India’s Vaccination Mess and How to Sort It

Chintan Patel and Vivek Kaul

The second wave of coronavirus continues to unleash its horror in India. This crisis has brought in focus the significance of mass vaccinations being carried out at a very quick pace. Without vaccinating a vast majority of our population against Covid-19, there is no pathway to normalcy and achieving herd immunity.

Policy-makers in India have finally awakened to this reality or at least that is what we hope. That they have been found so lacking – in planning, preparation, and priorities – speaks volumes of the caliber of our political and bureaucratic class.

As a piece in The Times of India, dated May 10, points out, at the current rate of vaccination, it will take around 1,000 days to vaccinate the adult population of 94 crore (around 94.3 crore to be precise). But assigning blame will not solve this crisis. Timely, considered action and policies might.

In this article, we try to assess the logistical readiness of a mass vaccination plan by looking at the capabilities and capacities at each step of the vaccination process. Specifically, we look at current and future vaccine supplies and discuss key issues related to vaccine administration.

Vaccine Supply

There are two vaccines available in India currently – Covishield manufactured by the Serum Institute of India (SII) and Covaxin manufactured by Bharat Biotech. In addition, we will be importing Sputnik V from Russia starting this month, with a small amount already having come in, and are likely to receive shipments of Astra-Zeneca vaccines from the United States. Also, Zydus Cadilla has announced that it expects to get emergency authorisation for its 3-dose vaccine shortly.

The table below lists the different vaccine sources and their estimated/committed doses for the next six months. Projections beyond October are subject to too many assumptions which can lead to wide variations in estimates. For now, a six-month planning and estimate window seems appropriate. Even then, these are estimates that may prove to be incorrect.

Expected vaccine Supply (in crore)

Source:

  1. Covishield : SII CEO statement reported by Reuters on April 21. India’s Serum Institute to raise output to 100 mln AstraZeneca doses by July, not end-May | Reuters
  2. Covaxin: Bharat Biotech statement reported by NDTV on April 21. Bharat Biotech Scales Up Covaxin Production To 700 Million Doses Annually (ndtv.com)
  3. Sputnik: India Today report on May 1. First batch of Russia’s Sputnik V Covid vaccine arrives in Hyderabad, to be sent for regulatory approval – Coronavirus Outbreak News (indiatoday.in) and Sputnik V, Covishield, Covaxin: What we know about India’s Covid-19 (BBC). 
  4. Astra Zeneca: Press statement by White House, reported by CBS News on April 26. COVID vaccine: U.S. aims to share up to 60 million AstraZeneca doses with other countries after FDA review – CBS News
  5. Zydus Cadilla: Press report. Zydus Cadila Likely To Seek Approval For Its COVID-19 Vaccine This Month (moneycontrol.com)

Let’s discus the above table in a little more detail. 

These are broad estimates derived from publicly available information as on May 7, 2021. The intent behind this exercise is to consolidate information emerging from various sources to provide a coherent and a reasonable picture of the vaccine supply scenario.

There might be major changes in either direction, that is, actual supply might increase due to new production or distribution agreements or actual supply might decrease if manufacturers are not able to deliver to their committed/planned volume. As we said earlier, this is a broad estimate.

1) The estimates for Covishield are based on their total production capacity projections given by Adar Poonawalla, the CEO of Serum Institute of India (SII). SII’s current production capacity is between 6 to 7 crore per month. We have assumed it to be at 6.5 crore per month. By July, SII expects to raise its production to 10 crore, as reflected in our estimates starting August. We assume that an increase in production will start hitting the market in the next month. 

On April 28, 2021, the government of India placed an order with SII for 11 crore doses for May, June and July. Over and above this, SII has announced that it has a separate order of 11 crore doses from state governments and private hospitals. But the delivery schedule for those orders is not publicly known.  

To add another layer of ambiguity on the demand side, SII is also obliged to export 20 crore vaccine doses in 2021 as part of its agreement with Astra-Zeneca and World Health Organization. Currently, vaccine exports have been halted due to the domestic crisis in India. It is possible that export of Covishield doses will resume once the crisis abates. In fact, 5 million doses of the Covishield vaccine which were to be exported to the United Kingdom have now been made available for inoculating those in the 18-44 age group.

Thus, our estimates allocate the entire production of Covishield for domestic use. Please note that if export of Covishield vaccines resumes, the actual supply numbers for India will be lower than estimated numbers.

Currently India faces a supply problem. In May, the supply of vaccine doses is expected to be around 8-9 crore. As one of us had earlier estimated, the total number of vaccine doses needed to vaccinate the remaining part of India’s adult population, stands at around 178-190 crore doses. The gap between what is available as of now and what is needed, explains the prevailing chaos when it comes to vaccines.

2) For Covaxin, once again, our estimates reflect the total monthly capacity. Bharat Biotech, the makers of Covaxin, have announced that they will be able to ramp up their annual production capacity to 70-80 crore vaccine doses by July. In an interview given in late April, Krishan Ella, the CEO of Bharat Biotech had remarked:

“Last month we produced 1.5 crore doses, this month we are reaching 2 crore doses, next month we will be making around 3 crore doses followed by 7 to 7.5 crore doses. We are ramping up the production and by July-August we will be able to reach 70 to 80 crore doses production capacity per annum.”

Using this as a guideline, we have budgeted 2 crore Covaxin doses for May, which ramps up to 3 crore in  June, rising to 6 crore doses per month starting in July (6 crore per month x 12 = 72 crore per year).

3) The first pilot batch of 1,50,000 doses of the Russian Sputnik V vaccine, was shipped to the Hyderabad based Dr Reddy’s Laboratories in early May. We have not counted those since the number is too small for this estimation exercise. As per the agreement between Russian Direct Investment Fund which is marketing the vaccine and Dr Reddy’s, 12.5 crore doses are to be imported to India between April and June 2021 .

We have split that number up from June to September (12.5 crore/4 = 3.13 crore), given that a bulk of these vaccines have not been delivered as yet . For October, we have kept the number at 3.13 crore. It is likely that the Sputnik V dose availability might go up after a few months since six local manufacturers are supposed to manufacture 75 crore doses of the vaccine after the initial batch of imports. The timing of the locally manufactured Sputnik V is difficult to predict. So, as a rough estimate we have retained the 3.13 crore figure for October as well.

4) It is likely that the US might begin to share some of the stockpile it has of the Astra-Zeneca vaccine, with India. We have estimated that to be 1 crore doses a month, starting in June.

5) Zydus Cadilla is expecting to get an approval for its three dose Covid vaccine in May. Their initial production capacity is slated to be 1 crore doses per month, which is expected to rise to two crore doses per month. Given that the vaccine has not yet been approved we stick with the initial capacity of one crore doses.

This vaccine is a three dose vaccine, hence, the “value” of a single dose is two-thirds of the other vaccines – all of which are two dose vaccines. Thus, the equivalent monthly supply estimate for Zydus Cadilla is 0.67 crore (two-thirds of one crore).

6) Another indigenous vaccine made by Biological E based in Hyderabad may become available in August. Since the vaccine hasn’t been approved yet, we have not included it in our supply estimates.

7) During any vaccination drive, some amount of vaccines get wasted due to improper handling, theft and human errors. The following chart shows the rate of vaccine wastage in a few states as of May 10.

Source: Ministry of Health and Family Welfare.

We have not included wastage in our analysis to keep things slightly simple. Having said that, doses lost due to wastage will decrease the available supply for inoculation. 

Finally, with these caveats, we can say that there will be a supply around 102 crore additional vaccine doses between May and October 2021. What this means is that vaccines will continue to be in short supply in the short-term.

The efforts highlighted above to get the various vaccines available in India are all positive steps. But as the numbers indicate, the supply pipeline is not adequate to meet our vaccination needs of close to 180 crore vaccine doses.

The primary reason for this shortage is that the government of India waited too long to place vaccine orders and when it did, it didn’t order enough doses.  This can be seen in the chart below that compares the vaccination order timelines for different countries.

Source: https://epaper.telegraphindia.com/imageview_359302_24528134_4_undefined_19-04-2021_1_i_1_sf.html.

In fact, as Satyajit Rath, a veteran biologist formerly associated with the National Institute of Immunology, Delhi, told the Deccan Herald, regarding the government barely stocking up on vaccines: “This was part of a pattern of treating the epidemic as a short-term crisis, somewhat like natural disasters such as an earthquake.”

Now let’s take a look at the possible steps that can be taken to augment the vaccine supply.

A supply of more than 100 crore doses of different vaccines by October, if achieved, will be no mean feat. But even that is not fast enough given our vast population. The following steps can be taken to increase the supply of vaccines. These are medium term solutions and will likely yield results over the 6-12 month horizon. This means that the supply of vaccines will continue to be an issue over the next few months. 

1) The central government should work closely with both SII and Bharat Biotech to enable them to hit maximum production capacity. Additionally, both manufacturers should be asked to furnish a weekly supply schedule for better planning and coordination, if that is not already happening. With multiple buyers in the mix now (with state governments and private hospitals) such a supply schedule assumes even greater significance.

2) India is the vaccine manufacturing headquarters of the world. According to Central Drugs Standard Control Organisation, there are 18 private and three public sector vaccine manufacturers in the country. One potential route to increase vaccine supplies is to leverage spare local vaccination manufacturing capacity to increase supply of Covaxin using licensing and/or royalty agreements with Bharat Biotech.

The intellectual property for Covaxin is jointly owned by Bharat Biotech and the Indian Council of Medical Research (ICMR), a government body. In fact, an arrangement along this line is already in motion where the Mumbai based Haffkine Institute, one of the oldest biomedical research institutes in the country, has been granted permission by the central government and funding by the Maharashtra government to start production of Covaxin.

Vaccines production from this plant is expected to take atleast one year. Other efforts, similar to this could be spawned with other vaccine makers after an assessment of technological and supply chain feasibility. However, based on the Haffkine timeline, it is clear that such efforts will not help in the short term. Having said that, we don’t know if the current wave is the last wave of Covid. 

3) India can import additional vaccines from the United States. The United States has a contract with Astra Zeneca for 30 crore doses of which six crore doses are either in stockpile or will be shortly available. Since the Astra Zeneca vaccine has not been approved in the US, India can apply a concerted effort – both diplomatically and/or financially- to receive a substantive portion of the stockpile.

India should also look at importing additional vaccines directly from vaccine makers. The Municipal Corporation of Greater Mumbai has such plans.

Among the major vaccines approved and in use elsewhere, the Johnson and Johnson (J&J) vaccine is the most attractive given that it is a single-shot vaccine and it does not need extreme cold storage. The J&J vaccine may not be the best use of taxpayer money, but one that private companies could pursue and make available to the general public at a higher cost. 

Vaccine Administration

Vaccine supplies are no good if they don’t translate into inoculation. En-masse administration of vaccines depends on several factors including number of vaccination sites, available personnel, location of sites, and public willingness to get vaccinated. Let’s look at this in some detail. 

The following chart shows weekly vaccination rates in India.

Source: dashboard.cowin.gov.in.

Here are some observations from the above graph.

1) The vaccination rate was quite low till early March. The spread of the second wave of covid clearly catalysed the public into action and the vaccination numbers rose steadily till the first week of April, barring a small dip towards the end of March.

From just over 4 lakh vaccinations in the week of February 27 to March 5, numbers jumped to almost 2.5 crore in the week of April 3 to April 9. After hitting that peak, numbers have dropped down to around 1.15 crore vaccines for first week of May. This is a drop of around 54% over just one month. As covid has spread, our vaccination rates have been dropping.   Vaccine supply shortages are mainly responsible for this drop in inoculation in recent weeks, and the lockdown imposed across large parts of the country may also have contributed to this.

2) The peak rate of around 2.5 crore weekly vaccines is an important statistic. It translates to a monthly rate of 10 crore vaccines – more than the projected supplies for May but about 30% short of the projections for June. What this tells us is that the distribution capacity can handle the imminent vaccination volume, but will need to start ramping up soon to keep up with the projected supply.

3) According to the Cowin dashbord, as of May 7, there were 58,214 vaccination sites (55,822 government sites and 2,292 private sites). Along with using government hospitals in the urban centres, the government has wisely activated the rural healthcare system for vaccine delivery as well. 

The rural healthcare delivery system in India is a three-tier system. The smallest unit, called sub-centres, are health outposts which are meant to be the first contact point between the community and the healthcare system. A group of sub-centres are served by a single primary health centre which has a doctor (medical officer) and nurses on staff. A group of primary health centres feed into a community health centre– which is akin to small hospital with specialist doctors and diagnostic equipment.

A study of the vaccination sites in different states on the Cowin dashboard reveals that many states are using sub-centres, primary health centres and community health centres, as vaccination sites. The rural population is being targeted here.

However, as is often the case, enterprising citizens often outthink policy makers, resulting in unanticipated policy outcomes. In this case, there are reports that urban Mumbaikars, who are digitally more savvy than the rural folks, are showing up in rural areas to get vaccinated. This phenomenon highlights the need to make the registration process more accessible to all.

Now let’s look at state wise vaccination data.  As of May 7, 2021, around 16.75 crore vaccine doses had been given. How do different states compare in this vaccine drive?  The table below provides some insights.

Vaccination Rates (in %)

Source: Author calculations based on data from Cowin dashboard and Unique Identification Authority of India. 

In the above table, we show the five states that are performing the best and five that are performing the worst when it comes to vaccination rates, among states which have a population of over 1 crore. 

Uttar Pradesh has the worst vaccination rate, where only 4.6 % of the population has gotten at least one dose of the Covid vaccine, and just above 1% has been fully vaccinated. It appears that the energy spent by state leadership in image management, has come at the expense of an effective vaccine roll-out strategy.

Bihar, Assam, Tamil Nadu and Jharkand, are the other laggards with no state having fully vaccinated over 2% of their population (except Tamil Nadu which is marginally over 2%). In case of Assam and Tamil Nadu, among other things, the recent state assembly elections may have been responsible for low vaccination rates.

Among states that are doing well, Kerala and Gujarat – with their oft-cited competing models of development – are doing remarkably similar when it comes to vaccinating their people.  Uttarakhand, Jammu and Kashmir, and Rajasthan, are the other vaccination leaders.

The ratio of folks fully vaccinated is not starkly different between the leaders and the laggards – 4.83% for Gujarat vs 1.17% for UP – but the figures for people with one shot taken does show a significant difference (17.28% for Kerala vs 4.59% for UP).

Till the end of April, states were dependent on the centre for getting vaccines. So, the discrepancy in vaccination rates is likely to have been a function of the centre’s distribution decisions, as well. The central government has not released the criteria used for vaccine distribution to the states, something that they should be doing for transparency and efficacy auditing.

Having said that, Gujarat has clearly been a beneficiary of the allotment mechanism, receiving the highest quota of vaccines from the centre after taking its population into account. As an April 19 newsreport on moneycontrol.com points out:

“As on April 8, the supplies to Maharashtra covered just about 8.5 percent of the population. For Delhi, it was 10.4 percent. On the other hand, Gujarat, which can’t be regarded as the most impacted state if one goes by official numbers, had got enough vaccines for 16.4 percent of its population – the highest.”

It appears that when it comes to competition between states, Prime Minister Narendra Modi continues to root for his home state.

Starting  May 1, the state governments can procure vaccines directly from the manufacturers. Having states compete for what is essentially a fixed supply isn’t a great idea since it will not increase the total vaccines available nationwide. Instead, the states and private corporations will fight over the 50% pool that has been de-regulated.

So states that have more leverage with vaccine makers or more financial clout/headroom stand a better chance of pulling ahead in the vaccination race. It will be interesting to see the trajectory of vaccination rates of different states as they begin to place their vaccine orders in the coming weeks and months. Also, this is clearly creating an access problem for the poor.

Vaccine Logistics 

As the supply of vaccines increases in the coming months, the question is do we have enough health care workers and vaccination sites to keep up with supply. 

First, let’s look at the manpower question. As per the Fifteenth Finance Commission Report tabled in February 2021, there were a total of around 27 lakh healthcare workers in India in December 2017. These include registered nurses (RN), registered midwives(RM), lady health visitors (LHV) and auxiliary nurse midwives (ANM). Specifically, there were 20,48,979 RNs and RMs, 56,469 LHVs and 8,60,927 ANMs, serving in the country. All these healthcare workers are capable of administering a vaccine.

Now, consider a full-throttle vaccination campaign with 1 crore doses/day. Assuming that a healthcare worker administers 50 doses a day, we would need 2 lakh healthcare workers which is less than 8% of the total available personnel. Thus, it is evident that labour won’t be a bottle-neck to ramp up the vaccine drive. 

Next, let us look at how many potential vaccination sites are available. Recall that currently, around 61,000 sites are being used. As per the Rural Health Survey of 2019, there are 1,57,411 sub-centres, 24,855  primary healthcare centres and 5,335 community health centres, across the country.

Thus, even without counting government hospitals and private clinics, there are over 1,87,000 potential vaccination sites, almost three times than are being currently used. Thus, vaccination sites also are not limiting factors in scaling up vaccine delivery.

One potential hindrance in getting maximum number of people to sign up for the vaccines is the current vaccination registration process. A huge rush for vaccines has made the signing up process a bit of a lottery. In fact, techies have resorted to writing scripts to alert them when an elusive spot opens up. For everyone else, the process consists of repeated tries on loop.

One major problem experienced by folks trying to sign-up for a vaccine is the non-receipt of a one-time password (OTP). The OTP is a pre-requisite to move ahead in the registration process, and many folks have been unable get past the OTP step. Technical glitches in the early stages of an app/website roll-out are not unheard of, but given the importance of this issue, one would have expected the “routine” bugs to have been ironed out before mass adoption.

That such glitches are so widespread indicates that the en-masse registration was not planned with adequate lead time. Here too, like most aspects of the Covid response, the government’s lack of readiness is being exposed.

The online registration will likely smoothen out over time, but currently it only caters to the internet-savvy comfortable in English. Online sign-ups may not totally work for all folks, both rural and urban. Systems that allow a registration method that is appropriate and accessible for those not comfortable with the current digital setup, need to be created. .As a start, the Cowin registration website needs to become multi-lingual.

The language barrier automatically excludes the majority of the country. As per the 2011 Census, only around 13 crore people identified English as first, second, or a third language. It is mind-boggling that the government decided to offer the registration process only in a language that the vast majority does not understand. That the registration process cannot support the major Indian languages, is again a sign of a system put together in haste.

Vaccine Hesitancy 

Vaccine hesitancy can also potentially derail the entire vaccination drive. If too many adults choose not to sign up for the vaccine, it won’t be possible to reach herd immunity quickly. In some ways, the severity of the second wave makes the most compelling argument for the need to vaccinate. Yet, for a variety of reasons, people tend to be hesitant.

Safety concerns, efficacy concerns, and ignorance (wilful or genuine) about the seriousness of Covid-19, are prime reasons that drive this hesitancy. WhatsApp messages and fake news exacerbate the psyche of suspicion and distrust. The best anti-dote to that is positive messaging and increased awareness about the benefits of vaccination. Given this administration’s core competence of narrative management, mass communication to encourage vaccine enlistment should not be a big hurdle.

As a more directed policy step to incentivise vaccinations, especially in rural areas, the central government could consider linking a Public Distribution Service (PDS)-based benefit with a vaccination dose. For example, for each vaccine dose a voucher for a few kgs of rice/wheat, which can be redeemed at the local ration shop, can be given.

This should not cost the central government much (other than perhaps transport and administration) since the Food Corporation of India storehouses are overflowing with way more grain than the strategic and operational buffer that needs to be maintained.

The pathway to a fully vaccinated Covid free India is not easy and won’t happen overnight. But, with proper planning and execution, we can make significant progress over the next several months. We all need to do our bit to succeed in this effort.

All, including Nero.

Only 3.78% of Adults Have Got Both Doses of the Vaccine

Honestly, I didn’t want to write this piece. But when a cabinet minister of the government of India uses basic maths to mislead, it didn’t leave me with much of an option.

Here’s what Dr Harsh Vardhan, who is the minister of health and family welfare and science and technology, tweeted earlier in the day today.

Regular readers would know how much I hate when people don’t know when to use percentages and when to use absolutes. Or the fact that they know and still do it, to mislead.

Harsh Vardhan’s tweet has multiple problems. Let’s look at it pointwise.

1)  The minister points out that the government of India has provided more than 18 crore vaccines free to states for vaccination. This is for vaccinating people who are 45 or more. So far so good. The thing is that India has the second largest population in the world. As per the World Bank it was at 136.64 crore in 2019, with China’s population being at 139.77 crore. With China’s population barely growing and ours continuing to grow, by now, we might be within the touching distance of China to become the country with the largest population in the world.

So, when it comes to things that need to be provided to all the population or a significant chunk of it, India is bound to be at the top. Also, vaccinating the population is not a race. It is the right thing to do.

2) Given this, it makes sense to look at what proportion of the population over the age of 18 has been fully vaccinated, meaning it has gotten both the doses of the vaccine. That’s a useful metric.

As I write this, the dashboard on the Co-Win website tells me that 3.56 crore individuals have taken both the doses. There are around 94.3 crore Indians who are aged 18 and above. This means that around 3.78% of the population (3.56 crore expressed as a percentage of 94.3 crore), for whom vaccines are available, has been vaccinated.

Yes, you read that right. Less than 4% of those age 18 or above, have got both the doses of the vaccine. Of course, this explains why Dr Harsh Vardhan’s tweet is an absolute number and not in percentage terms. This situation prevails nearly four months after the vaccination programme started.

That’s the real figure to look at simply because the aim of vaccination is to achieve herd immunity. As Ryan A Bourne defines herd immunity in Economics in One Virus as “a situation where enough people have immunity that any further outbreak of the virus fails to accelerate because there are too few individuals susceptible to infection.” Vaccinating a significant chunk of the population moves us towards the situation. And we are nowhere near that, the world’s largest vaccine drive notwithstanding. 

Data from the Financial Times, tells us that there are many nations in the world who have vaccinated a significant chunk of their population. This includes smaller nations like Israel and larger ones like United States. Very few countries where covid has spread as much as it has in India, have got a rate of vaccination as low as it is in the Indian case.

3) Also, what Dr Harsh Vardhan’s tweet does not tell us is that the rate of vaccination has been slowing down majorly over the last one month. During the week April 3 to April 9, the total number of vaccinations carried out stood at around 2.48 crore doses (includes both the doses). This has fallen every week since then and stood at around 1.16 crore doses, during the week May 1 to May 7. This fall of over 53% has happened primarily because the government was busy with elections and didn’t order enough vaccines until April 28, 2021.

4) When it comes to receiving the first dose, 13.49 crore Indians or 14.3% of the population that is being vaccinated has got the vaccine. On this parameter things look a little better for India.

To conclude, vaccinating a significant chunk of India’s population to achieve herd immunity, remains a real challenge. Further, while everyone cannot be vaccinated within a short-period, but misleading the country on it by misrepresenting data is not going to help anyone in anyway. 

Less Testing is Not Good for Covid Control

Several news reports and long threads on Twitter have pointed out that the number of covid tests across the country have fallen over the last few days. The total number of tests peaked at 19.45 lakh on May 1. They have since fallen to 16.64 lakh as on May 4. Other than not identifying people who have covid and don’t know about it, this is also not good for Covid control 

The following chart plots the total number of tests conducted every day, since May 20, 2020.

Source: https://www.covid19india.org/

Not surprisingly, as the number of covid tests have come down, so have the number of new covid cases. As of April 30, the total number of new covid cases was at 4.02 lakh, with the tests being at 19.2 lakh. They fell to 3.56 lakh as of May 3, when the number of tests fell to 15.05 lakh. As of May 4, the number of new tests stood at 16.64 lakhs, with fresh covid cases being at 3.83 lakh.

The following chart plots the fresh covid cases every day since January 30, 2020.

Source: https://www.covid19india.org/   

The fact that India hasn’t been testing enough has been true for a while now. As Bhramar Mukherjee, Soumik Purkayastha, Maxwell Salvatore and Swapnil Mishra write in The Hindu: “While testing and cases have grown at a comparable rate in the US, in India the growth in reported cases on an average has been nearly five times higher than the growth in testing. India is not testing enough.”

For the Indian case, the data for the period March 28-April 27 has been used, during which much of the recent surge in the number of covid cases has happened.

If we were to follow this method for the period between March 28 and May 4 (the latest data available), we get a similar kind of result. The number of fresh cases has risen at an average weekly rate of 45.98%, whereas testing has grown at 10.67%. This is in line with the point Mukherjee and her co-writers made in their piece in The Hindu. (Of course, it is also obvious looking at the slopes of the curves in the two charts).

If we look at a slightly longer time frame starting from March 1 and up to May 4, the average weekly growth in fresh cases stands at 43.58%, whereas the average weekly growth in number of tests is at 10.31%.

So, what does all this really mean? Let’s look at it pointwise.

1) Low testing leads to a lower number of fresh covid cases. This shows the central government and state governments where this is playing out in good light. With a lower number of fresh cases, they can claim that they are getting the pandemic under control.

2) With the number of cases falling, it also leads to a fall in what is referred to as the reproduction number. As Adam Kucharski writes in The Rules of Contagion, the reproduction number is “the number of new infections we’d expect a typical infectious person to generate on average”.

An estimate made by Sitabhra Sinha from the Institute of Mathematical Sciences in Chennai suggests that the reproduction number for India dropped to 1.16 for the week ending May 3. This is the lowest since March 19, when it was 1.19. Hence, data suggests that the spread of the infection is slowing down, with an average covid patient infecting a lesser number of individuals around him.

Of course, the question is whether this is a genuine drop or simply another manifestation of not enough tests being carried out.

3) The advantage of testing more is that more people who have covid can be identified quickly. This improves the chances of people surviving the disease. But then this is not the only issue at hand, for the government.

As Ryan A Bourne writes in Economics in One Virus: “As economist Alex Tabarrok has explained, there’s good reason to think that there is an inverted-U shape of Covid-19 cases as testing numbers increase. At first, conducting more tests leads to finding additional cases.” Of course, this makes governments look bad in the short run. And governments obsessed with narrative want to control the growing number of fresh covid cases, this way or that way.  

4) Other than increasing the chances of survival, testing also slows down the spread of the epidemic. As Bourne writes: “When testing is widespread and regular enough, conducting more tests actually reduces Covid-19 cases…[as]… potentially infectious people can isolate themselves immediately and notify those they have been in contact with sooner.”

What this does is it minimizes “the window of transmission between people becoming infectious and ultimately isolating—the time the person would likely be out spreading the disease.”

It leads to a genuine slowdown in the transmission of the disease and not just a slowdown at the data level. Hence, it is important that the governments keep encouraging testing.

Dancing in the Dark

It’s been four weeks since I have stepped out of the one-room kitchen apartment in central Mumbai that I live in. Of course, that is if you ignore the few times I have had to go down to collect some stuff that was being home-delivered.

The building that I stay in is right on the road that goes to one end of the Bandra-Worli Sealink, which connects the island city to its suburbs, and given that, it is normally buzzing with some traffic 24/7. But the traffic has been missing over the last few weeks, as Mumbai remains under a lockdown to control the second wave of Covid.

In the silence that surrounds me, I can hear the birds chirping for once, like I could the same time last year. For some reason, the dogs are barking more than they usually do. May be they are not being fed as well as they usually are, as people continue to stay at home.

The ground behind my apartment isn’t noisy anymore with kids and adults not playing cricket. But the sirens of emergency ambulances dashing across the city can be heard loud and clear, any time of the day.

The good part is there is less traffic on the roads, and they can get to the hospitals much faster.

What I can also hear loud and clear is the buzzing of my phone. The SOS cries on Twitter and Facebook have been going up by the day. People have been asking for help, even begging in some cases, for hospital beds, oxygen cylinders and all kinds of medicines.

As more and more cries for help hit social media, the responses seem to be coming down. I guess people are either getting comfortably numb or there is only so much that they can do.

Also, it’s finally hit me that quite a few families living in apartments around me are dysfunctional, perhaps they always were, and have now finally had the time to fight it out and figure it out. Of course, given how close we live to one another, noise travels from one apartment to another.

In all this, the father and son duo, who are my next-door neighbours, continue to play cricket on the verandah, with the father asking the son to bowl just as bowlers bowl in the IPL cricket tournament that is currently on. Who would have thought that IPL would happen during a pandemic and become a moral issue?

But then if capitalism is not a moral issue, what is?

The slumdwellers continue to drag water in buckets placed on a board with wheels, something very peculiar to Mumbai, and very difficult to visualise, unless you have seen it.

The grocery store and vegetable vendor I get my supplies from have become technologically savvy. They now take orders on WhatsApp and accept payments on Google Pay.

And that’s the beauty of capitalism, people adapt to make life easy for others and profitable for themselves. But when they overdo it, it becomes a moral issue.

In one way, everything has changed in the world that I live in. In another, nothing has.

The young guy, living in an apartment below my floor, continues to blast Bruce Springsteen. The Boss is singing Dancing in the Dark.

Messages keeps gettin’ clearer
Radio’s on and I’m movin’ ‘round my place
I check my look in the mirror
Wanna change my clothes, my hair, my face
Man, I ain’t gettin’ nowhere
I’m just livin’ in a dump like this
There’s somethin’ happenin’ somewhere.”

Each time he gets to singing Man, I’m just tired and bored with myself, I cannot help but wonder why this song hasn’t become an anthem for the times that we live in.

Bored, tired, jaded and hopeless, that’s how I feel right now.

And perhaps so do many others, who are waiting it out.

This piece originally appeared in the Khaleej Times under a different headline. 

Women Are Bearing the Brunt of India’s Unemployment Problem

This piece is an extension of a piece on unemployment I wrote sometime back. Nevertheless, you don’t have to read that piece in order to make sense of this.

Honestly, this is probably the most disturbing data driven piece that I have ever written, despite the fact that I started writing on the issue of unemployment more than half a decade back, when it wasn’t very fashionable to do so.

The brunt of India’s unemployment problem is being borne by women. This is not to say that the men are having an easy time. They aren’t, given that many more men enter the labour force than women.

Nevertheless, the proportion of women who are employed and get paid was low to start with, and it has become even lower over the years. This, at a time, when more and more women are going to school and college.

As the All India Survey of Higher Education for 2018-19 points out: “Total enrolment in higher education has been estimated to be 3.74 crore with 1.92 crore male and 1.82 crore female. Females constitute 48.6% of the total enrolment.” But all this education isn’t helping them find paid employment.

Let’s start with the unemployment rate for men and women. The following chart plots this data since January 2016.

Source: Centre for Monitoring Indian Economy.

The above chart tells us several interesting things.

1) The unemployment rate for women is significantly higher than that of men. In February 2021, the unemployment for women stood at 12.39% whereas for men it stood at 6.23%.

2) The unemployment rate for women in February 2021 is much lower than it was in January 2016, when Centre for Monitoring Indian Economy (CMIE) published the unemployment data for the first time. Have things improved? Keep reading to know the answer.

3) The peak unemployment rate for women during covid was 29.22% as of April 2020. The rate has fallen since to 12.39%, as of February 2021. Again, have things improved?

In order to answer the questions raised above, we need to understand how unemployment is defined. (For those who have read the earlier piece I wrote on unemployment, the next few paragraphs may seem like a repetition, which they are. I have repeated these paragraphs, simply because it is important for every piece to stand on its own, so that first time readers can also read and understand it easily).

A person is categorised as unemployed “because of a lack of job and where such a person is actively looking for a job”. The word to mark here is actively. Hence, a person can be categorised as unemployed only if he doesn’t have a job and is searching for one.

As the Centre for Monitoring Indian Economy (CMIE) puts it, a person categorised as unemployed, “should be unemployed on the date of the survey, should be actively looking for a job in the 100 hundred days (approximately three months) preceding the date of the survey and should be willing to take up the job if a job is found.”

They further point out: “A person is considered to be actively looking for a job if such a person has contacted potential employers for jobs, contacted employment agencies, placement agencies, appeared for job interviews, responded to job advertisements, online employment sites, made applications, submitted resumes to potential employers or reached out to family members, friends, teachers to look for jobs from them.”

To put it in short, waiting for a job offer to come, is not considered as actively looking for a job.

Let’s move on and plot the next two charts, the labour participation rate for men and women.

Source: Centre for Monitoring Indian Economy.

Source: Centre for Monitoring Indian Economy.

Before we interpret these charts, we first need to define what labour participation rate is. Labour participation rate is the ratio of the labour force to the population greater than 15 years of age. And what is the labour force? As per CMIE, labour force consists of persons who are of 15 years of age or more, and are employed, or are unemployed and are actively looking for a job.

Now we are in a position to interpret the above two charts. Let’s do that pointwise.

1) The labour participation rate for women is miniscule on the whole. In February 2021, it stood at 9.42%. What does this mean? It means that a very small proportion of women over the age of 15, are employed and get paid for it or are unemployed and are actively looking for. a job. And the tragic part is that this rate is falling. It was at 17.7% in May 2016. Since then it nearly halved.

2) The labour participation rate of men is considerably higher. It was 67.82% in February 2021, even though it has been falling. Hence, two in three men over the age of 15, are employed and are getting paid for it, or are unemployed and actively looking for a job. For women, this ratio is less than one in ten. That’s the difference between the two sexes and it’s huge. 

3) Urban women are in a much worse position on this front. The labour participation rate for urban women stood at 6.56% in February 2021. The rate had peaked at 16.58% in August 2016 and has been falling ever since. What does this mean? It means that it is more difficult for a woman to be employed and get paid, if she is in urban India than in comparison to rural India.

Also, the dramatic fall in the rate since August 2016, tells us that once a woman loses a job or a source of income, it is very difficult for her to get it back. And finally, very few women in urban India are stepping out of their homes to go to work and get paid for it. This has only increased post the spread of covid. The labour participation rate for women was 9.92% in January 2020. It’s not at 6.56%.

4) Now comes the worst part. Between January 2016 and February 2021, the number of women greater than 15 years of age has gone up by 5.41 crore to 49.49 crore. Hence, the number of women who have entered the working age population has gone up by 12.26% (5.41 crore expressed as a percentage of 49.49 crore). On the other hand, the female labour force, has shrunk by 2.75 crore to 4.66 crore. In January 2016, it was at 7.41 crore. This is a collapse of 37% (2.75 crore expressed as a percentage of 7.41 crore).

Let me just repeat this again. While the working age population for women over the last five years has gone up by 12.26%, the female labour force has collapsed by 37.11%. This also explains the fall in unemployment rate for women, given that much fewer women are actively looking for a job. Many women who haven’t been able to find jobs, have stopped actively looking and simply dropped out of the labour force.

Economists have struggled to come up with an explanation for this phenomenon. One possible explanation lies in the fact that the number of jobs available haven’t grown at the pace that could accommodate the new individuals, both men and women, entering the workforce. Hence, in a patriarchal society, men in deciding positions, have offered jobs to other men, forcing women who have searched and not found jobs to stop actively looking for a job and drop out of the labour force altogether.

5) Let’s take a look at the overall population. The working age population, between January 2016 and February 2021, has gone up from 93.85 crore to 105.8 crore, this implies an increase of 11.95 crore. Nevertheless, the number of people employed or unemployed and looking for a job, that is the total labour force, has fallen from 44.76 crore to 42.85 crore, or by 1.91 crore.

Sothe working age population has increased by 11.95 crore between May 2016 and February 2021, but the total labour force as such has fallen by 1.91 crore. What does this really mean?

While, the total labour force has shrunk by 1.91 crore, 2.75 crore women have dropped out of it. This basically means that the number of men in the labour force has gone up.

Hence, the brunt of India’s unemployment problem is being borne by women. Women who lose their jobs find it difficult to find a new one and over a period of time simply drop out of the labour force. Many women who enter the labour force and actively look for jobs, are unable to find one and eventually stop searching and drop out of the labour force.

Given that chances of men finding a job are higher, they continue to look for a job and the situation is not as bad as it is for women. Between January 2016 and February 2021, number of men who crossed the age of 15 and entered the working age population, increased by 6.54 crore to 56.30 crore.

During the same time, the number of men entering the labour force (that is either they were employed or were unemployed and actively looking for a job) increased by 83.62 lakh to 38.19 crore. Hence, in this case of men, the labour force at least hasn’t shrunk.

6) Given that more and more women are dropping out of the labour force, it makes it easier for the men who don’t drop out of the labour force to find a job, from the opportunities that come up. (I am using the word easier here and not easy. Kindly appreciate the difference between the two).

7) Urban women are likely to be more educated, but their labour participation rate is very low. Hence, what that means is that they are unable to utilise their education to work and earn money in the process.

8) Now let’s take a look at how things have been post-covid.  In January 2020, before covid had struck, the working age population had  stood at 103.13 crore. By February 2021, this had jumped to 105.8 crore, a jump of 2.67 crore. Meanwhile, the labour force as of January 2020 stood at 44.24 crore. It has since shrunk to 42.85 crore, by 1.39 crore. So, post-covid, the working age population has gone up by 2.67 crore, but the labour force has shrunk by 1.39 crore.

How have the women done on this front? The working age population post covid for women has gone up by 92.23 lakh whereas the labour force has shrunk by 78.03 lakh. Again, more women have dropped out of the labour force than men, given that the labour force has shrunk overall by 1.39 crore. Also, do keep in mind that the fact that a lower number and proportion of women enter the labour force in the first place.

To conclude, the world celebrated the international women’s day a few days back (on March 8). On that day, the corporates and the government institutions talked about the importance of the women who worked for them. The social media influencers talked about women. Many women talked about what it means for them to be a woman.

But almost none of them talked about one of the most important issues at hand, the fact that Indian women are bearing the brunt of India’s unemployment problem.

If you are reading this(man or woman) please share it with your friends and family. The first step towards solving any problem is knowing and acknowledging that it exists.