The announcement by the Principal Scientific Advisor K. VijayRaghavan, that a broad blueprint to cover 30 crore Indians under the ‘first wave’ of the Covid-19 vaccine has been prepared, will be undoubtedly greeted with some cheer, given how battered our economy is currently, and the fatigue with the lockdowns and social distancing norms, that has set in.
India has, using its leverage of having manufacturing facilities on its soil as well as the ability to conduct clinical trials locally, already obtained through advanced market commitment negotiations, a potential 1.6 billion doses, which can cover nearly 60 per cent of the population. One billion of these are from Novavax, a US-based late stage biotech company, which has signed an exclusive deal with Serum Institute of India (SII) for manufacturing and supplying to India and other low and middle income countries. Another 500 million is the Oxford-AstraZeneca vaccine, again, being manufactured at SII. A token 100 million doses, probably more for hedging the bets, has been procured in advance from the Gamaleya-Russian Direct Investment Fund, to be manufactured by generic pharmaceutical company Hetero.
The Novavax vaccine’s success is unknown as it is still recruiting volunteers for its phase III trial in the UK and is expected to complete the trial by January 2021. Though India leads the world in the size of the pre-purchases, it seems to have made lower priced deals, taking greater risk with the late-runner Novavax. Whereas most of the developed world has been doing frenzied Christmas shopping in advance, buying a confirmed 3.7 billion doses from the top 3 in the race currently (Pfizer, Moderna and AstraZeneca). These countries are also booking many more doses through potential purchase agreements with other developers. In fact, given the uncertainty around the success of vaccine candidates, countries are blocking more doses than needed for their population. Canada has procured 9.5 doses per person, Australia and UK 5.3, the EU 3.2 and the US 3.1 doses per person.
This frenzy is unlikely to end soon and herein lies the opportunity for India to cash in on.
Also read: Alleging serious side-effects, vaccine trial participant seeks Rs 5 cr from Serum Institute
Realising the manufacturing potential
India’s vaccine manufacturing capabilities are globally known. Serum Institute estimates that the 1.5 billion doses of vaccines it manufactures annually, are administered to about 65 per cent of the world’s children. Bharat Biotech, Shanta Biotechnics, Indian Immunologicals, Zydus Cadila and Biological E to name a few have the capability to manufacture for the world. Both Pfizer and Moderna’s mRNA vaccines haven’t inked deals with Indian manufacturers and Pune-based Gennova Biopharmaceuticals, a subsidiary of Emcure Pharmaceuticals, could just be the right candidate. The mRNA vaccines are priced between $10-30 per dose, depending on the negotiating power of the buyer. While Serum Institute of India’s CEO Adar Poonawalla has said that two doses of the Oxford vaccine would be available for about Rs 1,000, the Russians have quoted about Rs 700 a dose. The COVAX facility hosted by Gavi, which has 20 per cent of all countries enrolled, operates on the premise of not more than $3 per dose.
Some think tanks in India have asked for the preparation of large-scale plans to vaccinate up to 80 per cent of the country’s population. However, till we have conclusive evidence that long-standing herd immunity, based on the ability of the vaccine to prevent transmission even in asymptomatic cases, is possible with any of the vaccines, such a strategy and the attendant investment would be foolhardy. The government’s current plans to vaccinate the first in the line of fire and the most vulnerable populations can probably prevent an estimated 67,000 to 1 lakh deaths, as 53 per cent of all deaths in India have been in the 60+ age group with another 35 per cent in the 45-60 years age group. I estimate the average years lost per death due to Covid in India to be about 13 years. The disability adjusted life years would be lower because most of the mortalities characterise co-morbidities. This would mean that about 1.8 million life years have been lost (without accounting for disability adjustment) in India since the onset of the pandemic and the vaccination strategy could potentially save approximately 0.9 to 1.3 million life years.
Also read: UK to trial ‘game-changer’ blood test that ‘may detect 50 types of cancer’ at early stage
The cost of protecting lives
And what would the costs of protecting the lives of our most vulnerable be? If we estimate the costs of delivery to be similar to the cost of the Oxford vaccine, we will need about Rs 60,000 crore to vaccinate the most vulnerable. Even with the cheapest deal, the plan to vaccinate 30 crore Indians with two doses, will cost us as much as the Union government’s annual budget outlay for health that stands at Rs 69,000 crore. Adding more beneficiaries will only escalate these costs into multiples of our health budget and will have to come at the cost of other health interventions, which have been suffering post Covid. Finding the money for it, from an economy in recession will be a mighty challenge. Let’s face it, we aren’t the western world, to paper our fiscal deficit or China to bank on “dual circulation”. We are still in the Atmanirbhar phase, protecting our domestic consumption while being uncompetitive for most global supply chain demands.
It need not be so on the vaccine front at least.
Also read: UK asks regulator to approve Oxford-AstraZeneca vaccine for temporary supply
India has an opportunity
We are already the global supply chain engine for childhood vaccines and we can be so for Covid vaccines as well. The West’s ability and willingness to pay for the vaccine, given the current market rush, will be at least twice that of India (considering the median price of a dose of vaccine is $13). India should be using this rare advantage of possessing globally competitive manufacturing capabilities and the demographic advantage of having a young population that ensures we have a much smaller vulnerable population by proportion, and sell as much as possible when the asking price is high. Every dose that India manufactures and exports rather than consuming domestically will add to our ailing economy. We need the Narendra Modi government to take proactive steps to invite companies with successful vaccine candidates to manufacture here in India for the world. We also need to back our homegrown candidates such as the NIV- Bharat Biotech Covaxin, for if successful, we can reap the benefits of lower technology development costs as well as manufacturing costs with them.
If we stick to our current plan of vaccinating 30 crore Indians, and look at creating a positive climate for vaccine manufacturers to export 100 crore doses through a combination of manufacturing licensing and promoting India’s home grown vaccines, we will be able to export $13 billion worth of vaccines, which would add 2.5 per cent to our total exports of goods and services, while saving a similar amount on government expenses on vaccines procurement and delivery costs. For every 10 crore Indians whom we do not vaccinate and prioritise exporting those doses instead, would mean 0.2 per cent of our GDP as net gain. Unless our mortality numbers change dramatically, or data on vaccines providing herd immunity is conclusive, that is a number which is hard to beat.
Dr Anand Lakshman @DrAnandWritist is a public health specialist, and founder & CEO of AddressHealth. Views are personal.
Chinese Propaganda War on India and Others.
After the Chinese lost the battle of LAC to India in August 29/30, when India occupied Kailash Heights in Ladakh, the Chinese launched their propaganda offensive. They were unable to get the height(s) vacated hence propaganda was the only battle tactic they were left with. Their English language mouthpiece The Global Times was one of the key weapon. Furthermore, they have built an enormous network of influence in western media by spending an average of $10 billion a year over the past 10 to 12 years to get their point of view, no matter how false, broadcast or printed. In the past six weeks, there have been four glaring examples, three against India and one against Australia.
1. It was a surprise that a respected London media outlet, “The Times,” wrote an outright lie that the Chinese were using a “direct energy weapon” (microwave) at the LAC to chase Indian troops from the hills. The report was denied by the forward Indian troops at the LAC and also by the Chief of the Defense Staff that anything like that ever happened. Indian forces in most of the hill are adequately protected. The Direct Enegy Weapons are not advanced enough to reach from a distance and penetrate the bunkers and affect troops on the hill Features. They are only used for a limited demonstration of this type of weapon, for crowd control during a demonstration, etc. That was bad publicity for a non-existent weapon. Although there are reports of the Indian weapon «Kali» which is, in its infancy and needs a huge amount of energy (10 MW) to generate a ray strong enough to be effective. The Chinese were daydreaming. Ironically, the British media lowered themselves so low to publish a lie without checking it out. This means that the Brits are also taking Chinese money.
2. Another Chinese sponsored lie was published right after the above that Indian made radar set purchased by Armenia was in use during Azerbaijan – Armenia war. It failed to detect the incoming tiny armed drones from Azerbaijan. This was a Chinese outright lie. The Chinese were taking revenge on India for having published a report indicating that structural faults had been detected in most of the JF-17 manufactured by the Chinese in Pakistan after just 4 to 5 years of service. As a result of this report, the Chinese fabricated the Azerbaijani lie.
3. Another lie that was brought up by a group of lower-quality Chinese scientists was that COVID-19, instead of being from China, came from central India. The Chinese are badly stung by the reports that bat eating Chinese in Wuhan actually contracted it or maybe Chinese manufactured it in a laboratory and then spread it to the whole world. It has brought the world to a standstill and Chinese are accused of its deliberate spread. All commercial activities around the world have slowed down due to closures, lockdown and the enormous amount of money spent to keep people from starving to death. The Chinese are attempting to deflect the blame and have chosen India as the country to blame.
4. Australia is furious with the Chinese for posting a picture of an Australian soldier holding a knife to the throat of an Afghan boy. According to the Australians, that has never occurred. The photo tarnishes the Australian image, which they cannot tolerate. The immediate reason for this smear campaign against the Australians is that they willingly joined the Indian Ocean and Pacific “QUAD”. That will affect Chinese dominance and their security architecture, hence all the reasons they are crazy. This smear campaign, including the photograph, aims to teach the Australians a lesson.
There may be many more examples, but a few above come to mind from the sneaky Chinese tactics and amazingly the British media fall for it.
The Biological E vaccine, developed by Baylor college of Medicine can be produced up to 1 billion doses per year. It is supposed to be quite affordable and can be exported to 3rd world countries after a few million doses are reserved for us. However, the Phase 1, 2 and 3 trials should be speeded up so that exports can be started. It also has tied up with Johnson and Johnson to produce 400 – 500 million doses annually for India. They are testing single dose and 2 dose regime. May be, it can also be exported. Only one example is given, but other vaccine makers are also there who can export the vaccine, given that requisite support is given by the Govt. In short, we need to move fast to bring vaccines to international market and not move at bullock cart speed, which has been the case so far.