How Centre's botched vaccine policy has come back to bite India

Bhutan started its vaccination drive in late March, and within a month, it was able to give the life saving jab to almost five lakh people, which is 64 per cent of its adult population. That Bhutan became one of the fastest countries to vaccinate its adult population may be because of a good vaccination strategy, but it hinged on the gift of 5.5 lakh doses of Covishield from India over two instalments, in January and March. Over the next few weeks, Bhutan will start its second round, but the uncertainty over supplies from India, given the explosive second wave and its vaccine demands locally, has the country worried.

Another six lakh doses to Bhutan, a vital country for India diplomatically, may seem doable, even in the present constrained situation. However, vaccine supplies overseas, under the much tomtommed Vaccine Maitri programme came to a screeching halt in end March, once the caseload began rising back home and Indians, awakening from their initial apathy or scepticism for the shots, began to clamour for them. The last doses India sent out were to Albania and Syria, under the COVAX programme (a global initiative to provide vaccines to needy countries). The last commercial consignment was to Palestine on March 29. There is no clarity in how the country will deal with fulfilling commitents internationally.

“As things got tough, we spoke to the world and said we tried our best to live up to our committments, but please understand that we have a very serious situation at home and most countries understand that,” said External Affairs Minister S. Jaishankar at an event recently. Sources in the government say there is no talk on when Vaccine Maitri will resume.

After its grandstanding over the past year over its capacities to vaccinate the world, India now finds itself in a situation where it not only has to answer other nations who were promised doses—commercial and gratis—but also has to answer for the shutters-down boards at centres across the country. For even as it became apparent that demand was far outstripping supply, the Centre opened up the vaccination of all programme, despite acknowledging openly it was not “scientific”. It put the onus on the states, which had been clamouring for universal adult vaccination, to run the programme for the 18-44 age group, with no central subsidies. States and private institutions can negotiate packages with manufacturers individually.

Thus, a so-far smoothly running—if not drawing enough footfalls—programme ended up becoming a confusing one with differential pricing, leaving the poor floundering. Some states announced free vaccination for all, others haven't, and the supply shortage has made booking a slot, a crazy exercise. The tech-savvy stay up late nights, when the slots are updated, jumping between the CoWin and Aarogya Setu apps, and hoping to strike lucky. For others, this is yet another way of being edged out of a system where differential pricing has already undemocratised access.

The Centre has washed its hands of the mess, with Union Health Minister Dr Harsh Vardhan saying states were clamouring for universal vaccination, so why complain now. It restricts its committment to the 45+ group, and says there is enough stock of vaccines with states for innoculating this group. First-hand experience, however, shows how many centres are at a hand-to-mouth existence with doses. Ironically, where earlier vaccines went waste for want of people, today, the queues are long, vaccines limited. Some states have added to the confusion by diverting central allocations, made for the 45+ populations, to the younger age group. Centrally-procured vaccines are lower priced than the rates for states. The Centre has also clearly told the Supreme Court that there is no need for judicial interference in the vaccination policy, and that its overzealousness could lead to unintended and unforseen consequences. Again, the irony is unmissable, given the consequences of the Centre's vaccination policy so far.

Adar Poonawalla, head of Serum Institute of India, which accepted more international orders than it could handle, given the second surge in India, has spoken out in the UK about pressures and threats, further dimming India's international image. Poonawala may have bitten off more than he could chew, with a massive pre-order from the COVAX initiative as well as from foreign partners. He is scouting for production sites out of India, too, now. The Centre has distanced itself from the international commercial orders SII and Bharat Biotech undertook, saying those are private deals. Doublespeak, for when Vaccine Maitri was on, commercial consignments were shown as part of the diplomatic outreach.

China, with its robust production and supply chains, has eased itself into the space India was creating, specially in the neighbourhood. It has set up a consortium of nearby countries for “vaccine coordination”; India doesn't even recognise this initiative.

Charity, they say, begins at home. Did India go woefully wrong in not securing enough vaccines for its own use (at least the 45+ group), before opening up its pharmacy to the world? The vaccines are manufactured in the private sector, said noted virologist Gagandeep Kang. “In the absence of any pre-orders from India, the two companies took orders from foreign customers. The Centre, while easing rules to facilitate production ramp-up, did not place pre-orders. In fact, it placed its first order with SII on January 11, and rolled out the first vaccination phase on January 16.”

The country also took time in approving use of vaccines manufactured in other countries, perhaps in the misguided notion of giving a boost to local industry and earn the always welcome forex.

The result was the vaccine shortage at home. It was only in mid-April that it made announcements to allow vaccines which have been approved by regulatory authorites of certain countries or the World Health Organisation, without clinical trials in India. However, there hasn't been any import yet. The only vaccine which has come to India is the Russian Sputnik (1.5 lakh doses), but it is not in the market, as its partner Dr Reddy's Laboratories works out the commercial roll-out. Now, the WHO has given emergency approval for a Chinese vaccine developed by Beijing Institute of Biologal Products. If it gets into the COVAX procurement, it could find its way to India, a big beneficiary. Then, the tables will surely have turned.

To be fair though, the “ferocity of the second wave was unprecedented”, as prinicpal scientific adviser to the government K. VijayRaghavan said. While he and other technocrats in the government say that they expected a tamer second surge, virologists had been warning otherwise, pointing towards other countries, most of which were worse hit in the second round.

The decision to open up vaccination for all was more the result of Centre-state squabbles than any greater ideal. Ever since the vaccination rolled out, there has been a tug-of-war with non-BJP-run states and the Centre. Delhi Chief Minister Arvind Kejriwal, while mentioning his plans for vaccinating the city under three months, says he needs 2.6 crore doses at the rate of 85 lakh per month, not just for Delhiites, but also for those from satellite cities who come here for vaccination. The undercurrent was clear.

“We should not have opened up vaccination for all at this stage. In any country with a phased rollout, you go to the next group only after a majority of the population in the previous has been covered,” said Kang. Even frontline and healthcare workers have not all been covered by the second dose, though they were the first groups to get the shots.

As of May 9, of the 95 lakh healthcare workers who got the first shot, only 64 lakh got the second. The gap between the two shots for frontline workers is 1.39 crore and 77 lakh. The Centre has consistently been blaming states, which were carrying out the innoculations, for poor coverage.

Now that vaccination is open for all, what can India do to salvage the situation? “We need to augment production capacity and make our systems resilient,” said Sachin Chaturvedi, director general of the thinktank Research and Information Systems, and author of Logic of Sharing. “We managed to up the production of generic drugs to meet global demand during the first wave; we now also have less dependancy on China for active pharmaceutical ingredients. For vaccines, our dependance on the US and Germany is high and we need to improve our capacity as well as make our dependence resilient.'' Chaturvedi noted that India and South Africa were early movers to demand that COVID-19-related inventions be freed from Intellectual Property restrictions. “We now have the support of several countries; the next round of World Trade Organisation meeting on this is at the end of the month.”

Kang suggests a pragmatic use of available vaccines. Since the infected carry antibodies for at least six months, the jabs of recovered patients should be dealyed for that period. The government now has unclear directives on it. The gap between the two shots can also be increased to ensure that more people get covered by the first shot, at least. And there is no doubt that production has to be increased manifold. Sooner or later, young adults and children will also need the jab, because though they may not get severe sickness, they are as good transmitters as the others.