Expert Speak Health Express
Published on Mar 02, 2021
India flags off Phase-2 of the Covid-19 Vaccine drive: Progressing steadily, but is it enough?

This is part of the weekly series assessing the Covid-19 vaccine rollout in India and the world.

The biggest vaccination campaign in the world is well underway, with more than 244 million doses administered already. The past week, roughly 31 million COVID-19 inoculations were conducted around the world. In the last three weeks, the COVID-19 vaccine campaign has expanded from 73 countries to 103 countries.

The average daily rate of doses administered is approximately 6.73 million doses per day, increasing by 44 percent in a of three weeks. Though the average rate has been steadily rising, at this pace, achieving global immunity from the virus will be a long-drawn-out process. At this rate, the time needed to cover 75 percent of the global population with a two-dose vaccine is approximately 4.6 years.

This week, four new vaccines have moved to clinical trials, while Johnson & Johnson’s vaccine was approved for emergency use in the USA and Bahrain. The Oxford-AstraZeneca vaccine was authorised by Canadian authorities for emergency use in the country, and, India’s Bharat Biotech initiated the Phase 1 trials of the single-dose vaccine delivered as a nasal spray on Feb 16.

At the moment, there are 74 vaccines under clinical trials and another 182 vaccine candidates are in the pre-clinical investigation stages. Twenty vaccine candidates are in the final phases of testing in large-scale vaccine efficacy trials, and six candidates have been approved for full use, namely, Pfizer-BioNTech, Moderna (both Pfizer and Moderna were fully approved in several countries, emergency use in US, EU, other countries); Sinopharm (approved in China, UAE, Bahrain); Sinovac (conditional approval in China) vaccines; Sinopharm-Wuhan (limited use in China) and CanSino (approved in China).

Figure 1: Global Covid Vaccine Trend

Author’s own, data source: Our World in Data

The COVID vaccine drive is led by the United States, with 75 million doses administered as of February 28, followed by China (40 million<1>), UK (20.8 million) and India (14.3 million). While USA and China lead in absolute doses administered, the countries seem to be lagging behind with 22.7 and 2.8 doses per 100 population respectively, largely attributed to a high population base. Israel’s inoculation surpassed that of other countries with 88.5 doses administered for every 100 people.

Figure 2: Country wise Covid vaccine doses administered

Author’s own, Data source: Bloomberg Vaccine tracker

India’s COVID Vaccine Update

India’s total confirmed cases have surpassed 11.1 million, with 95,613 new cases reported in the past week. The past week saw a 20 percent increase in cases as compared to the week ending 21st Feb, striking fear that the country’s second wave may be starting; 108 Covid deaths were reported in the past 24 hours, taking the total to 157,194, as on Feb 28.

India has administered 14.3 million doses, making it the fourth highest country in terms of total vaccine doses administered, with 1.05 doses administered per 100 people. In the past week, India conducted approximately 3.1 million inoculations. India’s average daily vaccination rate saw a rise of 12 percent this past week, from 404,508 (as on the week ending Feb-21) to 454,916 (as on the week ending on Feb-28). The daily numbers have not shown the acceleration that India requires to cover the 300 million high priority population quickly, and this can prove costly if there is another wave. However, this week’s average vaccine numbers seem to be on the lower side due to the Co-Win app maintenance over the weekend (Feb 27-28), lowering the 7-day average of the country.

Figure 3: Covid Vaccine Trends in India

Author’s own, Data source: Ministry of Health and Family Welfare, Government of India

Within India, Uttar Pradesh continues to lead the country with more than 1.4 million doses administered, but the state requires targeted focus due to its large population base. Even with the highest inoculation numbers, Uttar Pradesh has only reached 0.62 people per 100 population, one of the lowest in the country. On the other hand, Union Territory Lakshadweep, at 3,078 doses, lags behind in absolute doses administered, but leads the states and UTs with 4.2 doses administered per 100 people. Bihar lags behind with 0.5 doses per 100 people.

Figure 4: Covid Vaccine Trends in Indian States

Author’s Own, Data source: Observer Research Foundation Vaccine Tracker

On March 1st, India commenced the second phase of its vaccination strategy. The country has initiated vaccinations for those who are over 60 years of age or for people aged 45 and above with co-morbid conditions. As per Ministry of Health and Family Welfare, 128,630 people over the age of 60 and 18,850 people between 45-60 years with co-morbidities were vaccinated on the second phase’s first day. This phase is expected to cover more than 130 million of the 60+ population alone, who constitute the majority of the vulnerable population.

The vaccine will be provided free of cost at government facilities, and the market price has been capped at INR 250 per dose at private medical facilities. For starters, the vaccine will be available at 7,935 private facilities and 687 Central Government Heath Scheme (CGHS) hospitals across the country.

Currently, there are eight vaccine candidates in different phases of trials in India. Additionally, discourse surrounding bringing other international vaccine candidates to India are underway.  Indian authorities are in discussions with Moderna, but have yet to take the discussion forward towards commercials and manufacturing. Contrarily, Russia’s Sputnik V was not authorised by the country for emergency use. India’s drug authorities have asked Dr. Reddy’s—the Indian pharma company that is facilitating Sputnik V’s trials—to provide additional immunogenicity data pre-approval. Similarly, Pfizer withdrew its application for emergency use in India, when asked for additional data and studies.

A Necessary Equitable future

This week observed multiple new countries initiating their vaccine drives. The number of countries conducting COVID vaccine drives increased from 73 to 103 over the past three weeks. Looking for a relief from the virus, estimates suggest that countries have already reserved 9.59 billion doses of the different vaccine. However, the access to vaccines remains partial to high and upper middle-income countries.

At least 42 countries—mostly belonging to North American and European region—have secured vaccine contracts to cover more than 110 percent of their population. The UK and Canada each have enough doses to cover three times their respective populations; conversely, many African countries lag behind with ~5-6 percent of their population covered by the current vaccine contracts.

Figure 5: World Map of Vaccine Contracts

Source: Bloomberg Vaccine Contract tracker, as of Mar 1st 2021

Sixteen percent of the world’s population has acquired 60 percent of the COVID vaccine doses. Even though vaccine makers across the world had promised ‘equitable access’ to the vaccines, as of now, most contracts have been awarded to rich countries.

Research published by the National Bureau of Economic Research indicated that, in a scenario wherein rich/advanced economies vaccinate their populations but ignore the poorer nations, the resulting vaccine inequity could cost the global economy more than US $9 trillion dollars in 2021. In such a situation, advanced economies may bear up to 49 percent of the resulting global loss of inequitable distribution of vaccines.

Figure 6: Covid Vaccine’s Inequitable coverage

Source: PandemIC Vaccine Equity Tracker, Feb 28 2021

Figure 5 shows the lack of equity in vaccine distribution globally. After more than two months of the ongoing vaccination campaign, only 11 lower middle-income and no low-income countries have started the vaccination drive. The developing world constitutes 84 percent of the global population and 71 percent of the priority population, but it holds only 38 percent of the vaccine contracts, as of now.

Adding to the lack of equitable vaccine distribution and effective immunisation systems in developing countries is the spread of newer variants of COVID-19, such as the ones emerging in Britain, South Africa and Brazil. The variant (B.1.1.7) found in Britain is thought to be 30-50 percent more infectious and likely to be more deadly, and has been found in over 90 countries. This raises doubts for the future.

As the virus continues to spread and mutate, it has the opportunity to evolve against immune responses to existing variants as well as the vaccines. Large unvaccinated populations may serve as incubators to the newer variants, possibly becoming resistant to vaccines, and becoming spreaders of new variants. This situation holds the ability to penetrate and infect fully-vaccinated countries in the future, endangering the world in the future. The inequalities in the distribution system may hold the key to prolonging the pandemic, by fueling the evolution of potentially more transmissible, vaccine-resistant variants of the virus, eventually dragging down rich and poor nations alike.

Amidst uncertainty, India continues to aid the world, while also fighting the pandemic at home. Yesterday, Ghana’s president became the first recipient of the CoviShield vaccine, which was provided by India under the COVAX initiative—a global initiative towards equitable access to vaccines. As we move forward, working together seems the only possible path towards a healthy future for all.

<1> China’s vaccination data not updated after Feb 9

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Kriti Kapur

Kriti Kapur

Kriti Kapur was a Junior Fellow with ORFs Health Initiative in the Sustainable Development programme. Her research focuses on issues pertaining to sustainable development with ...

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