Watching closely: What’s happening in COVID-plagued India?

By Archishman Ray Goswami & Sumit Mishra

India’s Vaccination Programme – the Domestic Drive

On January 16 2021, India launched one of the world’s most extensive coronavirus vaccination programs, marking the beginning of an effort to immunize more than 1.3 billion Indians. The Government of India has drawn plans to inoculate 300 million people by the end of August – almost equivalent to the entire population of the United States, by giving approval for two vaccines in January 2021 – the Oxford/AstraZeneca vaccine, known in India as Covishield, and a domestic product, Covaxin, developed by the pharmaceutical company Bharat Biotech. Unlike the Covishield, the Covaxin, when approved, was still in phase 3 human trials, and a full efficacy dataset has not been released or peer-reviewed. Still, the DCGI (Drugs Controller General of India) assured that the Covaxin was 100% safe. And amidst the rising number of COVID cases, on April 13, emergency use approval was also granted to Russia’s Sputnik V vaccine, making it the third such vaccine approved by the DCGI. 

  Source: Wellcome Trust, BBC research

Nevertheless, this effort’s sheer size has raised questions around how one of the most populous developing countries with a patchy health system and infrastructure would carry out such a Herculean task. India is banking on the successful track record of its four-decade-long vaccination scheme, the largest public health program in the world– the Universal Immunization Program – which targets 55 million Indians, receiving around 390 million free doses against a dozen diseases every year. However, it is worth noting that the Universal Immunization Program runs throughout the year, so replicating its success for Covid-19 vaccination will require ramping up its capacity to administer vaccines to reach the target of 300 million people by the end of August 2021. According to Health Secretary Rajesh Bhushan, out of the 239,000 vaccinators under the Universal Immunization Program, fewer than 65% of them will work towards administering coronavirus vaccines to avoid significant disruption to the routine vaccinations. India is looking to bridge this gap by training additional volunteers and using existing medical staff at private and government hospitals to vaccinate.

The Indian Prime Minister, Narendra Modi, has also suggested that the vaccination drive will utilize its experience of organizing the world’s largest democratic elections, whereby approximately 900 million voters are mobilized across 1 million polling stations to cast their votes. “The same process of identification and line-up can easily be replicated here (for the vaccine drive). Of course, the administration of the vaccine itself will have to be done by people who are trained for that,” said Professor K. Srinath Reddy, President of the Public Health Foundation of India. The Indian annual budget (2021-22) has allocated $130billion on Healthcare spending, a jump of 137% from the previous year, and specifically allocated $4.8bn to India’s Covid vaccination program.  These advantageous measures and experiences certainly bolster the confidence in India’s Covid vaccination program to a degree. Still, then it drills down to two crucial elements of this program – vaccine rollout (and ancillary services/equipment) and logistics.

Vaccine Rollout and Logistics

When it comes to vaccine making, a BBC article has described India as a “powerhouse”. India produces 60% of all vaccines across the globe, and for COVID-19, the Serum Institute of India (SII), the world’s largest vaccine maker, is producing Covishield for domestic and global consumption. The Department of Biotechnology informed the Indian Parliamentary Standing Committee on Science and Technology, Environment, Forests and Climate Change of Biotechnology that the estimated manufacturing capacity of Covishield is 70 million doses every month, while Covaxin has a planned production capacity of 12.5 million a month. For Sputnik V, the Russian Direct Investment Fund (RDIF), which is marketing the vaccine, has signed deals to produce more than 750 million doses of Sputnik V in India with six domestic vaccine makers, and the first batch of 125 million doses will be imported to India during this quarter. 
The other vaccine candidates currently at various stages of trial in India are

  •  ZyCov-Di, being developed by Ahmedabad-based Zydus-Cadila
  • A vaccine being developed by Hyderabad-based Biological E, the first Indian private vaccine-making company, in collaboration with US-based Dynavax and Baylor College of Medicine
  • Hyderabad-based Biological E to produce the vaccine developed by US firm Johnson & Johnson
  • HGCO19, India’s first mRNA vaccine made by Pune-based Genova in collaboration with Seattle-based HDT Biotech Corporation, using bits of genetic code to cause an immune response
  • A nasal vaccine by Bharat BioTech
  • A second vaccine being developed by Serum Institute of India and American vaccine development company Novavax

Despite a sluggish start, by April 16, India had administered over 117 million coronavirus vaccine doses across the country, maintaining an average of 3 million doses per day. However, in spite of this staggering vaccination accomplishment, this does not come without an array of challenges.  As India struggles with a substantial rise of coronavirus infections in the second quarter, several Indian states, including Maharashtra – currently grappled with one of the highest infection rates – have reported a shortage of vaccine doses. The central government has rebutted by saying that the problem was not as much of a supply but required better planning by the states. Meanwhile, the political tussle between the ruling Bharatiya Janata Party (BJP) and the opposition led by Indian National Congress (INC) has flared up, and they have exchanged jabs at each other over the vaccine shortage. The INC has blamed BJP’s overestimation of its capabilities, general negligence towards the INC-ruled states, and the export of around 60 million doses to 76 countries (as gifts and under commercial agreements) for the domestic vaccine scarcity. The BJP has shunned the INC’s allegations as “attention starvation” and an attempt to mislead the public. 

However, the “stress” on the vaccine rollout cannot be entirely ruled out. The government of India has now halted the exports of vaccines and have said they will fast track the emergency approval for foreign-made vaccines and potential candidates being Pfizer, Moderna, Johnson & Johnson. Even the domestic vaccine maker, the Serum Institute of India (SII), has stated that their production capability is “very stressed”. Although they are prioritizing India’s needs, they are still being short of catering for every Indian. SII has currently priced their vaccine – Covishield, at $2, to the Indian government, but this has been proven to not be sustainable for further expansion, especially to deal with the current upsurge in cases and demand for vaccines. SII would require around Rs 3,000 cr. (approximately $400 million) to ramp up its production from 70 million to 110 million doses per month from June onwards, so SII can either raise the price of each dose or the government of India’s financial assistance. 

The vaccination drive is supported by the enormous syringe making capacity of the Indian conglomerate Hindustan Syringes and Medical Devices (HMD) Limited, located in Faridabad, which is churning out almost 5,900 syringes (including auto-disable syringes) per minute, and the company is planning to scale it up to 7,500 per minute amidst the ever-rising demand of the local/global market and the growing COVID cases in India. India now locally produces millions of PPE kits – class-3 protection level under ISO 16603 standard, interestingly until January 2020, India was entirely dependent on its PPE kits imports. A report by Credit Suisse says that India has a sufficient capacity not only for vaccine manufacturing but for various components like vials, stoppers, syringes, gauze, alcohol swabs, etc.

As of April 13, there are 71,000 vaccination centers operational across India, staffed by millions of trained professionals and volunteers. India’s coronavirus vaccination drive is drawing benefit from the extensive size of India’s Universal Immunisation Programme, which is supported by around 27,000 functional cold chain points, which includes 76,000 cold chain ‘equipment’, 2.5 million health workers, and 55,000 cold chain staff. However, given the enormous size of this drive, the existing cold chain capacity needs to be expanded quickly, especially in densely populated parts of the country where this infrastructure is severely limited. 

Initially, people simply did not find getting vaccines as a necessity as parts of normal life return, and some were even susceptible to getting a vaccine. However, since the coronavirus caseload is getting bigger, more people are coming forward to get the vaccine. Although India’s domestic vaccination drive has accelerated in recent times, and currently it is the fastest in the world, the task ahead is formidable, as India will not only be battling the unprecedented surge in coronavirus cases, but it also needs to supply billions of doses to the world marred with this deadly pandemic.

Source: Ministry of Health and Family Welfare, Government of India. 

The Foreign Policy of the Second Wave: Unexpected Opportunities

Despite the domestic backlash against it, India’s vaccine diplomacy has played a significant role in shoring up its soft power capabilities over the past two months. However, with state governments across the country claiming vaccine shortages coupled with a second, deadlier nationwide wave of coronavirus cases, India’s vaccine supply to other nations has slowed down with a temporary halt on the exports. As discussed in previous articles, India’s vaccine diplomacy aims to leverage the soft power and international goodwill it generates as a tool to counter China’s geopolitical influence. Hence while India’s exertion of global soft power via vaccine exports takes a backseat, New Delhi may be expected to capitalize on this newfound influence via shows of hard power against Chinese influence, particularly in the Indian Ocean Region. Indeed, India’s participation in the recent French-led La Pérouse maritime exercises alongside other QUAD navies occurred amid a slowdown in Indian vaccine exports to other nations, signalling that while the vaccine shortage may have slowed down India’s ability to exert soft power, the South Block remains keen to maintain its hard power capabilities in its geopolitical rivalry with China.

However, the second COVID wave has also provided New Delhi with an unexpected opportunity to re-engage with Moscow. Russian Foreign Minister Sergei Lavrov’s visit to India in early April provided both India and Russia to discuss issues of mutual cooperation, from defence to vaccine manufacturing. It may be argued that Lavrov’s visit has paved the way for the Sputnik V vaccine’s emergency authorization for public use and manufacturing in India. An increasingly belligerent China, among other issues, has over the 2010s drawn New Delhi into a closer security relationship with the West in general and the US in particular- an issue which was catalysed by the Galwan valley incident in summer 2020, when Indian and Chinese troops engaged one another in a deadly face-off in the Ladakh region. Even as India maintains a closer relationship with the QUAD, the vaccine shortage has opened new areas of cooperation between India and Russia, setting a precedent for closer future collaboration on a range of intersecting security and geopolitical matters.

Simultaneously, however, the second wave in India comes when New Delhi seeks to cement ties with the Western bloc. With British Prime Minister Boris Johnson expected to travel to India on a state visit at the end of April, common geopolitical concerns around China’s expansion in the Indo-Pacific and associated problems such as the Coronavirus pandemic are expected to be on the table for discussion. Therefore, the current situation has also provided India with opportunities to balance ties with Western partners such as the UK on issues such as vaccine manufacturing in pursuit of broader geopolitical objectives.

Indeed, for India, the question of vaccines is inextricably linked to questions of geopolitics and foreign policy. Despite increased Chinese belligerence in the Indo-Pacific threatening the Indian Navy’s objectives of becoming a net security provider in the region, New Delhi has preserved its position of non-alignment between the US and Russia. However, exposed Indian geopolitical vulnerabilities may be exploited during the second wave in such a context. The Freedom of Navigation Operations (FONOPS) conducted by the US Navy in India’s EEZ around the Lakshadweep archipelago occurred soon after Foreign Minister Lavrov’s aforementioned visit to New Delhi, where cooperation on vaccine manufacturing between the two countries was discussed. In this regard, Washington’s message is clear- that while it has not yet taken any overt steps against Indian interests, it remains suspicious of Indo-Russian ties and will actively oppose closer relations between the two powers, especially if their bilateral cooperation on vaccine manufacturing sets a precedent for activities threatening US interests at any level.

Beyond domestic coronavirus concerns, however, India seeks to establish a global image as a destination for vaccine manufacturing. This is in line with India’s objective to establish itself as a manufacturing hub of other strategic materials following the pandemic, such as semiconductors, which India, in conjunction with the QUAD, seeks to manufacture in bulk to secure digital supply chains against Chinese control. Despite the apparent costs of the second wave, success in countering it and, more specifically, in manufacturing Indian and international vaccines in bulk would lend greater credibility to India’s plans to become a global manufacturing hub for critical forms of strategic infrastructure.

Over much of the past year, the coronavirus pandemic has threatened to put an end to India’s globally recognized growth story and its rise as a middle power. Despite the apparent human and economic costs of the first wave, India went unscathed. However, the impact of the second wave remains to be seen. With coronavirus cases on the rise across the country, one aspect becomes increasingly evident in summation- that the second wave has blurred the lines between domestic and international politics in India, underscoring to Indian foreign policymakers that domestic stability and success translates into the same in the field of international relations.

The Editors: Archishman Ray Goswami & Sumit Mishra

Archishman Ray Goswami is a 2nd year undergraduate student from India, studying International Relations at King’s College London. He specialises in Indian foreign policy and grand strategy, particularly in the Indo-Pacific and the Af-Pak region. He is especially interested in the intersections between terrorist groups, intelligence agencies and organized crime in the region.

Sumit Mishra is currently pursuing a MA in War in the Modern World from King’s college London and holding an MSc (from Imperial College London) and a B.Eng (from Queen Mary University of London). Sumit has a strong interest in the field of Geo-Politics and International Relations, and has gained significant exposure in situational analysis, risk assessment through educational research and a professional career in finance. His main research interest focuses on conflicts, non-state actors and foreign policy.

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