With the recent news of the success of the Pfizer and Moderna coronavirus vaccine, a ray of hope has emerged, with the global population seeing a prospective end to a months-long pandemic. As of September 2020, there were around 145 vaccine candidates, with roughly 30 undergoing clinical trials. However, even if a vaccine makes it through the long and extensive trial phase and is deemed ready for public use, a post-pandemic world is still a distant reality for most countries. The immediate struggle will be to secure widespread access to the vaccine, which in itself will be an extraordinary task to achieve. However, this daunting task will be more challenging for some countries than others. For India, with a population of 1.2 billion, to successfully bring an end to this pandemic, it will have to spearhead a monumental and unprecedented vaccine program. However, at this stage, India appears underprepared to conduct a large-scale drive of this scale.
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On one hand, India is no stranger to widespread immunisation drives. In fact, it previously conducted one of the world’s most extensive immunisation programs by reaching over eight million locations and vaccinating 344 million children against polio. This has not only provided a strong base for the infrastructural and logistical support needed for a prospective COVID-19 vaccine drive but has also instilled some optimism amongst the authorities that they can carry out this herculean task.
However, the fact that India’s path will be a rocky one was clear from the beginning. After Pfizer announced that its vaccine candidate was proving to be 90% effective in preventing COVID-19 infections, the celebration for Indians was short-lived. Soon after this announcement, several experts came out highlighting the difficulties that India would face in storing this particular vaccine candidate. Pfizer’s vaccine must be stored at minus 70 degrees Celsius, something which India is hard-pressed to achieve on a large-scale in the near future, prompting the emergence of reports which allege that the Pfizer vaccine is most likely not going to be purchased by India at all.
Moreover, while some vaccine candidates are more suitable for Indian infrastructure, India’s storage problem is not unique to the Pfizer vaccine. Currently, India’s units are mainly equipped for vaccines that need to be stored at two to eight degrees Celsius. However, most of the candidates that are approaching the finish line of the trials require storage facilities that can maintain at least zero degrees Celsius. Moreover, while India boasts a cold storage capacity of 40 million tonnes, merely 80,000 cold storage units meet the hygiene standards for storing vaccinations. This number will have to be multiplied at least ten times over to fulfil the Indian government’s promise of vaccinating 250 million Indians by July 2021. Further, there are still several uncertainties associated with the vaccine, including the temperature required for storage. In the absence of assurances on prices and procurement, corporations are wary of scaling up their infrastructure, particularly given that such capital expenditures may not yield the desired financial benefits once the current pandemic draws to a close.
However, the storage problem is only the tip of the iceberg. The ensuing struggle is that of distribution, which includes formulating a list of groups that the vaccine will be administered to on priority. Elsewhere, like in the United States or in Europe, this process is relatively simple, where the first group to receive the vaccine will be the front-line workers, including healthcare professionals, sanitation workers, and other essential workers, like members of the police force and armed forces. India, too, plans on first administering the vaccines to such workers. The Times of India reported that, according to a draft plan by a select committee set up for vaccine administration for COVID-19, around 70 lakh healthcare professionals, which includes “11 lakh MBBS doctors, 8 lakh Ayush practitioners … 7-8 lakh allied healthcare professionals and others, like sanitation workers, ambulance workers and hospital security” will be administered the vaccine on priority.
The second group typically features high-risk members of the population, including those with pre-existing conditions such as hypertension, diabetes and respiratory diseases. While this is similar to India’s draft plan, it may not be practical to achieve. Unlike most developed countries, India does not have a robust digitised healthcare system. While this has been on the Indian government’s agenda for some time now and the Ayushman Bharat scheme was definitely a step in the right direction, collecting data on this before a vaccine is available for public use is virtually impossible. Hence, identifying these individuals who have pre-existing conditions may be easier said than done.
Finally, the prospective vaccine will be administered to the rest of the population, which generally comprises younger individuals. However, the age demographics of India mean that, compared to other countries, India will have a disproportionate and overwhelming majority who fall under this third category. Leaving so many hundreds of millions of people unvaccinated poses the risk of continued contagion and overloading of India’s already overworked and understaffed health system. With merely 6% of the population aged over 65, 94% of India’s 1.2 billion people fall under this third category. This is a significant number compared to the United States and the European Union, where 16.5% and 20.3% of the population respectively, is over 65. Therefore, vaccinating the younger population in India would require a more robust and extravagant differentiation than the one used by other countries.
Evidently, India is in a sticky position when it comes to securing its own citizens. However, as a critical player in the pharmaceutical market and as one of the world’s largest producers for syringes in the world, it is under doubled pressure to also help meet the global demand for the vaccine too. Hence, adopting an inward-looking policy and purely focusing on domestic demand, like the European Union or the United States, is not an option for India. Moreover, with its ambition to emerge as a regional and international powerhouse, India also faces an increasing pressure to export vaccines to low to middle-income countries, specifically in its immediate neighbourhood. In pursuit of achieving this aim, India has already begun working to bolster the research capabilities of countries such as Afghanistan, Bangladesh, Nepal and Sri Lanka. Moreover, during a speech at the United Nations, Indian Prime Minister Narendra Modi vowed to use the country’s production and delivery capabilities to “help all humanity in fighting the crisis.” Hence, India must strike a difficult balance between retaining its position as a humanitarian power and helping meet global demand for the vaccine, while also continuing to prioritise the needs of its own people.
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This year has posed a wide array of challenges to the incumbent Indian administration, from an unprecedented recession to a health emergency. Achieving such an exceptional vaccination program, with an already crumbling economy, shows that the fight against this pandemic will continue long after a successful vaccine is made available for public use. Nevertheless, with its excellent production capabilities and its vast prior experience in vaccination drives, there is a spark of optimism. However, it is yet to be seen whether India will emerge as a shining pioneer, or as a grim example of another developing country that crumbled at the hands of the pandemic.