COVID-19 Vaccine Coverage in India: A District-Level Analysis

Abstract

India implemented the largest COVID-19 vaccination drive in the world, through which it vaccinated the majority of its population. Lessons from the Indian COVID-19 vaccination experience can be invaluable for other LMICs as well as for preparedness for future outbreaks. Our study is designed to explore the factors associated with COVID-19 vaccination coverage in India at the district level. We used data from COVID-19 vaccination in India combined with several other administrative data to create a unique data set that facilitated a spatio–temporal exploratory analysis by uncovering the factors associated with vaccination rates across different vaccination phases and districts. We found evidence that past reported infection rates were positively correlated with COVID-19 vaccination outcomes. Past cumulative COVID-19 deaths as a proportion of district populations were associated with lower COVID-19 vaccination, but the percentage of past reported infection was positively correlated with first-dose COVID-19 vaccination, which might indicate a positive role of higher awareness created by a higher reported infection rate. Districts that on average had a higher population burden per health centre were likely to have lower COVID-19 vaccination rates. Vaccination rates were lower in rural areas relative to urban areas, whereas the association with literacy rate was positive. Districts with a higher percentage of children with complete immunisation were associated with higher COVID-19 vaccination, whereas low vaccination was observed in districts that had higher percentages of wasted children. COVID-19 vaccination was lower among pregnant and lactating women. Higher vaccination was observed among populations with higher blood pressure and hypertension (which were a few of the co–morbidities associated with COVID-19 infection).

Facilitators and barriers to the uptake of COVID-19 vaccine precaution dose among adult population: qualitative analysis across six different states of India

“…Accessibility to vaccination centers in the rural and tribal areas due to long hours of travel, poor road connectivity, and lack of transportation facilities were all identified as barriers. This finding was similar to a district-level analysis of COVID-19 vaccine coverage, where it was observed that districts where higher concentrations of marginalized communities lived had much lower vaccination rates ( 11 ). However, special initiatives were taken to ensure equitable access by the local panchayat and healthcare system, such as creation of mobile units, conducting camps in the evenings or in places nearest to where people lived.…”

Analyzing the emerging patterns of SARS‐CoV‐2 Omicron subvariants for the development of next‐gen vaccine: An observational study

“…India has efficiently mass vaccinated its majority population. The vaccination rate was lower in rural India as compared with urban 39 . Regions with high population burden per health center likely had lower vaccination rates.…”

“…The vaccination rate was lower in rural India as compared with urban. 39 Regions with high population burden per health center likely had lower vaccination rates. The vaccination was reportedly lower among the pregnant and the lactating.…”

Vaccination coverage against COVID-19 among rural population in Haryana, India: A cross-sectional study

“…Previous studies have reported that an increase in the proportion of people living in multidimensional poverty reduces COVID-19 vaccination coverage [25]. Also, vaccine hesitancy tends to be influenced by numerous factors like gender, education, occupation, and socio-economic status, which usually leads to a rural disadvantage [26][27][28].…”