In Depth | As demand for COVID-19 vaccine dips in India, government and companies look to step up exports

Between January and February, the number of COVID-19 cases, active cases and test positivity rates declined sharply, providing India with a much-needed respite from the third wave of the pandemic.

A not-so-welcome development was a decline in the number of COVID-19 vaccinations although it has opened the doors to increased overseas shipments.

In January, for example, 215 million COVID-19 vaccine doses were administered, a figure that slumped to 107 million in February, down by over 50 percent in a month.

This was in line with the pattern of a consistent decline in average daily and monthly COVID-19 vaccination observed over the past few months.

It is also worrisome given that India started offering booster doses to the most vulnerable groups, including health and frontline workers and those above 60 years of age with comorbidities starting on January 10. Booster doses are given to a specified group of people who have completed nine months since their second dose.

Health economist Rijo M John explains that the sharp fall in vaccinations had been expected given that nearly 97 per cent of the adult population in India has received at least one dose and more than 81 % is fully vaccinated.

Even so, the dipping COVID vaccine demand has put vaccine makers, particularly those who received emergency use authorisation for their jabs in recent months, in a bind. To be sure, it has also opened up the possibility of more exports.

Senior government officials say that with the COVID-19 outbreak in India being under control, the Centre is pushing vaccine makers to ship their products to market outside India, mainly low- and middle-income countries in Africa and South America and other Asian countries.

Until now, Indian vaccine makers have lagged behind the commitments they made to export COVID-19 antidotes.

In contrast with over 1.78 billion vaccine doses administered in the country, less than 170 million doses have been exported through grants, commercial sales and the World Health Organisation-led initiative COVAX initiative, according to the ministry of external affairs data.

Vaccine demand low due to several reasons 

Epidemiologist Dr Rajeev Jayadevan said some Indian states achieved 100 percent first dose coverage really early on in the vacation drive, but some others like Manipur, Nagaland and Meghalaya have covered fewer people.

Those willing to be vaccinated would have received a jab already, which means that those who haven’t suffer from vaccine hesitancy, Dr Jayadevan said.

This is a phenomenon seen in all nations and can be called the glass ceiling. Also, the fear of COVID-19 has waned significantly, especially after the Omicron-led third wave that was less severe than the first two, according to Dr Jayadevan, who added that vaccine hesitancy exists in India too, although to a smaller degree than in wealthy nations.

But it’s the comparative low-interest citizens have exhibited in receiving precaution doses (a booster dose is being called precaution dose in India) that has sparked some concern. According to government figures, India has more than 30 million healthcare workers and 100 million people aged above 60 years.

Considering that at least half of those above 60 years will have at least one underlying health condition, this makes 80 million-plus people in the country eligible for precaution doses.

Until March 3, however, only about 20.3 million precaution doses had been administered.

Dr K Srinath Reddy, president of the Public Health Foundation of India, and a member of the national COVID-19 task force has an explanation.

“There is a widespread perception that the pandemic threat level has markedly reduced in India. Hence, there may be some degree of apathy for second and protective doses,” he said.

“Others may be waiting for newer vaccines, which they feel may be more effective against recent variants,” Reddy said, adding that even if a new variant emerges, fully vaccinated persons will have better protection than unvaccinated or incompletely vaccinated people.

Dr Rahul Pandit, director-critical care, Fortis Hospitals in Mumbai, who is also a member of the national and Maharashtra COVID-19 task forces, said the dramatic drop in coronavirus cases had created a public perception that the vaccines need not be taken.

“This perception needs to be corrected and the entire eligible population must be vaccinated as quickly as possible,” he said.

Fortunately for the country, beginning on January 3, when young adults aged between 15-17 years started getting vaccinated, 84 million shots have been administered to people in the age group. The number of 15-to-17-year-olds in India is estimated at 75 million.

Importantly, more than 75 per cent population in this adolescent age group is now covered with at least one dose of a COVID-19 vaccine.

The task now is to locate unvaccinated and vulnerable people, particularly those aged over 40, counsel them and persuade them to get vaccinated, said Dr Jayadevan.

“This will help prioritise vaccines by risk. We also need to vaccinate all immune-suppressed people with at least 3 doses because they are more likely to have bad outcomes and generate variants because of prolonged infection over months,” he said.

The way forward  

While India’s national coronavirus immunisation programme has largely hinged on Covishield, manufactured by Serum Institute of India (SII), and Covaxin, developed by Bharat Biotech international, with the Russian vaccine Sputnik V, playing a minor role, several other vaccines have been granted emergency use authorisation over the last few months.

These include Covovax, the Indian version of Novavax that is being manufactured by SII; Corbevax developed by Biological E and US-based Baylor College of Medicine and manufactured by the former; ZyCoV D by Zydus and Sputnik Light; a one-dose version of Sputnik V.

Dr Reddy’s Laboratories is the local partner for the Russian vaccine. A coronavirus vaccine by Janssen, a subsidiary of Johnson & Johnson, being produced by Biological E, has also received regulatory approval.

While the Centre has procured 50 million doses each of ZyCoV D and Corbevax, the vaccines are yet to be used in the country’s vaccination programme. There is no clarity yet on the prospects of the other three vaccines in India.

A senior health ministry official said that the use of these vaccines in the national immunisation programme will depend on the recommendations made by the COVID working panel under the National Technical Advisory Group on Immunisation but added that regulatory approval in India will aid their export efforts.

Overseas shipments 

“A large number of countries in Africa and South America apart from various small countries in Asia are largely dependent on India for their vaccine needs and we must help them,” the official said.

MEA figures show that from January 2021 until February 21, 2022, 162.9 million COVID vaccine doses, which also included Covovax, apart from Covishield and Covaxin, had been shipped outside India.

Of these, 107 million vaccine doses were commercial dispatches and 14.2 million were given in the form of grants; 41.5 million doses were shared with other nations through the COVAX route.

SII, Bharat Biotech, Zydus, Biological E and Dr Reddy’s Laboratories did not respond to a request to share their export plans. The ministry official cited above conceded that the country and its vaccine makers need to step up export efforts.

This is particularly necessary because there was a total ban on COVID-19 vaccine export since mid-April in the wake of the devastating second wave in India, the official said; the ban was only lifted in November last year.

At an event on March 3, health minister Mansukh Mandaviya underlined that India has, so far, helped 120 countries with COVID-19 vaccines that included supplies to 50 nations through the COVAX initiative.

A close look at export data suggests that 22.4 million vaccine doses, the most for any single country, had been sent to Bangladesh alone. The only other country which has received more than 20 million vaccine doses from India is Myanmar.

Dr Reddy's concurred with the ministry official, saying vaccine makers need to increasingly look to exports.

“The needs of the Indian vaccination programme and the international demand must be finely balanced as we step up our domestic production,” he cautioned.