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India opened vaccinations to all adults on Saturday in the hopes of taming a monstrous increase in COVID-19 infections, launching a massive inoculation campaign that was sure to test the federal government’s boundaries, the country’s vaccine factories, and the patience of its 1.4 billion citizens.

Due to lagging production and raw material shortages, the world’s largest vaccine manufacturer was also short of essential materials, delaying the introduction in many states. Even where the vaccines were available, the country’s large economic inequalities made it difficult to get the vaccine.

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On Saturday, a fire in a COVID-19 ward in western India killed 18 patients, and 12 COVID-19 patients died at a hospital in New Delhi after the facility ran out of oxygen for 80 minutes, putting the country’s ambitious effort in jeopardy.

Experts estimate that only a small portion of India’s population will be able to afford the shot at the rates paid by private clinics, leaving states to immunize 600 million Indian adults under 45, while the federal government immunizes 300 million health care and front-line staff, as well as people over 45.

Until now, government vaccinations have been free, and private clinics have been allowed to sell shots for a maximum of 250 rupees ($3).

This will no longer be the case: vaccine producers will set the prices for state governments and private hospitals. Some states may be unable to offer vaccines for free because they pay twice as much as the federal government for the same shot, and private hospital rates may increase as a result.

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According to Chandrakant Lahariya, a health policy expert, since state governments and private players compete for shots in the same marketplace and states pay less for the doses, vaccine makers can make more money by selling to the private sector. This cost can then be passed on to those who receive the shots, resulting in even more inequity.

β€œIt makes no sense for two different governments to pay two different prices,” he said.

The latest stumbling block in India’s slow immunisation efforts is fears that price problems will exacerbate inequities. Just about 2% of the population has been completely immunised against COVID-19, with the remaining 10% receiving only a single dose. Vaccination rates have also decreased. The total daily number of shots has dropped from over 3.6 million in early April to under 2.5 million right now.

The health minister in Maharashtra, the worst-affected state, offered free vaccines to those aged 18 to 44, but he also admitted that due to a shortage of doses, immunisation would not begin on Saturday as scheduled. One explanation for the drop in immunisations, according to states, is a lack of vaccines.

The country got its first batch of Sputnik V vaccines from Russia on Saturday, which is a positive development. Moscow has agreed to sell 125 million doses through an Indian pharmaceutical corporation.

When the cases dwindled in September, India felt the worst was over. According to health experts, however, mass gatherings such as political demonstrations and religious festivals were permitted to occur, and casual attitudes toward the risks fueled a global humanitarian crisis. The outbreak has been fueled in part by new coronavirus strains.

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India’s vaccine shortage has international ramifications since, in addition to its own vaccination initiatives, the country has pledged to ship vaccines internationally as part of a United Nations vaccine-sharing scheme that is reliant on its availability.

The two licensed shots β€” the AstraZeneca vaccine made by the Serum Institute of India and another made by Bharat Biotech β€” are expected to be produced at a rate of 70 million doses per month in India.

Half of those vaccines will be purchased by the federal government and distributed to states.
The remaining half will then be purchased by states and private hospitals for distribution to everyone over the age of 18, but at the companies’ discretion.

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