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India — The Union health ministry wrote to states on Tuesday, asking them to expedite the vaccination drive, and announced it has dispatched teams to states where Covid-19 cases are rising, as alarm grows over what looks like the beginning of India’s second wave of infections. The development now underscores more than ever the need to drastically scale up the vaccination process.

Data shows that the seven-day average of new cases across India dropped to its lowest on February 11, when it touched 10,988, but it has shown a sustained increase since then to reach 12,971 on Monday – a rise of 18%. This increase is fuelled in particular by Maharashtra, Punjab and Madhya Pradesh, where cases have grown 127%, 55% and 54% respectively.

The health ministry wrote to these states and two more, asking them to speed up vaccinations. Experts say it is now a race against time for India to begin a wave of vaccinations that will beat that of infections.

To do this, it may need to significantly review its approach, relaxing curbs to allow anyone who wants a dose to take it, let employers purchase in bulk to give to their staff, and allow more private involvement, including open market sales.

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“R(t) for India again on an upward trajectory crossing unity (1). If India could scale up Covid-19 testing so incredibly well with public-private partnership, why not follow that model for vaccine distribution? Don’t let the virus and its variants outpace the vaccines,” Bhramar Mukherjee, chair of biostatistics at the University of Michigan School of Public Health, said on Tuesday.

“In regions such as Maharashtra that are witnessing an increase in the number of cases and its neighbours, we should try to administer at least the first dose of the vaccine to all the people irrespective of age or profession. There is a need for faster immunisation in these areas as it will at least decrease the severity of the disease,” said Dr SK Sarin, director of the Institute of Liver and Biliary Sciences, who headed the Delhi government’s first committee on controlling and managing Covid-19 infections.

Over the last week, India has administered roughly 450,000 doses every day, roughly 52% of the target for each day based on the number of sessions held. For each session, 100 people are expected to get shots – on an average, 8,630 sessions were held daily last week.

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Officials have said that they expect to accelerate the drive to deliver 5 million doses a day. But, according to the government’s protocol, only those above the age of 50 or 60 will be the first to get doses come next month, when the first of the general public will be covered.

“There are various options being explored to involve the private sector as the government is looking at expanding the vaccination drive to reach 27 crore (270 million) people next month. This would mean more private hospitals and nursing homes opening up vaccination centres,” said Dr Randeep Guleria, director, All India Institute of Medical Sciences, Delhi.

Guleria added that one of the options to consider could also be roping in major employers. “There is a lot of interest from industries with a large number of people working, they could also be involved provided the capacity to vaccinate exists in the organisation,” he added.

India began its vaccination campaign on January 16 at a time when the epidemic was receding in the country. This gave the country a unique headway to build up an immune capital and potentially avoid a second wave, which in other countries has wreaked havoc.

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In the UK, for instance, the second wave began in early December and the country rolled out its vaccination programme around the same time. But the campaign was not fast enough to get ahead of the outbreak, and the country went on to experience its most devastating wave, which peaked three weeks later.

Hospitalisations and deaths have now been falling in the country, with officials attributing the improvement to vaccines and a lockdown.

In India, another expert said the country will still need to see how the process of vaccinating people in the general population pans out.

“The pace has to be picked up obviously and it will depend on factors such as vaccines opening up for general population beyond the essential services; and how many more Indian vaccines get regulatory approvals so that more cost-effective options open up,” said Dr K Srinath Reddy, founder, Public Health Foundation of India, while adding that the country may need to wait till April-May when there will be more vaccines approved.