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Mass vaccination, the escape route of Covid-19 in India, poses a major challenge

NEW DELHI – India is the world’s largest producer of vaccines, but over the past week it has also been the world leader in Covid-19-related deaths, and it is not at all clear that the country can get vaccinated out of the crisis.

The answer to this question is a matter of pressing concern in India, where a second wave of infection has left a picture of death and despair, but it can also have great implications for other countries struggling with the pandemic. .

India is a critical supplier in the global effort to immunize people against the coronavirus, and its struggles to deploy enough vaccine for its 1.4 billion people are being closely watched overseas.

In Africa, in particular, the effects of the Indian crisis are already being felt.

Mainland health officials who relied on vaccine shipments from India learned just weeks ago that they might not arrive on time. Indian Prime Minister Narendra Modi has suspended exports of nearly all of the 2.4 million doses of the AstraZeneca vaccine produced daily by its main vaccine company, the Serum Institute of India.

Now they will be used in India instead.

But even with this change, as well as the scramble from the Indian pharmaceutical industry to speed up production – including a deal to make the Russian-developed Sputnik vaccine – the effort to get as many Indians vaccinated as possible has been terrifying. overtaken by the speed of the virus ravaging the country.

“You can’t get the vaccine to get out of a flare,” said Dr. Celine Gounder, an infectious disease specialist and professor at the Grossman School of Medicine at New York University.

Even if India could somehow quickly solve its vaccine supply problem, Dr Gounder and others said, that might not help, at least not in the short term. Vaccines take two weeks for the first dose to work, and require about four weeks between the first and second doses.

The median incubation period of the virus, on the other hand, is four to five days, which means vaccinations won’t necessarily prevent infections.

India’s health ministry on Thursday reported more than 375,000 cases and more than 3,600 new deaths. With the death toll already rising to more than 204,000, hospitals have warned of critical shortages of ventilation beds, medical oxygen, drugs and other life-saving supplies.

“The ferocity of the second wave took everyone by surprise,” K. Vijay Raghavan, the government’s senior science adviser, said in an interview in the Indian Express newspaper Thursday. “While we were all aware of the second waves in other countries, we had vaccines on hand, and no indication from the modeling exercises suggested the magnitude of the surge.”

A New York Times immunization progress database showed that as of Thursday, around 26 million people – 1.8% of India’s population – had been fully vaccinated. This is a better rate than in some mostly poor countries where hardly anyone has been vaccinated, but it is still among the lowest in the world.

In the United States, on the other hand, where the government has spent billions of dollars to secure vaccines, the figure is 30%. And even in Brazil, where the virus has caused a particularly acute health and food crisis, 5.9% of the population has been fully vaccinated.

Mr Modi’s goal of vaccinating 300 million people by the summer seems increasingly unlikely.

Dr Peter J. Hotez, professor of molecular virology at Baylor College of Medicine in Houston, said one of India’s fundamental problems is simply not having the vaccine supply it needs. “They’ve never been scaled before to a level like this,” he said.

The Serum Institute and other vaccine manufacturers in India are now expected to produce hundreds of millions of doses, he said.

How long will it take Indian vaccine makers to ramp up production?

“You’re talking about weeks, if not more,” said Dr. Gounder, the infectious disease expert, who hosts two podcasts, “Epidemic” and “American Diagnosis.”

In New Delhi, it was clear that frustration and delays at vaccination centers were escalating.

Dr Aqsa Shaikh, who runs one of these centers, said she emailed the Serum Institute this week asking for doses and received an astonishing response: The company is so overwhelmed with demand. that he could take five or six months at the center He requested 3,000 doses per month.

“When I read this email, images of mass burials appeared in front of my eyes,” Dr Shaikh said. “We may have to close the center now if the government does not participate.”

On Wednesday, the United States government allowed families of diplomats to leave India and advised other Americans to leave “as soon as it can be done safely.”

Grim as India’s coronavirus figures are – and experts warn the reported death toll could be a significant undercount – its vaccination schedule was meant to be a bright spot.

Before the pandemic, India ran the world’s largest immunization program, providing routine vaccinations to 55 million people per year. After the coronavirus spread, the Serum Institute aimed to become the global vaccine maker, injecting tens of millions of doses of AstraZeneca into its factories in the western city of Pune.

But after an initial rapid rollout, averaging some three million injections per day, India’s vaccination campaign slowed down. On Thursday, the health ministry said it had administered less than 2.2 million doses in the past 24 hours.

Despite injections of money from Mr. Modi’s government, India’s major vaccine companies are struggling to increase production.

The Serum Institute produces around 60 million doses per month and another Indian company, Bharat Biotech, produces around 10 million doses per month of its Covaxin injection. A third company signed an agreement to produce Russia’s Sputnik V vaccine later this year.

But that’s a fraction of what India needs to immunize every adult, some 940 million people.

“It’s like inviting 100 people over to your house for lunch. You have resources to cook for 20. ”Dr Chandrakant Lahariya, epidemiologist, said on twitter.

Already, health providers are saying they are running out of vaccines. Many Indians who have received an injection report having difficulty getting a second.

“You feel like you’ve been cheated,” said Aditya Kapoor, a New Delhi businessman who said he was kicked out of two clinics when he went to get his second dose. “We are as vulnerable as we were on day one.”

An online portal the government launched on Wednesday to record the footage has crashed due to the demand; more than 13 million Indians eventually obtained nominations.

“The shortage is everywhere,” said Balbir Singh Sidhu, the Punjab state health minister, who is struggling to get the three million doses of the AstraZeneca vaccine he has ordered.

India’s health ministry denied there was a supply shortage and said it had tried to speed up the rollout by allowing private establishments to buy directly from manufacturers. But critics say the policy could lead companies to raise prices for private buyers.

In New Delhi, Dr Shaikh said his vaccination center would soon no longer be able to offer even the 150 doses he administered each day.

“Just thinking that I can’t help in our vaccination center makes me cry,” she said.

Sameer Yasir reported from New Delhi, Shashank Bengali from Singapore and Rick Gladstone from New York.

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