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India and COVID-19 vaccines: A national crisis with global ripples

The fallout includes supply shortages, missed doses, and refugee vaccination plans on hold.

A policeman asks people to leave as they stand outside the gate of a COVID-19 vaccination centre which was closed due to low supply in Mumbai, India, 3 May, 2021 Francis Mascarenhas/REUTERS
A policeman asks people to leave as they stand outside the gate of a COVID-19 vaccination centre, which was closed due to low supply, in Mumbai, India on 3 May, 2021.

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India’s coronavirus crisis has global vaccine ripples – from postponed vaccinations in refugee camps to shortages in dozens of countries still waiting for doses.

India has been the leading COVID-19 vaccine supplier to much of the world through COVAX – the UN-backed scheme shipping doses to countries from Afghanistan to Zambia. But now it is struggling to fully vaccinate its own population amid a coronavirus health crisis that grows worse by the day. 

India’s Serum Institute, which manufactures a version of the Oxford-AstraZeneca jab, was forecast to supply about 70 percent of the COVAX pipeline through the first half of 2021. But the Indian government suspended vaccine exports as its second wave began to surge in March – a move that has contributed to vaccine shortfalls around the globe.

COVAX’s original goal was to supply enough vaccines to cover three percent of countries’ populations by mid-year, and 20 percent by the end of 2021.

The programme had aimed to distribute some 187 million doses worldwide by the end of May. Some 60 countries were to receive Indian-made vaccines. As of 3 May, COVAX had shipped about 49 million doses of any kind.

Read More → Tracking the coronavirus pandemic and vaccine rollouts

The repercussions can be seen in dozens of countries that had been counting on COVAX, and among refugees and other groups still waiting for their first doses. 

Bangladesh, for example, has postponed COVID-19 vaccinations for some 900,000 Rohingya refugees, according to the UN’s refugee agency, UNHCR. Facing rising caseloads and vaccine shortages, the government says vaccinations for refugees won’t begin until COVAX supplies arrive, a UNHCR spokesperson told The New Humanitarian. 

Vaccinations were set to launch in the camps on 27 March, covering some 130,000 people in higher-risk groups under a national plan. No new date has been announced. “Rohingya refugees so far are the only group in Bangladesh society which is yet to benefit from the vaccination,” the agency spokesperson said.

Bangladesh had been slated to receive some 10 million AstraZeneca doses through COVAX by the end of May, but it’s still waiting for its first shipments – its early supplies were sourced directly, including donations from India. There have been relatively few COVID-19 cases among Rohingya refugees – about 570 as of early May. But infections, test-positivity rates, and hospitalisations are rising in the wider Cox’s Bazar district, the World Health Organization (WHO) says. Cases have also jumped by several dozen over the last week within the camps themselves.

“Rohingya refugees so far are the only group in Bangladesh society which is yet to benefit from the vaccination.”

Elsewhere, countries almost entirely dependent on COVAX supplies are seeing their early stocks dwindle. Ten countries in Africa have used up more than two thirds of their supplies, a WHO official said in April.

Some countries worry that second doses could be missed, which would limit vaccine effectiveness. Nepal, for example, may not have enough stock to complete vaccinations for some 1.3 million people who already received their first jab, the Kathmandu Post reported. India’s Himalayan neighbour is also struggling with its own rising caseload, which has overwhelmed hospitals and pushed authorities to warn that “the health system is not able to cope”.

This week, the WHO said 20 million doses are urgently needed “to cover interruptions in supply triggered by increased demands for vaccines in India”.

It’s unclear when India will be able to restart vaccine exports. The country is breaking daily global records for coronavirus infections – topping 400,000 in a single day on 1 May. Its overloaded health system is buckling under the pressure, with long queues outside hospitals and crematoriums, and severe oxygen shortages. 

Agencies involved with COVAX – including the WHO, UNICEF, and Gavi, the global vaccine alliance – say they hope exports can resume “as soon as possible”, but that India’s healthcare crisis is the priority.

“As India confronts a truly dreadful wave of the pandemic, it is clear that Indian vaccine production – for the next month at least – will be committed to protecting its own citizens,” a Gavi spokesperson said in a statement to The New Humanitarian.

The Serum Institute’s CEO, Adar Poonawalla, told The Financial Times that India’s vaccine shortage could last until at least July.

But India’s COVID-19 crisis is just one of many factors driving global vaccine delays.

There’s also a worldwide shortage of the raw materials needed to produce vaccines, which has affected all manufacturers. Some countries have struggled to get their rollouts off the ground because of funding or healthcare infrastructure problems, despite having access to early stocks. 

“It is clear that Indian vaccine production – for the next month at least – will be committed to protecting its own citizens.”

The global supply problems underscore a lopsided “vaccine inequality” that health agencies and rights groups have flagged for months.

Many wealthier nations scooped up early supplies by striking direct deals with manufacturers, including India’s Serum Institute. They’re rolling out vaccines to lesser-risk groups, while frontline health workers elsewhere are still waiting for their first doses.

COVAX supplies are also highly concentrated – dependent from the start on a handful of available vaccines and on the Serum Institute’s manufacturing capabilities.

Its current stocks comprise only three vaccines – two versions of AstraZeneca including the Serum Institute’s, and the Pfizer-BioNTech jab. Only 1.2 million Pfizer doses are in the COVAX pipeline through the first half of the year.

There has been a rush to diversify the pipeline’s offerings in recent weeks. On 30 April, the WHO approved the US-made Moderna vaccine for emergency use, and Gavi announced it had struck a deal to buy 500 million doses for COVAX. But the first 34 million jabs aren’t expected to be available until the last quarter of 2021.

The WHO also approved the single-shot Johnson & Johnson vaccine in March, though these jabs are still pending a supply agreement and wouldn’t be available until the second half of the year, the Gavi spokesperson said.

A WHO committee is also slated to review two vaccines this week from Chinese suppliers – Sinopharm and Sinovac.


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