What is ailing India’s vaccination strategy?

Vaccination, the strategy that is supposed to be the end game of the current coronavirus pandemic, is currently mired in a system of miscommunication seeking to hide the bad policy choices of the political executive in India.

India, which has been caught in the vortex of a second wave sparked by a new strain of the virus, is fumbling for words to explain away its inability to predict this unexpected surge. Its vaccination strategy, which was at an incipient stage before the current outbreak, is beset by the confusion engendered by the sudden development.

A political slug fest is playing out over what is wrong with India’s vaccination strategy. The opposition, which has long been sulking over the continued popularity of Prime Minister Narendra Modi, found an opportunity to paint their bête noire in lurid colours. The federal government for once appears weak and vulnerable as it failed to anticipate the tsunami of cases that had rocked its otherwise smooth-sailing boat. Here I am not going into the politics of vaccination and will attempt to look at some basic numbers that will give us an idea of the enormity of the challenge facing India.

India launched its vaccination campaign on January 16 with the first phase focused on health care and frontline workers. Later it was opened to above-60 years category and above-45 category in March and April. The campaign was going on smoothly with a daily dosage of somewhere between two-three million. The public at large were also not so eager to get the jab as the pandemic appeared to be receding on its own. Then came the outbreak of second wave in the beginning of April with a new strain of the virus fuelling it. The vaccine strategy became the focal point of discussion with the government coming under pressure to ramp up the campaign.

India opened up vaccination for all adult citizens above 18 years on May 1 after it came under sustained pressure from the state governments and public at large. The number of people under the category are projected to be 960 million. It requires at least 1.9 billion doses to inoculate this vast population. After deducting roughly 180 million doses which were already administered, India still requires 1.7 billion doses. At an average of two million doses being administered currently, it takes at least 850 days to vaccinate the remaining population. If we put this year-end as the target to reach full vaccination of all adults, we require at least eight million to nine million daily doses, a way too high from the current two million doses. Even 75 per cent vaccination of all adults requires 1.3 billion additional doses.

What should India do now to salvage the situation? It should see how it can ramp up supplies by enhancing the production capacity of existing producers and sourcing some additional supplies of Pfizer, Moderna and Russia’s Sputnik-V. India has lost initial advantage by not reaching deals with the US vaccine manufacturers who, at the moment, are fully preoccupied with pre-orders. They are unlikely to oblige India’s request for at least a few months. Sputnik, which has already entered India with initial doses of over 200,000, has tied up with Indian companies to begin local production. But it remains unclear by when it will resume local production and how many doses it will be able to supply by the end of this year.

At a recent submission to the supreme court, the federal government said Serum Institute is currently producing 65 million doses a month and Bharat Biotech is churning out 20 million doses a month. This roughly works out to three million doses a day. What was baffling is the current vaccinations hover around two million, a million short of their stated capacity. In the same submission, it is said the production capacities of these two firms will be considerably enhanced by the end of July.

India should drop its inflated sense of self-esteem a bit and seek the Chinese assistance in procuring Sinopharm doses, now that the vaccine is approved by the WHO. The UAE too is expected to commence the local production of the vaccine under the name of Hayat-Vax. New Delhi should look at this possibility given the dire situation prevailing in India.

The government has received a lot of unfair criticism over export of vaccines. India has exported a total of 66 million doses, of which only 11 million were given away to friendly countries as part of the diplomatic outreach. The rest are commercial exports by the companies and contributions to the WHO’s Covax programme. Even if all these exports, some of them are legally mandated, are blocked, it would not have made much of a difference to the Indian vaccine drive.

India should do some plain-speaking on the problem at hand. “By trying to say we are doing well, the government is only compounding the problem. It is time to acknowledge that we did not plan well in advance for the vaccines for whatever reasons and that the supply side issues will take time to resolve,” says Rakesh Dubbudu, founder of Factly website, a fact-checking initiative. Speaking to Khaleej Times, Rakesh, who has been focusing on the right to information issues for the last several years, says “requesting people to be patient and asking them to first allow the vulnerable to take the vaccine could be one way of solving the problem, just like how people were asked to give up subsidy in the case of LPG”

The strategy in the short term should be on testing, and isolation and observation of positive individuals and their contacts. Chief of Indian Council of Medical Research Dr Balram Bhargava revealed on May 11, according to a report in The Hindu, India has the capacity to conduct a total of 1.6 million RT-PCR tests and 1.7 million Rapid Antigen tests. Apparently, the country has not used this capacity with its daily tests never exceeding two million against a capacity of three million with both tests put together. Vaccination is likely to be a year-long process. The focus now should be containment and flattening the curve of infections.

— sreenivasa@khaleejtimes.com