Last month, Union Health Minister Mansukh Mandaviya announced that India would be resuming COVID-19 vaccine exports, under Vaccine Maitri – in the fourth quarter of this year – in order to fulfil its responsibility to COVAX. The COVAX programme is a vaccine alliance led by the Global Alliance for Vaccines and Immunisation (GAVI), the World Health Organisation (WHO), and the Coalition for Epidemic Preparedness Innovations (CEPI) in partnership with UNICEF, vaccine manufacturers and the World Bank, among others. COVAX coordinates international resources that seek to enable low-to-middle income countries equitable access to COVID-19 vaccines, tests, and therapies. When the Indian vaccination programme rollout started in January 2021, India began to export vaccines as part of the Vaccine Maitri scheme. Around 6.6 crore doses were either sold or donated before the export ban came into place in mid-April in light of a devastating second wave of COVID-19. However, in the months following the second wave, both the domestic production and speed of vaccination increased considerably. More than half of India’s eligible population – some 59.4 crore people – have received at least one dose of a COVID-19 vaccine as of September 2021. Following this, the government has decided to resume exports of the vaccine. Although the rate of vaccination in the country has increased, the pace of vaccination as per health experts needs to be increased further to enable the government to reach its goal of vaccinating all eligible adults by the end of December this year.
WHAT IS THE COVAX PROGRAMME?
The COVAX programme aims to vaccinate nearly 20% of the population in advanced market commitment countries, that is low-to-middle income countries that cannot afford to pay for the COVID-19 vaccines. These countries include those with a Gross National Income per capita of less than USD 4,000, along with some other countries which are eligible under the World Bank International Development Association. The funding target of the programme is USD 6.8 billion. This funding is mostly coming from high- and middle-income countries which will also receive a share of the vaccines produced for COVAX.
Ghana was the first country to receive vaccines under the programme in February 2021. Since then, more than 30.3 crore doses have been shipped to 142 countries around the world, including Bangladesh, Brazil, Ethiopia, and Fiji. COVAX has segregated its distribution in order of prioritisation. The first stage of the rollout will go to healthcare and social care workers. The second stage will target individuals over 65 years and those who are at “high risk”. Lastly, the final stage of the rollout includes further priority groups. No country will receive vaccines for more than 20% of their population before others in the COVAX financing group.
WHY IS INDIA RESUMING EXPORT OF THE VACCINES NOW?
The central government has been working to create a stockpile of vaccines for India in case of a third wave of COVID-19. As of September 2021, Indian companies have set up the capacity to produce nearly 300 crore COVID-19 vaccine doses a year. Currently, the Serum Institute of India (SII) is producing around 16 crore doses of Covishield (Astra-Zeneca) a month and has indicated it will make 22 crore doses of Covishield from October. Zydus Cadila’s vaccine is also expected to provide 1 crore doses a month of ZyCoV-D in the October quarter. Additionally, SII’s Covovax (Novavax) vaccine is also expected to be produced in the October quarter. India is aiming as well to produce more than 30 crore doses of Sputnik a year, although when that target might be achieved is not clear. Only surplus vaccine doses will be exported and the vaccination of Indian citizens will remain the priority of the Indian government. Other factors that have prompted the decision to resume exports include a steady decline in new cases, over half of eligible adults receiving at least one dose of the vaccine, and a small percentage of breakthrough infections.
DOMESTIC PRODUCTION STATUS
The two locally-made vaccines – Covishield and COVAXIN – are the mainstay of the country’s vaccine programme. The SII makes Covishield (under licence from AstraZeneca), whilst Bharat Biotech produces the locally-developed COVAXIN. The Department of Biotechnology under the Ministry of Science and Technology has launched ‘Mission COVID Suraksha Programme – the Indian COVID-19 Vaccine Development Mission’ last year. Under the Mission, facility augmentation of Bharat Biotech and one state public sector enterprise and two central public sector enterprises (PSEs) have been supported for the production of vaccines. The government has also extended financial assistance to one of the domestic manufacturers for ‘at-risk manufacturing’, and made advance payments against the supply orders placed with SII and Bharat Biotech. Additionally, streamlining of regulatory norms for approval of vaccines is in progress.
The initial manufacturing projection that Serum Institute of India had submitted to the government for the month of August was 12 crore vaccines. Bharat Biotech was expected to produce another 2-2.5 crore vaccine doses of COVAXIN in August. Officials said the August supply of COVAXIN has been about 2 crore doses but the Covishield supply was better than expected. From January 16 to August 5, 44.42 crore doses of Covishield and 6.82 crore doses of COVAXIN were supplied for the National COVID-19 Vaccination Programme. The government has previously said it has placed orders for the supply of 100.6 crore doses up to December 2021. “Between August to December 2021, 135 crore doses are expected to be available,” the government said.
WILL EXPORTS AFFECT DOMESTIC VACCINATION SUPPLY AND SPEED?
India’s total vaccine production has more than doubled since April and is set to quadruple to over 30 crore doses in October as per information provided by the Health Ministry. During the first few months of the vaccination drive, the rate of vaccination had a declining trend, coinciding with a drop in rates of infection. During the devastating second wave that followed, shortages of the availability of the vaccine were reported from all parts of the country, with many states temporarily suspending the vaccination programme several times. However, since then, a combination of factors including an increase in the supply of COVID-19 vaccinations, reduction in vaccine hesitancy due to the impact of the second wave, and an overall push for vaccination by health authorities has increased the pace of vaccination significantly in the country. One of the key reasons for the increase in the production of vaccines has been the introduction of a simpler licensing process.
An important point to note is that regional and gender disparities in India’s vaccination drive also persist with larger and poorer states lagging behind smaller and richer ones. Experts have said record-breaking days are encouraging but vaccination rates need to rise consistently. With nearly 100 crore doses needed to fully vaccinate all adults, experts say it is unlikely that everyone will be fully vaccinated by the end of the year. For that, one crore doses need to be administered every day. At the moment, according to the latest statistics, India’s average daily pace is about 70 lakh doses. The government needs to maintain a delicate balance between fulfilling its obligations to the COVAX programme while ensuring domestic supply and distribution of the vaccine is not affected in the next few months to successfully reach its goal of vaccinating all eligible adults.
As part of its Vaccine Maitri programme, before the export ban, India had exported and donated more than 6.6 crore doses of COVID-19 vaccines to 95 countries worldwide. However, out of this, only 2 crore doses were a part of the global COVAX facility. It is important to note that there is a distinction between donations of vaccines and the commercial obligations of vaccine manufacturers to export vaccines. Out of the 6.6 crore doses exported, 3.6 crores were commercial exports. The remainder of the exports were donated as aid to UN Peacekeeping forces and to neighbouring countries.
The programme aims to vaccinate nearly 20% of the population in Advance Market Commitment countries, i.e. low-to-middle income countries
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