For two days, Sanjay Kumar has been trying to get himself and his aging mother vaccinated against the coronavirus in the state of Uttar Pradesh, in northern India.
“I called three private hospitals in my neighborhood and all said they were running out of doses,” says Dr Kumar, a social scientist, who lives in Ghaziabad, on the outskirts of Delhi.
One of them is a 50-bed neighborhood hospital. “We don’t have any stocks of vaccines and don’t take reservations because people come in for jabs and fight (when we tell them we don’t have any stocks),” a front office worker said. At another hospital where Dr Kumar unsuccessfully requested a reservation, officials said they were out of doses Wednesday evening. “We have no choice but to fire people,” said one employee.
As India grapples with a second deadly wave of Covid-19 infections – with an average of more than 90,000 cases per day as of April 1 – its vaccination campaign appears to be struggling. A handful of states are reporting a shortage of doses even as the federal government insists there is enough in stock.
In the western state of Maharashtra, which reports more than half of new infections in India, the vaccination program appears to be halted. The local government says its current stockpile of 1.5 million doses will only last three days. Vaccination centers have been closed in the state capital, Mumbai, and parts of Kolhapur, Sangli and Satara districts. “If the vaccines do not arrive in three days, we will be forced to stop the campaign,” Health Minister Rajesh Tope told reporters.
Federal Health Minister Harsh Vardhan says the “allegations” of vaccine shortages are “completely unfounded”. He criticizes states for trying to “distract from their weak vaccination efforts by continually shifting targets.” Mr Vardhan believes states complaining of shortages have not even fully immunized their frontline workers.
This may not be entirely true. Vaccine shortages appear to be a reality in some states that have successfully vaccinated quickly, according to Oommen C Kurian of the Observer Research Foundation, a Delhi-based think tank. He told me the shortage could be triggered by a “mismatch between the production capacity claimed by Indian vaccine makers and the doses actually produced in the past four months or so.”
India’s vaccination campaign, the largest in the world, began on January 16 and aims to reach 250 million people by July. Initially limited to health workers and frontline staff, it has since been extended in stages to people over 60; those between 45 and 59 who have other illnesses; and those over 45 years old.
More than 90 million doses of two approved vaccines – one developed by AstraZeneca with the University of Oxford (Covishield) and the other by the Indian company Bharat BioTech (Covaxin) – have been administered so far. On average, three million jabs are administered daily. In addition, India has so far shipped 64 million doses of vaccine to 85 countries. Some come in the form of “gifts”, others in accordance with trade agreements signed between vaccine manufacturers and recipient countries, and the rest as part of the Covax program, led by the World Health Organization (WHO ).
When it comes to vaccine manufacturing, India is a powerhouse. It runs a massive immunization program, makes 60% of the world’s vaccines, and is home to half a dozen major manufacturers, including the Serum Institute of India – the world’s largest. But a large-scale adult vaccination program against a virulent pathogen like SARS-Cov2, the virus that causes Covid-19, poses unprecedented challenges.
On the one hand, experts say the vaccination campaign needs to accelerate much more to achieve its goal. It is not clear whether the country has enough vaccines and the state’s capacity to scale up the campaign.
The key question, as many have speculated, is whether India has sufficient stockpiles of doses to speed up the campaign and expand coverage to include young people. Some wonder if India has done the right thing by sending millions of doses abroad as part of its high-profile “vaccine diplomacy”.
The Serum Institute of India, which makes the Oxford-AstraZeneca vaccine, known locally as Covishield, has provided some clues. This week, he said his production capacity was “very stressed”. Adar Poonawalla, the head of the firm, said in an interview with Indian television that “we are still running low on being able to supply all Indians”.
Serum says it has supplied 65 to 70 million doses each month to India and has exported a total of almost equal doses since production began earlier this year.
In January, the company told the BBC it aimed to increase production to 100 million doses per month. Now he says he would not be able to meet the target until the end of June due to the time needed to repair the damage caused by a fire at his facilities in Pune city, in the west of the country, in January. Next, Mr Poonawalla said there would be no impact on production at Covishield, “due to the multiple production buildings that I had kept in reserve to deal with such eventualities.”
The company claims that pressure on finances is also hampering the drive to increase production. Mr Poonawala is seeking $ 400m (£ 290m) in government assistance or bank funding to invest in expanding his capacity. Serum sells a dose of the vaccine for $ 2 to the Indian government and “this rate is not sufficient to support further expansion,” he says.
“It was not a budget or planned initially because we were supposed to export [more] and obtain financing from exporting countries. Now this is not happening and we need to find other innovative ways to build our capacity, so that we can support our nation in light of the surge in cases, ”Poonawala told NDTV.
Clearly, India’s vaccine “shortage” will have a global impact.
Last month, India temporarily suspended all exports of the Oxford-AstraZeneca coronavirus vaccine. Serum says it shipped 30 million doses to Covax in January and February – half of its capacity – and now there is a shortfall of “30 to 40 million [export] doses “.
“We told them the need [for doses] Is India so bad that we have to prioritize Indian needs over export needs, “Mr Poonawala told CNBC-TV18. He also told Business Standard newspaper that Astra Zeneca had sent his company a “legal opinion (for delays in supplying the vaccine) and the Indian government is also aware of it.”
Experts say vaccine shortages in parts of India could be due to supply bottlenecks. Vaccine makers may also have “oversold” their capabilities while taking orders from around the world. “As cases increase and vaccine reluctance decreases, the demand for doses will increase. We need to plan better, ”said a senior official, who preferred to remain anonymous.
At the moment, India does not have too many options. A new vaccine – possibly Sputnik V – is expected to be approved by June. Covovax, another coronavirus vaccine developed by the Serum Institute in partnership with US vaccine developer Novavax, is not expected to be available until September.
India must therefore give priority to jabs. There is no other way to reduce the number of people dying from Covid-19 than to quickly provide vaccines to over 120 million elderly people in India. This is to be done in the coming weeks, with the help of local governments, civil society, including religious leaders and supported by targeted communication campaigns, Kurien said.