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Vaccine- No Easy Answers?

In a space of a few weeks we have gone from a feeling of complacent well-being to full-blown panic. Covid is back with a speed and scale that looks ominous. The focus is now on vaccination, but the going there too looks difficult.

The truth is that in the short run, there is no magic solution. There is not much room for manoeuvre that the government has today. For vaccination to slow down the spread the virus, a certain minimum threshold of people who are fully vaccinated is needed, and currently we have partially vaccinated about 5-6% of the population. The number of those fully vaccinated is negligible. No amount of acceleration of the vaccination effort is likely to yield immediate results at the aggregate level.

But the bigger problem is that even in the medium term, there is a real issue with the vaccination supply. The two vaccine manufacturers between them have delivered between 10 and 11 crore doses out of which between 1.5-2 crore remain in stock. The daily production of vaccines is between 20-25 lakhs while in the last few days about 35-40lakh doses are being used daily. Every day we use between 15-20 vaccines from our stock. So far, the supply has been smooth because we were utilising the stockpile that had been built over the last few months and but that is now close to running out. Soon we will have to limit our use of vaccines to only that number which is being manufactured. We will run never out of vaccine, because it is being replenished every day, but the current level of supply is unsustainable given current production levels.

The problem is compounded by two important factors. Serum Institute of India is temporarily prioritising India and diverting all its production to local needs but in 2 months time, it will go back to fulfilling its contractual obligations internationally. In the past, it has sent as much as 40% of its production abroad. The other factor is that given the fact that the vaccine has a two-dose regimen- as against 7 crore people who have had one jab, only 1 crore are fully vaccinated. Which means that as many as 6 crore people will need to get their second shot within the next few weeks. This will consume a significant proportion of the vaccine available, leaving little protection for other first-dosers.

There is every likelihood that production will get expanded by June- SII has said it will ramp up its production to 10-11crore doses a months and Bharat Biotech has similarly indicated that it is trying to push up production by 3.5-4 crore doses a month. But even this takes us nowhere near the numbers that India needs.

What options does the government have? Most importantly, it needs to clear the roadblocks that are standing in the way of other vaccines from entering India. Sputnik V has been waiting for approval for some time now, and Pfizer withdrew its application in December in the face of the Indian regulatory requirements. It is imperative that the government casts its net wide and gets as many vaccine manufacturers as possible to start supplying to the country.

The other measure that can be taken is to extend the time between the two Covishield doses to 12 weeks, which is in any case is what research indicates is the more effective interval between the two shots. This will ease the pressure on the system, since otherwise, and allow a larger number of unprotected people to get some cover.

The suggestion by some Chief Ministers to expand the eligibility criterion for receiving the vaccine is completely untenable given the current situation. At the current rate of production supplying just the 45+ population will take several months. The current strategy of focusing on the more vulnerable is the only sensible option available to the government. Similarly, any notion of opening up the vaccine in the market has little merit given that there is isn’t enough vaccine to go around. In any case, the process of distributing the vaccine used currently has been quite efficient and there is little reason to change that.

Could this situation have been avoided? While no one could have predicted the severity of the current outbreak, there is no question that the government has failed to plan ahead in order to ensure speedy and adequate vaccine supply. Given the fact that every person in India, barring young children would need to be vaccinated, there was little ambiguity about the quantity of vaccine needed. The production limits of the existing manufacturers were known, and there was no reason to drag one’s feet on approving other vaccines. Given that Covaxin has got authorised without going through all the stages of testing suggests that the government can be flexible in its regulatory stance when needed. The other vaccines in question have in any case been tested extensively globally. There is little reason to deny them entry into the country, especially given the supply constraints we face.

Which means that for this surge that we are witnessing, it is back to the same measures that brought down the numbers last year. Masking, social distancing, working as far as possible from home, avoiding social gatherings and the like. This is easier said than done, for there has been a huge slackening of safeguards that were used last year. The problem of complacency is a very real one. There was much exultation about how India had managed to contain the virus when the developed world had struggled, ignoring the fact that everywhere in the world, the virus tends to return with fury, and that a temporary lull did not a victory make. It does not help that last few months have seen a surfeit of public gatherings, both political and religious, that have not only gone unchecked, but in many cases have been actively promoted by the government. Unless this situation changes dramatically, things might just get worse.



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Views expressed above are the author’s own.



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