7.5 mn need 2nd jab in July; we have 4.8 mn doses: Rajasthan minister

In a Q&A, the state's Health Minister Raghu Sharma says Rajasthan has started work to ensure no shortage of medical oxygen during the third Covid-19 wave

Rajasthan is planning to procure Covid-19 vaccines directly from vaccine makers (if possible) to ensure the citizens who are due for their second dose, do not miss it. Speaking to Sohini Das, Rajasthan’s Health Minister Raghu Sharma says that the state has started work to ensure no shortage of medical oxygen during the third wave of Covid19. Edited Excerpts.

How do you plan to improve rural vaccination?

We have over 18,000 vaccination sites, most of which are in villages. The sub-centres are in remote areas where the population is around 3,000 or so. There are 14,000 sub-centres in rural areas, where auxillary nurses and midwives (ANMs) are present. We have 3,000-plus PHCs, mostly in rural areas. Vaccinations are happening now at sub-centres and PHCs and CHCs. All the PHCs are cold chain points and from there they go to remote areas in mobile vans.

Panchayat representatives and MLAs are going to rural areas where we see some vaccine hesitancy. We are trying to involve local influencers and religious leaders to overcome the problem in these areas. The hesitancy is more in tribal belts like Banswada and Dungarpur.

Do you have cold chain infrastructure for Pfizer, Moderna vaccines?

If Pfizer or Moderna vaccines come to India, then we will have to develop the sub-zero temperature cold chain. If the Centre tells us that they will supply us these vaccines, then we will make such storage centres. For Covishield and Covaxin, which we are getting now, storage centres that can maintain 2-8 degrees are required, which we already have. So far, we have not got any proposal from the Centre on supplies of Pfizer or Moderna vaccines

Are vaccine supplies streamlined?

We have a capacity to vaccinate 1.5 million people daily across Rajasthan. We have created infrastructure for that, trained manpower etc. Now, as against this capacity, last week we got around 290,000 vaccines and that too in tranches.

For the entire month of July we have been allotted 4.8 million doses of Covid-19 vaccines by the Centre. The private sector will get 1.6 million doses. Therefore, the total number of doses that Rajasthan will get will be around 6.5 million doses.

In July around 7.5 million people are due for their second dose in the state. If we get 6.5 million doses for the entire month, then a lot of people who are due for their second shot won’t get their vaccines, leave alone anyone getting a first shot. I have written a letter to the Health Minister Harsh Vardhanji on the matter and asking for 15 million doses in July. Then we can give 7.5 million second shots and also give some first shots. The supply is still not streamlined yet.

Centre has a formula according to which it allots vaccines, which takes into account, the state’s population, case load, wastage etc. Our wastage is zero. We have an approximate population of 80 million dose. Of this 25-30 million people are below 18-years. So, we need to vaccinate at least 55 million people, and need 110 million doses of Covid19 vaccine. This is considering no wastage. If we add waste to this, then we will need 120 million doses or so. So far, we have got 24.7 million doses. We have given the first dose to 20.6 million people and 4 million people have got the second dose.

Do you think Rajasthan and India at large can complete adult vaccination by December?

If doses come in a staggered manner, and in small amounts, then I do not think we can complete adult vaccination by December.

The Centre needs to draw up a plan whereby they estimate that once the first dose is done and the second dose is due, they need to send the exact amount of vaccines to the respective states.

Our CM has been reviewing the situation regularly. Last week we discussed if we should pay Rs 10-15 crore and procure the shortfall of doses for those citizens due for their second dose. We would want to procure directly. This would be a loss of face for the Centre.

Even if we try to buy directly from the vaccine makers, we do not know if that would be available.

It is not clear how much they make on a monthly basis. The Union government needs to make this public and transparent – what is the daily production of Covid-19 vaccines by Serum Institute of India and Bharat Biotech, what are their international commitments, what quantities would be available for India, and of this what will be available for private sector, and how much is available for public procurement.

Once this data is transparent, one can then estimate when the country can fully vaccinate its population and make a road-map accordingly.

We are optimistic that India will complete vaccination of its adults by December; the Union of India is claiming so. However, if they make the above declaration, then it would look more achievable.

We paid Rs 102 crore advance to Serum Institute and Bharat Biotech and bought 3 million doses of their vaccines earlier. This was when the PM had said that states can procure vaccines for the 18-45 age group. We've already used these 3 million doses in Rajasthan.

How are you preparing for the third wave?

In the first wave we had a maximum daily of 3,300. Our Bhilwara model was discussed around the country–active and passive surveillance, door to door campaigning, micro containment zones etc.

The second wave was horrible, when we say a daily case count of 18,000 or so. Deaths per day had touched 150-170. Now, the demand for hospital beds, ventilation, and oxygen all shot up. Our demand was 615 tonnes of medical oxygen per day, and we were getting 400 tonnes daily. The Centre had taken up the management of medical oxygen and allocation. We went to Delhi to discuss the matter asking them to follow a formula for allotment.

Now, for the third wave, we are now creating our own capacities. We are preparing to generate 1000 tonnes of medical oxygen per day in Rajasthan, so that we never face that shortage situation again in the third wave. Experts have said, the third wave would impact children more. So, we are strengthening the pediatric units in our hospitals in general hospitals, children's hospitals. We have identified 332 CHCs in rural areas where we are provisioning for 4-5 ICU beds in each of them, and have oxygen generation plants there. This would take off the pressure from the district hospitals. The third wave is expected to hit around September, and we plan to finish this work by then.

We have also started genome sequencing of the samples here at state-level. It is important to know which strain or variant is dominant in which area. If we identify this fast, then the treatment protocol etc can be addressed accordingly.

We have provisioned for an additional Rs 2,000 crore for the third wave that will take our total allocation to Rs 16,000 crore on health for next year. In 2020-21 the health budget was Rs 12,637 crore, or 9 per cent of the plan. For 2021-22 the allocation was Rs 14,464 crore, or around 10 per cent of the plan.

How does Rajasthan compare with all-India in terms of Covid parameters?

Our recovery rate is 98.9 per cent compared to an all-India recovery rate of 96.8 percent. Our motality rate is 0.93 per cent and case doubling rate is 4,847 days. In comparison, the all-India case doubling rate is 434 days.