BANGALORE - As India prepares to vaccinate its elderly population against the coronavirus from next Monday (March 1), public health officials are gearing up to tackle the immense logistics and still-prevalent pockets of vaccine hesitancy in the country of nearly 1.4 billion.

Minister of information and broadcasting Prakash Javadekar announced on Thursday that from the coming week, Indians over 60 years of age, as well as those over 45 with health problems that raise risks of severe Covid-19, can get their jabs at 20,000 private hospitals or 10,000 government-run vaccination centres.

The government centres will give free jabs. Private hospitals can charge 250 rupees (S$4.50) per vaccine dose, the government has said.

India's expansion of its vaccination drive is timely. The tumble in new infections is becoming a thing of the past, and the country might be poised for a new surge of Covid-19.

Late February's daily figure of more than 16,000 new cases is nowhere near last September's high of around 100,000 new cases a day. But as malls and schools open, buses and trains ply, and Indians abandon masks and social distancing, states like Kerala and Maharashtra are seeing infections spike. Nearly 200 Indians have also caught the more transmissible British, South African and Brazilian coronavirus strains.

"The virus has an ability to stage a comeback… so it's very important to vaccinate more people," said Dr Samiran Panda, a member of the national expert group on Covid-19 vaccines.

India started its vaccination drive on Jan 16, prioritising healthcare workers. It has a target of 300 million vaccinated by August, but so far, only 13.7 million doses have been given. Experts attribute the slow pace of about 390,000 jabs a day to organisational snags and worries over vaccine safety.

India has been administering two approved vaccines: Covishield, the AstraZeneca-Oxford vaccine manufactured by the Pune-based Serum Institute of India, and in smaller numbers, the indigenous Covaxin developed by Hyderabad-based Bharat Biotech.

Influential medical professionals have expressed concern over how Covaxin had been approved, and the government's opaqueness regarding side effects of Covishield. Rumours and fake information on social media also significantly hit the vaccine take-up rate.

"There has been a lot of discussion, although not all scientifically sound, about vaccine safety. I underline repeatedly that both vaccines are safe, safe, safe. No safety corner was cut before giving accelerated approvals," said Dr Panda, who is also the head epidemiologist at the Indian Council of Medical Research.

Thanks to the government's assurances and concerns about resurgent infections, vaccination is gathering speed and is bound to pick up further as senior citizens sign up.

The country's underfunded public health machinery will have to scale up fast.

Today, hospitals and medical colleges register their staff on a centralised government software application called CoWIN, which schedules each individual's time and location for vaccination. It also sends them an automated reminder message on their phone.

From this week, the CoWIN app will be open to 270 million senior citizens to register appointments for their jabs.

But a government doctor who managed the vaccination drive at a Mumbai hospital said that technical glitches in the app often brought everything to a stop.

"Multiple levels of officials can't log in at the same time, we can't register people manually, doctors don't get assigned slots, and messages don't go out on time," the Mumbai doctor said.

Mr R.K. Sharma, chairman of the government panel for Covid-19 vaccination, told The Quint he was aware of initial glitches, but attributed them to "issues with data," and not the technology.

"Our digital system is prepared for (10 million) Covid vaccinations per day without any problem," said Mr Sharma.

People will have the option of registering on site too, or booking appointments through 300,000 community service centres the government will set up.

Dr Panda believes that the primary challenge for India isn't logistics, but communication.

"Through the experience of rolling out vaccines for healthcare workers, we've realised that each state differs in preparedness and acceptance. We expect a similar heterogeneity for the above-60 population… A proper vaccine hesitancy mitigation plan needs to be framed to improve the uptake," he said.

The government was underlining three things in public messaging now, Dr Panda said: One, with three-quarters of Indians still unexposed, India has not achieved herd immunity. Two, Indians should not lower their guard just because there is a vaccine.

"Finally, wear face masks and don't throw lavish weddings and parties. This prevention tool is as important as a vaccine," said Dr Panda.

Q&A with Dr Samiran Panda on India's Covid-19 vaccination drive

Dr Samiran Panda, a member of the national expert group on Covid-19 vaccines, and head of the Epidemiology & Communicable Diseases Division of the Indian Council of Medical Research speaks to India correspondent Rohini Mohan about India's preparations as it expands its Covid-19 vaccination drive to people over 60.

Q: As India expands its vaccination drive to senior citizens, what's the greatest challenge?

A: Through the experience of rolling vaccines out for healthcare workers, we realised that states didn't have uniform performance. Odisha, Bihar and Uttarakhand performed well in acceptance by healthcare workers. But south Indian states mounted more resistance. We expect the same heterogeneity among the above-60 population. The reasons that influence the decision to take or not take the vaccine, will also differ between age groups. The reasons for vaccine hesitancy need to be understood so that appropriate interventions can be designed.

Q: What contributes to vaccine hesitancy in India?

A: About one-third (of the target group of healthcare workers) was ready to go get the vaccine as soon as it was ready. A second group was waiting and watching. The third group was influenced by some expert opinions in the media asking if the vaccines are safe. I underline repeatedly that both vaccines (approved for use in India) are safe, safe, safe. No safety corner was cut before giving accelerated approvals.

Q: Are the vaccines in India effective against the new virus strains?

A: Both vaccines (Covaxin and Covishield) should be able to tackle the UK and South Africa variants. About Brazil, we don't know for sure yet. First of all, limited numbers of other variants have been detected in India. Second, the new mutants will transmit through the same route as the currently circulating strain, so if we keep our guards up, we should be able to prevent the spread.

Q: How will the private sector be involved?

A: The vaccination drive will get a boost if the private sector is involved. But there should be a clear understanding that it is not a business opportunity. They should also not give a message that vaccine is everything so people then drop their guard. That will be a disaster.

Q: As India sees a Covid-19 surge, will vaccination help?

A: We are seeing an upwardly moving curve now, so it's very important to vaccinate. A good example is from Israel where because of the vaccination, there was a very impressive drop in the number of infections.

We shouldn't forget that both vaccines require two doses with a gap of 28 days. The immunity will kick in after 14 days of administration of the second dose. And the critical mass needs to be vaccinated, which won't happen overnight.

We should avoid mass gatherings, stop throwing large lavish weddings, and stop religious gatherings. And even in the name of elections (five states go to the polls this year), we cannot afford to lower our guard. We should join hands in maintaining Covid-appropriate behaviour while the vaccination programme is being rolled out.