|Project Rationale and Linkage to Country/Regional Strategy
Since the first COVID-19 case was reported in India on 30 January 2020, India's cumulative confirmed cases rose to 21.5 million with 234,083 deaths, as of 7 May 2021. India is currently going through the second wave, with over 6.1 million new cases and around 53,000 deaths reported within a span of 17 days between 21 April and 7 May 2021. The pandemic and the public health measures to curb the spread of the virus including lockdowns have severely affected the population, especially the poor and vulnerable. With the severe second wave, India's health system is struggling with high demand for hospital beds, life-saving oxygen, therapeutics, and medical personnel. The government is taking steps to address these issues, but immediate support is very much needed to address the hike in demand due to the rapidly increasing caseload.
Vaccination is key to reverse the negative impacts of the pandemic by preventing infections and protecting the population from death and morbidities as well as allowing the economy and society back to the pre-COVID-19 development trajectory. Building upon the Universal Immunization Program (vaccination for children and pregnant women), India quickly enhanced the systems for the unprecedented national vaccination program. India's vaccination program started from health care workers and frontline workers since 16 January 2021. On 1 March 2021, the coverage was expanded to those above 60 years of age and those above 45 years of age with comorbidities (a list of 20 comorbidities was outlined to substantiate vaccine eligibility). Thereafter, the priority groups were expanded, first, to all persons above 45 years of age from 1 April 2021, followed by anyone above 18 years from 1 May 2021. The country has administered 164 million vaccine doses: 10.7% of the population has received at least one dose of the vaccine and 2.5% have received both doses as of 7 May 2021. Private sector providers were roped in to increase coverage since 1 March 2021, and their roles have become increasingly important as the government allows the private sector to directly procure and deliver vaccines manufactured outside of India. It is the largest mass vaccination program ever tried in human history, and this requires strong planning and monitoring capacity to respond to emerging situations while coordinating across numerous stakeholders in a complex federal governance system. Further, Indian vaccine manufacturers are expanding production capacity, which has implications for the containment of the pandemic in the region and beyond. India also donated 7.35 million doses of vaccines to its neighboring countries.
While the vaccination is open to everyone in the priority groups (now by age cohort), there are several demand side constraints, especially for excluded or vulnerable populations such as women, older persons, people with disabilities, residents in rural and remote areas, and ethnic or religious minorities who may not have adequate information and awareness of benefits and risks of vaccines, may face physical distance, or lack mobility, and other socioeconomic barriers to vaccination. Women are often less prioritized for vaccination as their role for family care requires less activities outside of their residence, but they are still exposed to the virus through other family members. Women's role in family care makes it even more important that women are vaccinated. For herd immunity, vulnerable and excluded groups should be prioritized as they can be source of further outbreak unless they develop immunity and break the chain of infection. With the current surge, lots of volunteers, community groups, and the private sector are providing support to communities, but with little guidance and resources. Helping them to effectively and safely helping others is important to contain infection as well as facilitate vaccination access.