Arjun Kumar was wary about getting a Covid-19 vaccine until India’s deadly second wave reached villages near his home in the eastern state of Odisha.

Now, like thousands of others scrambling to book a vaccine appointment across the country, his chances of finding one hinge on who different state governments think should be given first priority on limited supplies.

“Initially I wasn’t planning to take the vaccination because people said you could die or get a fever. But now there is death all around, I’m scared,” Kumar, 30, a teacher, said over phone from his home in Nadarpur village.

Alarmed by the television coverage of the nationwide crisis and reports about deaths closer to home, Kumar has tried in vain to book a vaccine appointment repeatedly over the last two weeks, both in person and using an online registration system.

“Getting this vaccine seems like a matter of chance,” said Kumar, who became eligible for the jab on May 1, when India opened vaccination for all adults.

India is a major producer of Covid-19 vaccines, but by Monday it had fully vaccinated only 34.8 million people — about 2.5 per cent of the population, government data shows.

As supplies lag far behind soaring demand, state authorities are having to make difficult decisions on how to distribute the few doses they have available.

‘Poorest of the poor’

In some states, allocation policies are proving controversial.

In the state of Chhattisgarh, authorities faced a legal challenge for opting to give top priority to “the poorest of the poor” on the grounds they were the most vulnerable, with limited access to health services or benefits such as sick pay.

“In view of the limited supply of vaccines, this was done to ensure equity and social justice,” Priyanka Shukla, director of the National Health Mission in Chhattisgarh, told the Thomson Reuters Foundation.

After frontline health workers, next in line were low-income and marginalised groups, including indigenous groups, single and widowed women, the homeless and former bonded labourers.

But a court rejected the state government’s argument last week following a challenge by a group of residents, and people living above the poverty line will now also be eligible in the first phase.

India announced in April that vaccine makers authorised by the Centre would be able to directly sell 50 per cent of their stock to state administrations and private hospitals in an effort to boost the vaccination drive across the country.

But data collected from the health departments of five states and collated by the Thomson Reuters Foundation showed that the supply of vaccines was not meeting even half of the demand from health departments.

In Maharashtra, one of the states worst affected by the second wave, of the 120 million doses needed to cover the 18 to 44 age group, only about 1.1 million have been received.

Officials in the state are considering importing vaccines from overseas to plug the gap. Several other states have made similar announcements.

In Chhattisgarh and Assam, only a small fraction of the millions of required doses have arrived.

“Exact (delivery) dates are not known. Everything depends on the availability,” said Bijay Panigrahi, in-charge of the immunisation drive in Odisha, which has also received only a small number of the doses it needs.

‘Not fair’

The shortages and disparities in state immunisation policies have triggered demands from rights campaigners for authorities to ensure vulnerable groups get fair access.

“Prioritising the marginalised is essential because they inherently have poor health, poor documentation and poor access,” said Edwin, who uses one name and is the trustee of the charity Human Rights Advocacy and Research Foundation (HRF).

Migrant workers are among those at risk of discrimination as some states give priority to their own residents, he said.

Online registration could also lead to inequalities in vaccine access around the country and between different groups, campaigners said.

Many poor Indians do not have biometric identification cards that are often required to access public services, including vaccination registration — allowing those who do to jump the vaccine queue.

In some instances, residents from the cities of Pune, Bangalore and Hyderabad have booked slots in rural health centres, according to local media reports.

“It’s not fair because the stocks are meant for villagers,” said Sandeep Jathar, a rural development official from Mulshi village in Maharashtra, which has seen an influx of residents from Pune at rural health centres.

He said local officials were helping villagers register online to ensure they were not pushed to the back of the line.

Reuters