Campaign to vaccinate all adults off to a faltering start
India opened vaccinations to all adults on Saturday, starting an effort sure to tax the limits of the federal government, the country’s vaccine factories and the patience of its 1.4 billion people.
The world’s largest vaccine maker was still short of critical supplies – due to lagging manufacturing and raw material shortages that delayed the campaign in several states. Even where drugs were in stock, India’s wide economic disparities made access to the vaccine inconsistent.
The drive was also partly overshadowed on Saturday by a fire in a Covid-19 ward in western India that killed 18 patients, and the death of 12 coronavirus patients at a hospital in New Delhi after the facility ran out of oxygen for an hour and 20 minutes.
Only a fraction of India’s population will be able to afford the prices charged by private hospitals for the vaccine, experts said, meaning that states will be saddled with immunising the 600 million Indian adults younger than 45, while the federal government gives shots to 300 million healthcare and frontline workers and people older than 45.
So far, government vaccines have been free, and private hospitals have been permitted to sell doses at a price capped at 250 rupees, or around $3. That will now change: prices for state governments and private hospitals will be determined by vaccine companies. Some states might not be able to provide vaccines for free, since they are paying twice as much as the federal government for the same drug, while prices at private hospitals could rise.
As state governments and private providers compete for vaccines in the same marketplace, and states pay less for the doses, manufacturers can profit more by selling to the private sector, said Chandrakant Lahariya, a health policy expert. The increased cost would be borne by those receiving the drug.
“There is no logic that two different governments should be paying two prices,” Mr Lahariya said.
Concerns that pricing issues could deepen inequities are only the most recent hitch in India’s sluggish immunisation efforts.
Less than 2 per cent of the population has been fully immunised and about 10 per cent has received a single dose. The average number of doses administered per day has dipped from more than 3.6 million in early April to less than 2.5 million now.
In a positive development, India received its first batch of Sputnik V vaccines from Russia, under a deal with an Indian pharmaceutical company to distribute 125 million doses.
Some experts say that conducting a massive inoculation effort now could worsen the surge in a country that is second only to the US in its number of infections – more than 19.1 million.
“Having people wait in a long, crowded, disorderly queue could itself be a source of infection,” said Dr Bharat Pankhania, a senior clinical lecturer specialising in infectious diseases at the University of Exeter in the UK.
He urged India to first stop the circulation of the virus by imposing “a long, sustained, strictly enforced lockdown”.
As India’s deadly second wave of Covid-19 infections shows no signs of abating, industrial companies are shifting priorities to help manage the crisis.
From oxygen supplies being diverted from sectors including steelmaking, to the country’s IT industry engaging with its tech systems, corporates are rallying to address the enormous challenges.
“India is facing a humanitarian crisis of massive proportions,” says Gaurav Singh, chief executive and founder of Verloop.io, a Bangalore chatbot application, which is now focusing on using its platform to help connect those who need oxygen and those who have it, at no cost. “As human beings and corporations, now is the time for us to work together,” Mr Singh says.
India on Saturday recorded a global daily record surge of 401,993 new Covid-19 infections and 3,523 deaths, according to figures from the country’s health ministry.
As case numbers increase, hospitals are reporting severe shortages of beds, medicine and oxygen, leading to widespread loss of life.
Analysts say that industry has a critical role to play in addressing the crisis, as the Indian government struggles to cope. Exacerbating this, the country’s healthcare system was overstretched even before the pandemic.
“The Indian private sector has always worked hand in hand with the government during any moment of crisis,” says Sunil Chandiramani, the chief executive of Nyka Advisory Services and former national leader of EY India’s advisory services arm. “Covid-19 is another example where [it] has stepped up efforts with money, innovation and efforts across all fronts.”
Steelmakers are among those that have had to change strategy, as the government has ordered industries to limit the use of liquid oxygen so that it can be diverted for medical purposes.
Steel plants have responded accordingly and many are going above and beyond the demands of the government.
India’s largest steelmaker by market value, JSW Steel, says that it is increasing production of liquid oxygen. In April, it supplied more than 20,000 tonnes of liquid medical oxygen from its plants to state governments and hospitals treating Covid-19 patients, the company says. It is now supplying 1,000 tonnes of liquid medical oxygen a day. The company says it will prioritise these needs even it it means this will have a negative impact on steel production.
The company is “committed to augment the supply of liquid oxygen further in these critical times to save lives even by lowering the production of steel”, according to JSW. “We are leaving no stone unturned to push the supply of liquid oxygen in the interest of our nation.”
For one of India’s oldest conglomerates, Godrej Group, the pandemic has forced it to be constantly ready to shift strategy as new challenges emerge.
“We’ve improved our ability to adapt and create flexible operating systems to manage through the twists and turns of the crisis,” says Anil Verma, the executive director and president of Godrej & Boyce. “With the second wave under way, we are drawing on the learnings over the past year to anticipate the possible scenarios and prepare ourselves to meet them.”
When the pandemic first hit India last year, the company was forced to reevaluate its activities. “We manufactured ventilator valves in response to an urgent requirement from the industry – something which was a first for us,” says Mr Verma. “The country needed to [increase] its healthcare infrastructure.”
It supplied more than 9,000 hospital beds to medical clinics across the country and about 10,000 medical refrigerators for the storage of vaccines.
Meanwhile, the Serum Institute of India, which is producing the Oxford-AstraZeneca vaccine locally, has reduced the price of the Covid-19 vaccine for state governments in response to the current crisis. Bharat Biotech, based in Hyderabad and which produces India’s homegrown shot Covaxin, followed suit.
India officially opened up its vaccination drive to everyone over the age of 18 on Saturday, although many states are struggling with vaccine shortages. India has temporarily halted Covid-19 vaccine exports, although it exported tens of millions of doses earlier this year.
The Serum Institute, however, has plans to start vaccine production in other countries to meet demand, according to a report in UK newspaper The Times. India’s vaccination programme is regarded as the nation’s best hope of battling its way through the pandemic.
“There’s going to be an announcement in the next few days,” Mr Poonawalla was quoted as saying. For some businesses, the shift in the strategy is even more pronounced. In November, the promoters of Indian budget airline SpiceJet launched the healthcare company SpiceHealth.
Although air travel has taken a severe hit from the pandemic, SpiceHealth has gone from strength to strength. Using a similar low-cost model adopted with its airline, SpiceHealth is endeavouring to reach a large number of patients by offering budget healthcare services.
The company offers affordably priced RT-PCR Covid-19 tests, conducted in mobile laboratories across five states, including Kerala, New Delhi and Maharashtra. SpiceHealth also has a genome sequencing laboratory at Delhi’s international airport, aimed at trying to identify and contain the new mutant variants of Covid-19 that might be carried by travellers.
In the current crisis, it is focusing on addressing the country’s oxygen shortages, which are being felt most acutely in Delhi. “Amid the second wave of the coronavirus pandemic that has resulted in an acute shortage of oxygen in the country and a surge in Covid cases, SpiceHealth has been working actively with various state governments and hospitals across the country,” says Avani Singh, the chief executive of SpiceHealth.
SpiceHealth has airlifted more than 2,000 oxygen concentrators in the past two weeks for emergency use and distribution across India and it is continuing these efforts, she says.
“We have [increased] production of SpiceOxy ventilators and fingertip pulse oximeters to address the increased demand,” says Ms Singh.
Another company working to manage the crisis is Tata Group. It has imported 24 cryogenic containers needed to transport liquid oxygen and is also increasing its output of liquid oxygen from Tata Steel. The company has increased supplies of liquid medical oxygen to 800 tonnes a day.
Reliance Industries, controlled by India’s richest man, Mukesh Ambani, repurposed plants at its Jamnagar refinery to produce medical-grade liquid oxygen. The company, which was not a manufacturer of oxygen before the pandemic, is now producing 11 per cent of India’s total output, making it the country’s largest such manufacturer.
As the second wave of infections rages on, the role of industries is proving key to India battling the crisis.
“At the time of crisis, India and Indian industry have come together as a team,” says Mr Chandiramani.
India is facing a humanitarian crisis of massive proportions. Now is the time for us to work together GAURAV SINGH Verloop.io