Explained In Charts: The Status Of Vaccination Coverage In Urban Districts With India’s Most Populous Cities

On 28 April, when the second wave was at its peak and wreaking havoc across many states, this Swarajya article had suggested that States prioritise vaccinating their cities first. The rationale behind this was simple and straightforward. If resources are limited, in this case the vaccine doses, it makes utmost sense to deploy them wisely to get the best bang for the buck.

By April-end, the staggering contribution of India’s top cities in the second wave surge was clearly evident. In Maharashtra, over 52 per cent of total active cases were from five highly urban districts - Pune, Nagpur, Thane, Mumbai and Nashik. In Uttar Pradesh, where urbanisation is less compared to more developed states, one third of the total active cases came from from Lucknow, Kanpur, Varanasi and Prayagraj alone. Bengaluru urban district’s contribution to Karnataka’s active case load amounted to over 68 per cent. One-third of Rajasthan’s active cases were from two districts - Jaipur and Jodhpur - alone. Over 61 per cent of Gujarat’s active cases came from just two districts - Ahmedabad and Surat. Gurugram and Faridabad contributed almost half of Haryana’s active cases. And so on.

If we took out top 50 most infected cities from India’s active case map at that time, then there would be no second wave, no shortage of oxygen, ventilators or beds and no pandemic.

But could we have fully vaccinated our biggest cities by then at the pace of vaccination that was the norm by April? Most definitely. Total population of our top 100 cities is around 15 crore. Assuming 70 per cent of population above 18 years of age and aiming 70 per cent coverage, it would’ve meant jabbing 7.35 crore people, i.e 14.7 crore total doses (less than total doses administered at the time: 15 crore). So, it wasn’t the lack of vaccines but poor strategy of their deployment.

Had we targeted only India’s cities for vaccination in the first phase, we could’ve achieved herd immunity effects with 70 per cent of the population fully vaccinated in India’s top 100 cities and bypassed the second wave thereby saving the country from lakhs of deaths as well as lakhs of crores of loss to the economy.

The second wave should’ve made us wiser. Given limited resources in light of the size of our population, there was need to divert them in the most vulnerable areas, our cities, which have the potential to start a third wave and drive infection load, hospitalisations and death to high levels.

So, how have we done in the last four months? Let’s take a stock of the vaccination in India’s most urban districts which have country’s 22 most populous cities with population above 15 lakhs (plus Gurgaon and Noida which are important due to their proximity to the national capital and are also important economic centres).

Below is the estimated total population and estimated population of adults (those above 18 years of age) that is living in these urban districts as per the Aadhaar database (updated as late as August 2021).

Saturation in Aadhaar coverage over 100 per cent signals moving of migrant population to these areas since the last Census. Since this more accurately captures the population living and working in these districts, this has been taken as the Upper Limit (UL). The UL for population of those districts which have saturation less than 100 per cent has been estimated by assuming 100 per cent saturation level. Data on percentage of Aadhaar cards possessed by adults in Hyderabad is not available on the UIDAI dashboard.

The table below shows the data on doses (dose 1 and dose 2) administered so far in these 24 districts (Source: CoWin dashboard).

Based on the above two graphs, one can calculate the percentage of total population vaccinated so far as shown in the table below.

One might wonder about the high vaccination coverage (such as 99 per cent, 94 per cent or 83 per cent for Gurgaon, Kolkata and Bengaluru respectively) as percentage of total population but this could mean a couple of things. Either there is more population in these districts than what the Aadhaar coverage shows or it could mean people from neighbouring areas (where vaccine availability is/was less) coming to get jabbed in these districts. (For example, many Delhi citizens might have got vaccinated in Gurgaon or Noida when there was scarcity of doses in the national capital).

Similar trend appears in the table below which shows percentage of adult population that has been vaccinated so far.

This table is what we should focus on because those below 18 years of age have not yet become eligible for vaccines.

Excluding Hyderabad, out of 23 districts, 18 urban districts have vaccinated more than half of their adult population with at least one dose.

However, when it comes to fully vaccinated, only Gurgaon has over 50 per cent coverage. What’s more concerning is that while national average of fully vaccinated adults is over 23 per cent, half of the districts are below this figure. Though, a major blame for this has to be laid at the feet of the mandated dose gap of three months for the Covishield vaccine which has constituted over 88 per cent of total administered doses in the country.

So, one can expect that in the next two months, dose 2 figures will rise much faster and approach towards the dose 1 numbers thereby providing increased immunity to a large percentage of population in India’s urban centres.

Nonetheless, what this data shows is that we have again failed to focus on our cities and urban districts and gods forbid if there is third wave, we would’ve committed the same mistake as we did prior to the second one. The total adult population of these 24 districts is around 12 crore. In last four months, India has administered over 53 crore doses. Even if we had diverted a fourth of these to our 25 biggest urban districts, we could’ve nipped the possibility of a disastrous third wave by now.

Now that the supply of doses has increased substantially, one hopes that this is achieved by Diwali. In any case, the target of fully vaccinating a good majority of India’s adult population by this year’s end is now well within reach.