A medic fills a syringe with Covaxin before administering it to a health worker at Gujarat Medical Education and Research Society, Ahmedabad, November 2020. Photo: Reuters/Amit Dave
R. Ramakumar, a professor at the School of Development Studies, Tata Institute of Social Sciences, has said the Narendra Modi government simply can’t meet its target of vaccinating every adult by the end of the year. According to him, this is both because the supply of vaccines will be nowhere near sufficient and, second, because the vaccination rate can’t rise to the level required to meet the target.
He listed eight mistakes the Modi government had made that had landed India in its present predicament.
In a 45-minute interview to Karan Thapar for The Wire, Ramakumar said that, first, the government had failed to meet the target it set in its June affidavit to the Supreme Court – of making available 51.6 crore doses by July 31.
Even though Vinod K. Paul, who heads the body in charge of India’s COVID-19 vaccination drive, claimed at a recent press conference that the target had been met, a Union health ministry press release dated July 31 said that supply had been only 48.7 crore – short by 5.6% – while the actual consumption was only 45.8%, short by 11.2%.
Ramakumar called this “a serious setback”. According to him, the government’s policy statements, both in terms of its various affidavits to the Supreme Court and in terms of what its representatives have said at press conferences and press releases, “have zero sanctity”.
When asked whether the target of fully vaccinating all adults before the end of the year could be met, Ramakumar unequivocally said ‘no’. He broke his response into two parts: whether the necessary number of doses will be available and whether India could attain the requisite vaccination rate.
In terms of supply, Ramakumar cited the examples of May and July. In May, the Indian government claimed it would have 8.5 crore doses but administered only 6 crore jabs; in July, it claimed it would have 17 crore doses but delivered only 13 crore. The respective shortfalls were 2.5 crore and then 4 crore.
Because of this constant mismatch between what the government claimed and what actually happened, Ramakumar said, it was hard to estimate India’s actual vaccine production volume. In addition, “the government has not put out a clear number”.
However, Ramakumar also said he believes that at the moment India is producing between 11 crore and 12 crore doses a month – roughly 42 lakh doses a day.
He said the government has claimed it would have 135 crore doses by the end of the year. This is already a down-scaled figure because, initially, the government claimed it would have 216 crore doses. However, even 135 crore is unattainable. He expects the amount by the end of December 2021 would be a 100 crore, possibly less.
Bharat Biotech and Covaxin
Ramakumar also said the commitments Bharat Biotech has made regarding Covaxin are unreal and have made for “the biggest disappointment”. The government expects 40 crore Covaxin doses will be available between August and September 2021, but Ramakumar thinks this is unlikely.
According to him, there is a significant mismatch between what Bharat Biotech claims and has delivered, and between the contracts it has signed with the government and what it has delivered.
In addtion, Covaxin production at the company’s Bengaluru plant has suffered a serious setback because initial batches were rejected on quality grounds. The production at Indian Immunological will only start in two or three months, as N.K. Arora, a member of India’s COVID-19 response team, has himself said. Production at the Haffkine and Bharat Immunological units “will take much longer,” in Arora’s words.
Therefore, Ramakumar continued, it will be close to impossible for Bharat Biotech to deliver 40 crore doses of Covaxin between August and December 2021. This is one reason why the government’s reduced claim of 135 crore doses will be hard to realise.
Speaking about the rate of vaccination, Ramakumar said that as a one-off, India might be able to push the daily vaccination to 8 or 9 million doses a day – but to sustain it at that level for the next 150 days would be simply impossible. At the moment, India is averaging 4-4.5 million doses a day.
He used the example of Uttar Pradesh, India’s biggest state, to illustrate. In the best week, the state averaged 6.7 lakh shots a day. But if it has to vaccinate every adult with two doses each before the end of the year, it has to reach 16.1 lakh shots every day – more than twice as many as its current best day. This, he said, is nearly impossible, without even accounting for vaccine hesitancy.
Almost like a miracle, Uttar Pradesh touched 27 lakh doses on August 3 but the very next day, it administered only 3.5 lakh. In the preceding six days, it had been 3-4 lakh a day. And on one of those six days it was just 19,000. So the 27 lakh figure was a most probably a one-off and not the start of a trend.
Ramakumar also enumerated eight major mistakes the Modi government had made, and which account for India’s present unsatisfactory vaccination situation.
1. The government’s failure to invest and ramp up vaccine production, even though, as far back as May 2020, we knew India’s total capacity was nowhere near what was needed to doubly vaccinate 940 million people.
2. The country decided to limit itself to two vaccines produced domestically and shut the door on all foreign vaccines.
3. Unlike the EU, the US, the UK, Canada and Japan, which made substantial at-risk investments in vaccines that were being testing and may never have succeeded, India refused to do so.
4. India didn’t place any firm orders and make any payments to either of its domestic manufacturers until January 2021, failing to provide them any incentives.
5. India opened up vaccination for everyone over 18 years on May 1 – at a time India didn’t have enough vaccines for people over 45 years. By including an additional 600 million recipients, it converted a shortage into a crisis.
6. The confusion in mid-May 2021, when the government first claimed it would have 216 crore doses, strangely including five vaccines that were neither ready nor cleared for use. This was then scaled down to 135 crore but the resulting confusion convinced many people the government wasn’t in control.
7. The government has responded bizarrely, if not irresponsibly, to offers from Moderna and Pfizer for their vaccines. Vinod K. Paul has said that Pfizer offered 50 million doses over a 3-4 month period. Newspaper reports claimed that Moderna (through Cipla) could make a further 40-50 million available. But both manufacturers wanted indemnity against claims for vaccine-related adverse events, which the government said it was considering but hadn’t made decision about. India needs these vaccines, and shouldn’t drag its feet.
8. There’s an urgent need to reduce the quota for private hospitals from the present 25%. They are reportedly only using around 7%. If the quota were to be reduced and the government acquired more doses to then give to the states, vaccination could be stepped up. But Paul has said the government is not considering changing the quota.
Watch the full interview here.