Expert Speak Health Express
Published on Nov 24, 2020
Preparing India for a vaccine
India’s big bet for exiting the pandemic has always been the vaccine candidate being developed by AstraZeneca and scientists at Oxford University. AstraZeneca has tied up with the Serum Institute of India, and Pune-based SII has said it will have at least 100 million doses available in India by January. There are other quivers to India’s bow: Besides the indigenous vaccine being developed by Bharat Biotech, SII has also signed a licence for up to 100 million doses of Novavax’ vaccine candidate, if it proves effective. The Russian alternative, Sputnik-5, also has an Indian licencee and reportedly has an efficacy of over 90 per cent. But the AstraZeneca vaccine, known by the code name AZD1222, has always been the easiest to arrange constituent of a massive rollout effort. It is something of a relief, therefore, that AZD1222 has apparently proved to be effective enough to prevent 70 per cent of Covid-19 infections on average, according to preliminary data that the company released yesterday. The company sought to stress in its public statements that one dosing mechanism – in which a half-dose was administered first, and then a full dose – demonstrated about 90 per cent efficacy. That said, some scientists have expressed concern that this regimen was not tested on a large enough sample size. In fact, the half-dose sub-sample emerged from an error made by the testing administrators that was only discovered some way into the trial. The question is whether this result will be replicated in other large-scale trials of AZD1222, including one ongoing in the United States. Either way, in real-world settings the chances are that AZD1222 will have an efficacy of well below 90 per cent. There is a straightforward relationship between vaccine efficacy and how long it takes to reach herd immunity in the population: the less effective a vaccine in preventing infection, the larger the proportion of the population needs to be vaccinated in order for the spread to stop. A lot also depends upon the starting point: can you identify the location of the currently infected people? How many have already had the disease? And so on. Unfortunately, there have been no proper simulations in the Indian context for the vaccinated population proportion that’s required to control the spread of the pandemic. However, if we extrapolate from published results of such simulations for the United States<1>, it suggests that India might need vaccination levels in excess of 80 per cent before it is truly safe to reduce social distancing norms. The most reliable guides to the time it would currently take to vaccinate the entire Indian population comes from Adar Poonawalla, the CEO of SII. Mr Poonawalla has repeatedly warned that the vaccination programme will take till 2024 to reach every Indian. The chances are therefore that the pandemic will be with us in India not just next year, but well into the year after that. This is not news, but it is still unwelcome to hear. Simply put, it is now up to the government to try and accelerate this timetable, in the interest of the economy (as well as everyone’s mental health). That will not be easy. It requires not just the scaling up of manufacturing, but also of delivery systems and of awareness. Even as things stand, the vaccination programme will be an enormous national project. An acceleration of the timetable may turn out to be the biggest effort the Indian state has made in its history. It will be an enormous test of Indian state capacity, and of the administrative abilities (and co-ordination between) federal and state governments. Multiple agencies will have to work together, and resources will have to be pooled between different departments and ministries. Without such a whole-of-government approach, the programme is doomed to bureaucratic delays and other hurdles. Indeed, this is the sort of effort that ideally should be run by a specialised war room, with a senior official or even a Cabinet-level politician with no other responsibilities put in charge, who can speak to states and ministries wrapped in the PM’s own authority. The good news is that one person who seems to grasp the enormity of this challenge is Prime Minister Narendra Modi, who in his address to a group of chief ministers on 24 November hit all the right notes. First, he pointed out that India already has some experience with large-scale vaccination programmes in a manner that not even many advanced countries do. Second, he noted that we must be prepared for and overcome some sections of society rejecting a novel vaccine – after all, as he said, some people are distrustful even of vaccines with a 20-year proven record of safety. Third, he called for careful co-ordination on both prioritisation of the vaccine delivery and on the creation of delivery systems, with state-level steering committees and localised task forces. And fourth, he said that the vaccine rollout would need to be “smooth, systematic and sustained”. Most importantly, however, Mr Modi argued that the vaccination programme was not simply a government project but a “national commitment”. This is the right way to think about the task. It must be not just a whole-of-government effort, in fact, but a whole-of-society effort. In particular, the government will have to reach out to other implementing agencies. This would include philanthropic foundations and other non-government organisations, with which it has not always had a comfortable relationship. An opportunity to reset the vital partnership between philanthropy and the state is not to be missed. And then there’s the private sector, which as the vaccine development race and the PPE manufacturing response has shown is a vital pool of initiative and ability that cannot be wasted in a crisis. Incentives should be designed for corporations to manage the vaccinations for their employees, contractors and their families. Larger companies, with hundreds of thousands of employees, could potentially reach millions of people in this manner. The cost of this effort should be considered last of all. For one, the infrastructure that will be built for a vaccine rollout – both soft and hard – should have usefulness beyond this specific effort. Better equipped primary healthcare units will pay off in terms of improved health outcomes even after the pandemic is done, for example. And a cold chain built for vaccines can certainly have other uses for storing and managing agricultural produce. Most importantly, however, the vaccination effort should not be seen as expenditure but as an investment – if not in terms of the national accounts, then in policymakers’ minds. There is infrastructure expenditure, recovery efforts, and relief spending all in one. In fact, it would be the best economic stimulus we could hope for.

<1> Sarah M Bartsch et al., ‘Vaccine Efficacy Needed for a COVID-19 Coronavirus Vaccine to Prevent or Stop an Epidemic as the Sole Intervention’, American Journal of Preventive Medicine, Vol 59.4
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Mihir Swarup Sharma

Mihir Swarup Sharma

Mihir Swarup Sharma is the Director Centre for Economy and Growth Programme at the Observer Research Foundation. He was trained as an economist and political scientist ...

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