Memo To Chief Ministers: Vaccinate Your Cities First To End The Pandemic Faster

On 15 January, a day before India rolled out its vaccination program, I had a WhatsApp exchange with a friend who is a banker.

‘There is actually a strong case to vaccinate India’s 25 biggest cities first’, he had opined quickly adding ‘Lekin Modiji karne nahi denge’ (But Modi won’t let it happen).

I was also in full agreement with his advice and equally sceptical of political incorrectness of such a decision by the Prime Minister.

All the countries around the world are following a set pattern in their vaccination rollout - preferential jabs to healthcare workers followed by frontline workers, elderly and those with co-morbidities and then opening it up for all adults. The Central government had outlined the same phased rollout plan last year itself.

So, for the government to break away from globally accepted norms and give preferential treatment to urban centres would’ve been bad politics.

The opposition would’ve gone hammer and tongs painting the government as anti-poor and anti-rural India. The ‘suit boot ki sarkar’ narrative would’ve been back with many more takers for it this time. Such a move would‘ve even appeared to border on ‘unethical’ public policy.

But all these debatable assertions aside, looking at the havoc unleashed by the second wave, one can say for sure that vaccinating Indian cities first would’ve been massively effective so much so that we may have bypassed the whole second wave itself.

Look at the staggering contribution of top cities in India’s second wave surge.

In Maharashtra, over 52 per cent of total active cases are 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 are from Lucknow, Kanpur, Varanasi and Prayagraj alone.

Bengaluru urban’s contribution to Karnataka’s active case load is over 68 per cent.

One-third of Rajasthan’s active cases are from two districts - Jaipur and Jodhpur.

Over 61 per cent of Gujarat’s active cases are from just two districts - Ahmedabad and Surat.

Gurugram and Faridabad districts combined contribute almost half of Haryana’s active cases. On and on it goes.

These cities not only account for most number of cases in the states but also deaths.

Most of these districts are entirely urban in nature. They are cities masquerading as districts. The rural population is almost negligible in these areas which is not the case with other districts which have small towns.

If we take out top 50 most infected cities from India’s active case map, then there is no second wave, no shortage of oxygen, ventilators or beds and no pandemic.

By end of today, we would’ve administered 15 crore doses in total which includes at least one jab to 12.5 crore people and two to 2.5 crore.

Total population of India’s top 100 cities is around 15 crore. Assuming that 70 per cent of these are above 18 years of age and 70 per cent were to be targeted for herd immunity (both the percentages are liberal estimates and thus on higher side), it translates to 7.35 crore eligible people.

This means 14.7 crore total doses which is less than the number of jabs administered by India so far.

Had we targeted only India’s cities for vaccination in the first phase, we would’ve achieved herd immunity effects with 70 per cent of the population fully vaccinated in India’s top 100 cities. We wouldn’t be in the crisis that we are today.

We have tens of crores of more people to vaccinate than any other country and our resources are limited. Most of the developed world could afford to lose sight of the end goal and go with the seemingly ethical means.

But for a country the size of India, the prioritisation should’ve been based on the end goal of neutralising the potential for emergence of another wave. Witch this approach, we would’ve saved lot of lives including those of age old people and those with co-morbidities.

We missed the forest for the trees.

It’s another matter that the government would have got only bad press for its seemingly unethical policy and no plaudits for contribution towards ending possibility of a second future wave because no one (including those doling out wisdom now with benefit of hindsight) thought we would be hit so badly even until 20 days back.

Nonetheless, as every adult becomes eligible for vaccination from 1 May and the States get more control in the process from procuring vaccines to prioritising groups, there is an opportunity for them to innovate and chart their own independent paths.

They would reap great benefits if they focus on vaccinating cities first. They don’t face any ethical dilemma to deal with now that healthcare workers, frontline workers, old age folks and those with co-morbidities have got ample time to get their jabs.

Moreover, the Centre would continue to supply them vaccines for these groups. So, they have to only focus on administering the remaining 50 per cent jabs more wisely.

In May, the supply of vaccines is set to increase with Covishield and Covaxin production going up to 11 crore combined. There is leftover stock of another 2-3 crore doses from production in previous months.

From the first week of May, Russia’s Sputnik V will be available. The United States is also looking to loan to India a share of 6 crore doses of Covishield it has.

Assuming all this pans out, India would’ve around 15 crore doses (conservative estimate). To put this in perspective, we administered only 9 crore jabs this month.

Now, the States will get 50 per cent of the supply, i.e. 7 crore doses approx. They are more than enough to vaccinate 7.35 crore eligible adult population in India’s top 100 cities as lakhs of people have already got the jabs there and will continue to get in May also from the Centre’s quota.

To give an example, over 1.7 crore doses have been administered in Delhi, Mumbai, Thane, Bengaluru, Pune, Chennai, Kolkata, Ahmedabad, Surat and Jaipur alone. So, the challenge is much smaller than it appears.

We now know that even one jab given to large number of people will drive the pandemic to a halt as the results from the United Kingdom, Israel and other countries show.

States can easily fully vaccinate 70 per cent adult population in cities or give at least one jab and still have millions of doses left to administer to other smaller towns and rural areas.

The sum and substance of proposal is this: we have limited resources and we need to divert them in the most affected and most affect-able areas which are driving our large case load, hospitalisations and death figures. The need of the hour is to consolidate our resources and utilise them with extreme precision to get the best bang for the buck rather than spreading them thin which will take months to show results.