April 2021 has begun with sharp contrasts; on the one hand India has displayed its remarkable vaccination capacity notching nearly four million inoculations in a day, on the other it recorded the highest daily infection count globally.
The fatality rate is also uncomfortably high. With the experience of running the world’s largest vaccination drive in the past, India can clearly speed up its daily vaccination rate to much beyond the present scale and yet the country is stumbling badly. Despite beating down the first wave even after withdrawing the lockdown, panicky reactions in the second wave has set in.
A cautious India had taken time to look into the pros and cons of the effectiveness of different vaccines available and began its vaccination drive from January 16 by inoculating health workers in what is likely to be the world’s largest Covid-19 vaccination campaign. India’s vaccination programme began at a total of 3,006 session sites across the country.
India plans to vaccinate around 300 million people with two doses in the next six to eight months, which targets 26 million infants. The recipients include 30 million doctors, nurses and other front-line workers, to be followed by 270 million people who are either over 50 or have illnesses that make them vulnerable to Covid-19.
As India launches an ambitious effort to vaccinate 300 million people against Covid-19 within six months, it is employing two vaccines; both manufactured domestically. One is Covishield, the vaccine developed by Britain’s AstraZeneca and Oxford University, which is being manufactured in India by the Serum Institute, the world’s largest vaccine maker. The other is Covaxin, developed by an Indian firm Bharat Biotech in partnership with the Indian Council of Medical Research (ICMR) and National Institute of Virology (NIV). Covaxin is a whole-virion, inactivated SARS-CoV-2 vaccine with two adjuvants – Algel (alum) and Algel-IMDG.
India’s vaccination rate
Surpassing its past records India recorded more than 1.5 lakh fresh Covid-19 infections on April 10, becoming the second country after the US to register the grim milestone on the back of a sharp increase in cases from Chhattisgarh, UP and Bihar.
A huge 1,52,879 new cases were recorded on April 10 – up more than 5% from the previous day’s figure of 1.45 lakh. India crossed 1.5 lakh-mark in just six days after daily cases went past the one lakh – a 50% rise in less than a week. The peak count during the first wave of infections was 98,795, recorded on September 17, 2020.
Number of deaths too increased to 839 on April 10, the highest daily toll since October 16 last year. Although deaths have been rising steadily during the second wave, the toll continues to be low compared with the case fatality rates seen during the peak of the first wave in the country. Active cases are nearing the one-million mark. India is now the 4th-worst hit country in terms of active cases.
Maharashtra recorded nearly 59,000 new cases of the Covid-19 and 301 related deaths on April 9 compelling the state government to seriously consider the possibility of imposing a lockdown if the infections continued to surge. Uttar Pradesh reported 9,695 new cases and Delhi 8,521 on April 9. The five most affected states by total cases are Maharashtra (3,288,540), Kerala (1,154,594), Karnataka (1,033,560), Andhra Pradesh (913,274), and Tamil Nadu (911,110).
This sharp spike in new cases has now made it necessary to speed up India’s vaccination rate. India probably has done well in its vaccination drive so far considering the early glitches the programme had to face, but this now looks insufficient against the requirement arising out of the rapid surge in new cases.
Covid-19 vaccination drive across the country is near to a landmark achievement. The cumulative number of Covid-19 vaccine doses administered in India crossed the 10 crore mark on April10, the Union minister of Health and Family Welfare Ministry has informed.
According to the health minister over 10 crore fifteen lakh doses of Covid-19 vaccine have already been administered to beneficiaries across the country. The Health Ministry claimed that India had administered these doses within 85 days, faster than the United States' 89 days and China's 103 days. However, the 29 lakh doses administered on April 10 were a significant decline from the 45 lakh doses — an all-time record — administered on April 5. Since that high, the country’s daily vaccinations have seen a decline every day of the week, except for April 8, when it registered a moderate jump to 36 lakh doses and declined again on April 9.
In terms of average daily doses administered, India continues to remain at the top globally with 38,93,288 doses administered a day. India accounted for about 13% of the total vaccination doses administered till April 9 globally. According to data compiled by the ‘Our World in Data’ project at the University of Oxford as well as national data sources from some countries at least 754,913,748 doses of coronavirus vaccines have been administered around the world till April 9.
Maharashtra tops the list in terms of total doses administered. About one crore (99,23,534) doses were administered in the state till April10. Maharashtra is followed by Rajasthan with 95,35,608 doses and Gujarat with 90,56,842 doses. To add to some perspective, Maharashtra accounts for 9.8% of the total doses administered till date, higher than its (9.1%) share in the country’s total population (based on projected population for 2021). Rajasthan whose population (5.8%) is much lower compared to Maharashtra has fared better in administering the doses--with a 9.4% share in total jabs.
Looking at it from another perspective Maharashtra has administered 75 doses per 1,000 populations; much lower compared to some of the larger states such as Chhattisgarh (125.7), Gujarat (121.4) and Rajasthan (111.1). States such as Uttar Pradesh and Bihar, among the most populous states, -rank at the bottom. (Chaitanya Mallapur : Here’s how states are performing in the COVID-19 vaccination drive – Moneycontrol April 8, 2021)
Even after staying at the top in terms of average daily jab, only about 6% of the country’s population has received their first jab of the vaccine so far, indicating a long road ahead. With surge in cases, experts suggest the need to accelerate the pace of vaccination. The concern about speeding up the vaccination drive further gets a new momentum after India reported at least 100,000 new cases for the last three consecutive days with Maharashtra being the worst affected. Of the 979,608 active cases in India as per the April 9 update, Maharashtra accounts for 53% or 522,762 active cases, followed by Chhattisgarh (68,125) and Karnataka (53,414). Maharashtra also reported the most 56,286 or 43% of new cases on April 9 and 376 or 48% of the deaths.
Is India running out of doses?
But while India grapples with a deadly second wave of Covid-19 infections - with an average of more than 90,000 cases daily from the beginning of April - its vaccination drive appears to be struggling. Half a dozen states are reporting a shortage of doses even as the government insists that there's enough in stock.
Union health minister Harsh Vardhan says the "allegations" of vaccine scarcity are "utterly baseless" - more than 40 million doses are "in stock or nearing delivery", he claims.
That may not be entirely true. Vaccine shortages seem to be a reality in some states who have managed to vaccinate quickly and the shortage might be triggered by a mismatch between the claimed production capacity of Indian vaccine makers and the actual produced doses over the last four months or so, analysts argue.
When it comes to vaccine manufacture, India is a powerhouse. It runs a massive immunisation programme, makes 60% of the world's vaccines and is home to half a dozen major manufacturers, including the Serum Institute of India - the largest in the world. But a large-scale adult vaccination programme against a virulent pathogen like SARS-Cov2, the Indian pharmaceutical companies have been ramping up production by adding new facilities or converting existing production lines for some months now, both to meet domestic demand and meet global supply requirements.
The Serum Institute said in January it could at that point turn out between 60 and 70 million vaccine doses a month - this includes Covishield and the US-developed Novavax (not yet licensed for use). According to a BBC report SII was aiming to boost production to 100 million doses a month from March - but production was still at 60 to 70 million doses, and had not increased. Mr Poonawalla has now said ramping up to 100 million would happen only by June.
India has a major challenge inoculating its own population. "We are prioritising the needs of India", said Adar Poonawalla, the head of SII said in an interview on Indian television, but added “we are still short of being able to supply to every Indian”
Shortage of raw materials turns a big issue
The head of the Serum Institute of India (SII), one of the world's largest manufacturers of coronavirus vaccines, has said that its production capacity was "very stressed" (BBC News April 7). The SII had been supplying vaccines around the world, including to the Covax scheme for middle and low income countries.
Two vaccine producers in India have raised concerns about their ability to meet their production targets. The largest of these, SII - which produces Novavax and AstraZeneca vaccines - has warned of raw material shortages affecting production.
The problem of raw material shortage has been attributed to the US export bans on specific items needed to make vaccines such as specialised bags and filters. SII has reportedly said that it has also faced difficulties importing cell culture media, single-use tubing and specialised chemicals from the US. Another Indian manufacturer, Biological E, which is producing the Johnson & Johnson vaccine, has also raised concerns about possible shortages affecting vaccine production.
India goes slow on vaccine export
Amidst a fresh surge in Covid-19 cases the government has hinted it may need to “calibrate” its supply schedules to other countries, although it has not proposed a full ban on exports at this time. Unlike many other countries, the government has not placed a ban on exports, but that Covid-19 vaccine supplies to other countries would be made in a phased manner keeping in view the domestic requirements.
According to the Ministry of External Affairs, India has exported more than 60 million doses of Covid-19 vaccines since January 20 this year. While about 8 million were grants from the Government of India to other countries, most of the supplies have been procured by the international GAVI alliance that runs the COVAX facility (17.86 million) and commercial orders (34.17 million).
The shipments, all part of the decision to allow exports under the “Vaccine Maitri” programme, which has been praised worldwide, could now see a slowdown, the government appeared to indicate.
India has placed a temporary hold on all exports of the Oxford-AstraZeneca coronavirus vaccine since the increasing new cases meant domestic demand was expected to pick up in the coming weeks and more doses were needed for India's own rollout.
The move - described as a "temporary squeeze" by officials - is expected to affect supplies until the end of April. Some 190 countries under the Covax scheme are likely to be affected. The scheme, which is led by the World Health Organization (WHO), aims to ensure vaccines are shared fairly among all nations.
India's largest vaccine manufacturer, the Serum Institute of India (SII), has delayed shipments of the AstraZeneca jab to several countries in recent days, including the UK and Brazil.
The government has set an ambitious target of vaccinating 300 million people by July 2021, having also shipped more than 60 million vaccine doses to 64 countries, including the United Kingdom, Canada, Brazil and Mexico. But while India has the manufacturing prowess to vaccinate its population, the vaccination program itself has been met with serious challenges.
India has an estimated population of 1.38 billion people. Only about 100 million Indians (roughly 7%n) have received their first dose. Countries such as the US and the UK have already vaccinated 29% and 46%, respectively.
Reaching anywhere near the level of the US is a difficult task, but India needs to do that and do it fast as the second wave of the virus is spreading far more quickly than the first one. However, at the present inoculation rate even vaccinating 60% of India’s population, translates to nearly 800 million people, would take nearly two years provided supply chains remain unhindered.