The TLDR: The government’s ambitious first phase plan to vaccinate 30 million Indians has got off to an unsteady start. The reasons include: low turnout, malfunctioning vaccine app and, in some cases, open rebellion. Here’s a quick overview of where we are at the end of Day 3.

First, some numbers

The government plans to inoculate around 300 million Indians over the coming months. The first in line: healthcare and frontline workers. The campaign kicked off on Saturday, and here’s how it went: 

• On Day 1, of the targeted 300,000, only 207,000 received the first dose of the vaccine.
• The next day, i.e. Sunday, the number dropped to 17,072.
• On Monday, it spiked back up to roughly 148,000. 
• The overall total so far: 381,305—which is less than 100K above the first day target.

Point to note: Other countries like the US, UK and Russia—which had a head start—have vaccinated 14.3 million, 3.8 million and 1.5 million respectively. The US rollout—which kicked off mid-December—has been mired with delays and glitches as well.

The no-show problem

A lot of people who were registered to receive the vaccine simply didn’t show up. 

• In New Delhi, only 53% of them came forward for jabs. 
• In Tamil Nadu, the turnout was even lower: 16%.
• At one community centre in Rohtak, only 29 out of the expected 100 turned up.
• And the no-shows are creating a far more serious problem: In Nagpur, 51 vaccine doses went waste on Day 1. In Chennai at least 192 doses were wasted.
• At a Kolkata centre—where only 19 out of 100 came to get their shot—authorities gave six staff members the Covaxin vaccination instead.

A possible reason: A recent survey found that 69% of the respondents are not in a hurry to get a shot—up from 59% in November when no vaccine had been approved. More notably for this first stage, a December survey of healthcare professionals found that a whopping 55% are hesitant either because they’re worried about side-effects, or not sure about its efficacy. Also this: Only 26% of parents will allow their children to be inoculated.  

Not helping matters: The controversy over the efficacy of Covaxin—whose trial data is still incomplete (explained at length here). At this stage, healthcare workers do not have a choice as to which vaccine they receive. This has led to open rebellion in some places like RML Hospital in New Delhi. When the resident doctors association realised that the hospital had only received Covaxin doses, they simply refused to take the shot. In a letter to authorities:

"We would like to bring to your notice that the residents are a bit apprehensive about the lack of complete trial in case of Covaxin vaccine and might not participate in huge numbers thus defeating the purpose of vaccination. We request you to vaccinate us with Covishield which has completed all stages of the trial before its rollout."

Adding to the resentment: A double standard about who receives which vaccine. In Delhi, state and private hospitals administered Covishield, while the Union government-run hospitals received Covaxin. As one doctor in AIIMS said: “We are being told that if we don’t volunteer in the drive, we won’t get the shots later on. This is nothing but a pressure-building tactic.”

A glitch-ridden app

The Co-Win app: Given the government’s obsession with going digital, it unsurprisingly decided that the entire vaccination process is managed via an app called Co-Win—for Covid Vaccine Intelligence Network (yup, the W for the ‘Win’ is entirely arbitrary). To get the vaccine, recipients must register on the app—which sends them a message telling them when to show up at the centre. After the person receives the jab, the app is supposed to automatically update their information—and send a confirmation message. 

Glitches galore: But the app performed very poorly starting Day 1:

• Across the country, healthcare workers did not receive the alert telling them to show up. On Friday night—when 4000 registrants didn’t get the alert—Mumbai authorities had to make frantic calls instead.
• In many cases, workers received the alert the day after their assigned date.
• At other centres, staff was not able to record who had received the first jab due to data lags and system failures.
• As a result, a number of states like Punjab and Haryana cobbled together their own process—using individual phone calls and manual data entry to sidestep the app.
• Maharashtra delayed the vaccination rollout to today until the tech issues were resolved.

The safety record

For all the fears about the vaccines, the number of adverse reactions—580 in total—have not been alarming. There were only seven cases of hospitalisations—of which only one is still in hospital under observation.

Number of deaths: There have only been two so far. Authorities have ruled out the vaccine as a cause of death in one case in Uttar Pradesh—citing cardiopulmonary disease (pockets of pus in lungs, enlarged heart). The post-mortem is still awaited on the other but Karnataka authorities say it was likely a heart attack.

Important point to note: Last week, the health ministry’s guidance offered this advice:

“A set of instructions circulated by the health ministry to all states last week had said a history of chronic diseases or underlying disorders such as cardiac, neurological, pulmonary, renal or malignancies are ‘not contraindications’ for Covid-19 vaccines—in other words, people with such health disorders can receive the vaccines.”

OTOH, Bharat Biotech has now released a detailed factsheet strongly advising people with a variety of underlying conditions to avoid taking Covaxin. These include those who are acutely ill, with autoimmune disorders, cancer patients, or have bleeding disorders or are on blood thinners.

The bottomline: All big initiatives tend to stumble at the outset. The big question is whether the government will help fix these bottlenecks—or leave the states to sort it out by themselves. Also: in hindsight, waiting to rollout Covaxin would have been a far wiser choice.

Reading List

Times of India has the most on the Co-Win app issues. The Telegraph has the most details on the deaths. South China Morning Post and Times Top10 have details of the glitches. Read: our explainers on the Covaxin trial data and the great challenges of distributing the vaccines in India. A related good read: The Atlantic offers a balanced and knowledgeable take on the rising panic over mutations.