Challenges in Vaccine Procurement in India – Explained, Pointwise

Introduction

According to the data from the Ministry of Health and Family welfare, so far, India has vaccinated only 417 million people (less than 3.1% of the population has received both doses). The population of India is 1.3 billion. If vaccines require two doses then India needs more than 2 billion doses across the nation. But neither the Covaxin nor the Covishield has that much production capacity to meet the world’s largest Covid-19 vaccination drive in India. So, India needs to do large-scale vaccine procurement to meet India’s ambition towards universal vaccination against Covid-19.

Recently India started procuring Russia’s Sputnik-V vaccine in India. Apart from that, 10 states (Rajasthan, Madhya Pradesh, Uttarakhand, Tamil Nadu, Maharashtra, Karnataka, Andhra Pradesh, Telangana, Haryana, and Delhi) decided to procure vaccines globally as there is a shortage of vaccines in India. In this article, we will explain various issues associated with vaccine procurement in India.

Present status of vaccine manufacturing in India
  1. Both Serum Institute of India and Bharat Biotech are providing vaccines to India in fight against Covid-19.
  2. The world’s largest vaccine maker, Serum Institute of India, initially promised to supply 100 million doses of vaccines a month. But in reality, it only provided between 50 million to 60 million doses.
  3. On the other hand, Bharat Biotech has a planned production capacity of 12.5 million a month. But their current production is somewhere between  1-5 million.
  4. So, India’s monthly Covid-19 vaccine manufacturing capacity is about 60-65 million doses only.
  5. The target of vaccination will require more than 1.5 billion doses. As Covaxin and Covishield require two doses. But the present production capacity cannot meet that amount in a short time.
  6. Moreover, according to the Ministry of External Affairs website, India almost exported vaccines to 95 countries in the world. As of May 11, India exported 663.698 lakh vaccine doses to foreign countries. Out of this, 16% was sent as aid, 54% as commercial supplies, and 30% as part of WHO’s COVAX program.
  7. So, technically the vaccine availability in India reduced further below the daily requirement of vaccines in India. For example, With only 20 million vaccine shots available for the entire month of May, many State governments have resorted to floating global tenders for COVID-19 vaccines.
  8. On May 1, the first consignment of the Sputnik V vaccine – 1.5 lakh doses – arrived in India. According to the health ministry’s website, the Vaccine is started administered to people recently.
Global Vaccine sources and producers
  1. According to the Covid-19 vaccine market dashboard, 14 vaccines are licensed or approved for emergency/conditional use. These 14 vaccine prices range from $2 to $40. So far 12.2 billion doses have been administered. The majority of them occurred in developed countries. So, to achieve a similar feat India needs to procure from global players.

Share of people vaccinated

Source: Our World in data

Global Vaccine manufacturers and their type of vaccines
Vaccine ManufacturerType of Vaccine
CoronavacSinovac (China)Purified inactivated SARS-CoV-2 vaccine
Sputnik-VGamaleya Institute (Russia)Disabled Adenovirus vaccine
Pfizer/BioNtech Comirnaty Pfizer/BioNtech(US)mRNA vaccine
Covishield AstraZeneca/Oxford/SIIDisabled Adenovirus vaccine
JanssenJohnson and Jonson(US)/Merck & CoDisabled Adenovirus vaccine
ConvideciaCansino Biologics(China)Disabled Adenovirus vaccine
ModernaModerna Inc(USA)mRNA vaccine
  • Globally developed countries hold huge stocks of Covid-19 vaccines. For example, Rich countries with 14% of the world’s population have secured 53% of the best vaccines. For example, The USA has committed stocks of 1.2 billion doses. Even though the population is around 300 million. But recently the US started to release vaccine stocks after global concerns. India can take opportunities on that and procure vaccines.
  • India can negotiate with vaccine manufacturers like Moderna, Pfizer etc for procuring vaccines.
Government initiatives in vaccine procurement
  1. Changes in vaccination policy: The Government of India recently announced the fourth phase of its New  Covid-19 vaccine policy. The policy Liberalised and Accelerated vaccine procurement. Under the new rules, the Centre will procure only 50% of vaccines produced by manufacturers. The remaining 50% can be acquired by the states directly or by private hospitals and industrial establishments at a predecided price.
    • Apart from that, The Centre allowed the imported, fully ready-to-use vaccines to be entirely utilized in the other-than-Government of India channel.
    • Thus, if a foreign pharma giant brings its vaccine to India, it will be free to directly sell the entire stock in the open market at a competitive price.
  2. Talks with global manufacturers: According to the Ministry of External Affairs, India is in touch with US entities for procurement of vaccines and manufacturing them in the country to augment vaccine supply.
  3. Permitting the import of the Sputnik V vaccine: The central government allowed Russia’s Sputnik-V vaccine import into India.
  4. Raising issues in global forums: As the Intellectual Property Rights hinder the supply of vaccines, both India and South Africa have proposed to waive off IP rights like patents, copyright, and trademarks for prevention, containment, or treatment of Covid-19. Other developing countries started to co-sponsor India and South Africa requests. The TRIPS Council also discussed this issue both formally and informally.
Challenges in Vaccine procurement
  1. Issues in permitting States to procure vaccines: As the central government left the states to decide the prices from foreign pharma companies, it is leading to various issues in procurement. Such as,
    1. Unhealthy competition among States: States will compete among each other for the limited vaccines. This will reduce cooperative federalism in India.
    2. Non-uniform vaccine prices and Higher cost of Vaccines: There is inexperience in States regarding international market and negotiation. Further, the States will have to procure doses at higher rates than a single national purchaser. As there is a competition of states involved. This leads to increased cost of each vaccine dose in India compares to any other part of the world. Also, the prices will essentially increase state government expenditure. For example, Recently Supreme Court noted, states are paying more – between 300 rupees to 400 rupees per dose – while the central government is paying 150 rupees.
    3. Detrimental to India’s image: As several states floating separate tenders to procure Covid-19 vaccines from abroad, This will be detrimental for India’s image in the world. Also, this will fracture India’s bargaining power.
    4. The difference in Covid-19 reduction rate among rich and poor states: Richer states will be better positioned in procuring the highest number of vaccine doses from abroad. So, they can reduce the Covid-19 caseload faster. On the other hand, Poor states might suffer more from the present and future Covid-19 waves.
    5. Against India’s Vaccination policy: In India, the Center procures vaccines and the States administer them. This helped India to deal with public health problems such as polio, etc. The new vaccination policy is a violation of India’s prior vaccination policies.
  2. Challenges in distribution
    1. Unequal distribution of cold storage facilities among states. Even if states procure vaccines, they cannot distribute the vaccines easily. For example, out of the 28,932 cold chain points, half are in the five southern states, Maharashtra and Gujarat. Whereas the eight states in the North and Odisha that account for over 40 percent of the country’s population have only 28 percent of the cold chain points.  
    2. The Issue of Vaccine wastage: According to the RTI information, India has wasted more than 44 lakh of 10 crore doses(Till April 11). Tamil Nadu wasted over 12 percent, followed by Haryana (9.74%), Punjab (8.12%).  Ideally, a vaccination center must have 10 recipients to make optimal use of a single 10-dose vial. If the person is not available then that vaccine vial becomes a waste.
Suggestions
  1. Conducting a detailed demand-supply analysis: To conduct a calibrated expansion of the eligibility criteria India needs to conduct a detailed analysis including the vaccine manufacturers’ real-time production capability, the supply chain delays, etc.
  2. Change the vaccination policy: The Centre needs to take charge of all procurement and negotiations with all vaccine suppliers including domestic and foreign suppliers without any exception. Even the Supreme Court also raised issues in state procurement and called the central government to relook its procurement process.
  3. Work with domestic manufacturers to increase the supply: The Centre should seek clarity from Serum Institute of India and Bharat Biotech regarding their weekly schedule of supplies, production capacity, etc. This will help India to know the amount of vaccine shortage and plan India’s future procurements.
  4. Signing business deals with foreign manufacturers: India can also sign agreements with global vaccine manufacturers like Pfizer, Moderna, etc.  The government can include prior purchase agreements to strike a better and lower price in vaccine procurements.
Way forward

In conclusion, the government not only needs to focus on vaccine procurement. But also has to focus on monitoring the progress of domestic and foreign vaccines, tracking adverse events of vaccination, reviewing the performance of vaccine and sharing it with people to ensure public confidence. Further, it will also make India a step closer to Universal vaccination.

 

Types of Vaccines:

  • mRNA vaccines: It is a new type of vaccine to protect against infectious diseases. It does not use the conventional model to produce an immune response. mRNA vaccine carries the molecular instructions to make the protein in the body through a synthetic RNA of the virus. The host body uses this to produce the viral protein that is recognized and thereby making the body mount an immune response against the disease.
  • Adeno Virus vaccines: In this type, a modified version of adenovirus is used. The virus can enter human cells but not replicate inside. A gene for the coronavirus vaccine was added into the adenovirus DNA, allowing the vaccine to target the spike proteins that SARS-CoV-2 uses to enter human cells.
  • Inactivated SARS-CoV-2 vaccine: In this type, an inactivated live virus is used to create an immune response against the disease.

 

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