India runs the risk of losing its pharma edge
The world now agrees that the only solution to the Covid-19 pandemic is to vaccinate, vaccinate, vaccinate. New Delhi has joined the consensus, thanks to a brutal second Covid-19 wave. Equally belatedly, India has realised there is a race among countries seeking vaccine dominance. A major step in India’s new vaxpolitik was placing jabs at the heart of an upgraded British relationship and in its present interactions with the United States (US).
The world has so far produced two billion vaccine doses, but needs 11 billion more by year-end —with several billion boosters possibly needed every subsequent year. The countries on top of this process will benefit enormously, from goodwill to profits to know-how.
India, long the world’s largest vaccinemaker, could lose its crown of jabs. It excels in mass manufacturing, but lags in innovation. The country’s workhorse Covid-19 vaccine, made by the Serum Institute of India, uses a British formula. Worse, there is no Indian vaccine using mRNA technology, though one is in the works, the future of vax tech. With the world’s largest child population, vaccines crucial to its pharma sector, and for national security concerns, India needs to work hard to ensure its vaccine throne is not usurped.
To stay ahead of the pack, India must create its own pack. This means international partners for funding, tech and markets. The AstraZeneca-Serum Institute-Oxford University triad is seen as exemplary leading to inexpensive vaccines, zero patent hassles and export opportunities. Britain’s pharma sector is infused with a non-profit culture. All of this provides a template for a future bilateral partnership in vaccines, diagnostics and more. In contrast, while US inputs are indispensable to India’s vaccine production, New Delhi’s experience with US big pharma has been bruising – Pfizer and Merck were at the forefront of the intellectual property rights (IPR) pharma battles between India and the US in the 1990s and early 2000s, which still rankles.
The meat of the new India-United Kingdom (UK) relationship is medicinal. Foreign minister S Jaishankar highlighted the “action plan on health and life sciences, that includes cooperation on vaccines, therapeutics and diagnostics”. The bilateral roadmap puts down the ambitious target of “helping guarantee equitable global supply [of Covid vaccine] by April 2022.” As important is the long-term plan to align medical standards, institutions and people.
The UK was a thought-out choice. Its medical researchers are second in quality citations using the H index, number two in medicine Nobels, and its universities are among Europe’s best. And London is willing. Prime Minister Boris Johnson often cites the AstraZeneca success, but also needs partners to fulfil his government’s plans “to develop vaccines against emerging diseases in 100 days.”
New Delhi’s science bureaucracy was fixated on simply adding more vaccine assembly lines. Foreign assistance was treated as only about funds – like the Quad vaccine agreement. Overseas tie-ups for new technologies were spurned. It was proud of a domestic pipeline of 30-plus vaccine possibilities, even though few are cutting edge and their development meant a leisurely timeframe. Events have tragically shown this attitude as misguided. India should have put vaccines on mission mode; instead, they were left to a five-year plan.
A longer-term problem is the lack of urgency about mastering mRNA vaccine technology. Mutating viruses require nimble vaccines. The older technologies India depends on have gestation periods of 10 years or more; mRNA vaccines can be put together at warp speed — no living cells are needed, fewer ingredients are required, and batches can be cooked up in two hours. Next-gen mRNA vaccines are scalable and do not require deep freezers.
Presently, Gennova is the only one Indian firm with an mRNA candidate. If the next few years are a race between Covid-19 variants and vaccine upgrades, mRNA will become the global standard. And if India does not find allies to develop its own versions, it will lose its vaccine supremacy and end up seeing its own costs rise. China has begun trials of its first mRNA vaccine, Walvax. Pfizer’s CEO has told investors he plans to sell Covid-19 boosters for $150-plus.
Signing up with the UK is not the only element of India’s new vaxpolitik. The US, the European Union and Japan are crucial as well. A single vaccine vial can require as many as 200 different ingredients and components. Many of these are monopolies. The capping technology used in all mRNA vaccines, for example, is the monopoly of one US firm. When the Indian foreign minister and his US counterpart, Anthony Blinken, met at the G-7 foreign ministers’ meeting, vaccines were topic number one on the agenda — as will be the theme of their discussion during Jaishankar’s current visit to Washington.
Vaxpolitik requires the country’s health care and life science bureaucracy to think in strategic terms, with India as part of a global coalition rather than a stand-alone nation. A deep-seated tradition to view pharmaceuticals as a matter of price-haggling, using other’s intellectual property, and sticking with obsolete processes needs to be changed. Washington’s leftward shift on the issue may mean India will get patent waivers for mRNA ingredients. If so, New Delhi needs to have a plan to help Indian pharma firms master the new techniques and standards required. Vaccines were once a sleepy low-margin highvolume niche that pharma multinationals were happy to leave to India. It is set to become cut-throat, high-tech and geopolitical with no guarantee India will come out a winner.
VAXPOLITIK REQUIRES THE COUNTRY’S HEALTH CARE AND LIFE SCIENCE BUREAUCRACY TO THINK IN STRATEGIC TERMS, WITH INDIA AS PART OF A GLOBAL COALITION RATHER THAN A STAND-ALONE NATION