Representative photo: National Cancer Institute/Unsplash.
Despite multiple lockdowns, forms of treatment and therapies, and intermittently aggressive contact-tracing, countries around the world have failed to arrest the spread of the novel coronavirus to the extent they had intended. A vaccine administered to 70-80% of the global population seems now to be the only path to normalcy.
While this is an ideal figure, the whole world – much less any individual country – doesn’t have the capacity to manufacture and distribute these doses in a reasonable time frame. Further, the expertise to develop, test, manufacture and distribute the vaccine is scattered around the world. So in the face of an international pandemic, it is imperative that countries work together to share their expertise and abilities to deliver adequate quantities of a reliable and tested vaccine to everyone.
The COVID-19 Vaccine Global Access Facility (COVAX), an initiative of 172 countries is one platform to exchange expertise and enable equitable access to the vaccine. COVAX plans to pool economic resources of its member countries to achieve two objectives: enable vaccine developers to make high-risk investments for the development of vaccines, and subsidise vaccine costs for middle- and low-income countries.
However, this engagement has been undermined by economically powerful countries staying away from the consortium, and vaccine nationalism. We believe India has a central role to play in COVAX – both as a mass producer of vaccines and a regional leader. Globally, India possesses the largest vaccine-manufacturing capacity of any single country. However, it still needs new production facilities to be set up to meet the global demand for a two-dose vaccine regimen (first dose + booster). India also needs to use its diplomatic ties with its neighbourhood partners to create manufacturing hubs that will further bring down vaccine prices and better enable local access to vaccines.
Challenges to COVAX
Equitable access to vaccines is necessary to limit the spread of the SARS-CoV-2 virus, and initiatives like COVAX will help realise this access. However, COVAX doesn’t enjoy the full support of the US, China and Russia at the moment. The financial resources of these large economies will be crucial to utilise COVAX’s full potential. Further, countries that are already part of COVAX have signed individual agreements with private vaccine developers for priority access.
For example, the Indonesian government’s facilities are working with Sinovac, a private Chinese entity. Bangladesh’s BEXIMCO has signed an agreement with the Serum Institute of India. Canada has deals for guaranteed supply from Pfizer and Moderna from the US. Australia has one with AstraZeneca. These actions are understandable – but they will also divert a part of the already limited collective manufacturing capacity of these companies, which will then affect their ability to supply vaccines to COVAX.
Two candidate vaccines of Indian origin, COVAXIN and ZyCov-D, have entered human trials. India’s total vaccine production capacity, led by private producers, is estimated to be 3 billion doses per year. Indian firms like the Serum Institute have signed supply and license agreements with Novavax and production agreements with AstraZeneca for 100 million doses of their vaccine, AZD122 (a.k.a. the ‘Oxford vaccine’). News reports also indicate Dr Reddy’s Laboratories could be starting clinical trials of Russia’s Sputnik V vaccine in India soon.
Indeed, it is critical that India sets up strategic partnerships with vaccine-research companies to perform clinical trials for more candidate vaccines within India. The ability to produce massive quantities of cheap but reliable vaccines needs to be leveraged to attract more vaccine candidates to Indian shores.
The world acknowledges India as a powerhouse when it comes to vaccine production. But a recent lesson the global community has learned is that depending on production and supply-chain facilities in one geographical region during a pandemic can be disruptive. For example, the pharmaceutical sector in India and the US, which depend heavily on active pharmaceutical ingredients from China, were left scrambling as most producing units in industrial cities were shut. US retailers, South Korean car manufacturers and Japanese electronics firms all have reported some form of interruption in the supply of intermediate and finished goods from China.
Further, with its current production capacity, India can’t cater to the global demand for vaccines by itself. With a two-dose regime shaping up to be the standard with most COVID-19 vaccine candidates, new production facilities will have to be set up.
Diverting crucial but limited resources towards the large-scale production of COVID-19 vaccines is also likely to impact the production of vaccines for other diseases. As it happens, Serum Institute has temporarily diverted its existing plant in Pune to solely manufacture AstraZenaca’s vaccine, while a new, larger plant is expected to take two more years to become fully functional. A survey conducted in June 2020, by UNICEF, Gavi, the Bloomberg School of Public Health and other institutes, found that already established vaccination programs in over 60 countries of the 85 surveyed were being interrupted by governments’ rush to address COVID-19 on priority.
A COVID-19 vaccine can’t be produced at the expense of other vaccines – which means we need to coopt unused capacity and set up new manufacturing facilities. In such a scenario, public-sector undertakings like the Central Research Institute, Kasauli; the Pasteur Institute of India, Coonoor; and the BCG Vaccines Lab, Chennai – which haven’t been functioning optimally for various reasons – will have to be roped in.
This is a unique opportunity for India to support its domestic vaccine industry towards setting up vaccine production facilities in other countries. South Asian and African nations are possible destinations for India to create goodwill through scientific outreach. Channels of cooperation established through pan-governmental organisations like the Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation and the Coalition for Disaster Resilient Infrastructure can be roped in for wider reach.
Malaysia’s foreign minister Hishammuddin Hussein has expressed his desire to make Malaysia a hub of vaccine production for the ASEAN region. India can lend its expertise in this area, taking a positive step towards mending ties with Malaysia while enhancing its footprint in the ASEAN region.
Africa has 14% of the world population and a high prevalence of infectious diseases – but accounts for only 0.1% of the world’s vaccine production. India can piggyback on the already existing African Union framework for pharmaceutical manufacturing and create local hubs for vaccine production. India can also interact with regional trading blocs like the East African Community, the South African Development Community and the Economic Community of West African States to the same end. These facilities could be used for a COVID-19 vaccine or to produce vaccines relevant to Africa’s needs.
Despite the limitations of COVAX, the initiative promotes cooperation between nations, keeping at its heart the interests of low- and middle-income countries. This global effort is by far the most feasible strategy to tackle the current pandemic. The chances of a successful vaccine being scuttled due to bilateral rivalries are lower in such a multinational setting.
Any candidate vaccine that successfully emerges from phase 3 clinical trials will probably be produced by Indian manufacturers. India must take the lead in developing the requisite infrastructure and extending it to various other countries under the aegis of COVAX. The expansion of vaccine production facilities will enable local access, reduce cost and build scientific expertise that can have several long-term benefits for the host countries.
Ruturaj Gowaikar has a background in neuroscience and is currently a student with Takshashila Institution’s GCPP (Defence and Foreign Affairs) Programme. Shambhavi Naik is a research fellow at the Takshashila Institution.