How India frittered away vaccine gains

Ablack-and-white image of Rajkumari Amrit Kaur, Health Minister in Nehru’s Cabinet, receiving a box of penicillin at the Palam Airport surfaced on WhatsApp groups in February this year. The consignment was a gift from the Canadian Red Cross to fight infectious diseases. The picture was juxtaposed with the news of Canada seeking the Covid-19 vaccine from India in 2021. The allusion was that while India was dependent on western countries for medicines in 1947, those very donors are now depending on India for vaccines.

But, within a few weeks, there was a dramatic role reversal. The Ministry of External Affairs started sharing pictures of planeloads of medical supplies coming from dozens of countries. The shipments were rushed to distant locations straight from the airport, reminding one of the ‘ship-to-mouth years’ of food imports in the 1950s and 1960s.

How did a country which declared in the United Nations not long ago that it had exported more Covid-19 vaccines to countries across the globe than it had administered to its own people, turn into a vaccine-deficient country so rapidly? The answer is simple — due to lack of planning, along with too much bravado and politics.

Indian companies joined the Covid-19 vaccine race early on, drawing from their experience with developing a ‘pandemic-scale’ vaccine during the 2009 H1N1 pandemic. Using the seed strain supplied by the WHO, the Serum Institute of India, Bharat Biotech and Panacea Biotec developed H1N1 vaccines within 12 months. The Health Ministry supported them with Advance Market Commitments (AMCs) even though the spread of H1N1 in India was not alarming. The companies were also given Emergency Use Authorisation (EUA) from the national regulator.

All this incentivised vaccine production, helping India build a stockpile for a potential surge. Advance purchase commitment was critical in covering the risk of private companies.

In the interim, 1.5 million doses were imported from Sanofi-Pasteur to vaccinate healthcare workers in the worst-hit city of Pune.

The need and mechanism for creating a stockpile of vaccines in case of emergencies were reinforced in the National Vaccine Policy adopted in 2011.

For reasons best known to the Health Ministry, the pandemic template of 2009 was not immediately activated in 2020. The SII and Bharat Biotech, which contributed to the stockpiling exercise in 2009, anticipated advance purchase commitment this time too as the task at hand was more challenging than that at the time of H1N1.

In contrast, governments in the western world were pumping billions of dollars into vaccine development and helping companies through AMCs. They are now reaping the benefits with the bulk of their populations vaccinated and have been successful in bending the pandemic curve.

Even after Bharat Biotech announced its vaccine on June 29, 2020 and the SII signed up with AstraZeneca on June 4, 2020 to supply one billion doses to the global markets, the policymakers showed no alacrity to explore options like the AMCs and the need to mop up available production capacities.

Instead, the PM went on a solo three-city ‘vaccine tour’. Firm orders were placed only in early 2021, by which time the SII and Bharat Biotech had made commercial commitments to other countries. No efforts were made to expand the capacity of the two manufacturers or book spare capacity with other vaccine manufacturers (that were contracted by Russia to produce Sputnik V) or license Covaxin (jointly developed by Bharat Biotech and the ICMR) to public sector vaccine manufacturers.

The first meeting of the National Expert Group on Vaccine Administration for Covid-19, tasked with all aspects of vaccine delivery, including financing and licensing, took place on August 12, 2020. This was three months after the SII had signed up with international buyers. All that the expert group decided was that ‘India will leverage domestic vaccine manufacturing capacity and will also engage with all international players for early delivery of vaccines not only in India but also in low-and middle-income countries.’

Vaccine export was on the agenda even before the government had booked a single dose for the Indians. It was a classic case of misplaced priorities. The bravado continued as long as January 2021 when the vaccination drive began for healthcare workers. The Prime Minister spoke of ‘saving the lives of citizens of many countries by sending Covid vaccines there’ in his speech to the World Economic Forum (WEF) on January 28, 2021.

In addition, the government could never make up its mind on the vaccination rollout plan. Three days after the first meeting of the expert group (on August 15, 2020), Prime Minister Modi announced that the government had prepared ‘an outline to ramp up production of the vaccines and to make it available to each and every person in the shortest possible time.’

Was it the recommendation of the expert group to vaccinate all Indians, and did it prepare a plan between August 12 and 15 to procure two billion doses for ‘each and every’ Indian? Apparently not. Because soon thereafter, Health Minister Harsh Vardhan spoke of getting 400-500 million doses available by mid-2021, implying that all Indians would not be covered. On December 1, Health Secretary Rajesh Bhushan further contradicted the Prime Minister by stating that the government never spoke of vaccinating the entire population.

Between June 2020 — when it became clear that the two vaccines would be available in India — and April 2021, vaccine-related policymaking was in limbo.

Meanwhile, the ruling party politicised Bharat Biotech’s Covaxin by dubbing it a ‘swadeshi’ vaccine and projecting it as a personal achievement of the Prime Minister (BJP leaders in Delhi launched the Modi Tujhe Salaam campaign when the vaccination started). Free vaccines were promised in election campaigns and the MEA launched an extensive ‘Vaccine Maitri’ drive.

As shortages became apparent and public anger mounted with the second wave surging, several hurried steps were announced: schedules for different age groups, separate procurement by states, dual pricing for private and public sectors, increase in the gap between two doses to suit reduced availability etc.

Early leads of 2020 that could have helped India become vaccine-sufficient were frittered away, reducing the world’s vaccine capital to a mess.