Corporation staff wait in a queue to receive COVID-19 vaccines at the Raja Street Health Centre, Coimbatore, June 1, 2021. Photo: PTI
On May 30, 2021, the Centre put out a press release that announced India’s vaccine plan for June 2021.
In this release, the Centre said that it would “make available” 12 crore vaccine doses in June 2021. Of these 12 crore vaccine doses, 6.1 crore doses are to be the Centre’s quota, and 5.9 crore doses will be “available” for direct purchase by state governments and private hospitals.
This announcement is interesting because India has never administered 12 crore vaccine doses in any prior month. However, a closer examination of the data for May and June 2021 throws up two conclusions.
First, a similar announcement was made by the Centre for May 2021 too, and it was hardly fulfilled.
Secondly, the GoI’s new announcement for June 2021 is not based on any realistic assessment of the vaccine industry’s capacity to supply. Such announcements are made only to create an atmosphere of “positivity”, as the Centre’s spokespersons have often tried to do in the past.
Actual production in May 2021
What did the Centre announce for May 2021? In two press releases dated May 1, 2021 and May 14, 2021, the Union health ministry had stated that it would “make available” a total of 4.4 crore doses for direct purchases by the state governments and private hospitals in the month of May. It included 2.13 crore doses for the first fortnight of May and 2.27 crore doses for the second fortnight of May.
“Make available” was the keyword in both these press releases.
It was not doses actually allocated and received by either entity. The press releases only meant that “x” quantity of vaccine doses can be purchased in “y” month.
How was this figure arrived at? It appears that the Centre worked backwards from a total figure for vaccine production and then divided the doses across itself and states and private hospitals.
For this, the Centre probably assumed a total production capacity for India. If we refer to the affidavit submitted by the Centre to the Supreme Court of India, it had submitted that the production capacities of Serum Institute of India and Bharat Biotech were, respectively, 6.5 crore doses per month and 2 crore doses per month. Adding the two, we get a total production capacity of 8.5 crore doses per month. The third vaccine – Sputnik V – is available only in trickles.
The Centre then divided this 8.5 crore vaccine doses into two parts, as per the 50:50 formula announced on April 19, 2021. It kept for itself 4-4.5 crore doses and then said that the remaining 4-4.5 crore doses were “made available” for states and private hospitals for direct purchase in the month of May.
Such a method would look reasonable at first glance. However, the problem is that the production capacity of 8.5 crore doses per month was just an estimate. Actual production of vaccines from Serum Institute of India and Bharat Biotech was significantly lower. My estimates show that India’s actual monthly production of vaccines in May 2021 was not 8.5 crore doses, but only around 6-6.5 crore doses.
For this purpose, I assumed the total doses administered in a month as a proxy for production in that month. CoWIN data show that the total doses administered in May 2021 were only 5.98 crore, at an average rate of 19.3 lakh doses per day. Even if we assume 3-4% wastage, the figure reaches nowhere near 8.5 crore doses a month.
If the production capacity was really 8.5 crore doses per month, as the Centre has claimed for May 2021, why was it that only 5.98 crore doses were administered? The reason, I argue, is that India does not produce 8.5 crore doses per month.
Globally, adenovirus vaccine production is seriously hampered by yield instabilities across plants. In March 2021, Anthony King wrote an important article in Chemistry World explaining why scaling up adenovirus vaccine production is a major challenge in the industry. The major steps in vaccine production involve growing mammalian cells in small, and then large, containers of size up to 2000 litres for over two months. After this, the virus is allowed to replicate in these cells for a few more days.
In all these processes, producers have prior estimates of the rate of replication of the virus in these cells. These prior estimates would be true only if the cells divide and grow as expected. But they may not do so at the expected rate. A range of variations exist in production conditions, which essentially makes biological production fundamentally different from the more precise industrial production. Prior estimates can go widely off-the-mark. An industry analyst is quoted in King’s report thus:
“It never goes to plan at the start…Conditions do not translate directly from small to large scale, mixing is different, pressures are different, the heat transfer is different. All this needs to be optimised at each scale. It is normal to have hiccups.”
Examples of such hiccups are many across the world.
For example, the yields from an AstraZeneca plant in Belgium, owned by Novasep Holding, was far lower than the prior estimates. Similarly, Johnson & Johnson also faced difficulties with yields in its plants in Europe. Such problems, combined with a refusal of vaccine producers to be fully transparent about their actual capacities, are possibly the reasons why India did not produce 8.5 crore doses in May 2021. We will not know the full story till Serum Institute of India and Bharat Biotech decide to confess.
The case in India
Take the case of May 2021. Only 5.98 crore doses were administered in May. If, according to the Centre’s affidavit, India’s production capacity is 8.5 crore doses per month, where are the rest of the vaccine doses?
Of these 5.98 crore doses, 5.1 crore doses were Covishield doses and 0.9 million doses were Covaxin doses. However, we were told in the affidavit that Serum Institute of India can produce 6.5 crore doses of Covishield per month and Bharat Biotech can produce 2 crore doses of Covaxin per month. What happened to the rest of their production?
As a result, any projection given by the Centre on what the state governments and private hospitals would be “made available” is nothing but writing on water. On May 30, 2021, the Centre had stated that 4.03 crore doses were “made available” under the Centre’s quota and 3.9 crore doses were “made available” to state governments and private hospitals for direct purchase in May 2021. If we add up the two channels, we get a total of 7.9 crore doses for May 2021. But only 5.98 crore doses were administered. The difference is extraordinarily huge: about 2.5 crore doses. Such a large quantity cannot be accounted for by vaccine wastage.
The outcome is that states are being consistently misled by the Centre on what is available for their purchase in a month. The Centre knows this and yet prefers to continue with the practice to keep up the aura of “positivity”.
Now, there is one way to check for these discrepancies. We must look at the proportion of doses administered (not imaginarily “made available”) from the Centre’s quota and through direct purchases by state governments and private hospitals. However, the Centre does not provide us data with that level of disaggregation. Therefore, we know that the numbers do not tally, but we simply cannot pinpoint as to why.
The Centre may argue that we are missing out on the production in May that is still in stock for use in June. In other words, there was indeed a higher level of production in May, but it was not administered in May. So, there is no real issue of the numbers not tallying. Let us now see if this claim could be true.
On May 30, the Centre had said that 1.75 crore doses were still with the states to be administered. This was the stock. States have always disputed these stock figures put out by the Centre. Let us still work with the figure for the time being. This would mean that a total of 7.73 crore vaccines (5.98 + 1.75 = 7.73) were produced in May 2021.
However, there were stocks on April 30 too, which were administered in May. We should deduct end-April stocks from end-May stocks. The stock on April 30 was 1 crore doses.
On the net, then, the difference is close to 75 lakh doses only. Even if this was true, there were still close to 1.7-2 crore unaccounted doses in May. Where are those doses?
In sum, the Centre, Serum Institute of India and Bharat Biotech were overstating India’s production capacities in May 2021. If the May capacities were overstated, how can we be sure that the promises to expand capacities in June 2021 would be fulfilled?
The promise for June 2021
Let us now come to the promises made by the Centre for June 2021. The Centre says 12 crore doses will be available in June 2021. Remember, India administered only 5.98 crore doses in May 2021.
How can it double the rate of administering vaccinations in just one month? Where is the fresh supply going to come from?
The Centre has itself stated that the production in June 2021 would not exceed 8.5 crore doses. It was only in August 2021 that Serum Institute of India’s capacities were to rise from 6.5 crore doses per month to 10 crore doses per month. Regarding Bharat Biotech, the capacity was expected to rise from 2 crore doses per month to 3.3 crore doses per month only in July 2021. Further expansions are expected only in August and September. In both Serum Institute of India and Bharat Biotech, even the present capacities do not appear realistic.
How can we, then, consider such future projections to hold true? Large imports of Sputnik V would begin only by August 2021. The three new Covaxin licensee companies would start production only by November or December 2021.
Therefore, the number of doses promised for states in June 2021 is just another unrealistic projection. The figures released are far removed from the reality of vaccine productivity in India. They are put out only to deceive the public into a mood of “positivity”. Facts do not matter; only narratives do.
This is precisely the devious plan under which Union ministers are making hyperbolic claims that India will vaccinate 100% of its population by December 2021, and a few others are writing that India would vaccinate 75% of its population by October 2021.
What is the reality?
In end-May 2021, the share of population vaccinated at least once was only 12% in India as compared to 58% in the United Kingdom, 50% in the United States and 43% in Germany. The share of population vaccinated twice was only 3% in India as compared to 37% in the United Kingdom, 40% in the United States and 17% in Germany.
Also, the number of doses given per 100 persons was 15 in India compared to 92 in the United Kingdom, 88 in the United States, 59 in Germany and 40 in China. India’s was also not the world’s largest vaccination programme, as the Centre likes to claim. The number of people who received one dose was about 16 crores in India and about 17 crores in the United States.
The Centre should end the practice of deception, of using wrong claims and fake promises. A democratic government should tell its citizens the reality, however unpalatable it might be. And the reality is that India cannot vaccinate 100% of its population before 2024 at the present rate. If, by then, vaccines for children also become available, India can complete the task only by 2025 or 2026.
R. Ramakumar is professor at the Tata Institute of Social Sciences, Mumbai.