A Vulnerability Index for Management of and Response to COVID-19 Epidemic in India

Background: COVID-19, like in other parts of the world, is spreading rapidly in India. Despite government’s efforts to contain the disease in the affected districts only, it has so far hit 558 out of 640 districts. There is a need to prepare a tool for district level planning and prioritisation for effective allocation of resources. This study provides a vulnerability index for identifying vulnerable geographies in India based on population characteristics. Methods: We computed a composite index of vulnerability at state and district levels based on 15 indicators across five domains – socioeconomic, demographic, housing and hygiene, epidemiological and health system. We used percentile ranking method to compute both domain specific and overall vulnerability and presented them spatially along with number of positive COVID-19 cases in districts. Findings: Nine of 30 large states - namely, Bihar, Madhya Pradesh, Telangana, Jharkhand, Uttar Pradesh, Maharashtra, West Bengal, Odisha and Gujarat - covering all the regions of the country except the north-east, were found to have high overall vulnerability (index value more than 0.75). These states also have high vulnerability as per several of the five domains. Although our intention is not to predict risk of infection for a district or a state, we see a reasonable connect between vulnerability and the current concentration of COVID-19 cases at the state level. Interpretation: The vulnerability index identifies vulnerable geographies in India as per five dimensions of vulnerability and help planners effectively prioritise the geographies for resource allocation and adopt risk mitigation strategies for better preparedness for and response to COVID-19 epidemic.Funding Statement: No funding was available for this work.Declaration of Interests: The authors declare no competing interest.