Covid-19 vaccines in India run out as second wave accelerates

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On Friday, the country reported 217,353 new cases, the highest figure in a day so far, according to data from the Ministry of Health of India. India added a million new cases in less than a week, surpassing 14 million cases on Thursday.

States and cities impose new restrictions, including weekend and night curfews in the Delhi capital region, where 19 million people live. Migrant workers are also leaving the main cities en masse to their hometowns, fearing that possible blockades will leave them stranded.

And through it all, the supply of vaccines has dried up on the ground, with at least five states reporting severe shortages and urging the federal government to act.

In the face of the crisis, the government and SII have shifted the focus of vaccine supply to COVAX to prioritize their own citizens at home.

“Dose deliveries from the Serum Institute of India will be delayed in March and April,” said COVAX, led by a coalition that includes the international vaccine organization Gavi and the World Health Organization. in a press release on March 25th. ensuring the supply of doses of Covid-19 vaccine produced by IBS is due to the increased demand for Covid-19 vaccines in India ”.
AstraZeneca vaccine boxes, manufactured by the Serum Institute of India and provided through the global COVAX initiative, arrive in Mogadishu, Somalia, on March 15th.

India had provided 28 million doses of the AstraZeneca vaccine so far and planned to administer another 40 million doses in March and 50 million in April, according to the statement, which adds that COVAX and the Indian government “continue discussions ”On the completion of supplies.

It is not the first time India has to pause its COVAX contributions: in January, the government restricted the export of SII-produced AstraZeneca vaccines “because they want to prioritize the most vulnerable and needy segments,” Adar said. Poonawalla, general manager of SII.

But these repeated delays have hit hard countries hard. The director of Africa’s disease control body warned that controlling India’s exports could be “catastrophic” for the continent, while Pakistan, one of the main recipients of the program, decided to allow imports and sales of private vaccines filled the gap.

Vaccination centers keep people away

India administers two vaccines nationwide: the Oxford-AstraZeneca vaccine, also known as Covishield, and its own Covaxin, developed jointly by Bharat Biotech and the Indian Government Council of Medical Research (ICMR).
The country began its vaccination program in January for health workers and priority groups, with the goal of completely inoculating 300 million people in August. But the program got off to a slow start, facing logistical problems and hesitation among the population, especially towards Covaxin, which was approved for emergency use before the efficacy data for its third phase trial were published. .
So far, only 14.3 million people have been fully vaccinated, just over 1% of India’s population, 1.3 billion, according to Johns Hopkins University.

But public confidence increased as the government intensified an awareness campaign to alleviate concerns and the vaccination program picked up speed. As new daily cases accelerated in March and April, several states began reporting lack of vaccines.

A vaccination center in Mumbai, India, that had to move people away due to the shortage of vaccines on April 9th.

In Odisha, about 700 vaccination centers had to close last week due to the shortage, health authorities wrote in a letter to the central government, warning that the state would soon run out of available stock.

Rajesh Bhaskar, a Punjab health official, told CNN last week that the state had about 450,000 doses of Covishield and 30,000 doses of Covaxin. According to the latest available government statistics, there are more than 27 million people in the state. “We want to vaccinate about 100,000 people a day, and the current supply is insufficient to meet that demand,” he said.

Several districts in Maharashtra, the hardest-hit state, had to temporarily suspend vaccination actions, including more than 70 centers in Mumbai that closed last week, according to state health minister Rajesh Tope. Maharashtra had administered more than 11.1 million doses as of Thursday, most of the Indian states, according to the Indian Ministry of Health.

“In both cities and towns, we have created teams … to bring everyone over the age of 45 to get the vaccine,” Tope said on April 7th. “People come to the centers, but our health workers have to tell them they haven’t received the vaccine, so they should go home.”

There are several challenges that contribute to the shortage: one is the supply of raw materials, said former ICMR Director General Nirmal Kumar Ganguly.

India “has the capacity to produce,” Ganguly added, but supply chains have been disrupted during the pandemic. The vaccine formulas and materials needed “cannot be changed overnight, so we have to rely on the import of raw materials.”

The United States has imposed a temporary ban on exports of raw materials essential for vaccine production, and the EU has similarly tightened restrictions on vaccine exports. India is now working to “adapt to materials that are made at home or in neighboring countries like Singapore,” but that will take time, Ganguly said.

An additional challenge is the country’s confidence in SII, he added. There are other vaccine manufacturers in the country, such as Bharat Biotech, but SII remains the largest.

“The need for us to expand our capacity has become clear,” Ganguly said. “We are one of the vaccine exporters, but now two or three Indian companies are doing it, the rest are not big players and some are totally new in vaccine production.”

Mixed government response

Several states have called for more doses from the central government, but federal officials have backed down and insisted the situation is under control.

Tope’s complaints were “nothing more than an attempt to divert attention from the repeated failures of the Maharashtra government to control the spread of the pandemic,” Indian Health Minister Harsh Vardhan said in a statement last week. Interior Minister Amit Shah also rejected claims by states, saying their information “was not true” and vaccines were available, “as much as required.”

Prime Minister Narendra Modi has expressed praise for the success of vaccination in India. During a meeting with state governors on Wednesday, Modi “stressed that India has become the fastest nation to reach the ten million (100 million dose) vaccine target,” according to a statement from his office.

It took India 85 days to reach 100 million doses. In comparison, the US took 89 days and China 102 days, according to Modi’s office.

And on Tuesday, Rajesh Bhushan, secretary of the health ministry, said the problem was poor planning and management, not a supply. “We are making doses available to states in a timely manner,” he said, adding that states should “look at how many unused doses are at each point in the cold chain.”

His statements received outrage from local and state leaders. Shah’s claim was “really completely wrong” he tweeted Rajasthan Chief Minister Ashok Gehlot on 10 April.

And while a last-minute shipment from the central government had saved Uttarakhand from complete scarcity, it is far from a perfect solution and “supply is unpredictable,” health department official Kuldeep Martolia said on Monday.

The boxes of the AstraZeneca vaccine, produced by the Serum Institute of India and donated by the Indian government, arrive in Kabul (Afghanistan) on February 7, 2021.

As a sign that the federal government may feel pressure, it took steps this week to open the doors to vaccine imports. On Tuesday, it announced it would speed up emergency approvals for vaccines already approved by the World Health Organization or authorities in the United States, Europe, Britain and Japan.

Companies have yet to apply for approval in India, but they will be exempt from having to conduct local security testing, streamlining the process.

“If any of these regulators have approved a vaccine, the vaccine is ready to be introduced into the country for use, manufacture and completion,” said Dr. VK Paul, a senior health official in the group. Government thinker Niti Aayog said at a news conference on Tuesday. “We look forward to and invite vaccine manufacturers like Pfizer, Moderna, Johnson & Johnson and others … to be ready to come to India as soon as possible.”

The measure is “a step calculated” by the government to “ensure we have more vaccines available,” Ganguly said. The government could also expand its supply through the private market, but that also poses additional challenges, he said, including the question of how to make a price of vaccines to provide equitable access to the poor.

But even the possibility of importing foreign vaccines will not be a quick fix, as companies like Pfizer and Moderna have other orders to fulfill first, including the supply of vaccines to the US. India has just granted an emergency use permit for the Russian Sputnik vaccine, but “by the time they build up manufacturing capacity and manufacturing requirements, it will take five to six months,” he said. dir Ganguly.

Meanwhile, the government is working to expand local production capacity: a state biomedical institute in Maharashtra was given the green light to manufacture the Covaxin vaccine on Thursday, through a technology transfer with Bharat Biotech.

A sadhu wearing a face mask takes a dip in the Ganges river during the Kumbh Mela festival in Haridwar, India, on April 12th.
Meanwhile, the second wave erupts, with cases escalating sharply every day. Millions of people travel across the country to the city of Haridwar in Uttarakhand to celebrate the Kumbh Mela, a Hindu festival and the largest pilgrimage on Earth. Despite warnings about Covid’s risks, huge crowds gather to pray, attend ceremonies and dive into the Ganges River.

There are already increasing cases in Haridwar, causing the state to impose restrictions on Thursday. At least one religious group attending the festival, the Niranjani Akhada, has called on outsiders to withdraw amid rising cases.

“This wave is a very, very threatening view, which is happening right now in India,” Ganguly said. “We’ve never seen anything like it.”

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