A health worker opens a freezer during a Covid-19 vaccine in Delhi, January 2nd.
Photographer: T. Narayan / Bloomberg
Photographer: T. Narayan / Bloomberg
While major countries, such as the US and China, are struggling to vaccinate their populations with rapidly approved fires, tens of millions of prepared doses for India remain in storage, despite being authorized for use.
While distribution in other countries began immediately after approval, with pre-signed pricing agreements, New Delhi and Serum Institute of India Ltd. – the largest manufacturer of vaccines in the world by volume and The local partner of AstraZeneca Plc – have engaged in months of negotiations behind closed doors and have not yet signed a formal supply agreement. This has left at least 70 million doses of vaccine in the tongue, despite the urgent need in a country facing a second outbreak in the world.
Photographer: Dhiraj Singh / Bloomberg
On Sunday, Serum billionaire CEO Adar Poonawalla said Indian officials had agreed “orally” to buy 100 million doses at a “special price” of 200 rupees ($ 2.74) a shot, under about Price tag between 4 and 5 USD awarded to the British government. The company then wants to sell the vaccines privately to individuals and companies at an increased cost of 1,000 rupees within two to three months.
According to Abhishek Sharma, an analyst at Abhishek Sharma, the Indian government may seek to put pressure on Serum to cut its prices, as seen in the controversial decision to approve a rival vaccine developed by a local company that is still recruiting volunteers for stage testing. final. Jefferies.
The confrontation has cost precious time in a country where infections have exceeded 10 million and reflect the tension between the public interest and private profit from pharmaceutical companies that want to quickly recover their investments in the pandemic.
Although richer developed economies have largely avoided pricing disputes in their launches so far, the issue of how much inoculation should cost amid a pandemic that kills more than 10,000 people every day globally , will likely increase as distribution expands to the developing world.
For Prime Minister Narendra Modi, every penny spent on the price of a vaccine in a nation of more than 1.3 billion people will have serious financial consequences for his administration.
“When you buy in bulk, there is obviously the advantage of being able to negotiate the price,” said Randeep Guleria, a member of the Modi working group for Covid-19 management and director of the All India Institute of Medical Sciences. interview Monday. He added that negotiations are under way under public procurement policy and “obviously they may also be able to decide what the market price should be next”.
Guleria said the purchase agreement will be signed “any day now.” India is ready to launch Covid-19 vaccines within 10 days of its approval by the drug regulator, Health Secretary Rajesh Bhushan told reporters on Tuesday. He did not say whether a price or supply contract was signed.
It took five to six days for the first strikes to be carried out by Britain after it gave the emergency signs. Pfizer Vaccines Inc. and Astra-Oxford.
“Negative Hill”
In October, people with knowledge of the issue told Bloomberg that New Delhi had set aside 500 billion rupees for vaccination efforts, estimating a total cost of about 6-7 USD per person. An Indian health ministry spokesman could not be reached for comment.
“The government does not easily give money to the private sector so easily,” said Ramana Laxminarayan, founder of the Center for Disease Dynamics, Economics and Politics in the Indian capital. “They are simply good at the game, because they have budgetary pressures – bureaucrats, if they come back with a bad deal, the minister will send them immediately and say ‘get me a better price.'”
India’s blue vaccination scheme predicts that 300 million people will be inoculated in the first stage of the deployment, starting with health workers, followed by police and soldiers, then comorbidities and people over the age of 50. . Guleria said the process would take up to three to four months to complete.
Workers are transporting a temperature-cooled container to Indira Gandhi International Airport in New Delhi on December 22, 2020.
Photographer: Anindito Mukherjee / Bloomberg
Local officials across the country have been asked to draw up priority vaccination lists, but the preparatory work seems uneven, according to interviews with doctors and local representatives. Some localities also seem to be preparing to administer two different vaccines at the same time.
Although the AstraZeneca shot has been tested in global studies and has received an emergency license from UK and Indian regulators in recent days, the vaccine developer in Hyderabad Bharat Biotech International Ltd. has not yet begun analyzing the Phase 3 test data, but has also received controversial approval for limited use by the South Asian country over the weekend.
“There are several vaccines that will be used,” said Amit Thadani, a surgeon at Nirmaya Hospital in Mumbai. “They will allocate a certain type of vaccine to be used in only one district, so if there is a problem, it is easy to identify what specific vaccine is causing it.”
Serum, which has an agreement with AstraZeneca to produce at least one billion doses, has already reduced an initial production target of 100 million by December due to slower-than-expected approvals.
Poonawalla began publicizing debates over potential vaccine prices in September, which some health experts saw as part of a lobbying effort.
In Sunday’s interview, Poonawalla was optimistic that a written agreement would be reached in a few days. “We have already packed it, we just have to send it in trucks to all states and deliver it,” he said, referring to the 70 million doses the company has prepared for distribution.
“Hurry approval”
Meanwhile, India’s decision to grant Covaxin approval to Bharat Biotech restricted approval, despite the lack of final test efficacy data, left observers unable to do so. In August, the company’s president, Krishna Ella, told a conference that their vaccine would be cheaper than bottled water – which costs less than half of what Serum offers the AstraZeneca vaccine.
“Covaxin’s hasty approval, even as a reserve candidate, is driven primarily by the Indian government’s trade considerations,” Sharma analyst Jefferies of Mumbai said in a report on Sunday. If Covaxin “is able to prove its effectiveness in the next few months, subsequent vaccines will have to compete on both price and efficacy.”
The rapid approval of Bharat Biotech may also be due to the fact that India does not want to be subject to a single vaccine manufacturer.
In an echo of a long-running debate over the role of private pharmaceutical companies, concern is already growing that Serum’s position as the sole domestic supplier of a potential life-saving vaccine is too strong.
Outside India, AstraZeneca only supplies to governments and has not yet entered into any private transactions with companies or individuals. However, Serum wants access to the private market with a higher margin in a few months, where it intends to increase the price of photography five times, according to the price plans shared by Poonawalla.
The first mover
The proposed price of 1,000 rupees per dose is “absolutely lower the price and capitalize on its position as a first mutant,” said Malini Aisola, co-ordinator of the All India Drug Action Network, a health watchdog. “Personally, I don’t think it should provide approval for private use at this time.”
But for the best in India’s stratified society, waiting for the Byzantine public health system to deliver doses is not an option.
A large private bank is waiting for guidance on data and reference prices from the government, which would allow it to consider purchasing vaccines directly from producers, according to creditor officials, who asked not to be identified because the deliberations are private.
For now, Serum is still waiting for the first order from the government. Poonawalla said India must first provide enough vaccines for those most in need. “If we were to sell it the way we wanted, it makes logical sense that some of the most vulnerable people might miss out,” he said.
New Delhi also knows that the vaccine manufacturer will not be able to easily change these massive volumes elsewhere.
“India buys a lot of vaccines from the Serum Institute every year and I know how to play this game,” Laxminarayan said. “India can wait a little longer, but it will not be so easy for Serum for them – the government has ways to rely on it.”
– With the assistance of Ragini Saxena and Suvashree Ghosh