India’s push to be the world’s Covid-19 vaccine pharmacy
24 Feb 2021|

On 23 February, India accounted for 11 million of the world’s 112 million Covid-19 cases and 156,498 of 2,848,247 world deaths. Only the US had more cases and the US, Brazil and Mexico have recorded more deaths than India. Yet India’s Covid mortality rate of 113 deaths per million—only 35% of the global average of 319—places it 112th of 221 countries and other locations (including, for example, the cruise ship Diamond Princess) covered by Worldometers.

I discussed India’s Covid situation in the global context in an academic article in January. What’s interesting since then is the extent to which India is suddenly attracting world attention. One component of this is the surprisingly low mortality rate considering the many adverse initial conditions in the country.

The second is the overdue recognition that India is a vaccine superpower with a US$42 billion pharmaceutical sector, including US$20 billion worth of exports in 2019–20, a point I alluded to in a Strategist article in June. In combination with the country’s emphasis on vaccine affordability and access, this gives India the potential to be the pharmacy to the world.

It also gave India the self-confidence to refuse emergency-use authorisation for the Pfizer vaccine, based on trials in Germany and the US, unless it met the Indian regulator’s demand for a local safety and immunogenicity study as a ‘bridging trial’. Pfizer withdrew its application.

As with everything else, India does things by scale. In January, the BBC noted that India produces 60% of world vaccines by number of doses. The Guardian published an interview with Adar Poonawalla, CEO of the Serum Institute of India, the single largest manufacturer of Covid vaccines in the world by volume, on 14 February. It expects to be making 100 million doses per month by the end of March. Another company, Bharat Biotech, has the goal of making 200 million vaccines annually.

Matching India’s impressive private-sector manufacturing capacity scaled up to meet world needs is the emerging character of India’s vaccine diplomacy. The key consideration driving the country’s vaccine exports is a careful balance between world needs and demand. This echoes the government’s commitment to prioritise the poor, the vulnerable and the frontline workers in the domestic vaccination drive.

India has enormous experience in implementing mass-vaccination programs for smallpox, tuberculosis, polio and other illnesses. At full stretch, India will be vaccinating 85 million people per month. By 22 February, in 38 days India had vaccinated 11 million people. The goal is to cover 300 million people by the end of July.

India’s donations to neighbouring countries Nepal, Bangladesh, Sri Lanka, Maldives and Bhutan are nearing 6 million doses. India has pledged another 10 million doses to Africa and 1 million to UN health workers. As Indian vaccines arrived in Johannesburg, Foreign Minister S. Jaishankar tweeted on 2 February: ‘In it together. Made in India vaccines land in Johannesburg, South Africa. #VaccineMaitri’ (maitri means friendship.) Afghanistan, Myanmar, Mauritius, the Seychelles, Kuwait, Morocco and Brazil are also in queue.

Meanwhile, Pakistan has been the beneficiary of Chinese largesse with a donation of 1 million doses of the Sinopharm vaccine in two consignments. At the virtual meeting of the World Health Assembly on 18 May, President Xi Jinping affirmed that a coronavirus vaccine would be ‘a global public good’ and represent ‘China’s contribution to ensuring vaccine accessibility and affordability in developing countries’.

It’s worth noting that this language is a challenge to the big (by market capitalisation) Western pharmaceutical firms’ drive to enforce intellectual property rights on all countries. China and India have been the leaders against that, arguing for affordable access for the people of poor countries as a higher priority.

Peter J. Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital and a former science envoy in the Obama administration, argues that compared to China and Russia, India’s approach is ‘more of a pure expression of true “vaccine diplomacy”’. ‘The likelihood is that India is going to rescue the world in making low-cost high-quality vaccines available and responding quickly to the new variant to adjust their vaccines accordingly.’ By contrast, China seems more intent on linking exports to exerting political influence, he said.

Duke University’s Global Health Institute notes that, in an ugly outbreak of vaccine wars, rich nations comprising just 16% of the world’s population (including Australia) have cornered 60% of the global vaccine supply (4.2 billion doses) and low-income countries have secured only 270 million doses. Yet even on purely self-interested calculations, the equitable distribution of vaccines is essential: the rich world cannot be free of the threat of Covid-19 unless all countries have reached herd immunity by a combination of pre-existing immunities, infection and vaccination. Recreating a healthy rules-based international order that breaks down barriers to the free flow of masks, protective gear, test kits and pharmaceutical supplies would be a global public good.

Last April, Prime Minister Narendra Modi exhorted India to become ‘the global nerve centre of … multinational supply chains in the post Covid-19 world’. In his virtual address to the UN General Assembly on 26 September, Modi boasted that India’s pharmaceutical industry had sent essential medicines to more than 150 countries and promised: ‘India’s vaccine production and delivery capacity will be used to help all humanity in fighting this crisis.’

‘Sicken thy neighbour’ policies led dozens of countries to impose restrictions, including outright bans in some cases, on exports of critical medical supplies like masks, medicines, ventilators and disinfectants. Espousing nationalist rhetoric and policies, while abandoning international cooperation, aggravated the crisis. Governments can better protect the people they claim to represent by reversing the equation—ditching pandemic nationalism and embracing global cooperation instead.

Finally, albeit somewhat unfortunately, there’s also an element of schadenfreude in Indian circles that a developed Western country like Canada, whose do-gooder instinct often leads to irritating moralistic lectures on India’s perceived human rights failings, should see its Prime Minister Justin Trudeau phoning Modi on 10 February in a plea to boost vaccine supplies. Modi said India ‘would do its best to support Canada’s vaccination efforts’, but the request came too late to make the cut in India’s initial allocation of vaccines, subject to export restrictions because of the massive domestic need, to 25 countries.