Analysing the data for COVID-19 prevalence rates, relative population sizes and vaccine coverage across Indian states, RAVI DUGGAL explains why India needs a better and more scientific vaccine disbursal policy, and how to rampantly boost our vaccine production capacity through compulsory licensing.
AS India enters the third phase of its ambitious COVID-19 vaccination drive, many state governments are reporting vaccine shortages and are having to close down some of their vaccination centres, with supplies available for only 2 or 3 days. Most of these states are non-Bharatiya Janta Party (BJP) ruled ones, but some BJP-ruled states like Uttar Pradesh are also reporting impending shortages.
What is causing these shortages? One factor is that of our total vaccine production till March, we had exported twice the number of vaccine doses that we had domestically used, as per data furnished in the Rajya Sabha.
other is the very low level of production in contrast to the huge population of the country and its demand.
Some state governments are claiming that the Union Government is biased in favour of BJP-ruled states, with such states getting vaccines out of turn with either their proportion of population or their COVID prevalence rate.
Data shows a mismatch between COVID-19 prevalence and vaccine supply in most states.
To verify these claims, let us crunch the relevant data. The graph below maps the COVID prevalence rate of all states along with their respective vaccine coverage rate (states are organised in descending order of their vaccine coverage).
We see that the gap between vaccine coverage and the prevalence rate is highly variable across states instead of being flat or proportionate. This indicates that vaccine supplies are not based on either the population size or prevalence of COVID cases in states.
The larger the gap between the two indicators in the graph, the greater would be the supply of vaccines for that state. Hence, states like Maharashtra and Delhi, with some of the highest COVID prevalence, have some of the lowest such gaps, indicative of a low level of supply of vaccines.
Scientific vaccine disbursal formula needed
The Union Government must evolve a scientific formula to disburse vaccines since it has monopoly control over vaccine purchase and supply. Such a formula could use the population size and prevalence of cases weighted equally to determine the volume of vaccines that a state should be getting; this would reflect reasonable equity.
As the vaccination momentum grows and demand increases, especially as we find ourselves well and truly in the grip of a second nation-wide COVID wave, with single-day new cases across the country crossing a high of over 1.4 lakh as well over 700 new fatalities daily, the vaccine supply chain has got impacted. This is both because stocks are depleted, and our vaccine production capacity is struggling to keep up with the required daily vaccine dose delivery.
Since India began its vaccination drive about three months ago, over 70 million of our population has received the first dose of the vaccine. Of these, only 10 million have received the second dose. Nearly 9.5 crore doses have been used in the country, and about 6.5 crore doses have been exported to other countries, including by way of donations, as per the Union Health Minister.
In all this time, why has India not ramped up its production capacity by at least 8 to 10 times, given its status of ‘the pharmacy of the world’? Why do we continue to rely only on two producers: Serum Institute and Bharat Biotech, and wait for them to make investments to increase their respective capacity?
India must begin compulsory licensing of COVID-19 vaccines
The Union Government could easily have invoked compulsory licensing to allow other pharma companies who have vaccine production capacity to produce these vaccines alongside others as and when they are authorised for use in the country.
The use of compulsory licensing would dramatically change the political economy of the COVID vaccine. With a substantial increase in volumes, the price would also get reduced, and India could then supply the vaccine in larger numbers to other countries.
With further spikes in this second wave, allowing compulsory licensing and expanding the production base is something the government must consider on a priority basis. Once the production is ramped up, purchase and distribution can be decentralised so that states can have control over their supplies and can also commit state budgetary resources towards funding vaccinations. That is the only feasible way we can move swiftly towards eliminating shortages, and closer to universal access to the vaccines.
(Ravi Duggal is a sociologist, health researcher and activist associated with the Peoples Health Movement. The views expressed are personal.)