Dear Prime Minister Modi, making COVID-19 vaccination free for people aged 45 and under will cause thousands of additional deaths.

On 7 June 2021 India’s Prime Minister Narendra Modi announced that from 21 June COVID-19 vaccination would be made free for people aged 45 and under [https://www.reuters.com/business/healthcare-pharmaceuticals/indias-modi-pm-announces-free-covid-19-vaccines-all-adults-2021-06-07/].

People in this age range had become eligible for vaccines in back in May, but (unlike people at older ages), were required to pay. At first sight, the new policy looks like the end of unfair discrimination against younger Indians. In his national address, Prime Minister Modi stated:

“Several voices were raised. Like why age groups were created for vaccination? On the other hand, someone said that why should the central government decide the age limit? There were some voices also that why are the elderly being vaccinated earlier?” [https://pib.gov.in/PressReleseDetail.aspx?PRID=1726112].

Also, there has been widespread criticism that many people in India have struggled to pay for COVID-19 vaccination and that this has led to a high degree of inequality [https://www.independent.co.uk/news/vaccine-inequality-in-india-sends-many-falling-through-gaps-india-english-new-delhi-indians-uttar-pradesh-b1853958.html].

In fact, offering younger adults in India a free vaccine will do a lot more harm than good.

A high proportion of India’s population aged 60 or more have still to receive even one dose of any vaccine, despite having had theoretically free access since March. This is mainly because there has not been enough free vaccine to go round. People aged over 60 are at least 50 times more likely to die of a COVID-19 infection than those aged 45 or under. Put another way, you need to vaccinate 50 times as many people aged 18 to 45 to save one life, than if you vaccinate people aged 60 or more. Yet over recent weeks, the number of people aged under 45 getting a first vaccine dose has been substantially higher than the number aged 60 or more [https://pubmed.ncbi.nlm.nih.gov/34108191/]. Despite requiring them to pay, vaccine roll-out for younger adults in India is proceeding faster than among older people.

It is not possible to give reliable estimate of how many lives in India will be unnecessarily lost due to this misguided approach to age prioritisation. According to official reports, over 18,000 people died due to COVID-19 last week. No data are available on the distribution of these deaths across age categories and international experts indicate the true numbers of COVID-19 deaths are in fact much higher [http://www.healthdata.org/print/8660]. As such, the weekly number of deaths resulting from denying vaccination to those at greatest risk will be in the thousands rather than the hundreds.

The majority of Indians of all ages will struggle to access free vaccines, regardless of Prime Ministerial Promises. And the majority of poor Indians of all ages will struggle to pay for their own. And this new policy means the majority of vaccinations will continue to be provided to those least in need.