As Small States Lead Covid Booster Dose Coverage, A Look at Why the Drive Failed to Take Off in India

Small states and Union Territories, including Ladakh, Sikkim, Delhi and Lakshadweep, are leading in the coverage of booster doses in India, data shows.

According to data collated by ORF, a Delhi-based independent think tank, Andhra Pradesh, Bihar, Delhi and Haryana have seen the most growth in the uptake of booster doses between April 15 and June 10.

Precaution dose for the 18-59 years category began on April 10 this year.

While the uptake remains low across India, a few states with relatively higher coverage of eligible population (18+ years) with booster doses are Ladakh (31%), Andhra Pradesh (10%), Andaman & Nicobar Islands (9%), Lakshadweep, Sikkim and Delhi (approximately 8%).

So far, the trend among states is that the smaller states and UTs are leading in the coverage of eligible populations with boosters, with a few exceptions like Andhra Pradesh

Tamil Nadu and Jharkhand have the lowest coverage in the country, standing at less than 2% of the eligible population. “Coverage of the second dose is also lagging in these states due to vaccine hesitancy,” Mona, who leads the Covid trackers at ORF, told News18.com. “This is a matter of concern because their populations have significant proportions of elderly (60+ years).”

What does data reveal about other booster trends?

Overall in India, data shows, around 15% of the beneficiaries above 60 years have received the booster shot whereas less than 1% of beneficiaries have received the shot in the age group of 45-59 years and 18-44 years.

Around half of the eligible population of healthcare workers and frontline workers have received the shot.

The top four largest states of India have not even covered 5% of its eligible population with precautionary doses.

Uttar Pradesh has so far covered only 2.19% of its eligible population with the booster doses, whereas Madhya Pradesh, Maharashtra and Rajasthan have covered 2.66%, 3.34% and 3.76%.

Why do we need booster shot?

Boosters are highly recommended, especially in the era of new Omicron sub-variants such as BA4, BA5, and BA2.12.1.

For instance, a study that evaluated the vaccine effectiveness in preventing severe Covid-19 showed that vaccine effectiveness dropped from 90% to 54% during the emergence of new variants.

In comparison, the vaccine effectiveness remained higher than 80% in individuals who received three doses. This is clear evidence indicating that people who haven’t taken booster doses are at a significantly higher risk of developing severe Covid-19 than those who had received the booster dose.

What went wrong in India’s booster rollout?

On December 25, PM Narendra Modi announced the decision to roll out booster doses, formally known as precautionary doses in India.

However, before the government could fully roll out the booster programme, the third wave led by Omicron had gripped the country in January and registered the peak on January 21 with around 3.5 lakh cases in a day.

“The Omicron wave hitting too many people led people to move away from boosters thinking that they have already got the infection and now, there is no need to get another shot,” said Dr Libin Abraham, research associate, department of microbiology and immunology, University of British Columbia, Vancouver.

The good thing is, in the Omicron wave, the population got relatively milder infection which ultimately gave them the hybrid immunity — the superior form of immunity.

Hybrid immunity is even better than the immunity gained from the mix-and-match of the vaccines. It means that the body has received the immunity via natural infection along with two doses of vaccination.

“It’s a natural infection plus a vaccine-based immunity. There is enough data to show that hybrid immunity outperforms the immunity received via natural infection alone or via vaccine alone,” Abraham said.

However, those who are elderly, fragile, have comorbid conditions or have not got the natural infection yet need to take booster doses immediately.

“Delaying boosters is bad. If these people catch infection, even with milder Omicron, the body may not be prepared to handle a high viral load. They will be at a disadvantage as it might be more than six months or even a year until the last dose of vaccine whose protection might have gone down,” he added.

“There is no more caller tune reminding people of boosters or free booster doses for everyone. This shows that the government is also not very serious like they were earlier.”

According to Shinsmon Jose, scientist and research instructor at the division of infectious diseases, College of Medicine, University of Cincinnati, USA, there are multiple reasons behind the slow booster dose uptake.

First, there was an error early in the vaccination drive in communicating what to expect from vaccines.

“While these vaccines are designed to protect people from severe diseases, the early messaging wrongly indicated that vaccines would provide absolute protection from infections. That was asking for more than a vaccine can deliver, especially considering we are dealing with an airborne respiratory virus with a short incubation period.”

With new variants that could partially escape antibody-mediated protection, even vaccinated people started to get infected, leading to people losing confidence in vaccination.

“As a nation with limited resources to handle another wave, we should spend more time and effort conveying the boosters’ significance.”

Other reasons for slow booster uptake include “anti-social, anti-vaccine, alternative medicine practitioners, and AYUSH sympathisers such as Awaken India Movement campaigning against vaccines, and fees for boosters in most states for people below 60yrs.”

“Finally, heterologous vaccination was not approved in India till last week, limiting the choice for people.”

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