THE VACCINE CRISIS
A deadly second wave of Covid has exposed India’s optimistic vaccine strategy. Where did we go wrong and how can we set it right?
THE SECOND WAVE of Covid-19 infections has hit the nation like a fierce tide. The number of daily cases crossed a hundred thousand within two weeks—almost five times faster than in the first wave. Another nightmare is unfolding across hospitals in major metros. In the national capital, Delhi, 50 hospitals ran out of ICU and ventilator beds last week. In Maharashtra, which accounted for over 40 per cent of the new cases, chief minister Uddhav Thackeray was forced to impose what he called a ‘Janata Lockdown’, restricting personal movement and economic activity. Meanwhile, nine other major states showed an alarming rise in cases and there is a looming threat of mini lockdowns across the country, threatening the fragile economic recovery India has managed in recent months.
“This wave is just ripping through cities,” says Malini Aisola, public health expert and co-convenor of the All India Drug Action Network. “There is full-blown panic.” India has only itself to blame. Lulled into complacency by a steep drop in cases towards the end of 2020, the central and state
governments lowered their guard as did the public. Besides permitting massive public gatherings like the Kumbh Mela in Haridwar and election rallies in poll-bound states, the enforcement of Covid-appropriate behaviour was lax ever since the easing of restrictions once there were signs of the first wave receding. So great was the collective relief at the apparent retreat of the pandemic that people threw all caution to the wind and dropped their masks—and their guard—as if the pandemic had been vanquished. This, despite visible evidence of the second and even third waves hitting countries like the US and UK harder than the first. In India, the virus seemed to have mutated into a stronger and deadlier strain during the current surge. The National Institute of Virology (NIV) in Pune, for example, found the double mutant (B.1.617) strain in 61 per cent of the 361 samples taken from Maharashtra from January to March. “These new strains are far more infectious than the ones we dealt with last year,” admits Dr Randeep Guleria, director of the All India Institute of Medical Sciences (AIIMS) in Delhi.
THE EXPLOSION OF CASES saw the central as well as state governments rushing in with short-term measures, including ramping up tracking and testing for the virus apart from treatment. But what the second wave has exposed is the short-sighted approach India has shown in its vaccination strategy despite having a head start in development and production. Vaccination against Covid-19 may or may not prevent a person from getting infected, but several studies have shown that it is likely to make an attack milder, requiring less hospitalisation and reducing the chances of mortality. Vaccines are also critical in building herd immunity among populations to slow down the waves of infections that could keep returning.
While the Union government boasts that it has vaccinated over 108 million people since the drive began on January 16, the fact remains that less than 7.9 per cent of our population has been vaccinated as compared to 57 per cent in the US and 60 per cent in the UK. Worse, many states, including Maharashtra, complained of a shortage of vaccines even as the Centre trotted out figures that it had over 30 million doses in stock and blamed the states instead for their poor planning and distribution.
The finger-pointing aside, there is little doubt that India faces a vaccine emergency. For the country to vaccinate the 75 per cent of the population needed to achieve herd immunity, it will take up to the summer of 2022 at the current rate of vaccination. The ideal scenario, say experts, would be to do it in the next three months. This means ramping up the current capability of vaccinating 4 million a day to 20 million, five times the number. The failure to do so would almost certainly lead to a third wave after the current one subsides.
How did we get to this sorry pass, from a position of comfort just a few months ago? What do we need to do to step up the drive and blunt the progress of the virus?
WHAT WENT WRONG?
For a country that has the experience of running the world’s largest immunisation programme apart from the second largest capacity globally—after the US—to make vaccines, producing the Covid vaccine and administering it to its people should have been a manageable task. We also had an added advantage. Worldwide, by the end of last year, there were only about a dozen vaccine candidates that were in the final stages of clinical trials. India already had three Covid vaccine candidates—Covishield, Covaxin and ZyCov-D—in the pipeline. To its credit, the Indian government had the NIV collaborate with Bharat Biotech, a private pharma giant, to develop Covaxin. Covishield, on the other hand, was developed by Oxford University in collaboration with pharma giant AstraZeneca, and they signed up with the Serum Institute of India (SII),
SINCE COVAXIN WAS DEVELOPED IN PARTNERSHIP WITH A PUBLIC LAB, THE GOVERNMENT COULD HAVE LICENSED OUT ITS PRODUCTION TO OTHER PRIVATE FIRMS TO BOOST SUPPLY OF THE VACCINE
the world’s largest manufacturer of vaccines, to initially manufacture a billion doses to supply to countries across the world, including India.
This is where Indian health planners stumbled. The rich nations, representing just 14 per cent of the world’s population, bought up more than half (53 per cent) of all the most promising vaccines, including Covishield, according to the People’s Vaccine Alliance, a coalition of 50 organisations. After Pfizer partnered with BioNTech, the Trump administration paid almost $2 billion for 100 million doses, with an option to acquire another 500 million if the vaccine succeeded. Today, the US has enough doses to vaccinate its entire population twice over. Israel took the step of offering Pfizer access to its citizens’ medical records, in return for enough doses to vaccinate its entire population. The country is close to achieving 75 per cent vaccine coverage already.
The Indian government, on the other hand, placed only limited orders with both vaccine manufacturers, SII and Bharat Biotech—110 million in the initial phase. Dr V.K. Paul, NITI Aayog member and co-chair of the National Expert Group on Vaccine Administration for Covid-19 (NEGVAC), says, “Our priority was to vaccinate vulnerable groups. A target of 300 million was set for July, for healthcare workers, frontline workers, those above 65 and those with co-morbid conditions. Protecting them was important since they were the most at risk from Covid-19. Private sales were not allowed to ensure there was enough vaccine for the priority groups.” So confident was the government of meeting the target that in a major outreach it exported 65 million doses to needy countries across the world as part of Mission Maitri. Meanwhile, poor communication led to vaccine hesitancy, with only 40 per cent of the target group taking their shots in the