India is the home of the world’s biggest producer of Covid vaccines. But it’s facing a major internal shortage

With India experiencing a devastating second wave of the coronavirus pandemic, questions are being asked about how the country — which is home to the world’s largest vaccine manufacturer — got to this tragic point.

India continues to report massive numbers of new infections. On Tuesday, it passed the grim milestone of having reported over 20 million Covid cases and at least 226,188 people have died from the virus, although the reported death toll is believed to be lower than the actual death toll.

In the meantime, India’s vaccination program is struggling to make an impact and supplies are problematic, despite the country having halted vaccine exports in March in order to focus on domestic inoculations.

The sharp rise in infections seen in India since February has been attributed to the allowing of a large religious festival and election rallies, as well as the spread of a more infectious variant of the virus. Prime Minister Narendra Modi and his governing Bharatiya Janata Party have been criticized for a lack of caution and preparedness, and accused of putting politics and campaigning above public safety.

A war of words over the government’s vaccination strategy has also ensued. Ruling lawmakers have been criticized for allowing millions of doses to be exported earlier in the year.

To date, India has administered around 160 million doses of a coronavirus vaccine (the predominant shots being used are the AstraZeneca shot, produced locally as Covishield, as well as an indigenous vaccine called Covaxin developed by Bharat Biotech). In April it approved Russia’s Sputnik V vaccine for use and the first batch of doses arrived at the start of May, although it has not yet been deployed.

Only 30 million people have had the complete two doses of a Covid vaccine in India so far, government data shows. That’s a small number (just over 2%%) of India’s total population of 1.3 billion people — although around a quarter of that total are under 15 years old and, as such, are not eligible for a vaccine yet.

Since May 1, anyone aged 18 or over is eligible for a Covid vaccine although this expansion of the vaccination program has been hampered given the shortages of doses that have been reported throughout the country by national media.

Dr. Chandrakant Lahariya, a doctor based in New Delhi who is also a vaccines, public policy and health systems expert, told CNBC Wednesday that India’s large adult population makes the immunization effort difficult.

“Even if the projected supply was available, India has opened the vaccination to a far bigger population than probably any setting can expect the vaccines (to cover). It is essentially an outcome of limited supply and a vaccination policy which is not mindful of supplies. No amount of advanced planning could have assured that sort of supply, which is needed now with the opening of vaccination for 940 million people in India,” he said.

Vaccine supplies are “unlikely to change drastically,” Lahariya said. “India needs anywhere between 200 to 250 million doses a month to function Covid-19 vaccination drives to full capacity and it has around 70-80 million doses a month. Clearly, there is a long way to get (to) that kind of supply,” he noted.

The shortcomings in vaccine supplies has inevitably led to a deflection of blame with vaccine manufacturers in the firing line. Questions over vaccine prices, manufacturing capacity and the destination of supplies have beset the world’s largest vaccine manufacturer, the Serum Institute of India, and Bharat Biotech, the Hyderabad-based pharmaceutical company that manufactures Covaxin.

Both have had their vaccine price structures (that is, different prices for doses destined for central government, state governments and private hospitals) criticized, which led the SII’s CEO to later reduce prices amid a public backlash.

Adar Poonawalla, CEO of the SII which produces the Covid vaccine developed by AstraZeneca and the University of Oxford, said Sunday that the institute had been blamed for a vaccine shortage and scapegoated by politicians, but said it had not boosted capacity earlier because of an initial lack of orders.

“I’ve been victimized very unfairly and wrongly,” he told the Financial Times on Monday, adding that he had not boosted capacity earlier because “there were no orders, we did not think we needed to make more than 1 billion doses a year.”

Poonawalla noted that the Indian government had ordered 21 million doses of Covishield from the Serum Institute at the end of February but didn’t indicate when or if it would buy more, then it ordered an additional 110 million doses in March when infections started to rise.

Poonawalla said that the Indian authorities had not expected to confront a second wave of cases and had, as such, not been prepared for the onslaught in new infections in late winter.

He said that the country’s shortage of vaccine doses would continue through July, when production is expected to increase from about 60 to 70 million doses a month, to 100 million.

For its part, the Indian government insists that it has, and is, ordering more vaccines to meet demand. On Monday, the government issued a statement in which it refuted media reports alleging that it had not placed any fresh orders for Covid vaccines since March, stating that “these media reports are completely incorrect, and are not based on facts.” It said it had advanced money to both the SII and Bharat Biotech for vaccines to be delivered in May, June and July.

On Tuesday, Poonawalla issued a statement in which he sought to calm tensions between the government and SII, noting that “vaccine manufacturing is a specialized process, it is therefore not possible to ramp up production overnight.”

“We also need to understand that the population of India is huge and to produce enough doses for all adults is not an easy task … We have been working with the government of India since April last year. We have got all kinds of support be it scientific, regulatory and financial,” he said. Poonawalla said that the SII had received total orders of over 260 million doses, without specifying the buyers.

Asked whether the government had got its approach to vaccine procurement and production wrong, Lahariya noted that the government had become complacent, although the trajectory of the pandemic had been hard to predict.

“To be fair, I believe there have been two surprises. Unlike a year ago, when Covid-19 vaccine availability was being forecasted around mid-2021, the vaccine became available a bit earlier. Second, the lull in Covid-19 cases in India sort of set the complacency at all levels,” he noted. Lahariya added that while many months were spent on prioritizing the target population for vaccination, the program had then been opened to all adults “too soon.”

“It has been an issue of hurried and arguably, politically influenced planning, while this should essentially be a public health decision. That’s why a written plan with details on various aspects, such as supply forecast, could have made the difference.”

How the vaccination strategy will impact on Modi’s ratings long term remains to be seen. But there is already evidence that Modi’s ruling BJP are being made to pay for the Covid crisis at the polls.

Modi’s party failed to win the key state of West Bengal at a regional election last weekend, and failed to win in three other state elections in April, although it retained power in the state of Assam.

Dr. Manali Kumar from the Institute of Political Science at the University of St. Gallen in Switzerland noted that “this second wave is a disaster created by the complacency of the Indian government, which is now busy controlling the narrative rather than tackling the problem.”

“Maybe the worst of the disaster that is now unfolding in India could have been avoided if restrictions on public and private gatherings had been left in place,” she noted, adding that “decades of neglecting investments in healthcare infrastructure and an electorate that has not prioritised public services are also to blame.”

Prime Minister Modi has defended the government’s vaccination strategy, telling ministers in April that “those who are in the habit of doing (playing) politics, let them do so … I have been facing various allegations. We can’t stop those who are hell bent on doing politics. But we are committed to service to mankind, which we shall continue,” he said, the Times of India reported.

He also noted that a previous peak in infections, last September, had been controlled at a time when vaccines were not available and track and tracing cases and mass testing had been relied upon.