The Central government’s current approach has inappropriately prioritised people for Covid-19 vaccination and this policy of focusing on younger age groups “is causing huge numbers of avertable deaths and is deeply inequitable,” said a group of medical doctors and experts in a commentary published in British medial journal BMJ on Wednesday.

Between May 3 and June 5, more first doses were administered to people under 45 than over 60, even though at least 7.7 crore people aged 60 remain unvaccinated, the experts said. “Due to elevated Covid-19 case fatality among the oldest, this policy will result in tens of thousands of deaths that could have been averted by a more targeted roll-out,” they said.

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Among those who contributed to the commentary were Peter Llyod-Sherlock of University of East Anglia, the corresponding author, Soumitra Pathare of Centre for Mental Health Law and Policy, Mumbai, Soumitra Ghosh of the Tata Institute of Social Sciences, Mumbai, and Arokiasamy Perianayagam of the International Institute of Population Studies, Mumbai.

The authors urged the government to take a more targeted approach and reallocate available doses to older people, especially in more deprived areas.

In January 2021, India began its vaccination programme with health professionals and frontline workers. In March, it was extended to people aged 60 or over and those aged 45 or over with comorbidities, and in April to anyone aged 45 or over. From 1 May, vaccine entitlement was extended to all people aged 18 or over, although people under 45 had to pay.

Earlier this week, the government announced that vaccines would now also be free for people aged 18-45, which the authors felt, would likely increase the focus of vaccination on people in this age group, rather than those aged 45 or over.

According to the authors, in practice, access to Covid-19 vaccination is mainly determined by socioeconomic status, with very low coverage in rural areas and among disadvantaged urban populations. As a result, Indians of all ages are increasingly resorting to private purchases, and the country’s minimal pension system makes this especially unaffordable for older people.

They also said that India is not alone in focusing Covid-19 vaccination efforts on other age groups ahead of older people. Concerns about these cases prompted the World Health Organisation Director General to say: “There is a disturbing narrative in some countries that it’s OK if older people die. It’s not OK… It is important that everywhere older people are prioritised for vaccination. Those most at risk of severe disease and death from Covid-19, including health workers and older people, must come first. And they must come first everywhere.”

The authors also pointed out that of late some States, including Maharashtra, opted to diverge from the national policy by suspending vaccination drive for people aged under 45 and reallocating available doses to older people. “We urge the central government to adopt the same approach until all older people in India have received at least one dose, they must be the priority for vaccination. India’s approach to Covid-19 vaccination prioritisation is causing huge numbers of avertable deaths and is deeply inequitable, both between age groups and within them,” the experts said.

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