ballari died of a heart stroke two days after the jab.[46]

Kerala initially received 433,500 doses of Covishield, and an additional batch of 360,500 Covishield doses were announced three days later. In total, 459,853 people from the state registered for the vaccine, including 1,75,673 healthcare workers from state-run hospitals, 199,937 from private hospitals, 2,932 from federal hospitals, 74,711 police staff and 6,600 municipal workers. A total of 24,558 healthcare workers were vaccinated on the first three days. No adverse reactions were reported.[47] After vaccinating 3.75 lakh health workers by 11 February, the focus of the campaign shifted to other front-line staff such as police and municipal workers. The second dose was provided from 15 February onwards.[48]

In order to create public confidence in the vaccine, several prominent officials and politicians took the vaccine. This includes Health Minister KK Shailaja,[49] Chief Minister Pinarayi Vijayan,[50] state police chief Lokanath Behera,[51] former Chief Minister VS Achuthanandan[52] and Thiruvananthapuram District Collector Navajoth Khosa.[51] By 21 February, 3,36,327 health workers and 57,658 other frontline staff had been vaccinated, and Kerala requested more vaccines from the national pool.[53]

Vaccination of senior citizens and people over 45 with pre-existing conditions began in March. In addition, vaccines ere also provided to government employees involved in running the upcoming state elections. Since the online registration system was not accessible to everyone, and particularly to senior citizens, vaccination was also provided without prior registration. Asha workers would help senior citizens in finding and booking slots at the nearest vaccination centre. District and Taluk hospitals and Primary Health Centres would provide vaccinations, in addition to selected private hospitals and special vaccination camps.[54]

Maharashtra received 963,000 doses of Covishield and 20,000 doses of Covaxin. 785,000 health workers had registered to get the vaccination. 14,883 health workers in Maharashtra given COVID-19 vaccine on Tuesday[55] In Mumbai, only 1,926 people could be vaccinated on the first day, due to a combination of low turnout and technical problems with the software. The vaccination drive was temporarily suspended due to the technical glitches in the software alerting people to their vaccination appointments.[31]

Odisha had received doses of both Covishield and Covaxin. The first vaccine dose was given to a sanitation worker on 16 January.[56] Covishield is the predominant vaccine used in Odisha. All the districts use Covishield to vaccinate their people. The only exception being Khurda where both covaxin and covishield are used to vaccinate people.[57]

On 3 January 2021, the state conducted its first round of dry run for COVID vaccination in 7 districts.[68] On 13 January, Rajasthan received the first consignment of COVID-19 vaccines at Jaipur and Udaipur, which included Bharat Biotech's Covaxin and Serum Institute of India's Covishield.[69] The vaccines were then transported to state and district level storage centres.

On 16 January, as a part of nationwide vaccination programme, the first dose of the vaccines were given to selected frontline health workers at 167 sites across the state.[70] In a review meeting held in January 2021 by the state government, the state head of World Health Organization said that Rajasthan is the best state in terms of preparation for COVID vaccination.[71] The second dose of the vaccine started from 15 February.[72]

One person was admitted to Bangar District Hospital following suspected anaphylaxis.[29]

Tamil Nadu received 536,000 doses of Covishield and 20,000 doses of Covaxin.[73]

One person was admitted to hospital following complications, but was later discharged.[29]