Whenever we have a shortage in any essential item (goods or services), we tend to have a riot-like situation due to the size of our population. Given the number of vaccine doses required vis-a-vis the number manufactured and the miniscule percentage of people who have been inoculated so far, there is a real chance of this happening, particularly in rural areas. There are two aspects in this, viz. production (supply) and distribution.
Increasing supply: As regards enhancing production, the government’s recent announcement that 216 crore doses would be available between August-December would certainly come as a relief to all. However, what does the country do until August when the second wave is already raging across the country and most worryingly, spreading into the interiors of rural India?
Waiver of IPR restrictions so that domestic manufacturers can produce the generic vaccine will be hard and time-consuming as it requires unanimous consensus from all WTO members. Hence, it might not be very useful to tackle the immediate and short-term supply crunch but would be valuable to increase supplies in the future.
As regards vaccines approved by the drug regulator and available in the country, the Russian vaccine Sputnik V, recently approved for emergency usage in the country, is the only one in addition to Covishield and Covaxin. The vaccine candidates of Biological E, Zydus Cadila and Gennova (mRNA) and Bharat Biotech’s nasal vaccine are in various stages of clinical trials. The SII’s Novovax is still in clinical trials and is likely to enter the markets only by September. The international vaccine manufacturers Pfizer, Moderna and Johnson & Johnson (single dose), who are yet to be approved by the drug controller, have stated that they can supply only in the third quarter of this year if they are assured faster regulatory clearances and freedom on pricing and exports. However, the silver lining is that the government has now clarified that any vaccine approved by the WHO and FDA, US, can be imported and administered in India.
Thus, in the immediate term, the only way to increase supply is through global vaccine imports. Multiple states including Odisha, Delhi, Rajasthan, Maharashtra and Uttar Pradesh have decided to float global tenders, which will allow them to bridge the shortage in central supply. Looking at the world market for vaccines, Pfizer plans to ramp up its manufacturing to produce 250 crore doses by the end of this year, Moderna plans to facilitate 70 crore doses in 2021 and J&J targets manufacturing 100 crore doses by the end of this year. However, import of these vaccines would be heavily dependent upon the real possibility of export bans by the respective countries as we hear the WHO expressing concern that rich countries have now started vaccinating children two years and above whereas several nations have not even administered the first dose to their frontline Covid warriors. Hence, these global tenders floated by the states may not bear much fruit as the vaccine manufacturers globally are limited and armed with patent rights.
Way forward to augment supplies in the immediate run: Diversifying domestic production is the need of the hour. Since Covaxin is an indigenously produced vaccine, the Indian government can allow other domestic manufacturers to produce it by waiving patent rights. The government can also use the compulsory licensing mechanism under Section 92 of the Patent Act as well as the WTO’s TRIPS regime to allow domestic manufactures to also produce vaccines without fear of IPR violations. However, this may also take time as vaccine manufacture is a complicated process involving transfer of know-how as well. It is also important that the Central government quickly authorises emergency usage of vaccines that have already undergone rigorous trials in developed nations and have high efficacy. It will also increase vaccine competition and the consumers will have the option to choose from multiple vaccines, which in turn will help bring down prices and break possible monopolies. All this however is without prejudice to the fact that since the numbers of vaccine manufacturers are almost the same, they may still form a cartel thus defeating the purpose of the global tender.
Distribution challenges: The next issue is the challenges in distribution of vaccines in rural areas. So far India has vaccinated its people mostly in cities. When it comes to rural areas, infrastructure as well as personnel issues have to be addressed in order to ensure that the vaccine administration regime complies with Covid protocol. Failure would lead to vaccine riots since people by now have gathered knowledge that vaccines are the only panacea. Another issue would be the lack of internet facility besides low tele-density (40-60%) without which logging into the COWIN app would not be possible, failing which vaccines would be denied to them. Last-mile delivery itself could be another huge, intractable bottleneck.
Conclusion: As the Covid-19 strain mutates, the government needs to prepare for a scenario where there is a need for booster shots targeting the emerging variants almost every year. Hence, it is important to build a supply chain of vaccines in the country that is resilient in the long term. If India is to vaccinate its population every year, then our demand would be the largest in the world, which itself should be a very attractive proposition for any global manufacturer.
India must also carefully calibrate its import policy to develop the correct incentives for global manufacturers to supply their vaccines in the country. To begin with, we must not ask every state to get into a contract with manufacturers separately as we may not be able to leverage placing large orders, which is an advantage for India considering our large population. The Centre must bulk buy vaccines, which will give it the negotiating power in the global market, and then distribute them amongst the states that can focus on last-mile delivery to each citizen.
(Views are personal)
Amar Patnaik
(BJD Rajya Sabha MP from Odisha, former CAG bureaucrat with a PhD in management and now an advocate)
(amar_patnaik@yahoo.com)