Why few Indians are lining up for Covid-19 booster doses

Around the same time last year as Covid-19 cases had begun surging in India – climbing to more than two lakh on April 15 – a scramble was under way for vaccines amid a dire shortfall. Vaccine centres in major Indian cities witnessed long queues. Citizens often waited for hours on end to get their shots.

By the time the four-day Tika Utsav, or vaccine festival, had ended on April 14, India had administered more than one crore first doses of the vaccine, according to data from the Co-WIN dashboard. But this was grossly inadequate, as was evident from the devastating effects of the second wave that summer.

Cut to 2 pm on Wednesday at the Kokilaben Dhirubhai Ambani hospital’s deserted vaccination centre in a Mumbai suburb, nearly a week after the Centre allowed all adults above the age of 18 to take a precautionary, or booster, dose.

Swati Khawle, at the registration counter, said around 50 beneficiaries had come to the centre for a precautionary dose till the afternoon. Barely 10 of them were in the 18-59 age group. “The footfall is low,” said Khawle, “But it’s only been few days, it may pick up in coming days.”

Eligibility, reduced cost

The Union government had authorised a precautionary third dose for healthcare and frontline workers, and senior citizens, aged 60 and above, from January 10. From April 10, all adults above the age of 18 were eligible for booster doses if nine months had elapsed since their previous shot.

Many Western countries had rolled out booster doses – a third dose of a Covid-19 vaccine – around September following concerns that vaccine immunity had begun to wane. A third dose for vulnerable categories was expected to provide increased protection from severe disease.

Following the outbreak of the Omicron variant, some countries such as Israel, Germany, the United States and the United Kingdom rolled out a fourth dose earlier this year for those in high-risk categories.

In India, those in the 18-59 age group will have to pay for the precautionary dose at a private hospital but these shots are available for free at government centres for senior citizens, and healthcare and frontline workers.

Further, major Indian vaccine manufacturers – the Serum Institute of India that makes the widely-used Covishield, and Bharat Biotech that produces Covaxin – have reduced the cost of one dose to Rs 225.

Most private hospitals have revised their rates to Rs 386 per dose for either vaccine since April 10. Earlier, a single dose of Covishield cost private hospitals Rs 600 while Covaxin cost Rs 1,200. Private hospitals would then add their own charges while administering doses to beneficiaries.

Few takers, many reasons

Between April 9 and April 14, a total of 7.41 lakh booster shots across all age groups were administered, down from 8.57 lakh between April 2-8, and 9.22 lakh from March 26-April 1. According to data from the health ministry, till April 14, a total of 1.03 lakh precaution doses had been administered to beneficiaries in the 18-59 age group. In total, 2.49 crore precaution doses have been administered so far in India.

From a general relaxation in precautions and reduced fear to previous infections, there appear to be multiple reasons why few Indians have taken precautionary doses.

For one, most people aged 18 and above might not be eligible for the booster shot yet. The first round of vaccination opened for them only on May 1 last year. Given that a three-month gap between two doses was in place, alongside a high demand for the vaccine, beneficiaries had become eligible for the second dose only in August.

A booster dose can be taken only nine months since the last dose, so most of those vaccinated May onwards will start becoming eligible towards the end of April.

In fact, doctors say many people in this age group are yet to take their second dose. Dr Balkrishna Adsul, who is in charge of the vaccination centre at Dr RN Cooper Hospital, said most of those coming to the hospital are either teenagers getting their first or second doses, or elderly citizens getting their precautionary shots. “A huge section of the population has still not got their second dose,” said Adsul. “We are calling them on phone to come take it.”

According to Adsul, a combination of factors has kept people away – an overall decline in new Covid-19 cases, a lack of urgency about getting boosters and the Omicron wave that began and ended between January and February.

Urvi Shah, 40, who was at the RN Cooper centre to get her son, in the eighth standard, his first shot of the vaccine, said she plans to get a precautionary dose but is in no hurry to do so. “His school has started offline classes,” she said. “Right now, getting him immunised is more important.”

Her husband is due for a precautionary dose as well. She said his office had arranged for vaccinations last year. “This time, the office has not mandated a booster shot yet,” she said. According to Shah, there is no fear and panic over Covid-19 any more.

“People are learning to live with it,” she said.

Dr Santosh Shetty, chief operating officer at Kokilaben Hospital, said a major reason why the demand for booster doses is low is the recent Omicron wave that infected a large section of the population between January and February.

According to Shetty, the booster dose uptake is currently among students going abroad and businesspeople who have to travel. “We have not placed an order for large quantity like we did last time,” said Shetty, “We will place vaccine orders based on consumption.”

Dr Jyotika Shroff, 53, an anaesthetist at a private hospital, said that her husband took a booster dose in January at the advent of the Omicron wave, but she is yet to get one. “It is good to take precaution, but there are fewer cases right now… there is no hurry,” she said. Shroff, who also got her son vaccinated at RN Cooper Hospital, is eligible for a booster dose as she is a medical worker.

“We still have immunity against the virus I believe,” she said.

Wait and watch approach

A member from the National Technical Advisory Group on Immunisation said the immediate requirement for a booster dose is among senior citizens and frontline workers. “In younger population, we have not found the need for booster yet,” the member who did not want to be identified.

The government is also waiting for the results of a study by the Christian Medical College, Vellore, assessing the effectiveness of Covaxin being administered as a booster dose to beneficiaries who previously received Covishield and vice-versa.

However, virologist Dr Shahid Jameel welcomed the decision to allow all eligible adults above 18 years of age to take booster doses. “A 59-year old with comorbidity needs a booster more than a 60-year-old with no comorbidity,” said Jameel. “People should be free to choose a booster if they have health issues.”

According to Jameel, a booster may not not prevent infection but it will provide protection from severe disease.

Jameel said the low turnout could also be due to inadequate communication by the private sector about vaccinations. Further, he said many Indians were infected during the third wave and developed hybrid immunity – protection provided by vaccination as well as natural infection. “In some people, the natural immunity post an infection stays for six months, in some it deteriorates after three,” said Jameel. “People may have decided to wait longer.”

Dr Joy Chakraborty, chief operating officer at PD Hinduja Hospital, said private hospitals have started advertising the availability of booster doses on social media. “We think the count of people will increase,” he said.