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So how has India's vaccination strategy really fared?

Using absolute data when it comes to total cases and deaths, but normalizing with respect to the population when it comes to vaccination is convenient use of data for a particular agenda, says Akhilesh Mishra.

Opinion So how has India's vaccination strategy really fared-VPN
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New Delhi, First Published May 26, 2021, 3:34 PM IST
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India's vaccination drive against the COVID-19 pandemic has attracted global attention. There are multiple reasons for this. India is the largest vaccine manufacturer in the world. 

In the last few years, especially under Prime Minister Narendra Modi government, India has demonstrated an unapparelled ability to reach the last mile in scale and speed, which has no peers. 

More than 423 million unbanked people were banked through Jan Dhan, more than 233 million uninsured people were insured in social security network through Jan Suraksha, and more than 288 million entrepreneurs were funded through collateral-free Mudra loans. 

The digital payments revolution launched in November 2016 has been another world-level success story. In 2020, India emerged as the world's biggest real-time payments market with more than 25 billion transactions. In just one month alone -- March 2021 -- more than 2.73 billion transactions took place through the revolutionary UPI framework with a total value of almost $80 billion.

So, when India announced the 'world's largest vaccination drive', there was naturally global interest in how India would go about it. So how has India fared? Let us explore some of the related issues and the questions that are being asked.

Is India's vaccination pace slower than the global standard?

As of May 25, 2021, India has administered 196.4 million doses. In countries reporting reliable data, only the United States has administered more doses than India. However, the US started its vaccination drive almost a month before India and therefore, in terms of the pace of vaccination, India has set the global benchmark as being the fastest. 

India reached the landmark of 170 million administered doses in 114 days; the US took 115 days while China did it in 119 days.

Is there a shortage of vaccines in India?

India is among the select few countries to manufacture its own vaccines. One vaccine -- Bharat Biotech's Covaxin -- is completely indigenously developed, while the other, Covishield, is also being manufactured in India. 

Very recently, a third vaccine, Sputnik, has been introduced. Nowhere in the world are the vaccines available off the shelf. If we go by the sheer volumes of vaccine doses administered in the time frame that India has done, there is no equivalent case of any country doing it faster. 

Indeed, given the manufacturing ability the world over, almost every other country is worse off than India. In a period when the pandemic is still raging, an argument like this may not be much succour, but in terms of practical realities, India's vaccine stocks in sheer volumes the highest in the world.

But is India way behind in percentage population covered?

Using absolute data when it comes to total cases and deaths, but normalizing with respect to the population when it comes to vaccination is convenient use of data for a particular agenda. The fact is, there exists a finite capacity of per day manufacturing of vaccines. 

That finite capacity has been expanded manifold in the last year, but it could not have been and has not been expanded infinitely. Therefore, given India's population, which is almost five times the size of the next most populous country, the per cent population coverage will always take a longer time to stack up.

The correct metric to track would be how India is faring in vaccinating its people as compared to the world manufacturing ability of vaccines.

Since January 16, 2021, the day India started its vaccination drive, the world minus China has administered 1,135 million doses. Out of this, India's share is 196.4 million -- a little over 17.3%.

Did India order enough vaccines in advance?

The question of ordering enough vaccines or not is relevant for countries that do not manufacture domestically and have to source is from outside. Barring the last few weeks when Sputnik started being used, the entire requirement of India was being fulfilled domestically.

In a time when very few countries are exporting vaccines to others as the pandemic is still raging, what is the worth of orders without securing an assured supply line? As an example, take Canada. It proactively ordered 338 million shots, enough to vaccinate its population five times over. Yet, how many doses has Canada actually managed to administer? Just over 21 million as of May 24, 2021.

How much does India, which 'only ordered 116 million shots' as per those questioning India's policy, perform in comparison? India has administered 196 million doses! This is almost twice its ordered quantity and almost ten times more than Canada! The fact is this is happened despite, as media sources reported, that Novavax, a company that India was banking on to produce vaccine doses, has been delayed for various reasons.

So, what was the use of all those 'orders' proactively made and what was the problem with India's lack of orders?

The fact is, with India's ability to produce millions of vaccine doses per month domestically and with exports banned, practically every dose produced by the 'world's largest vaccine producer' has, by default, been ordered by India and is for domestic consumption.

So, in essence, by its export ban, India has 'ordered' 2 billion shots for its own population already!

But why did India export vaccines?

India has administered over 196.4 million doses to its own citizens, while it has sent just about 66 million vaccine doses abroad. This means India's domestic vaccine doses administered are already more than three-fold than its exports. Out of these exports, only 10 million are those that were given as grants to other countries out of goodwill, for free. Many of these countries were small, without domestic resources and often did not have anyone else who was willing to help them on priority.

It cannot be that India wants support on the issues it raises at global platforms from these countries, and who have always stood by India no matter what, but will close its doors when other countries are in crisis!

About 35 million vaccine doses out of the total 66 million sent abroad were sent under contractual obligations. About 20 million vaccine doses were given to COVAX, an initiative run by the United Nations to vaccinate poor and vulnerable people in poor countries which had little or no access to vaccines. 

Most of India's vaccine exports were sent in February and March when the vaccination was going on for healthcare workers, frontline workers and senior citizens. These vaccines were, anyway, not being used for the general population.

When India did face problems with the second wave in April, the government stopped vaccine exports, and the world understood. It is because they had also seen how India kept its word when the situation was relatively more in control.

If India had stopped these vaccines from going out even before the second wave, very few countries would have come forward to help India when it was facing its own second wave! India produces vaccines indigenously, but it needs raw materials and other things from different countries. 

If India stopped vaccines another country had already ordered from going out, would such countries allow other raw materials to be shipped out of their countries to India? The questions raised on 'Vaccine Maitri' come from a lack of nuance and grasp on international realities.

What about expansion in domestic production capacity?

Covid-19 vaccine research started only last year. In a finite span of time, manufacturing capacity can be increased manifold. But it will still be a finite increase in the real world. An infinite increase in capacity in finite time is obviously unrealistic to expect.

So, what has been the capacity expansion?

Prime Minister Modi directed the government to play the role of investor, incubator, evaluator as well as a buyer so that production could be quickly scaled up.

Accordingly, financial, institutional, regulatory and legal help was provided to all manufacturers to quickly scale up production. India plans to administer 510 million doses by July 2021 end, and orders for the same have already been placed. With new vaccines in the process of approvals, by 2021 end, 2.16 billion doses of vaccines have been lined up. 

Meanwhile, a total of 12 private and public sector enterprise have tied up with Bharat Biotech -- the manufacturer of Covaxin -- and Dr Reddy's Laboratories -– the licensee for Sputnik vaccine -- to ramp up production manifold.

Vaccines approved by international drug regulators, such as the US FDA, have also been given fast track path in India. As and when they come, they will only add to the 2.16 billion doses pipeline.

What is the current status of the vaccination drive?

India's vaccination drive has progressed as per scientific protocol and WHO guidelines. The aim has been to first contain mortality and then prevent infections. 

Accordingly, from January 16 to February 1, health workers were prioritised; from February 2 to February 28, frontline workers were priority; from March 1, vaccination was opened for all above 60 years and those above 45 years and with comorbidities; from April 1, all above 45 years became eligible; and from May 1, all above 18 years are eligible for vaccination.

The vaccination process has now been opened for states as well as the private sector. More than 46,000 sites are administering vaccines, and in just 25 days since they became eligible, more than 28.6 million people between 18-44 have already been vaccinated.

The government of India has ensured a central channel, which will be 50% of all vaccines administered in India, that will always be free. The central government will procure these vaccines and give them to the state governments to administer to people free of cost. This will ensure that every poor person always has the option to get vaccinated for free.

At the same time, the balance 50% channel has been left open for state governments and private hospitals to devise their own vaccination drives as per their local needs and priorities.

What next?

In addition to the already assured domestic supply line, many foreign vaccine manufacturers are in an advanced stage of negotiations. They have been given deemed emergency approval in case they are approved by regulators such as the US FDA. 

This obviates the need for local bridging trials. Meanwhile, Bharat Biotech has been given approval for trials of its Covaxin vaccine for children below 18 years of age.

As India further scales up its manufacturing capacity and other vaccines in the pipeline, India is on its way to vaccinating enough people in time to tame the deadly virus.

The intensity of the second wave has also started subsiding, oxygen, hospital beds, and essential medical supplies have stabilised, and strict containment measures have been put in place. Over the course of the next few weeks, hopefully, the worst may be over.

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