April was the cruelest month for India. Along with the spring rains, it brought the deadly second wave of COVID-19. People died in their thousands every day without medical care as overflowing hospitals turned away patients gasping for air. All of a sudden, India found itself at the epicentre of a global pandemic.
Towards the end of May, as the daily case numbers of the devastating second wave of COVID-19 started to fall, Prakash Javdekar, the union minister for information and broadcasting, came out with an announcement: 108 crore Indians will be vaccinated by the end of the year 2021.
The message was aimed at reassuring a war-weary populace that was battling a scourge which raged with relentless fury. The import was that another outbreak like this would be averted at any cost.
The surprising announcement, however, has failed to convince experts. The task of immunising the entire, 1.4 billion-strong population appeared daunting. How realistic was such a target in a country that barely managed to immunize 5% of its population after six months of efforts? Where will India get the estimated 216 crore vaccine doses required for this process, they wondered.
But policymakers have brushed aside such concerns.
“Two billion doses will be made in the country in five months for India and for people of India,” said VK Paul, a member of NITI Aayog — India’s public policy think tank — and the chairman of National Expert Group on Vaccine Administration for COVID-19 (NEGVAC), at a press conference.
Miles to go..
On May 12, India’s health minister Dr Harsh Vardhan said the country’s vaccine production is likely to be at 8 crore doses in May (26.6 lakh doses/day) and 9 crore doses in June (30 lakh doses/day).
Responding to the Supreme Court’s suo motu examination on Government of India’s handling of the second wave, the center had, three days earlier, assured the court that the total onshore manufacturing capacity of the Covishield, Covaxin and Sputnik V vaccines would cumulatively cross 14 crore dose/month mark by July 2021.
Critics slammed the claims saying that they are just fantasy. According to them, simple arithmetic can prove that achieving the target within the next six months is extremely difficult, if not downright impossible. If the government’s goal is to produce 216 crore doses between August and December 2021 to inoculate the country’s population, it will have to make 43.2 crore doses a month and 1.44 crore doses per day beginning August. To reach these numbers India will have to ramp up daily vaccine production in August to almost 5 times the present manufacturing capacity from June.
Perhaps with these figures in mind, India has waived off mandatory “bridge trials” as a part of its efforts to remove the regulatory barriers standing in the way of vaccine imports. In addition, the government is in discussion to grant foreign COVID-19 vaccine makers such as Pfizer Inc protection against legal liability, reports said.
Critics are of the view that India could have avoided this last-minute rush and the running after vaccine suppliers to accede to their demands if it had done proper planning and fact-checking. Instead of finding ways to stockpile vaccines, the government grew “complacent” and declared victory after the first wave, they allege.
Even though still largely unpredictable, the course of the pandemic is now clearer than earlier. It is now known that it follows a cyclical pattern through repeated outbreaks. There is hardly any place in the world where COVID-19 can be claimed to have been brought under full control after the initial outbreak itself. Subsequent surges in the form of second, third, fourth, and even fifth waves are found everywhere. The only variation seems to be in the intensity. The surges can be more, or less, lethal, depending on how the country has been dealing with the pandemic.
Critics assert that India either overlooked these aspects or got it all wrong, leading to “gross mismanagement” and a more grievous second COVID-19 wave. Day-to-day infections surged to dizzying highs leading to a total collapse of the country’s already challenged healthcare system. Hospitals, already understaffed, were quickly overwhelmed with patients. Securing a bed in a hospital was like winning a lucky draw. As people jostled for beds, critical patients lay gasping for oxygen due to a severe shortage of the life-sustaining gas. Mortuaries and crematoria overflowed with corpses as COVID-19 patients died in their thousands. Funeral pyres burnt on deserted grounds and maidans. Unburied dead bodies floated in scores in the river Ganges–India’s most sacred river.
“A crisis is inevitable in any healthcare delivery system if case counts become too high to handle regardless of however sound they actually are,” said an epidemiologist preferring anonymity. “We have seen that happening even in places well-known for their robust healthcare infrastructure when the pandemic-caused infections reached astoundingly high numbers.”
He pointed out that even in the US, the health system was thrown totally out of gear in many states during the pandemic. Italy too had a terrible healthcare crisis. This will be the story anywhere when the system gets overloaded, he added.
However, the similarities end there, he pointed out. These countries went all out stockpiling vaccine doses from all potential sources before the next wave, realising that vaccination was the only way out. The nations with home-grown vaccine makers lent their support to these companies to ensure adequate doses for the entire population. Even countries without vaccine-making capabilities forged deals with actual and potential manufacturers to secure the first batches of the vaccine. The need was urgent.
Today, one and a half years into the pandemic and a little over six months after the first COVID-19 vaccine was greenlighted, over 50% of the population in about half a dozen countries are fully vaccinated, and at least half the population in another two dozen countries have received at least one dose of vaccine.
As of mid-June, nearly 45 percent of the adults in France, more than 50 percent in the United States and more than 60 percent in Britain have been inoculated against the virus. In Asia, about 20 percent have received at least one dose. Many countries have started immunizing their people on a war-footing as the threat of new variants increases. China, Japan, South Korea and Australia are among those that have seen a sharp rise in inoculations recently.
The story of India, home to the world’s largest vaccine producing industry, is one of missed opportunities. Despite starting a highly publicized vaccination programme in January, the country could fully vaccinate less than 5% of the population, and partially vaccinate about 16%, in the first six months.
Moreover, the vaccination rate dropped by 28.7% in May compared to April due to a shortage of shots. In fact, despite the shortage, the central government announced that it was expanding the vaccination programme to everyone above 18 years of age, resulting in chaotic conditions at many vaccine centers.
A wasted opportunity?
So, where did the math go wrong? Before COVID-19, India was the largest supplier of vaccines in the world. More than 70% of the vaccine was supplied by Indian companies.
“India has about 50 companies that can produce vaccines,” said a microbiologist based in Delhi, who too did not want to go on record. “With planning and support, India could not only have avoided the crippling shortage for its own people, but also for others,” she added.
According to Central Drugs Standard Control Organisation (CDSCO), India has 21 vaccine manufacturers and the combined licensed production capacity is around 8 billion doses per annum.
The inactivated virus technology used in Bharat Bio’s Covaxin started in India in Haffkine Institute, Mumbai and has a history of almost 100 years.
There are more than 30 companies that have the necessary knowhow and capacity for manufacturing adenovirus-based vaccines such as the Oxford-AstraZeneca shot and Russia’s Sputnik V.
In this regard, apart from Oxford-AstraZeneca’s tie-up with Serum Institute, five Indian biologic companies have tied up with Russia’s Gamaleya Research Institute for Epidemiology and Microbiology for producing 850 million doses of Sputnik V vaccine. Similarly, Biologic E has a tie-up with Johnson & Johnson for producing 400 million doses of its single-shot vaccine already approved in the US. Serum Institute also has an agreement with Novavax, US for producing one billion doses Covovax (NVX-CoV2373) in India.
Obviously, India’s great vaccine manufacturing prowess made the country better placed to fight the pandemic. Nonetheless, the country today finds itself in the middle of a debacle.
Critics ask why didn’t India take the obvious steps that all countries with indigenous manufacturing capacity resorted to, such as placing advance orders for vaccines, extending credit to vaccine manufacturers to expand capacity, leveraging existing public sector units and roping in other producers to manufacture Covaxin, a vaccine developed with the help of state-owned ICMR.
They point out that India should have used the nearly five-month gap between the two waves to put in place emergency hospitals, oxygen, other medical support systems and accelerate vaccine production.
The reason for India’s debacle perhaps lies in the low death rates reported during the first wave, which in turn fed a sense of complacency in policy-making circles and the people in general.
Hurting your friends
Even as India commenced its COVID-19 immunization, touted as the ‘world’s biggest’, in mid-January, the country also started shipping vaccines to neighboring countries like Bangladesh and Sri Lanka and others in Africa, Latin America and the Caribbean region.
As of 22 March 2021, India had dispatched 60.4 million doses to over 76 countries through different modalities, including grants in aid, gifts, commercial contracts and through the WHO – Gavi COVAX alliance.
Addressing the 2021 Annual Davos Dialogues of the World Economic Forum virtually, PM Modi claimed: “India has been successful in saving so many lives, we saved the entire humanity from a big tragedy.”
However, as the second wave lashed across the country in April, India tightened its grip on vaccine exports.
Particularly hit hard was COVAX, the global initiative set for equitable access to COVID-19 vaccines. SII had committed one billion vials by the end of 2021. As of February end, Serum Institute could supply only 28 million doses to COVAX and there hasn’t been any further shipments.
According to UNICEF, SII is on track for a shortfall of 180 million doses in its commitments up to June and another 200 million by December. This is a disaster for all the countries that had banked on the COVAX platform for their vaccines.
No less than 91 countries have been severely impacted by India’s ban on the export of coronavirus vaccines, informed WHO officials.
The export curbs have not helped to significantly improve the country’s vaccine stockpiles, and have proved to be “too little, too late”.
Experts are of the opinion that India could not leverage its strengths in vaccine manufacturing because of poor response to the crisis and confusion within the government.
“The government seemed much keener on ensuring credit for what it was doing rather than ensuring that the pandemic does not spread in India. The result was a certain amount of schizophrenia,” remarked noted economist and Nobel laureate Amartya Sen while speaking at an event organised by Rashtra Seva Dal in June.
The government appeared to be “trying to generate credit” by boasting that India would save the world, while allowing the “problem to develop and have a grip over the lives” of Indians, added the professor of economics and philosophy at Harvard University.
The government, for now, maintains that it will complete the mission of innoculating everyone by the end of the year.
“Vaccines will be available for all as we move forward,” said VK Paul of Niti Aayog when asked about the shortage of coronavirus vaccines in the country.