Author : Oommen C. Kurian

Expert Speak Health Express
Published on May 04, 2021
Next three months of the world’s largest vaccination drive: Managing expectations

The latest available numbers indicate that the daily vaccination numbers are showing a worrying decline even as the eligibility criterion is expanded to include everyone above 18 years of age. Despite the clear decline in the number of vaccine doses administered per day, states are still facing shortages of vaccines in many districts (Graph 1). India has administered around 159 million doses, and the states have just 5.8 million doses left.  With procurement numbers indicating conservative supplies in the next three months, India needs to be strategic in vaccine deployment and expectations of a massive scale-up should be toned down.


Vaccine Stocks with the Government of India:

According to latest government communication, a cumulative total of 165.4 million doses were shared with states, of which 5.8 million are in the cold chain and the rest already administered. In order to address the shortages,  an additional 5.6 million doses are being rushed to the states within the next couple of days. The Centre has clarified that  a fresh order of 110 million Covishield shots was made in the last week, along with an order for 50 million doses of Covaxin. More than 120 million doses of Covishield and 60 million doses of Covaxin are to be delivered by end July including those pending from the last order. Assuming these commitments are fulfilled uniformly across the next three months, the Centre will have 194.4 million doses (180 million from the two companies, and the rest already in the pipeline or with the states) over three months, to administer in the 45+ age group as the Centre is continuing to focus on the vaccination of those in this age bracket, with the States and private sector handling the vaccination of those above 18 and below 45 years of age. (Table 1).

Table 1: India Vaccine Supply Situation (May-July 2021): Doses in Millions

Covishield Covaxin Total
Balance with States NA NA 5.8
In the pipeline NA NA 5.6
Pending from past orders 12 11 23
To be delivered by July end 110 50 160
Total (Central Pipeline) 122 61 194.4
Available for States and private hospitals 110 29 139
Grand total 232 90 333.4
Assumptions: 1. Zero exports of Covaxin or Covishield and the commitments will be shared uniformly across months. 2. Enough current stocks with Serum Institute to offset the gap between capacity and commitments. 3. We don’t know how many doses of Sputnik V from the 250 million committed will reach India by July end. 4: Status quo will prevail for Covovax and Johnson & Johnson till July end. 5. Serum Institute’s commitment of 110 million doses to States/Private hospitals is for the next 3 months.

Source: Various GoI and Company press briefings

In parallel to the Central pipeline, The Serum Institute of India aims to provide 110 million additional shots to States and private hospitals, largely to cater to the 18-45 age group (as the other demographic groups will continue to receive shots through the Central supply). No similar assessment from Covaxin is available yet. Thus, a total of 334.4 million doses are at India’s disposal till the end of July, plus a trickle of Sputnik V doses of a few millions, based on government procurement decisions and import volumes. Imports of the Russian vaccine have started,  however, timelines of import volumes are not available in the public domain. Twenty million doses of the AstraZeneca vaccine will be imported from the US in the next couple of months, but those have not been added to these calculations so as to offset vaccine wastage.

Domestic Production and expected supply of vaccines:

The Serum Institute has just announced that it will invest GBP 240 million in the United Kingdom to expand its vaccine business, including possible manufacturing. This may have implications for the company’s future expansion plans for India. The monthly Indian production capacity for Covishield will remain at 60-70 million doses per month in its Indian facilities till the end of July.

Bharat Biotech produced 15 million doses of Covaxin in March, and scaled up production to 20 million doses in April and aims to produce 30 million doses in May. Continuing with the momentum, the company claims that its capacity will be ramped up to 70 million by August 2021.

In parallel, imports of 250 million doses of the Sputnik V vaccine is expected this year, starting from this month. Domestic production of 850 million doses will start in India later, but a majority of the doses will be reportedly for the international market. One and half lakh doses of the Russian vaccine have already reached India, and emergency use approvals are in place. However, enhanced cold chain requirements may mean it may be deployed largely in urban areas. Market price is yet to be announced. Serum Institute’s production of the Covovax vaccine will start only later in the year as at-risk manufacturing is delayed due to raw material shortages. As for Johnson & Johnson, the single shot vaccine will be available in India latest by July 2021. For the same reason, in the coming three months, India will continue to rely mostly on Covishield and Covaxin.

Publicly available numbers indicate that in the coming three months, India will have 3.7 million doses per day to administer, including doses distributed by states and private hospitals. The Central pipeline focusing on priority groups will administer 2.2 million doses per day. We need to note that these numbers are based on very harsh assumptions, like zero exports of vaccines from Serum Institute as well as Bharat Biotech, which are highly unlikely. This means that the actual deployment of vaccines may likely be even lower.

In a situation where the 7-day average of daily vaccinations has come down from 3.6 million doses a month back to 1.7 million doses now, India will be forced to focus on vaccinating high-risk groups rather than reach a large number of the 18+ population. Experiences like Italy’s, where the vaccination programme was accused of inoculating too many of the ‘wrong people’ - overprioritsing youngsters over the elderly- resulting in avoidable deaths among the elderly, should offer us lessons.

In addition, anecdotal evidence from cities suggest that the elderly are making multiple unsuccessful trips to vaccination centres to get a jab, which makes a quick solution an ethical imperative. When a highly transmissible virus is wreaking havoc, India cannot accept its high-risk population making several desperate trips to overcrowded vaccination centres, standing in line for hours, only to be told that vaccines are not available. Vaccination centres turning into superspreader locations is the last thing India needs in the middle of its worst crisis since the Partition of the country in 1947.

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Oommen C. Kurian

Oommen C. Kurian

Oommen C. Kurian is Senior Fellow and Head of Health Initiative at ORF. He studies Indias health sector reforms within the broad context of the ...

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