India’s crisis reveals why vaccine equity is more important than ever

India desperately needs more vaccines. But so does the rest of the world. 

With just over 10 vaccinations administered per 100 people in India, compared with 71 in the U.K. and 70 in the U.S., it’s clear that equitable distribution of vaccines is still a pipe dream. By any account, the optics are terrible — healthy younger people being vaccinated in the U.K., U.S. and EU as funeral pyres rage in India. 

This disconnect has led to urgent calls for countries vaccinating quickly to donate doses to India. And in some cases, it’s followed by action. After a call between U.S. President Joe Biden and Indian Prime Minister Narendra Modi, Washington promised to share its 60 million doses of the Oxford/AstraZeneca jab — which has not yet been authorized in the U.S. — with the world.

But the question remains whether such aid will help boost India’s low vaccination figures or immediately curb the pandemic. As many public health experts and officials have been pointing out since India’s outbreak became acute, waiting until countries are on their knees and then throwing jabs their way neither prevents future outbreaks nor addresses crises elsewhere.

Winnie Byanyima, executive director of UNAIDS, the United Nations’ program on AIDS, sees the real underlying problem as “huge inequality in access to vaccines.” And that can’t simply be solved by sending vaccines to wherever there are spikes in death rates, she argues.

“We need a global plan for production and for allocation for the whole world,” she said on Wednesday at a press briefing hosted by the ONE Campaign.

Path out of the fire 

Public health experts are pointing out that poor vaccination coverage is one, but not the only, reason behind the horrifying speed at which coronavirus cases surged in India.

Other factors are mass gatherings and coronavirus variants spreading like wildfire, along with what Indian health economist Rijo John describes as “somewhat irresponsible statements” from politicians at the highest levels. One example: India’s ruling Bharatiya Janata Party (BJP) trumpeted in February that India had “defeated COVID-19 under the able, sensible, committed and visionary leadership of Prime Minister Modi.”

A broad loosening of pandemic measures followed. In March, millions of Hindus gathered on the banks of the Ganges for the religious Kumbh Mela festival, despite cases already rising in the country. And elections have gone ahead without precautions, often with large rallies led by political parties, including Modi’s BJP, that attracted scores of largely unmasked supporters.

The result: Just two months after the pandemic was declared “defeated,” India was reporting in excess of 360,000 daily cases a day and over 3,000 daily deaths, with gravediggers working through the night. 

John, pointing to India’s declining vaccination rates over the past few weeks, is among those who thinks vaccine deliveries from elsewhere will still help. “Clearly there is a major supply shortage,” said John, who lectures as adjunct professor at Rajagiri College of Social Sciences. “Any kind of vaccine delivery program from outside India to Indians would be of immense use.”

But John admits that vaccines are “not an immediate solution.” In fact, many experts maintain that jabs alone, right now, won’t end the crisis.

“India has not been able to vaccinate its population at risk of serious illness,” David Heymann, a professor of infectious disease epidemiology, pointed out at a Chatham House briefing Wednesday. “As a result, they’re having serious illness. It’s too late now to vaccinate those people.”

Instead, the immediate focus should be oxygen, ventilators and dexamethasone as tools to bring the pandemic to heel, Heymann explained.

Some countries are answering this call. Many EU members, including Ireland, Belgium, Romania, and Portugal, are sending support under the EU Civil Protection Mechanism. On Thursday, several other countries, including France and Italy, announced they’ll be sending supplies, including oxygen generators, ventilators and the antiviral medicine remdesivir.

The U.K. and the U.S. have also stepped up to the plate, with the U.K. sending over 600 pieces of medical equipment, including ventilators and oxygen concentrators, while the U.S. announced similar support, totaling over $100 million. The U.S. also said that it has redirected its order of manufacturing supplies for the Oxford/AstraZeneca vaccine, which would allow India to produce over 20 million doses.

But one good still off the table for the U.K. — which is now offering the jab to healthy adults 40 and over in England — is vaccines. London continues to state it doesn’t have surplus doses to donate to India. 

‘We have to think about other parts of the world’

While the crisis in India may be particularly acute, many other countries are seeing frighteningly high cases and deaths as well, some officials and experts have been pointing out.

Although it’s “extremely important to be supportive of India … we have to think about other parts of the world from Africa to Latin America,” said former European Commission President José Manuel Barroso on Wednesday. He pointed to Brazil as an example of an “awful situation.”

While India is currently the overwhelming contributor to daily new confirmed cases globally, Brazil, the U.S. and Turkey are also each contributing in excess of 40,000 new cases on average a day. And looking at a per capita estimate, Brazil is currently worse off than India — although the latter is quickly catching up.

In late March, Brazil reached its highest per capita case rate ever, 36.5 per 100,000. That yielded its highest coronavirus death rate ever, over 1.4 per 100,000. India’s death rate (while likely under-reported) is still far below Brazil’s, although its infection rate is rapidly approaching that of the South American nation.

Moreover, what’s happening in India is happening in “more and more developing countries,” said UNAIDS’ Byanyima. And while vaccine donations help, they “will not help us to solve this global problem — we need a global plan.”

“Around the world, governments are not acting together behind a plan,” she said. “Their actions, or the actions of companies, are a lot about the interest of profit to companies and the interests of individual countries.”

Global inaction

The problem is that the mechanism set up to facilitate this global equitable distribution — COVAX — isn’t going very well, not least because it was heavily leaning on India to produce its vaccines. 

To divert supplies back home, India has halted exports of vaccines out of the country, preventing jabs going from the Serum Institute of India to countries supported by COVAX. In total, the Serum Institute is meant to produce 1.1 billion vaccine doses for COVAX.

This meant that in March and April, COVAX was falling 90 million doses short for the 60 lowest income countries, said Seth Berkley, CEO of Gavi, the Vaccine Alliance.

“We are waiting for when supplies will resume,” he said. “We’re looking at other options at the same time.”

The situation in India has “severely impacted the predictability” of the rollout in Africa and would likely do so for weeks and even months to come, warned the director of the Africa Centres for Disease Control and Prevention, John Nkengasong, on Thursday.

“If India … cannot even meet its needs, I don’t know how they can export vaccines to Africa,” he said.  

For now, the prospects for coordinated, well-funded global action look far off. The ACT Accelerator, which includes COVAX, has a funding gap of $19 billion as of late April. And while COVAX began delivering doses in February, WHO Director General Tedros Adhanom Ghebreyesus has repeatedly criticized countries for bypassing the facility and agreeing to bilateral deals, which he says drives up prices and reduces available vaccines for COVAX.

Still, for now, those countries that do offer to donate doses should do so through COVAX, said ONE Campaign’s acting CEO Tom Hart, on grounds that it’s more efficient.

“Through COVAX, donated doses could be distributed quickly and equitably in other parts of the world so we can hopefully prevent the kind of catastrophe that’s unfolding in India,” he said. 

Additional reporting by Helen Collis. 

This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial.