Indian hesitancy sets back world’s biggest Covid vaccination drive

India’s Covid-19 vaccine drive has been hampered by turnout as low as 22% in some states, as fears over the safety of the vaccine and the spread of misinformation has fuelled widespread hesitancy.

On Saturday, India launched the world’s largest vaccination programme as it began the massive task of vaccinating its 1.3 billion citizens against coronavirus.

On the first day of India’s vaccine drive on Saturday, more than 200,000 vaccinations were given – the highest one-day total of any country – but nonetheless fell short of the nationwide government targets by over 100,000. By Tuesday evening, the government said 631,417 people had been vaccinated, far below the expected figure.

So far the overall national turnout has averaged a lacklustre 64%, while in states such as Tamil Nadu and Punjab, uptake of the vaccine was as low as 22% and 23% in the first two days of the vaccination drive.

The low turnout was attributed to a nervousness about safety among the healthcare workers who were first in line to receive the vaccine, as well as technical difficulties with the app designed to alert people to their vaccine appointments.

Two Covid-19 vaccines have been approved for emergency use in India, the Oxford/AstraZeneca vaccine – known as Covishield in India – and a domestically developed vaccine called Covaxin, produced by Indian company Bharat Biotech.

The Oxford/AstraZeneva vaccine, which has completed international trials and was found to have about 62% efficacy with two doses, has already been widely distributed in the UK. Britain’s NHS says of the vaccines in use in that country: “The coronavirus vaccine is safe and effective. It gives you the best protection against coronavirus.”

Covaxin has not completed phase 3 trials and so there is no final data on its efficacy, making India one of the few countries rolling out a vaccine still in its trial stages. However, the drugs controller of India said interim data from an ongoing trial of more than 22,000 people showed it was “100% safe” and effective.

Nonetheless, some healthcare professionals in India expressed concerns that they had not been provided with enough data on the vaccines’ safety and efficacy and were nervous at the speed the vaccines were being rolled out.

Dr Namrata Agarwal, a paediatrician in Kashipur, was among those not eager to take the vaccine. “I’m very hesitant,” she said. “All the protocols have been rushed and hurried through. I am not so concerned about the efficacy of a vaccine – that can vary – and I can handle that but what concerns me is its safety and the chance that it might cause harm.”

On Tuesday, Bharat Biotech released a fact sheet of those with underlying heath problems who should avoid the Covaxin vaccine, raising questions about why it had not been publicised before the vaccine was released.

Dr Mandeep Aulakh, a pathologist in Chandigarh, said she would wait a few weeks before getting vaccinated. “The vaccine development was rushed,” she said. “I also have a few allergies so I have not volunteered to take it.”

The Indian government had hoped to vaccinate 300 million people by August, a target that will prove challenging if uptake remains at its current rate.

In the capital, Delhi – which hopes to vaccine 100,000 people a day – only 3,598 healthcare workers received their vaccine on Monday, far below the daily target of 8,136, making uptake just 44% that day in India’s capital. In Delhi’s largest hospital, All India Institute of Medical Sciences (AIIMS), just eight healthcare workers out of an expected 100 turned up on Monday for their jab.

In Mumbai, one of the cities worst affected by Covid-19, turnout for vaccines was 48% on the first day, with 1,926 out of a target of 4,000 people turning up for their vaccine. It was far below Mumbai’s ambitious target of vaccinating 50,000 healthcare workers a day.

Dr Amit Thadhai, director of Niramaya hospital in Mumbai, said: “There have been a long series of questions which have been raised about the safety and efficacy of the vaccine. The fact that doctors have been asked to take it first has caused problems; doctors are not used to enrolling in trials which is why the uptake has been so low.”

Thadahi said there was also a decreased sense of urgency to take the vaccine because the number of Covid cases in India was in rapid decline, with new cases at their lowest level since mid-June. “The motivation to take a vaccine is not great at the moment,” he said.

On Saturday, the state of Maharashtra, which is home to Mumbai, temporarily suspended the vaccination drive after less than 2,000 people were vaccinated across the state. It was partly attributed to widespread technical glitches which meant people were not given alerts for their vaccination appointments.

Misinformation and fake news about the vaccine was also doing the rounds on WhatsApp. In one widely circulated video, Dr Johan Denis, an alleged “medical doctor and homeopath” from Belgium, made the unsubstantiated claim that “the vaccine is not proven safe or effective” and the false statements that: “It’s a fake pandemic … it’s all been orchestrated to create fear to make you take the vaccine which might cause irreversible changes to your DNA.”

Ashraf Buchson, a carpet seller from Delhi who had been forwarded the video, said the videos had given him second thoughts about the vaccine. “When I see these videos, I feel anxious. I don’t know who to believe and everyone in my family is divided,” said Buchson.

The low turnout appeared to take state governments by surprise. In Karnataka only 47% of people registered to receive a vaccine had turned up to their appointments by Monday, making the state government unlikely to hit its target of vaccinating 650,000 healthcare workers by the end of the week. “Despite the district having the highest literacy rate in the state, I am surprised at why healthcare workers are reluctant to take vaccines,” Karnataka’s health minister, K Sudhakar, told local media.

Many doctors said politicians and public figures should be publicly taking the vaccine to allay fears. “If well-known figures take it, it will help push up the numbers,” said Dr Sanjiv Zutshi, a cardiologist in Delhi who is going to get the jab in two days.

Dr Arun Shah, former head of the Indian Council for Medical Research, agreed. “The prime minister himself and the health minister should have the vaccine. That would reassure many people. And to create a sense of confidence, every vaccinated person should share photos and their experience on WhatsApp to spread reassurance,” said Shah.