On Jan 16, 2021, India began the world’s largest vaccination programme for COVID-19. The pandemic had caused over 155 thousand deaths and had brought the Indian economy to its knees. The Covid-19 vaccine was seen by many as the saviour. However, vaccination of 1.4 billion people in the country poses a herculean task. The vaccination drive would have to overcome several logistical and implementation issues.
An independent India post-1947 set up vaccine laboratories and manufacturing facilities throughout the country. The initial vaccination efforts led to the eradication of smallpox in 1977 in India. The expanded program of immunization was introduced in 1978 which was followed by the Universal Immunization Program (UIP) in 1985. The UIP is one of the largest immunization programs in the world and is a major public health intervention in the country. Under the Universal Immunization Programme, the Government of India is providing vaccination to prevent seven vaccine preventable diseases: Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B, Haemophilus influenzae type b (Hib) and Diarrhea. India was declared polio free in 2012; this major feat by the country was possible largely due to the UIP.
Vaccine Production Capability of India
India’s vaccine production capabilities have grown over the years due to a combination of massive increase in population, UIP and an emphasis on domestic production by the Government of India. Today, the country produces 60% of all vaccines in the world. It also has the world’s largest production facility in Pune called The Serum Institute (SII). In terms of estimated production in 2021, India would only be second to the US. More than 3.5 billion vaccines could be made in India this year as compared to 4 billion in the US. These vaccines are considered reliable due to India’s proven track record and are also cheaper than their western counterparts. The UN Secretary-General Antonio Guterres recently termed the vaccine production capacity of India as the “best asset that the world has today”. The need to use this important asset wisely is essential to India’s Covid-19 vaccination strategy.
India’s Covid-19 vaccination Plan
India’s plan is based on a phase-wise inoculation of its population, with science and logic at the helm. The first phase requires the Covid-19 frontline workers, and medical staff to be vaccinated first, these amount to 30 million people. The government wants to protect the medical workers since a shortfall of that resource would prove to be disastrous in the fight against the virus. The second phase mandates the inoculation of citizens above the age of 50 with a subgroup of people above 60 given priority. This segment amounts to 270 million people. According to the plan phase two should end by July-August 2021.
To help with the implementation the government has introduced a new application called Co-WIN. This application would be used to track the beneficiaries for vaccines on a real-time basis and register them for vaccinations. The app will also provide information on vaccine stocks, storage temperature and vaccine utilization. 1.54 lakh Nurses and midwives from the UIP are going to be included from to further help with the inoculation drive.
The government has also taken steps to strengthen the cold chain facilities in India to help with the storage of some vaccines that require sub zero temperatures. Finally, there has been a consistent effort by the government to prevent the spread of misinformation about vaccines, and for this purpose they have reached out to local, religious and community leaders to improve confidence among the masses. Dr. Mahesh Sharma became the first MP to be inoculated, this increased confidence within his constituency.
The Government of India has announced that the Covid-19 vaccination would, however, be voluntary. This was based on past experiences and expert suggestions. Health experts point out that while vaccination is mandatory in countries such as Australia and the USA, they lead to lower public confidence in vaccines as people are forced to get their children vaccinated if they want to avail services like schools and child care payments. The alternative model followed, for instance, in the UK is much more feasible; it requires increasing access to the vaccine and educating the public on its benefits. The war against the pandemic cannot be won if people are forced into the vaccination, this would lead to more dismay and panic amongst the masses.
Currently, India has 2 vaccines available, both of which have been “made in India.” These include Oxford AstraZeneca’s Covishield and Bharat Biotech’s Covaxin. Covishield is being produced by SII in Pune and has an efficacy rate of 90%. There is still no data on the efficacy rate of Covaxin. The Lancet published Covaxin’s phase I trial data, giving it a green light for safety and stating that it generates adequate immune response, but further efficacy trials were warranted. The government has ordered 21 million Covishield doses and 10 million Covaxin doses. Both these vaccines are cheaper than other vaccines available worldwide and also easier to store. Covishield costs the government Rs. 200 per dose while the Covaxin costs around Rs. 206 per dose. This is much cheaper than foreign vaccines such as Pfizer-Biotech vaccine (Rs.1400) and Moderna (Rs. 2500). Pfizer’s vaccine requires -70 degree celsius for storage while the Indian vaccines require 2-8 degree celsius and are therefore easier to store. According to the government, 4 more vaccines are in the pipeline. These include the Russian Sputnik V vaccine and Zydus Cadila’s coronavirus vaccine ZyCoV-D.
Recently, the UN chief joined the WHO in slamming rich countries for hoarding vaccines. This is turning out to be a huge obstacle in the efforts of vaccinating the world. Rich countries gambled on several vaccines as they could not predict which ones would actually turn out to be effective. The result was that they bought enough to vaccinate their population multiple times. For context; the UK has ordered 54 million vaccines in excess while Canada has bought 156 million more than required. The EU as a bloc has ordered 525 million more than needed. The USA has bought enough to inoculate its population 4 times over. This vaccine hoarding happened in parallel with a multilateral effort called Covax to support the progress and equitable distribution of 2 billion doses of Covid-19 vaccines to the world’s poorest countries. Last week, in the G7 summit, in response to international pressure, France called for 5% of each country’s stockpile to be donated to poor countries.
The Indian government has seen this as an opportunity to fulfil its foreign policy goals. With its massive vaccine production capability, India has launched Vaccine Maitri (Friendship). It aims to provide vaccines, at times free of costs as “gifts”, to fellow developing countries. This has earned the country a lot of goodwill in the international community as well as in its neighbourhood where it is battling China for influence. India has already distributed almost 23 million doses of vaccine worldwide to 20+ countries. The external affairs ministry said that it plans to supply vaccines mostly free of charge to 49 countries in Latin America, the Caribbean, Africa and Asia. Indian vaccines are expected to reach CARICOM countries, Pacific Island States, Nicaragua, Afghanistan, Mongolia in the next few weeks. As part of Covax alliance, India would supply Africa with 10 million doses. The country has also recently promised to give UN peacekeepers 200 thousand doses as well.
Shortcomings and criticism
While the overall vaccination has received praise, there have been a few critiques as well. The approval of Bharat Biotech’s Covaxin without any efficacy data available has been heavily criticised. The participation of citizens in Bhopal without consent and questionable data collection methods by Bharat Biotech has further reduced confidence. India exporting a large number of vaccines has also received mixed reactions from the public. With such a huge vaccine production capability, the government has still not allowed the participation of the private sector in the vaccination drive. The Confederation of Indian Industry in a letter to the Prime Minister requested him to give an approval to the private sector to take part in the drive in order to speed up the process and reach more people. Businesses in the country would gain significantly from the rollout and the private sector could play a crucial role in inoculating an additional 10 crore workers in the formal sector and local communities. Finally, no politician or national leader has been allowed to take the vaccine. This move has lowered the confidence in the masses with respect to the vaccine. If a prominent figure like the Prime Minister takes the Vaccine live on television it would boost public morale.
India’s Vaccination Policy is multi-facetted. Through this article we see how India’s history of setting up the vaccine industry has helped it become a major international player today. Furthermore, it has allowed the government to fight the pandemic without any external help. The success of this policy is essential in winning the fight against covid-19.
Aviral Anand is a first year undergraduate at Ashoka University pursuing Economics and International Relations.