Why is India, the world’s No 1 vaccine maker, struggling to inoculate its own people against the coronavirus?
- Earlier this year, New Delhi thought it had the pandemic under control as it balanced a domestic inoculation drive with selling or donating jabs as part of its vaccine diplomacy
- But a record-breaking wave of new cases and the limits of its focus on home-grown vaccines mean it now produces too few doses to meet its target of 4 million jabs per month
The South Asian nation needs around 120 million doses per month to maintain its targeted average vaccination rate of around 4 million a day, but it is making only 65 million doses every month. How did it end up with this massive shortfall? And why, after a good start, are participants in India’s vaccination drive turning up at clinics for a jab only to be met with a closed door and a sign saying “No vaccines available”?
Until recently, India was able to manage the delicate balance between inoculating its own people and selling or giving vaccines to other countries as part of its so-called vaccine diplomacy. It was not just supplying to its neighbours or low-income countries; the likes of Britain, Canada and Saudi Arabia were also waiting for supplies of Covishield, the AstraZeneca vaccine being manufactured under licence by the Serum Institute of India (SII).
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The positive momentum continued when its vaccination drive began that month; the government calculated it had enough jabs for a slow, staggered roll-out, supported by domestic vaccine production until later in the year when foreign vaccines might also become available after being approved by the drug regulator.
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The next month, members of Modi’s Bharatiya Janata Party (BJP) competed to fawn over what they dubbed his “masterful” handling of the pandemic, while other nations floundered. But the government had no idea it was about to be blindsided by a second wave that would sweep across the country towards the end of March, swamping hospitals and reversing the gains made in previous months.
“The government erroneously concluded in January that India had reached herd immunity and the pandemic was over,” said Professor K. Srinath Reddy, president of the Public Health Foundation of India (PHFI). “Instead, driven by variants, the virus resurged, this time in an open, bustling society where many people had abandoned all precautions.”
Suddenly, Reddy added, what had been planned as a “leisurely vaccination campaign in a non-pandemic situation” looked at risk of being scuttled by the tide of cases.
It dawned on the government, as Covid-19 roared across India, that its basket of two vaccines – the second is the home-grown inoculation Covaxin, developed by Bharat Biotech – was insufficient to support the gigantic scale of its vaccination drive.
Critics say the BJP was so infatuated with Covaxin – a source of great pride for the party that resonated perfectly with its policy of Atmanirbhar Bharat, or “self-reliant India” – that the government dropped the ball on the need for other vaccines to supplement the programme.
So quickly did the drug regulator give emergency-use approval to Bharat Biotech, which had not even finished clinical trials of Covaxin when it was granted in January, that the BJP was accused of exploiting the vaccine to foster nationalism.
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But Bharat Biotech makes only 5 million doses per month. SII rolls out 60 million doses of Covishield per month. With India pushing daily inoculations up to 4 million, several states raised a hue and cry in early April about not having enough vaccines at a time when infections were surging. People began asking why so many vaccines were going abroad.
An earlier BJP boast that India had sent more vaccines abroad – 64 million between January and March – than it had used at home was now being used against it, with many questioning the government’s priorities.
Professor Giridhar Babu, head of life course epidemiology at the PHFI, last week told local media that India needed to give between 7 million and 10 million doses per day “if we want to make a dent in terms of reducing mortality”. “I don’t see that happening with the current availability of only two vaccines,” he said.
Realising it might need the bulk of SII’s production for domestic use – particularly after having opened up vaccinations to everyone over the age of 45 from April 1 – the government privately told the company not to export any vaccines. India has exported just 1.2 million doses this month.
“The cause of the shortages was complacency and this government believing its own hype,” political analyst Arati Jerath said. “It was laggard in ensuring the rapid production of vaccines, although India is the world’s vaccine powerhouse. Nor did it anticipate a second wave despite clear warnings and evidence from Europe and the US. A total underestimation.”
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Jerath said Modi had realised he was in danger of appearing to be failing his own citizens, but it was already too late. While both SII and Bharat Biotech have asked the government for funds to expand their manufacturing facilities – with SII asking for US$400 million to raise its monthly Covishield production capacity to 100 million doses by the end of next month – the government has yet to make the decision.
Some analysts say the price of 150 rupees (US$2) per dose that the government agreed to pay the SII, instead of the 250 rupees (US$3.30) the company had asked for, has left the SII with a very slight profit or none at all for investing in new production capacity.
“The government has given no decision, and I am hearing from my source that it is reluctant to clear public funds for this expansion, and these companies don’t want to take the risk of bank loans,” said T. Sundararaman, global coordinator of the People’s Health Movement network.
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Another reason for the current shortage is the government’s overreliance on two home-made vaccines while failing to accelerate the approval of foreign vaccines such as those made by Pfizer, Moderna, Johnson & Johnson, and Russia’s Sputnik V.
While the Modi administration rushed to approve Bharat Biotech, the drug regulator insisted that foreign drug companies needed to go through time-consuming bridging trials in India before they could be approved.
“That was short-sighted,” Sundaraman said. “The Russian Sputnik vaccine could have been approved months ago and production could have been well under way by now. There has been no focus either on the need to scale up domestic production massively or approve foreign vaccines.”
Some Indians were incredulous at the demand for bridging trials here. “Why not trust a vaccine that’s been through every regulatory hoop in its own country and an advanced country at that?” asked Mumbai-based architect Vikram Bakshi. “It’s disappointing the government didn’t do some simple vaccine arithmetic early on and realise that two vaccines would not be enough for our population. We have lost too much time.”
Only on Tuesday did India belatedly decide to fast track vaccine imports, with Sputnik V set to be the first to arrive. The wait for the others will be longer as the manufacturers are already overcommitted to other governments.
To date, India has vaccinated more than 115 million of its population of 1.4 billion people – and millions of Indians due for the second dose in the coming weeks are wondering if another jab will be available. At this rate, it will take until the end of 2023 to vaccinate the entire country, analysts say – meaning the world’s largest manufacturer of vaccines may end up being one of the last to inoculate its own people.
