Analysis: India’s vaccine inequality worsens as campaign languishes

Urban Indians are receiving COVID-19 vaccines much faster than the hundreds of millions of people living in the countryside, according to government data, reflecting the growing inequality in the country’s vaccination campaign.

In 114 of India’s least developed districts – collectively home to around 176 million people – authorities have administered only 23 million doses in total.

This is the same number of doses that have been administered in nine major cities – New Delhi, Mumbai, Kolkata, Chennai, Bengaluru, Hyderabad, Pune, Thane and Nagpur – which together account for half the population.

The disparity was even greater last month, after the government allowed the private sale of vaccines for adults under 45, an offer that favored residents of cities with larger networks of private hospitals. In the first four weeks of May, those nine cities administered 16% more doses than rural districts combined, according to data from the government’s Co-WIN vaccination portal.

“My friends in town were vaccinated in private hospitals,” said Atul Pawar, a 38-year-old farmer from Satara, a rural district in western Maharashtra, India’s richest state. “I am prepared to pay, but the doses are not available and the district borders are sealed because of the lockdown.”

The Department of Health and Family Welfare did not respond to a request for comment.

India has administered more than 222 million doses since its campaign began in mid-January – only China and the United States have administered more – but it has delivered the two required doses to less than 5% of its 950 million adults.

Rural India is home to more than two-thirds of the country’s 1.35 billion people. While urban areas account for a disproportionate share of confirmed COVID-19 cases, those worried about the virus spreading in the countryside say statistics underestimate cases in villages, where testing is less comprehensive.

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Prime Minister Narendra Modi’s government provides free vaccines to vulnerable people, healthcare workers and people over 45 years old. As of last month, states are also expected to purchase vaccines for young adults or provide them commercially through the private sector.

Poorer states say this makes their residents more vulnerable. Eastern Jharkhand state, where almost all districts are classified as poor, this week urged Modi to give him free vaccines for all age groups.

In many states, doses for those under 45 are available primarily or entirely in urban areas. Some officials say it’s intentional, as the infection spreads more easily in crowded cities.

“This is because of the strong positivity” in urban areas, said Bijay Kumar Mohapatra, director of health for the eastern state of Odisha, explaining the state’s decision to prioritize cities.

Large international and national companies such as Microsoft (MSFT.O), Pepsi (PEP.O), Amazon (AMZN.O), Reliance Industries (RELI.NS), Adani Group and Tata Motors (TAMO.NS) have organized vaccinations for their employees, in many cases in partnership with private hospitals. Most of these businesses and the huge private hospitals that serve them are located in urban centers.

Vaccination rates in rural areas have also fallen due to more uneven internet access to use the complex online system to register for vaccines, and perhaps due to greater reluctance among villagers to among the townspeople.


The Indian Supreme Court criticized the government’s management of the immunization program this week and ordered it to provide a breakdown of vaccines administered in rural and urban areas.

“Private hospitals are not evenly distributed” across the country and “are often limited to large cities with large populations,” the highest court said in its order dated May 31.

“As such, more will be available in these cities, as opposed to rural areas,” he said. Private hospitals may prefer to sell doses “for lucrative transactions directly to private companies who wish to vaccinate their employees.”

Dr Rajib Dasgupta, head of the Center for Social Medicine and Community Health at Jawaharlal Nehru University in New Delhi, said the risk of unfairness was that parts of India would build up disproportionate immunity.

“This can make the rural population relatively more vulnerable.”

Our standards: Thomson Reuters Trust Principles.

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