As the world’s largest supplier of medicines and producer of 60% of the world’s vaccines, India has long been known as the ‘world’s pharmacy’.
Now, as the frantic search for a Covid-19 vaccine gathers momentum, the country is playing an increasingly strategic and central role in the development, manufacturing, and most importantly, the possible future distribution of various potential injections of Covid.
With more than 7.5 million cases and some 115,000 deaths, India is also one of the countries most affected by the virus, second only to the United States.
An agreement has already been reached for the Serum Institute of India, based in the city of Pune, to produce one billion doses of the Oxford / AstraZeneca vaccine, considered the forerunner in the vaccine race. In anticipation of its success, it has already started the production of nearly 2 million samples of the vaccine and is conducting phase 3 human clinical trials on thousands of patients spread across 15 Covid-19 hotspots in India.
This week, the Serum Institute of India said it was confident that the AstraZeneca vaccine would be ready by December and would be licensed for distribution in India in March.
Adar Poonawalla, executive director of the Serum Institute of India, said he was “very optimistic” that more than one successful vaccine was imminent.
“A lot of the data that I have seen unofficially on many of these vaccines is very promising and more than three or four vaccines will be successful very soon in the next year,” Poonawalla said.
The Serum Institute, which this week also began human trials with an intranasal Covid vaccine, is just one of dozens of Indian companies in the race to produce the highly coveted vaccine, nearly 200 different types of which are being developed across the world. the world. .
Johnson and Johnson, whose Covid-19 vaccine is also in phase 3 clinical trials, have struck a deal with the Indian pharmaceutical company Biological E to produce up to 500 million doses if successful.
Bharat Biotech, a Hyderabad-based pharmaceutical company, has an agreement to manufacture 1 billion doses of the University of Washington intranasal vaccine, now in clinical trials, and Indian pharmaceutical giant Dr. Reddy’s has an agreement to conduct trials in phase 2/3 humans in India from Russia. controversial Sputnik vaccine and then produce doses of 100 million. At least a dozen indigenous vaccines are also being developed in India.
All of this places India, and therefore the global south, in a significant and powerful strategic position in terms of vaccine distribution, particularly domestically and non-Western countries. Poonawalla of the Serum Institute said that “50% of whatever we make will go to India and the rest will go to low- and middle-income countries.”
To have the capacity to make hundreds of millions of promised Covid vaccines, Poonawalla said the company would stop production of other vaccines destined for the US and Europe, such as measles, mumps, rubella and hepatitis B, though will still be supplied by countries.
Mahima Datla, CEO of Biological E, which will make the Johnson and Johnson vaccine, took a different approach, saying the company was committed to the Covax vaccine alliance, signed by 135 countries, which will drive equitable sourcing and distribution of the vaccine. .
“We have never made trade-off decisions between the vaccine needs of India and global organizations like UNICEF,” said Datla. “So far we have no obligation to reserve a certain quantity of vaccine for India. But in the future, there could be a gap between supply and demand that could put us in that position. “
The irony, however, is that while India is one of the world’s largest vaccine-producing nations, it faces one of the world’s greatest challenges in immunizing its 1.3 billion people.
India has a highly effective immunization program for babies and pregnant women, but there is nothing for the rest of the population, particularly the elderly who are the most vulnerable to the coronavirus. The already overburdened healthcare system has been pushed to the limit by the pandemic in many areas and swaths of rural India with little access to medical care.
India, which suffers from extreme heat, also lacks adequate cold chain facilities to ensure that the vaccine remains refrigerated and therefore effective, until the time of administration. Some of the vaccines being developed may need to be stored down to -70 ° C.
There is also the question of cost. The Serum Institute said it expected the vaccine to cost around $ 5 (£ 3.80). With the Indian government aiming to vaccinate 250 million people by July 2021, it means it will have to raise $ 1.25 billion to cover the costs.
“The complications in India are going to be phenomenal,” said Gagandeep Kang, an Indian professor of microbiology who is a member of WHO’s global advisory committee on vaccine safety. “The main concern is scale and follow-up, how do you know who received the vaccine and who did not, and the fact that the necessary storage conditions are still unknown.”
However, Kang said that an even more worrisome threat looms in India, that of a virulent anti-vaccine movement that has already gathered momentum in rural villages against the measles, mumps and rubella vaccine in the past five years. Kang said that he had witnessed how anti-vaccine conspiracies had spread like wildfire in WhatsApp messages written in local languages, which had been very difficult to counter.
“I am concerned that the later a Covid-19 vaccination program is implemented in India, the more conspiracy theories against vaccines and the more resistance we will have to face,” Kang said.
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