India weighs options in debate on who gets first shot of Covid-19 vaccine

Companies wait for government orders as top medical research group says health workers must get first inoculation

As the world races towards the coronavirus vaccine, the larger debate on who gets it first, how and for what price has also gathered pace, especially in the backdrop that unlike many rich countries that have invested and made advance payments for vaccine procurement and its development, no such move has yet been made by the Indian government. 

The Indian Council of Medical Research has said that the vaccine should be made available to the health workers first. Health secretary Rajesh Bhushan also said recently that there was already a growing consensus that the frontline health workers have the best claim to the vaccine. “This would also avoid shortage of healthcare professionals.”

The statement however, has been seen by experts more as a suggestion or a wish not backed by any action. Whether  the government will provide the vaccine to health workers for free or whether any of its arm procure coronavirus vaccine for the country is also not clear. 

The ICMR in response to some of these queries said it did not wish to respond.  Government sources indicated that the ICMR and the health ministry are still deliberating on these issues. "There is not much clarity on which candidate may emerge successful, and therefore, the government has not made any funding commitments to any local player to pick up its vaccines. However, some grants have been made available from the department of Biotechnology," said a senior official.

Indian companies have joined Covax - Covid-19 Vaccine Global Access,  and have partnered with the Bill and Melinda Gates Foundation and Gavi to supply vaccines to low and medium income countries.  Many rich countries such as the US, Japan, UK among others have already paid drug companies upfront to secure billions of doses of vaccines. 

“Countries can do bilateral deals and can also be part of the Covax facility...The bilateral deals run the risk that some companies may not end up with a successful vaccine whereas in Covax you are pooling that risk by investing a large number of candidates,” said Soumya Swaminathan, chief scientist, World Health Organisation. 

 

The availability of vaccines through Covax will depend upon the funds available with the initiative to purchase the vaccines. Gavi has estimated $2 billion as the minimum requirement for initial supplies and it has so far raised $600 million. India, since it is not counted among the high and upper middle income countries, does not need to make any advance payment to Gavi as one of its eligible members. 

“Model that we want to promote is that whatever is available, share it equitably,” Swaminathan said. 

WHO is also expecting countries who have placed bulk orders to share any excess supply they might have with other countries. 

Indian vaccine makers are keenly waiting for the government to give some sign for procurement of vaccines. “We understand that the initial batches of the vaccine produced would be procured by the government for equitable distribution. However, the government has not yet shared the risk of development, or invested in the project thereby committing to procure vaccines,” a leading vaccine manufacturer said. 

Panacea Biotec and Hyderabad based company Indian Immunologicals  have also said that there has been no discussion on procurement of vaccines with the government till now. “The government is perhaps waiting for more clarity on which candidate can emerge successful, and then take a call on investments or procurement,” said Rajesh Jain, managing director, Panacea Biotec. 

Another vaccine manufacturer indicated that the government has assured help in scaling up manufacturing if a vaccine is proven successful in phase 3 trials.

The department of pharmaceutical too had recently held a review meeting with glass vial makers on production capacity and did a stock-taking of preparedness.

Serum Institute of India has partnered with Gavi and Gates Foundation to supply 100 mn doses of Covid19 vaccines  - AstraZeneca-Oxford candidate and Novavax candidate, at a price cap of $3 or Rs 250 per dose. For this, the Bill & Melinda Gates Foundation, via its Strategic Investment Fund, will provide at-risk funding of $150 million to Gavi for supporting SII in the manufacture.

Beyond the 100 mn doses commitment to Gavi, SII will be free to price the vaccines in the Indian market. Adar Poonawalla, CEO of SII has, however, indicated earlier that the price of the vaccine would be less than Rs 1000 per dose. 

Vaccines that were made available for free in India include polio, diphtheria, tetanus, BCG, according to experts. For various other diseases, such as hepatitis, chicken pox people had to buy the vaccine on their own, experts said.

“Government will say we have made the vaccine available in the country: Go buy it. That is what has happened with the influenza vaccine.  If they were serious in terms of wanting to use a vaccine, they would definitely have spent some money on it,” said Jacob John, senior virologist.

Funding aside, vaccine makers are also highlighting issues such as faster permissions and easier clearance by the government. Towards this end,  Krishna Ella, managing director, Bharat Biotech said at a recent event,  “It was important for the government to decentralise the clearance process for vaccine development as well as set up regional offices of regulatory bodies.” 

India is banking heavily on its vaccine manufacturing capabilities - among the highest in the world to give it a good bargaining position in accessing the vaccine. 

Speaking at the ICMR seminar on vaccines, Dr Anthony Fauci,  director of the National Institute of Allergy and Infectious Diseases (NIAID), and a leading infectious disease expert had said that India's private sector will have a 'very important role' to play in the global battle against Covid19. 

“Moving forward, we and other (US National Institutes of Health) institutes will continue to work with Indian counterparts and colleagues to assure Indian scientists and Indian impressive research and development capacity are integrated in the global efforts to address the Covid-19 vaccine," he had said.

However, experts say that if the handling of pandemic is anything to go by then the decision to buy vaccines may also be left to state governments as they deem fit.