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India’s vaccine crisis is a warning to the world

A second wave of Covid-19 is tearing through India. The country’s overwhelmed health system is teetering on the edge of collapse: shortages of hospital beds and oxygen have contributed to a situation where confirmed deaths stand at more than 200,000 while the real death toll is likely to be much higher.

While other countries attempt to plug the widest gaps in the country’s hospital system by sending urgently-needed medical supplies, India is trying to ramp up the vaccination drive as a way out of the crisis. But a beleaguered rollout, raw material shortages and misplaced priorities has meant that only a tiny percentage of the country has been vaccinated, and it is struggling to meet surging demand.

For a country of almost 1.4 billion people, the vaccine rollout in India was too slow. Since the vaccination drive got underway on January 16, 2021, less than two per cent of the population has been fully vaccinated, and less than ten per cent have received their first dose.

India is currently vaccinating about two million people a day. Its vaccination strategy should have been more aggressive, says Prashant Yadav, who studies health care supply chains at the Centre for Global Development in Washington, D.C. Yadav thinks that the government should be aiming to vaccinate ten million people a day, a number echoed by other researchers.

India is home to the largest vaccine manufacturer in the world: the Serum Institute of India. It’s also home to the second-biggest manufacturer: Bharat Biotech. Together, these two facilities have a combined output of about 2.5 million doses a day. Despite this vaccine-producing heft, a relatively small number of that capacity has gone towards vaccinating people within India.

India’s vaccination rate started with a few hundred thousand people per day, then slowly picked up speed, reaching one million per day, then two million in March. By late March, when it started hitting 2.5 million a day, the vaccination rate and the vaccine production rate were neck and neck. Up to that point, the Serum Institute had exported millions of vaccine doses to some of the world’s poorest countries as part of COVAX, the program that aims to equalise global Covid-19 vaccine access. The manufacturer was instructed to halt exports in order to prioritise vaccines for the Indian population.

Vaccine sites are now running out of doses and are having to turn people away. While this jam in vaccines was not the cause of the surge in cases, says Yadav, maintaining the supply “could have been a way to prevent it”.

The production of vaccines relies on surprisingly basic materials. The Serum Institute is having to make use of single-use bioreactors, owing to a rapidly expanded production line. Large plastic bags, glass vials and filters are all necessary if not rudimentary ingredients in the process, and missing even one of these can disrupt the whole production. The biggest manufacturers of these materials are mostly located in the US and the European Union, says Yadav. “Essentially, everyone buys from them.”

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And India was getting most of its supply from the US. But then, on February 5, president Joe Biden announced he would be using the Defence Production Act to direct domestic manufacturing and production towards addressing domestic needs. “It's not technically an export control, but it's saying, ‘Put everything else to the back and focus on supplies for us’,” Yadav says.

Given that most manufacturers stockpile about two or three months of equipment, and that the Serum Institute first complained it was running low in March, Yadav reckons that the facility will run out by mid-May if it doesn’t get new supplies. Suresh Jadhav, the executive director of the Serum Institute said that the institute’s vaccine manufacturing would be affected in the next four to six weeks. Going elsewhere for a replacement manufacturer requires rigorous checks and approval, which takes time – time India doesn’t have. The Serum Institute was left in a desperate situation. On April 16, Adar Poonawalla, the chief executive of the Serum Institute, publicly reached out to Biden on Twitter, pleading with him to “lift the embargo” on raw material used to make the vaccines.

His calls were answered, and on April 25, the US removed impediments to the export of raw materials for vaccines. But the lifting of the ban won’t bump up vaccination capacity overnight, Yadav says. In fact, it may take six to twelve weeks to see any effect. But it will ensure that nothing gets cut, and potentially boost manufacturing capacity, he says.

The US has also said it will send up to 60 million doses of the AstraZeneca vaccine to other countries, and India could be one of them. But it will be “as they become available”. The US has also said it will fund Biological E, an Indian vaccine manufacturing company, to produce at least one billion vaccine doses by December 2022.

From May 1, all adults in India will be eligible to receive the vaccine. But that means nothing if there aren't enough doses to go around. It will require a unified global effort to scale up vaccinations in India, says Amar Ramudhin, a supply chain expert at the University of Hull. Supply chain issues happen everyday at a local level that go under the radar, says. “And it's the same exact thing that's happening, but at a much more global level.”

And the fallout will not only be felt in India. Since late March, when case numbers began to rise, India has reserved virtually all its doses for domestic use as it struggles to inoculate its own population. This means it will not be able to fulfil its commitments to the low- and middle-income countries it promised vaccines to.

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This article was originally published by WIRED UK

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