The Vaccine's Last Mile Problem

India is racing to vaccinate its villages, including many in remote and desperately poor areas where suspicion of the government’s motives runs deep

- Upmanyu Trivedi, Chris Kay, and Malavika Kaur Makol

Outside a three-room concrete building coated in faded red paint, Neeral Kullu was waiting anxiously. The 35-year-old farmer had spent the late August morning walking across miles of jungle, dirt tracks, and lush fields to reach this makeshift vaccination clinic in Simdega, a rural district in Jharkand, one of India’s poorest states. At the entrance he was greeted by two white-coated nurses stationed at a small table laid out with syringes, Covid-19 vaccination cards, and paracetamol tablets. Still, Kullu was unsure he’d actually get an injection. The first time he’d tried, a couple of weeks earlier, fewer than five people had turned up, and he was told to come back the next day, because opening a precious 10-dose vial for so few recipients would be a waste. When he returned, a nurse told him his blood pressure was too high and sent him home.

On this visit, Kullu sheltered under a fig tree while he waited for his turn. His blood pressure was normal, but when a nurse tried to register him on the government’s vaccination tracking app, a new obstacle popped up: She couldn’t get a phone signal. Clutching her handset, she took five steps away. Still nothing. Then another five steps. Suddenly, a couple of small bars popped up on the screen. She could record Kullu’s shot. A few minutes later another nurse injected him with his first dose of AstraZeneca Plc’s Covid vaccine. Kullu, who wore a sky-blue polo shirt with a prominent tear at the chest, blue shorts, and rubber sandals, was elated. “The gods are supporting me today,” said the father of two, beaming.