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COVID-19 | Are we staring at a potential vaccine supply crisis in the race to 1.4 billion doses?

The ability to carry out the world’s mass vaccination exercise in record time, will depend on keeping vaccine supplies of hundreds of millions of doses flowing uninterruptedly for months.

April 07, 2021 / 01:10 PM IST
Currently, two vaccine producers are producing 64 million doses a month.

Currently, two vaccine producers are producing 64 million doses a month.

As on April 6, India administered 83.1 million Covid-19 vaccines. Of these, 72.2 million people had received their first dose, while nearly 11 million had been given the second dose.

The daily run rate is also cantering towards 5 million jabs a day. Impressive as it may appear, the pace of inoculation has still some catching up to do, given India’s population size and geographical spread.

The mass vaccination exercise is a function of three critical, interconnected factors.

One, it is a colossal public administration effort. It requires technology-enabled real time information systems, micro level logistical planning, nimble, quick bureaucratic decision-making and staggered advance planning involving the Centre, states and district authorities.

Two, vaccination in India is a voluntary move. The government has appealed to the eligible group of people to get themselves vaccinated. The decision lies entirely with the individual. People’s reluctance can be overcome only by communication and persuasion, not by coercion.

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COVID-19 Vaccine

Frequently Asked Questions

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How does a vaccine work?

A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

How many types of vaccines are there?

There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

What does it take to develop a vaccine of this kind?

Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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Third, and most importantly, the ability to carry out the world’s mass vaccination exercise in record time, will depend on keeping vaccine supplies of hundreds of millions of doses flowing uninterruptedly for months.

The Herd Community Angle

The primary purpose of vaccination is to achieve herd immunity from a highly communicable disease. Once herd immunity has been established for a while, and the ability of the infection to spread is hindered, the disease can eventually be eliminated. This is how the world eradicated smallpox, for example.

The more infectious a disease, the greater the population immunity needed to ensure herd immunity. For example, measles is highly contagious and one person with measles can infect up to 18 other people. This means that around 95 per cent of people need to be immune in order for the wider group to have herd immunity.

What is the population threshold for herd immunity in the case of Covid-19? No one knows the answer yet because the deadly virus continues to demonstrate newer characteristics, flummoxing scientists.

That said, covering 70 percent of India’s population may be adequate to come closer to achieving herd immunity from Covid-19. That still amounts to inoculating over 900 million people in a few months.

Leaving children aside, the first operational target would still be to administer Covid-19 jabs to around 700 million people. This translates into 1.4 billion vaccine doses, assuming a two-dose vaccine.

The task, for vaccine producers and the government, is to secure continuous supplies of 1.4 billion doses over a 12-month period. Given this titanic necessity, the current Covid-19 supply capacities fall significantly short.

Currently, two vaccine producers—the Pune-based Serum Institute of India (SII) and Hyderabad-based Bharat Biotech—are producing 64 million doses a month. SII is manufacturing 60 million doses of Covishield, while Bharat Biotech is producing 4 million doses of Covaxin a month.

This, effectively, translates into just above two million jabs a day. The current rate of more than four million daily shots is primarily driven by existing supplies that have been stockpiled since January.

Need Of The Hour

SII has also warned of raw material shortages affecting production because of the US export bans on specific items needed to make vaccines, such as specialised bags, filters, cell culture media, single-use tubing and specialised chemicals.

Biological E, which is producing the Johnson & Johnson vaccine, has raised similar concerns about likely shortages affecting vaccine production.

US President Joe Biden invoked the Defense Production Act (DPA) that empowers the president to restrict trade in response to domestic emergencies. Prime Minister Narendra Modi’s intervention may be required to get around this to ensure vaccine supplies in India.

Reports suggest that SII and Bharat Biotech will be able more than double their combined capacity to 140 million doses a month by August. There’s a clear case for quick government fund support to enable vaccine manufacturers to rapidly ramp up production.

There’s also a clear case to accelerate, with adequate safety, the approval process to Russian Gamaleya Research Institute’s Sputnik V vaccine with which India has a licensing deal through local manufacturers to produce 200 million doses.

Lastly, the government should consider giving regulatory clearance to Pfizer and Moderna vaccines. These may not be part of the national Covid-19 vaccination programme because these are relatively costlier and require storage in extreme sub-zero temperatures.

But there is still a strong case for allowing private hospitals that have storage infrastructure to import and administer these vaccines at a price to those who are willing and can afford.

Every dose of incremental supply will eventually add up to the 1.4 billion doses required. Otherwise, the virus will continue to affect lives and livelihoods. India cannot allow sluggish decision-making to lose this battle.
Gaurav Choudhury is consulting editor, Moneycontrol.
first published: Apr 7, 2021 01:10 pm

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