by Anika Ajgaonkar
(Credit: VOA News, May 13, 2021.)
(Note: This article covers an event that is evolving rapidly. All information and statistics are accurate and relevant as of May 13th, 2021.)
As the Covid-19 pandemic continues to take its toll worldwide, many countries are now vaccinating their populations against the virus. In India, the country with the world’s second largest population, how is the government immunizing over 1.4 billion people?
In the US, 45.9% of the population has received at least 1 dose of vaccine, while 34.2% are fully vaccinated, adding up to a total of about 257 million doses administered so far. This is good progress towards vaccinating America’s 332 million population. In India, about 176 million doses have been administered as of May 13, 2021, but it will take quite some time to fully vaccinate the estimated 1.4 billion population. 10.1% of the population has received at least one dose (almost 138 million people), but only 2.8% has been fully vaccinated (about 38 million). It is important to note that these numbers can be deceptive—although the sum of people who have received at least one dose of vaccine in India is slowly catching up to that of the US, the percentage is only 10.1% compared to 45.9% because of how large India’s population is.
Indigenous V.S. Foreign Vaccines
India has developed two vaccines of its own, Covaxin, developed and manufactured by Bharat Biotech, and Covishield, the Indian version of the Oxford-AstraZeneca vaccine that is manufactured by the Serum Institute in Pune. Both are dual dose vaccines. More vaccination centers have been providing Covishield than Covaxin, the latter of which was signed into emergency use even as its phase III clinical trials were still ongoing.
The Covaxin vaccine was developed using Whole Virion Inactivated Vero Cell derived platform technology, meaning it is made up of killed coronaviruses which are safe for injection. When a person receives Covaxin, their body recognizes the foreign antigen and promptly creates antibodies to defend against both the injected, killed virus and the circulating, live virus. On April 21, data from Covaxin’s phase III trials was released, revealing its efficacy rate to be about 81%. Covaxin has been found to protect against the Brazilian variant and the Indian variant. On the other hand, Covishield is a weakened version of a common cold virus from chimpanzees, modified to look like coronavirus. Data shows that when administered in a “half-dose, full-dose” method, Covishield efficacy can be as high as 90%. Neither vaccine requires storage at sub-zero temperatures (giving them an edge up over the Pfizer-BioNTech and Moderna shots, which need to be stored at -70℃) but rather, at 2-8℃, more feasible for India’s hot climate.
Sputnik V, a vaccine developed by Moscow’s Gamaleya Institute, is on the fast-track for use in India because of a new government policy, which permits the use of vaccines approved in other countries. Sputnik has a 92% efficacy rate. Other vaccines, such as Pfizer and Moderna, may become available in India later this year. For now, India-based vaccines Covishield and Covaxin will provide the supply.
Vaccination Rollout
India started its national vaccination program on January 16, 2021. The Indian vaccination program is being run in phases. Phase I prioritized healthcare personnel and frontline workers such as police, paramilitary forces, sanitation workers, and disaster management volunteers. Phase II targeted citizens over 60 and citizens aged 45 to 60 with comorbidities. Phase III, which began on April 1st, made all citizens over 45 eligible for vaccination, and as of May 1, 2021, all citizens 18 or older are eligible as well, opening vaccination up for close to 400 million more people.
Prices and Accessibility
Covishield costs ₹400 ($5.42) for states and ₹600 ($8.13) for private hospitals, while Covaxin costs ₹600 for states and ₹1200 for hospitals. The company producing Covaxin claims the manufacturing cost is more expensive because the vaccine is more purified and uses inactivated virus particles. For the average person, a vaccine will cost about ₹150 - ₹250 ($2.03 - $3.38), making Indian vaccines among the most affordable in the world.
The central government is procuring vaccines and allocating them to states. In government hospitals, eligible citizens can receive the vaccine free of charge. Meanwhile, private hospitals, more popular among the wealthy, charge up to ₹250 ($3.34) per dose. Bharat Biotech is providing the first 1.65 million doses free of charge to the government, and in many states, such as Maharashtra, Rajasthan, and Kerala, the government is providing free vaccines to all citizens.
India’s Deadly Second Wave & Global Aid
Recently, the new double-mutant Covid-19 (officially B.1.617) variant hit India, and the country is currently undergoing a devastating second wave. Record numbers of cases are being broken daily, with 400k cases recorded in just a single day last week. The healthcare system in India is being pushed to its limits, and as a result, many of the ill are now unable to get a hospital bed or necessary oxygen. The country is also facing a shortage of medical personnel to attend to patients who have fallen sick. Images of mass cremations and funeral pyres have spread like wildfire online. Many patients in India report only mild symptoms at first, but within days their condition becomes fatal and requires hospitalization. During this time, it is more important than ever that India speeds up its vaccination efforts, which have been falling rapidly behind.
India exported more than 66 million vaccines to 95 countries worldwide during earlier stages of the pandemic, when it was still relatively unscathed in the first wave. Countries who could not afford the more expensive alternatives provided by other companies, or who were being turned away by other vaccine-manufacturing nations prioritizing their own citizens found salvation in India’s donations. India’s actions played a vital role in minimizing “vaccine apartheid,” where wealthy Western countries are vaccinated before their lower-income peers. Reports of American vaccine company Pfizer have come out accusing it of bullying certain Latin-American governments during Covid-19 vaccine negotiations. The company has reportedly demanded countries to put up sovereign assets, like bank reserves, embassy buildings and military bases, as collateral for getting vaccines, in addition to drafting policy that exempts Pfizer from all legal and fiscal responsibility in case of lawsuits for negligence or adverse effects. During such times, when poorer countries may have to risk putting their sovereignty at stake just to receive life-saving medicines, India’s no-strings-attached and affordable vaccine diplomacy has been immensely helpful. The government calls this initiative Vaccine Maitri, literally, “Vaccine Friendship.” Effectively, it has developed positive foreign relations at a time when many Western countries, such as the US and the European Union, are being accused of hoarding vaccines and medical supplies.
Though the decision to send so many vaccines abroad was controversial, it seems India’s good will is being reciprocated by nations around the world during its hour of need. More than 13 nations have extended their assistance to India, including Singapore, Saudi Arabia, the UK, France, the European Union, the UAE, Australia, and Russia. Many are exporting oxygen tanks and concentrators to alleviate the massive shortage India is experiencing, as well as other types of equipment and medicines to aid its persevering healthcare workers. Even smaller countries, such as Bhutan and Bangladesh, have offered whatever support they can provide. India’s foreign secretary, Harsh Vardhan Shringla, said that many other countries were grateful for the aid India provided worldwide, and are now returning the favor. It is diplomatic relations like these during the pandemic that reveal what it means to live in an interdependent world, said Mr. Shringla in a press conference on April 29.
In January, the US invoked powers under the Defence Production Act (DPA) to prioritize the American population, greatly lessening the volume of vaccine manufacturing materials and emergency medical supplies exported outside the country. This severely hindered Indian vaccine manufacturing and slowed down the country’s capacity to vaccinate its population during India’s catastrophic second wave. According to an estimate by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), a vaccine manufacturing plant will typically use some 9,000 materials. These are obtained from about 300 suppliers spread across around 30 countries. Of these 9,000 materials, many of the scarcer components required for vaccine production in India came from the US. Effectively, laws imposed under the DPA had a debilitating effect on vaccine production. The US received harsh backlash from the public for not coming to India’s aid during its devastating second wave, when just last year, India lifted its export ban on hydroxychloroquine and gave the US close to 29 million doses after then-president Trump threatened “retaliation” if India did not comply. Eventually, the US caved in to the public pressure and began a belated effort to assist India, which includes vaccine production materials, oxygen-related supplies, and therapeutics.
For now, India is continuing its vaccination efforts and grappling with a challenging and deadly second wave of cases. It will take some time until herd immunity is achieved, but until then, India will have to ride the storm out and do its best to keep its people safe. Despite these turbulent times, global efforts to help nations in need and generous displays of goodwill in return have shown that the world is more than capable of coming together to end the pandemic. Through collaboration and collective action, India and countries like it suffering during this time will be able to put this chapter behind them and come out stronger than before.
Works Cited
Bharat Biotech-Vaccines & Bio-Therapeutics Manufacturer in India, Bharat Biotech, 2021, www.bharatbiotech.com/covaxin.html.
BQ Desk. “India To Open Covid-19 Vaccinations To All Above 18 Years Of Age From May 1.” BloombergQuint, 20 Apr. 2021, www.bloombergquint.com/coronavirus-outbreak/india-to-open-covid-19-vaccinations-to-all-above-18-years-of-age.
“Coronavirus (COVID-19).” Google News, Google, news.google.com/covid19/map?hl=en-US&mid=%2Fm%2F02j71&gl=US&ceid=US%3Aen&state=3.
Corum, Jonathan, and Carl Zimmer. “How Bharat Biotech's Vaccine Works.” The New York Times, The New York Times, 4 Jan. 2021, www.nytimes.com/interactive/2021/health/bharat-biotech-covid-19-vaccine.html.
Dasgupta, Debarshi. “US Loosens Restrictions on Export of Covid-19 Vaccine Raw Materials to India.” The Straits Times, 28 Apr. 2021, www.straitstimes.com/asia/south-asia/us-loosens-restrictions-on-export-of-covid-19-vaccine-raw-materials-to-india.
Davies, Madlen, et al. “Pfizer Plays Hardball in Covid-19 Vaccine Negotiations.” STAT, 23 Feb. 2021, www.statnews.com/2021/02/23/pfizer-plays-hardball-in-covid19-vaccine-negotiations-in-latin-america/.
Desk, BQ. “India To Open Covid-19 Vaccinations To All Above 18 Years Of Age From May 1.” BloombergQuint, 20 Apr. 2021, www.bloombergquint.com/coronavirus-outbreak/india-to-open-covid-19-vaccinations-to-all-above-18-years-of-age.
Doshi, Menaka. “Free To Rs 2,400: What A Covid Vaccine Will Cost You.” BloombergQuint, 29 Apr. 2021, www.bloombergquint.com/coronavirus-outbreak/the-price-of-covid-vaccines-covishield-and-covaxin-in-india.
Doucleff, Michaeleen. “People Are Talking About A 'Double Mutant' Variant In India. What Does That Mean?” NPR, NPR, 24 Apr. 2021, www.npr.org/sections/goatsandsoda/2021/04/24/988744811/people-are-talking-about-a-double-mutant-variant-in-india-what-does-that-mean.
Ganapathy, Nirmala. “India Accepts Oxygen Supply from 40 Countries, Including Singapore, amid New Covid-19 Wave.” The Straits Times, 29 Apr. 2021, www.straitstimes.com/asia/south-asia/india-accepts-oxygen-supply-from-40-countries-including-singapore#:~:text=The%20Republic%20of%20Singapore%20Air,Indian%20Air%20Force%20last%20Saturday.
“Here's How India Plans to Store Covishield and Covaxin Vaccines: The Weather Channel - Articles from The Weather Channel.” The Weather Channel, weather.com/en-IN/india/coronavirus/news/2021-01-16-heres-how-india-plans-to-store-covishield-and-covaxin-vaccines.
“India Coronavirus: Over-18s Vaccination Drive Hit by Shortages.” BBC News, BBC, 1 May 2021, www.bbc.com/news/world-asia-india-56345591.
“India Population (LIVE).” Worldometer, www.worldometers.info/world-population/india-population/#:~:text=The%20current%20population%20of%20India,the%20latest%20United%20Nations%20data.
Li, Shan, and Vibhuti Agarwal. “What We Know About India's Covid-19 Variant B.1.617.” The Wall Street Journal, Dow Jones & Company, 3 May 2021, www.wsj.com/articles/what-we-know-about-indias-double-mutant-covid-19-variant-11619193481.
Nair, Vishwanath. “Maharashtra, Rajasthan Join States Promising Free Covid-19 Vaccine.” BloombergQuint, 26 Apr. 2021, www.bloombergquint.com/business/maharashtra-joins-a-growing-list-of-states-promising-free-covid-19-vaccine.
Orgi. “Age Structure And Marital Status.” Census of India: Age Structure And Marital Status, censusindia.gov.in/census_and_you/age_structure_and_marital_status.aspx.
“Over 16 Crore Covid-19 Vaccine Doses Administered in India: Govt.” News18.Com: CNN-News18 Breaking News India, Latest News Headlines, Live News Updates, News18, 4 May 2021, www.news18.com/news/india/over-16-crore-covid-19-vaccine-doses-administered-in-india-govt-3707600.html.
Reuters. “India Likely to Get Major Chunk of U.S. Vaccine Exports.” The Hindu, The Hindu, 27 Apr. 2021, www.thehindu.com/news/national/india-likely-to-get-major-chunk-of-us-vaccine-exports/article34425122.ece.
Sai Balasubramanian, J.D. “Why Did President Trump Request India For Hydroxychloroquine?” Forbes, Forbes Magazine, 14 Apr. 2020, www.forbes.com/sites/saibala/2020/04/13/why-did-president-trump-request-india-for-hydroxychloroquine/?sh=3bae859270bb.
Shesgreen, Deirdre. “Is Biden Administration Doing Enough for India? Some Accuse US, Wealthy Nations of 'Hoarding' COVID-19 Vaccines.” USA Today, Gannett Satellite Information Network, 3 May 2021, www.usatoday.com/in-depth/news/politics/2021/05/03/india-gets-us-aid-amid-covid-crisis-biden-weighs-vaccine-sharing/4886666001/.
“Sputnik V, Covishield, Covaxin: What We Know about India's Covid-19 Vaccines.” BBC News, BBC, 14 Apr. 2021, www.bbc.com/news/world-asia-india-55748124#:~:text=It%20says%20it%20is%20producing,it%20can't%20cause%20illness.
Thiagarajan, Kamala. “What Do We Know about India's Covaxin Vaccine?” The BMJ, British Medical Journal Publishing Group, 20 Apr. 2021, www.bmj.com/content/373/bmj.n997.
“Vaccine Supply.” Ministry of External Affairs, Government of India, www.mea.gov.in/vaccine-supply.htm.
WION. (2021, January 23). Gravitas plus: India sets an example with vaccine maitri [Video]. YouTube. https://www.youtube.com/watch?v=7O7j5VX0ncs
WION. (2021b, April 26). Gravitas: India’s health diplomacy pays off, 13 countries offer assistance [Video]. YouTube. https://www.youtube.com/watch?v=Sh1c68_C5Rk