On Friday, the country reported 217,353 new cases – the highest in one day to date, according to data from the Indian Ministry of Health. India added a million new cases in less than a week, more than 14 million on Thursday.
States and cities are imposing new restrictions, including curfew and curfew in the main Delhi region, which is home to 19 million people. Migrant workers are also leaving large cities en masse to go to their hometowns, fearing they will be stranded by potential lockdowns.
And despite all this, vaccine stocks have dried up on the ground, with at least five states reporting serious shortages and urging the federal government to take action.
In light of the crisis, the government and SII have shifted their focus from delivering vaccines to COVAX to giving priority to their own citizens at home.
India had so far provided 28 million doses of the AstraZeneca vaccine and an additional 40 million doses were planned to be delivered in March and 50 million in April, the publication said, adding that COVAX and the Indian government ” continue conversation “about completing supplies.
It’s not the first time India has had to cut its COVAX contributions: In January, the government restricted exports of AstraZeneca vaccines produced by SII “because they want to prioritize the most vulnerable and needy segments first,” said Adar Poonawalla, CEO from SII.
Vaccination centers are sending people away
But public confidence rose as the government launched an awareness campaign to address concerns, and accelerated the vaccination program. As new daily cases accelerated in March and April, several states began to report major vaccine shortages.
In Odisha, nearly 700 vaccination centers had to close last week due to shortages, health authorities wrote in a letter to the central government, warning that the state would soon use up available supplies.
Minister of Health Rajesh Tope said several districts in Maharashtra, the most affected state, had to temporarily halt vaccination trips, including more than 70 centers in Mumbai that were closed last week. Maharashtra had administered more than 11.1 million doses since Thursday, most of all Indian states, according to the Indian Ministry of Health.
“We have set up teams in both cities and towns … to vaccinate everyone over the age of 45,” Tope said on April 7. “People come to the centers, but our health workers have to tell them they didn’t get the vaccine, so they have to go home.”
There are several challenges that contribute to the shortages – one of which is the supply of raw materials, former ICMR Director General Nirmal Kumar Ganguly said.
India “has the capacity to produce,” Ganguly added, but supply chains have been disrupted during the pandemic. The vaccine formulas and materials needed “cannot be changed overnight, so we depend on the raw materials imported.”
An additional challenge is the country’s dependence on SII, he added. There are other vaccine manufacturers in the country, such as Bharat Biotech, but SII remains the largest.
“The need has been made abundantly clear that we need to expand our capacity,” said Ganguly. “We are one of the exporters of vaccines, but these are currently done by two or three Indian companies. The rest are not major players and some are totally new to vaccine manufacturing.”
Mixed government response
Several states have asked the central government for more doses, but federal officials have pushed back, urging the situation to be under control.
Tope’s complaints were “nothing more than an attempt to divert attention from the repeated failure of the Maharashtra government to contain the spread of the pandemic,” India’s Health Minister Harsh Vardhan said in a statement last week. Home Secretary Amit Shah also rebutted states’ claims, saying their information was “untrue” and vaccines were available, “as needed.”
Prime Minister Narendra Modi has hailed India’s vaccination effort as a success. During a meeting with governors on Wednesday, Modi emphasized “that India has become the fastest nation to reach the milestone of 10 crore vaccinations (100 million doses),” a statement from his office said.
And on Tuesday, Rajesh Bhushan, the health ministry secretary, said the problem was poor planning and management – not delivery. “We will make doses available to states in a timely manner,” he said, adding that states “should look at how many unused doses there are at each cold chain point.”
And while a last-minute shipment from the central government saved Uttarakhand from a complete shortage, it is far from a perfect solution and “the supply is unpredictable,” said Kuldeep Martolia, a health department official Monday.
In a sign that the federal government may feel the pressure, it took action this week to open the doors to vaccine imports. On Tuesday, it announced it would speed up urgent approvals for vaccines already approved by the World Health Organization or authorities in the United States, Europe, Britain and Japan.
Companies are still required to apply for approval in India, but they will be exempted from conducting local safety testing, speeding up the process.
“If one of these regulators has approved a vaccine, the vaccine is now ready to be brought into the country for use, manufacturing, filling and finishing,” said Dr. VK Paul, a senior health officer in the government think tank. Niti Aayog, said at a news conference on Tuesday. “We hope and invite vaccine makers such as Pfizer, Moderna, Johnson & Johnson and others … to be ready to come to India as early as possible.”
The move is “a calculated move” by the government to “make sure we have more vaccines available,” Ganguly said. The government could expand its supply through the private market as well – but this also poses additional challenges, he said, including how to price vaccines to provide fair access to the poor.
But even the ability to import foreign vaccines won’t be a quick fix, as companies like Pfizer and Moderna will have to fulfill other orders first, including supplying vaccines for the US. India has just approved the use of Russia’s Sputnik vaccine, but “by the time they build production capacity and manufacturing requirements, it will take five to six months,” Ganguly said.
Meanwhile, the government is working to expand local manufacturing capacity – a state-run biomedical institute in Maharashtra was given the green light on Thursday to manufacture the Covaxin vaccine, through a technology transfer with Bharat Biotech.
The number of cases in Haridwar is already on the rise, prompting the state to impose new restrictions on Thursday. At least one religious group attending the festival, the Niranjani Akhada, has asked out-of-state people to withdraw amid the increase in the number of cases.
“This wave is a very, very threatening sight happening in India right now,” Ganguly said. “We’ve never seen anything like it.”