With India now in the throes of a second wave of the COVID-19 outbreak, there have been several calls for the government to rein in its vaccine diplomacy and instead direct its efforts towards the domestic inoculation drive. Despite several reassurances by the government that it has been prioritising domestic demand, India continues to export 50% more vaccines than it has set aside for consumption. While this benevolent approach has been applauded by several international organisations and political leaders, domestic audiences have been irked by these figures. However, is a shift in policy really necessary, or are these just emerging sentiments of vaccine nationalism that could undermine the global fight against the pandemic while failing to serve any real purpose for India’s domestic vaccine roll-out?
In light of an uptick in cases, Indian authorities have already realigned their policy to focus on domestic demand. Initially, following concerns raised by the Bangladeshi government about whether Dhaka’s contract with the Serum Institution of India (SII) for the Oxford-AstraZeneca vaccine will be honoured, the Indian government provided reassurances that it had not imposed any restrictions on vaccine exports. Consequently, it has made agreements to provide 200 million vaccines doses to the World Health Organisation-led COVAX program, along with 900 million doses of the AstraZeneca vaccine via bilateral commercial deals.
However, the zeal with which India was moving forward with its vaccine diplomacy has been halted over the past few weeks. After being asked to prioritise domestic demand, the SII has said that certain deliveries to the United Kingdom could be held up. Further, an order to Nepal has also been temporarily suspended. Moreover, the SII has also communicated the possibility of a delay in the deliveries of vaccines to Saudi Arabia, Brazil, and Morocco, citing the need to meet domestic demand. Despite this recalibration, however, restricting the export of vaccines will not provide the push needed for India’s domestic vaccine roll-out.
Admittedly, India’s inoculation drive has not been as successful as predicted, despite its high production and vaccination capabilities and its population’s inherent trust in vaccines. According to the Indian Ministry of Health’s update on Thursday, around ___ individuals have been inoculated so far. While these numbers may look impressive in isolation, merely 50% of the healthcare workers have received the jabs. Moreover, the number of vaccines administered each day continues to fluctuate to disturbing degrees.
This has resulted in several political leaders and critics of the Indian government questioning the vaccine roll-out strategy. For instance, Shaktisinh Gohil, the spokesperson for the Indian National Congress party, said that, at the current rate, it would take 12.5 years for 70% of the population to be inoculated and for India to achieve herd immunity. Given this troubling outlook, some have accused the Indian government of focussing on securing international goodwill rather than leveraging India’s strong production capacity to help the country’s own citizens.
Although the hyper-polarisation of Indian politics means that opposition parties are likely to oppose virtually anything the ruling government does, these concerns may not be entirely misplaced. Adar Poonawalla, the Chief Executive of the SII, has said that the institute may not be able to maximise its production capacity due to the United States’ (US) ban on the export of certain raw materials required for vaccine production. Consequently, the SII, along with Biological E, an Indian pharmaceutical company that has been granted the contract to mass-produce the Johnson & Johnson vaccine, has complained about a shortage in specialised bags, filters, cell culture media, single-use tubing and specialised chemicals from the United States. This could prospectively impact the production capabilities of Indian vaccine producers and impact the domestic vaccine roll-out.
That being said, the impact of this ban is yet to be felt on India’s inoculation drive. Unlike the issues faced by several European countries, the reason for India’s sluggish roll-out is not a shortage of jabs to administer. Since January, the SII has produced 130 million doses of Covishield (the Indian name for the AstraZeneca vaccine) and is set to produce an additional 100 million by April. While a substantial amount had been set aside for export, India continues to retain a significant number of these jabs for its own citizens. For instance, according to the Union Health Ministry, Maharashtra has enough surplus stocks to last for an additional two to three weeks.
In fact, at the moment, most of the country’s vaccination capacity is being under-utilised. For example, the St. Stephens facility in New Delhi has the capacity to vaccinate over 400 people per day, but continues to see a daily footfall of only around 36 people. Financial Times reports that in smaller cities, merely 30-50% of medical facilities’ capacity to administer the jabs is being used. While having surplus vaccines may not appear to be a major concern, with the short shelf life of the COVID-19 vaccines, hoarding vaccines could lead to significant losses for the pharmaceutical companies and result in the highly valued vaccines being rendered worthless.
The relative failure of the current vaccine roll-out program is a result of several social factors. To begin with, India has witnessed a surge in vaccine scepticism due in part to the expedited approval process and the lack of transparency surrounding the emergency approval of vaccine candidates. This has made individuals increasingly sceptical about vaccinations. Moreover, with the vaccine drive beginning at a time where the number of cases was consistently declining, there was a lack of urgency felt amongst the masses to expeditiously register for the vaccine and get inoculated.
Seeing as India continues to hold a surplus of vaccines and given the prevalence of vaccine scepticism and the lack of precautions taken by the Indian population, the slow vaccine roll-out cannot be blamed entirely on vaccine diplomacy. That being said, Indian authorities should accept the request by pharmaceutical companies like SII to open up domestic sales of the doses. Currently, while the SII has signed commercial contracts with countries across the globe, the roll-out in India continues to rest in the hands of the government. Consequently, pharmaceutical companies sell the doses to the Indian government at a subsidised rate, which then distributes them among individual vaccination centres. Hence, the pharmaceutical companies claim that by allowing them to directly enter into commercial contracts with hospitals and healthcare centres, India could speed up the roll-out by making the jabs more accessible.
Further, the current one-size-fits-all approach also needs to be abandoned. Currently, India has adopted a top-down approach, with a central policy on the vaccine drive being applied across the board. Currently, the number of vaccines being supplied to states and the upper limit for the number of jabs to be administered each day, along with the group of individuals it is accessible to, are all decided by the centre. However, even if the power of distribution of the doses is kept with the centre, it needs to adopt a differentiated approach to the roll-out. According to statistics published by the Indian Ministry of Health, 70 districts across 15 states have seen a 150% surge in infections. The vaccination process must be expedited in such harder-hit regions, and the jabs should be made accessible to a larger group of individuals.
Hence, while the blame for India’s slow vaccine roll-out has been blamed on vaccine diplomacy, its missteps actually have more to do with its inefficient use of its inoculation capacity, its inability to ensure that citizens continue to socially distance and wear masks, and its failure to effectively tackle vaccine scepticism. Therefore, shifting away from vaccine diplomacy could result in a global shortage of inoculations without offering any significant value to India’s domestic roll-out. In fact, given the interconnected nature of today’s global economy, abandoning such an altruistic approach could even harm India’s economic recovery, as crucial trading partners could be left battling the pandemic for even longer. Consequently, while Indian authorities must err on the side of caution to avoid any shortages within India, they must simultaneously leverage India’s supreme production and inoculation capacities in conjunction with vaccine diplomacy efforts to meet the needs and demands of both its own people and those across the globe.
India’s Domestic Vaccination Drive Does Not Require it to Abandon Vaccine Diplomacy
The success of India’s vaccination drive does not require it to abandon its vaccine diplomacy but instead calls for a more diverse approach to its roll-out.
March 25, 2021
SOURCE: THE INDIAN EXPRESS