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Monday, February 26, 2024

Vaccines for Export Not for Indians


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Two Covid-19 vaccines are currently made in India: Covishield by Serum Institute of India (SII), which is made based on a technology/patent, and under license from UK-based AstraZeneca; and the home-developed and produced Covaxin by Bharat Biotech.

Soon, two more vaccines will be made in India. The first is the Sputnik-V vaccine developed by Gamaleya Research Institute of Epidemiology and Microbiology of Russia, and is licensed by the Russian Direct Investment Fund (RDIF) to seven companies for manufacturing in India, Dr. Reddy’s Laboratories, Hetero Biopharma, Gland Pharma, Stelis Biopharma, Panacea Biotec, Virchow Biotech and Shilpa Medicare. The fourth India-made vaccine will be made by Biological E, based on technology developed by two American hospitals, Texas Children’s Hospital Center for Vaccine Development and Baylor College of Medicine, along with California-based company Dynavax Technologies Corporation.

The AMB has levelled allegations on Modi that he exported (or allowed the exports of) vaccines instead of using them to vaccinate Indians at home.

Yes, it is correct that India exported 66.37 million (6.637 crore) doses of Covid vaccines to 93 countries between 20 Jan and 16 April 2021. Out of these, ~35.467 million doses of Covishield and 325,000 doses of Covaxin were sold commercially, while 10.72 million doses of Covishield and 19.86 million doses of Covaxin were given free of cost as grants.

India’s neighbours got 21.168 million doses, or 31.9% of the total. The UK and Canada got 5.5 million doses (8.3%), as per the commitment SII had with AstraZeneca. Poor African nations and UN health workers/peacekeepers got 29.108 million doses (44.3%). Middle-eastern countries which supply us with oil or have a huge Indian diaspora, or both, got 5.325 million doses (8%). Brazil bought four million doses (6%). That accounts for 98.1% of the vaccines exported by India. If you were India’s PM, to which of these groups of nations would you have not exported the vaccines?

59.391 million doses (89.5% of the total) left India by the 14th of March, when India had a 7-day moving average of 21,146 cases, or just 21.6% of the first wave’s peak. When cases started crossing 25,000 per day almost every day, Modi took a decision on 24th March to stop Covid vaccine exports completely.

The All India Peoples Science Network, a national federation of science networks, issued a statement, urging the Central Govt. to oppose the “misguided vaccine nationalism” that India is exporting vaccines without prioritising domestic needs, and to continue exporting Covid-19 vaccines. Like I keep saying, no PM or government can satisfy everyone.

Compared to the 66.37 million doses exported, India has administered 170.18 million (~17 crore) doses to residents in 114 days. Out of this, 109.06 million doses were administered in the last 40 days as on 9 May @ 2.727 million (27.27 lakh) doses per day.

See this graph of the number of people who have received at least one dose in 11 countries with >60 million population. Pakistan, Nigeria, Bangladesh, Japan, Ethiopia, the Philippines, Egypt, Vietnam, the DRC, Iran, Thailand, and Tanzania do not even figure in the graph, as their numbers are too low. See India’s numbers compared with much richer nations.

Vaccines for Export Not for Indians - Vaccines

Yes, Israel has vaccinated 62.64% of its population as of 9th May and this fact has been much talked about in the media and on WhatsApp chats, saying India should follow Israel’s example.

Do the dumb fools who say such nonsense even understand basic math? Israel’s population is just 0.66% of India’s. As on 9th May, India has administered 16.2 times the number of vaccinations that Israel has done.

In the same way, comparisons with Chile, Bahrain, Serbia, Aruba, Hungary, Qatar, and Uruguay—which the Times of India made on 5th May—do not make sense.

When comparing what percentage of the Indian population has been vaccinated, we should compare ourselves only to large countries (population of over 100 million or 10 crore), which is what this graph does. Again, countries with very low numbers have been left out. The USA has been left out because its high number makes the lines of countries below India almost disappear.

Vaccines for Export Not for Indians - Vaccines

It is clear that India has not done badly at all, considering that Brazil’s Per Capita GDP (PCGDP) is 5.75x of India, Mexico’s is ~4.2x, and Russia’s is 5.3x. In fact, we have done better than Indonesia (~1.94x), the Philippines (~1.66x), and even Japan, which has ~19.6x of India’s PCGDP.

On 10th May, 27 European Union (EU) nations with 5.616 times India’s total GDP and average 17.9 times India’s PCGDP were able to manage only 93.49% of the vaccination numbers India had achieved.

My German friend told me she has not even got a single dose, as only those aged 60+ and special categories such as healthcare workers were eligible. A friend in Canada said is wife and he were waiting for their first shot for over three months, and were told it would be delayed indefinitely as India stopped vaccine exports to Canada.

Did you know that, out of 837 million doses of vaccines which were projected to be manufactured worldwide in 2020, only 3.7% were actually produced? (Source: Airfinity).

Therefore, India is not the only country that has had to delay vaccination.

Look at this chart of the world’s largest vaccine manufacturers and the number of doses they are expected to produce in one year from May 2021 to April 2022.

Vaccines for Export Not for Indians - Vaccines

Vaccines for Export Not for Indians - Vaccines The chart on the left lists the vaccines manufactured by country as on 3 March 2021. Similar data was not available after this date when I was writing this. Contrary to popular belief, India is NOT the world’s largest Covid vaccine manufacturer. India is the world’s largest producer of all types of vaccines, but not specifically for Covid vaccines, in which category it is the fourth largest.

When we start comparing ourselves to a rich country like the USA, it is just not fair. A crorepati (multimillionaire) commented on a WhatsApp group that India should have given emergency approval to Pfizer and let some business houses set up the cold chain infrastructure (unlike AstraZeneca’s Covid vaccine Vaxzeria, made and sold as Covishield in India, and the fully Indian Covaxin developed and manufactured by Bharat Biotech, which have to be stored at 2º to 8ºC, other vaccines need to be stored at minus 70ºC and therefore need a ‘cold chain’), as “India had 50 million (five crore) people who are ready to pay ₹10,000 for a Covid vaccine.” In reality, as per the Swiss bank Credit Suisse, India only has ~7.6 lakh dollar millionaires, or those who have a net worth of $1 million (₹7.5 crores). Even if we were to assume that people with a much lower net worth—say ₹1 crore—can afford the ₹10,000 per vaccine dose, the population won’t cross 10 million (one crore). India’s most authoritative rich list provider Hurun India says that there are 412,000 dollar-millionaire households in the country. Only 97,689 Indians declared incomes of ₹1 crore or more in 2018-19.

The USA, under its “Operation Warp Speed” (for Trump-haters and Joe Biden–Kamala Harris fans, fact is that this operation was started by President Donald Trump in May 2020), invested $12.4 billion (₹91,740 crores) in ‘potential’ Covid vaccines to be made by six companies, as per a 14 December 2020 article in Time magazine. The operation aimed to provide at least 300 million doses of vaccines by Jan 2021, and 900 million in total.

Vaccines for Export Not for Indians - Vaccines

Considering that India needs 2.121 billion (212.1 crore) vaccines for the 6+ population including wastage and the vaccines already administered, and assuming an average price of ₹650 (as a major proportion would need to be imported), could the GOI have invested ₹1.38 trillion (₹1.38 lakh crores) for a similar operation, and that too within 3-4 months? The amount that the USA invested was only 0.055% of their GDP and the amount that India would need to invest would be 1.03% of our GDP, or about 18.7 times that of the USA.

Maybe we should have, but a wiser decision was perhaps taken to have domestically-manufactured vaccines. After all, no one was expecting such a severe second wave.

There were a lot of controversies raised by the Congress, AAP, Mamata Banerjee’s TMC, and other opposition parties, about the price of Covishield and Covaxin being higher for states than for the Centre. SII is selling Covishield to the Centre at ₹150, to state governments at ₹300, and to private hospitals at ₹600. The price for the Centre had been decided way back in Oct 2020, and SII makes a loss on each dose at this price. Besides, though the Centre is paying ₹150 per dose, it is giving it 100% FREE to the states—after all, it is the states which carry out the vaccinations, not the Centre.

As far as the price of ₹600 for private hospitals is concerned, those who are getting vaccinated at private hospitals were surely watching movies at multiplexes before the onset of the pandemic. Even if the hospital charges ₹750–800, it is less than the price you pay for a movie ticket and popcorn. In any case, I haven’t heard of any significant number of private hospitals complaining.

Consider that the price of Russian and Chinese vaccines is more than ₹750, and that of American vaccines is more than ₹1500, SII’s price of ₹300 and ₹600 is not bad at all.

The Congress and other parties also raised hue and cry to let Pfizer vaccines be imported. Mind you, all the noise was only to allow Pfizer, there were no asks for Janssen (Johnson & Johnson), Novavax, or Moderna. Why? Is there any financial interest involved? I wouldn’t be surprised if there is, after all the Congress has been known for dozens and dozens of kickbacks and scams.

In early Dec 2020, Pfizer was the first company to seek emergency–use approval in India but has not attended subsequent meetings called by India’s Central Drugs Standard Control Organisation. The company had sought to import and distribute its vaccine in India without doing local trials. “Based on … our understanding of additional information that the regulator may need, the company has decided to withdraw its application at this time,” Pfizer said in a statement to Reuters on 5 Feb 2021, adding that it will in the future look to resubmit its application with the additional information that the Indian regulator requires. There are some unconfirmed reports that the GOI wanted the vaccines for ₹600 per dose, but Pfizer wanted more than double of that price.
Anyways, the most important thing is to understand by when the entire 18+ population in India will get fully vaccinated with two doses, and the chart below tries to explain that.

Vaccines for Export Not for Indians - Vaccines

Yes, all adults (18+) in India may have to wait until 27 Dec 2021 (7½ months) to get fully vaccinated as per these simple calculations (which I will modify based on some additional parameters), but this data disproves the claim of many people in opposition parties, and other members of the AMB, that India will take 44 or 63 months for all 18+ Indians to get two shots. One lady (I think she was a Trinamool or Left supporter, I frankly don’t remember which) said on TV that it will take 11 years. Maybe she gets her data from the ISI or the Pakistan Army!

The population of children and adolescents aged 6–17 in India is ~321 million, and they will need 642 million doses. Even if the domestic production and imports don’t increase further, all of them can also be vaccinated by 12 Feb 2022.

However, both these target dates assume that there won’t be any further wastage. As on 20th April, ~6.5% of the Covid-19 vaccines have been wasted across the country. This means that more than 8.83 million doses have been wasted. Tamil Nadu had the highest wastage of 12%, followed by Haryana at 9.74%, Punjab at 8.12%, Manipur at 8%, and Telangana at 7.55%. The PM has spoken to most state chief ministers asking them to take measures to reduce or completely do away with this wastage.

If the wastage comes down to say 5%, the target date for all adults will move to 4 Jan 2022, and for the entire 6+ population to 26 Feb 2022.

But we have to factor in another Indian reality—that the vaccines will not reach the remotest (and probably poorest) corners of the country. Here are some realistic assumptions that I have made, factoring in the 5% wastage.

Vaccines for Export Not for Indians - Vaccines

I strongly believe that the percentages given above for people who refuse to vaccinate (the decision makers being parents in case of the 6-17 population) are realistic. I also believe that the vaccines will (unfortunately) not reach 6.45% of India’s population.

In conclusion, I believe that the dates given in the above table—5 Dec 2021 for the 18+ population, and 16 Jan 2022 for the 6–17 population—will be the actual dates when all the people who want to be vaccinated (and to whom the vaccines can reach) will be fully vaccinated.

We can thus hope that there will be lesser critical cases and lesser deaths due to Covid-19 in India in the year 2022 and beyond, till the pandemic lasts, if its lasts beyond Mar–Apr 2022 at all.

Vaccines for Export Not for Indians - Vaccines

DISCLAIMER: This article reflects author’s view point. Goa Chronicle may or may not subscribe to views of the author

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