Why India’s COVID spike means the world has to wait for its jabs

On 18 March, some younger Britons who may have been expecting to get their COVID jabs in the coming weeks, were told they would have to wait.

Among the reasons cited why the programme to offer coronavirus vaccinations to the under-50s would be delayed was supply problems in India.

But now it has emerged British under-50s are not alone.

India is a key supplier for vaccines across the world, and over the weekend it was revealed Delhi is restricting exports to other countries because it needs to keep the jabs as it fights to contain a surge in cases.

The number of people testing positive in India has more than quadrupled in a month.

The situation is so serious, there have been warnings the health system could be overwhelmed.

But India’s decision to limit exports has hit a plan to send vaccines to some of the world’s poorest countries – putting lives there at risk.

It has also left other countries scrambling to find alternative sources for COVID inoculations

In doing so, the move has shone a light on how vaccines are being used as bargaining chips in international diplomacy and how what happens in countries thousands of miles away can mean life or death for someone in another part of the globe, including the UK.

The world’s biggest vaccine maker

The Serum Institute of India is one of the world’s biggest vaccine manufacturers and is part of a plan to provide vaccines to most of the world’s developing economies.

Among them are countries that might otherwise struggle to get jabs in a world where more advanced nations are hoovering up supplies for themselves, having financed them.

Under a scheme called COVAX, more than a billion AstraZeneca jabs are to be sent to countries around the world in the coming months.

Around 225 million doses of the AstraZeneca jabs were due to be manufactured and sent out by SII by the end of June, under a plan drawn up by the organisers of COVAX.

About 97 million of those doses were due to stay in India but millions more were to be sent to countries in desperate need.

Another company, the South Korean firm SK Bioscience, was due to provide about a third of the AstraZeneca COVAX total for other countries.

One of the organisers of the scheme, the vaccine distributor GAVI, said when the plan was made that between 35% and 40% would be dispatched by the end of March.

So far, India’s External Affairs Ministry says around 17 million doses have been exported under COVAX – which, according to Sky News analysis, is about a two-fifths of what should have been supplied by the end of March under the original plan.

While the COVAX scheme is expected to provide a critical line of defence for many countries that may not have the resources to manufacture their own vaccines, it has also been backed by some of the richest countries, including the UK, which has invested £548m.

Meanwhile, the UK is understood to have struck a deal with SII to supply 10 million of the 100 million AstraZeneca doses it had originally ordered, after funding the drug’s development to the tune of £65m last May.

As of today, SII has supplied only half of what the UK is said to have ordered – leaving the UK government forced to admit vaccine supply in April would be “tighter” than expected, and those aged under 50 would have to wait longer for their first jabs.

India is yet to officially admit to banning exports of AstraZeneca’s vaccine manufactured by SII, but sources have told Reuters it has done effectively that.

The two Reuters sources seemed to confirm earlier claims by SII that it was the Indian government that was holding up supplies, rather than any issues with supply itself.

Housing Secretary Robert Jenrick told Sky News that the hold-up in the supply of the British shipment was down to “lumps and bumps” in the manufacturing process.

But SII chief executive Adar Poonawalla told The Telegraph: “It is solely dependent on India and it has nothing to do with the SII. It is to do with the Indian government allowing more doses to the UK.”

Sky News understands there is no hold, as such, but supplies to other countries going forward may be restricted.

The organisers of COVAX have told those countries which were going to receive doses under the programme to expect a delay.

A joint statement issued by GAVI, WHO and UNICEF places the blame firmly at the door of India’s explosion in COVID cases, saying: “Deliveries of COVID-19 vaccines produced by the Serum Institute of India (SII) to lower-income economies participating in the COVAX Facility will face delays during March and April as the government of India battles a new wave of COVID-19 infections.

“COVAX and the government of India remain in discussions to ensure some supplies are completed during March and April.”

The barrister
Harish Salve, 65, is a member of London’s Blackstone Chambers but also spends part of the year in India, working as an advocate.

“It’s a scary thing. They have lifted all restrictions a while ago, air travel is back to a high level. From January to March, there are loads of festivals and you can’t keep people back. Social distancing and discipline is alien to our culture.

“When the lockdowns were put in place, that was a bad time because people lost jobs and there was a migration crisis. I don’t see that kind of economic pain that we saw last year (this time). Nobody is in favour of a lockdown. They feel they are too drastic.

“There should be stricter enforcement, but I know people who have had weddings, and mass gatherings have returned now.”

“People are concerned and you have this local sentiment, asking ‘why are we exporting vaccines when we need them?’. This will only grow as figures go up.”

‘It will result in deaths’
While it is not known exactly how many planned orders will not be fulfilled, the expectation is that there will be potentially serious consequences.

Dr Michael Head, senior research fellow in global health at the University of Southampton and an expert in vaccine supply chains, told Sky News that, while keeping hold of the vaccines will save lives in India, it will result in deaths in other countries.

He said: “It will cost lives… If there’s more vaccine going into arms in India, then good for India and to some extent the globe, but that obviously therefore means a shortage elsewhere and that will cost lives in, for example, sub-Saharan Africa, where countries were lined up to receive some doses that they therefore won’t.

“A lot of countries will be rather put out by their not receiving vaccines that they’ve been expecting.”

He said part of the problem was the reliance on one supplier – SII – to such an extent, which means that when that one site is unable to export, the world is left “in trouble”.

He added: “The vast majority of people in those countries will remain unprotected for longer as a result of vaccines not getting into their country and (being) distributed around. That will mean the global pandemic carries on a bit longer, so it does increase the risk of new variants emerging relatively undetected…, variants that impact upon vaccine effectiveness.”

Prof Kirsty Le Doare, professor of vaccinology and immunology at St George’s University of London, told Sky News: “In countries like Uganda that rely on AZ vaccine from (the) COVAX initiative, delay in vaccines will mean that our frontline healthcare workers will not be able to receive their vaccines as scheduled.

“This will have a knock-on effect as we prepare for the wave currently in Tanzania and Kenya to hit our borders. Uganda has faired well with the pandemic at present, but… we need the vaccine to protect our fragile healthcare system and to maintain public confidence in vaccines.”

The comms man
Rahul Gossain, 40, works in corporate strategic communication and lives in Delhi

“The cases went up because of the relaxations. People are used to living in social environments so were fed up. Social gatherings are part and parcel of life. As the number of cases went down, so they eased restrictions – offices were opened and so were schools.

“Festivals and cricket matches happened during a period when rates are low and the real impact will be seen in a few weeks.

“Urban India is very concerned but in the rural areas people aren’t wearing masks. There is complacency.

“Healthcare has coped really well and people have understood it really well. Things that happened in the US and UK did not happen in India at hospitals, there is understanding of how treatment has to be handled.

“People are grateful they are getting the vaccine but understand they have wait because of India’s population. Its more of a political thing rather than the public being angry.”

The largest vaccination drive in the world
So far, India has vaccinated 61 million people, out of an adult population of somewhere between 900 million and one billion people.

As of 1 April, its health authorities say anyone aged 45 or over can now go forward for a vaccination, in a drive it is championing as the largest in the world.

That means around 280 million more people are currently due for the jab than have had it so far.

Health policy officials say the programme badly needs to step up a gear, with one senior government official saying on Tuesday the COVID situation was going from “bad to worse”.

“Remember if the cases are more, they will eventually overwhelm the system”, senior health official Vinod Kumar Paul told a news conference.

As well as AstraZeneca, India has approved one of its own vaccines, by maker Bharat Biotech, but the lion’s share of the jabs given out so far are those developed by Oxford University in conjunction with the Anglo-Swedish pharma giant and made by SII.

It is thought other vaccines may come on stream in the coming days.

When compared with countries like the US, Europe, or some of those in South America, India’s COVID rates don’t seem that bad.

In the last two weeks, the case rates rose to around 46 per million per day, which is low compared to the worst country in the world at the moment, Hungary, where nearly 900 out of every one million are testing positive every day, according to OurWorldInData. This excludes micro-states, with small populations, like San Marino.

But, as in Africa, the figures can be deceptive, often masking the true level of infection.

Added to that, that figure of about 46 million is more than double what it was a fortnight before.

A number of other African and Asian countries are also seeing rapid rate rises, but few have such a large population as India, which makes Indian figures more reliable.

In the last few days, the number testing positive in a day has broken records in some states.

Deaths are also rising sharply, with the numbers doubling in the last two weeks, according to OurWorldInData.

An indication as to whether an outbreak is under control, and also whether figures are likely to be accurate, is how many, out of those tested, test positive. The higher the figure, the more out of control an outbreak, with WHO saying the rate should be below 5% for an outbreak to be considered under control. India is currently seeing 5.5% of people test positive for every test taking place, and that figure is rising.

The holy man
Baba Machendra Puri, 41, is a Naga Sadhu and is taking part in the Kumbh Mela, in Haridwar.

“I am a Naga Sadhu and have been attending all Kumbh melas . Bathing at the Kumbh has always been part of our Hindu tradition since time immemorial. We will continue following our Hindu belief and practices. The water that flows from the mountains in mother Ganga not only washes us of our sins but also destroys all diseases and illnesses. I will take the holy dip and am not scared of the pandemic. I will follow all the COVID protocols given to us by the authorities.

“There are thousands and thousands of us here taking the holy dip and following our traditions.”

‘People think this is over already’

A number of major events are contributing to rising rates, including the ongoing Kumbh Mela, where millions of devotees gather in the Indian city of Haridwar, aiming to bathe in the River Ganges, close to where it emerges from the Himalayas.

Earlier this week, pictures showed people thronging together to throw coloured powder at each other and spray water as part of the annual Holi spring festival, despite government attempts to limit gatherings.

At the weekend and in the last month or so, long lines of people were seen forming outside polling stations, many tightly packed together and some not wearing masks.

Unlike in the UK and many parts of Europe, there is no national lockdown in India at present.

The state of Maharashtra, one of the worst affected by the current surge, is considering imposing stricter curbs, but opposition parties and industrialists have opposed a lockdown, saying it hurts the poor the most.

Professor Giridhara Babu, head of life-course epidemiology at the Public Health Foundation of India, told Sky News that the latest surge was due to a combination of factors.

He said: “The virus itself is changing; it’s probable we have a more infectious strain. The host immunity, both in terms of vaccination and infection… is changing; and the third factor is environment… the factors around us which promote viral transmission, which include crowd formation, lack of compliance of the appropriate behaviours, and lack of strict regulatory measures such as lockdown – all of these things will favourably allow the transmission of the virus.”

He said India is embarking on its second wave, but during the first, not only did the government effectively lock down the country before the virus took hold, people were largely compliant.

It resulted in India having a comparatively low death rate compared to many countries, despite its decentralised health system, which is heavily reliant on the private sector. Since then, Prof Babu said, things have changed.

“People have this COVID-19 fatigue,” he added. “The second thing is… the role of the vaccine – people think that since the vaccine is around the corner, although they may not have got it, this is definitely the end of COVID.

“Even though the government keeps saying wear masks, even after vaccines, people are in a mood to think this is over already.

“And (at) the government level, I think there are too many things going on… elections… the need to ensure the economy has to be strengthened, all sorts of priorities which were delayed last year.

“But unless we get our act together… I can’t think it will be as favourable as it was last year.”

Rising rates over the last few weeks have led to widespread criticism that domestic needs should be catered to first.

All the government has said officially is that there will be no immediate increase in vaccine exports.

But, according to the news agency Reuters, it spoke to a source that said: “No exports, nothing until the time the India situation stabilises. The government won’t take such a big chance at the moment when so many need to be vaccinated in India.”

China and Russia poised to seize opportunity

Few governments have criticised India, but a number have actively stepped-up action to find alternative suppliers, including South Korea, Philippines, Vietnam and Indonesia, none of which were due to receive doses directly from SII before May, but which may be finding supplies they were due to receive delayed.

Last week, WHO director-general Tedros Adhanom Ghebreyesus hit out at the kind of vaccine nationalism that has left part of the COVAX programme struggling.

He said: “COVAX is ready to deliver but we can’t deliver vaccines we don’t have. Bilateral deals, export bans, vaccine nationalism and vaccine diplomacy have caused distortions in the market with gross inequities in supply and demand.”

China and Russia poised to seize opportunity
Few governments have criticised India, but a number have actively stepped-up action to find alternative suppliers, including South Korea, Philippines, Vietnam and Indonesia, none of which were due to receive doses directly from SII before May, but which may be finding supplies they were due to receive delayed.

Last week, WHO director-general Tedros Adhanom Ghebreyesus hit out at the kind of vaccine nationalism that has left part of the COVAX programme struggling.

He said: “COVAX is ready to deliver but we can’t deliver vaccines we don’t have. Bilateral deals, export bans, vaccine nationalism and vaccine diplomacy have caused distortions in the market with gross inequities in supply and demand.”

He later urged India to continue providing other countries with vaccines.

A spokesman for SII referred Sky News to the Indian government for comment. Indian Ministry of External Affairs spokesperson Arindam Bagchi denying imposing a ban on exports, saying: ” We have not imposed any export ban on COVID-19 vaccines. Till now we have supplied vaccines to more than 80 countries across the world.”

With so many possibly more deserving countries now crying out for vaccines, it could mean that the UK will have to wait even longer for the five million doses that would have given the British vaccine rollout the spurt it needed to go beyond the first nine priority groups

In the meantime, those countries that were relying on AstraZeneca doses to start reducing their rates in the same way the UK has, may increasingly be looking to countries like China and Russia to provide what they need.

Philippines and Vietnam have both approved Russia’s Sputnik V vaccine, along with more than 50 other countries, mainly developing nations.

Chinese vaccine maker Sinopharm, meanwhile, plans to produce its COVID-19 vaccine at a new plant in the United Arab Emirates.

There is likely to be anxiety in some western governments that as developing nations become increasingly reliant on Chinese and Russian vaccines, they may be more willing to overlook any human rights allegations which would otherwise be discussed at the United Nations.

There are some, no doubt, who will say India is only doing what the UK and US are already doing – hanging on to all the vaccines they produce for domestic use and protecting their populations.

The EU hit out in the last month at its inability to acquire UK-made vaccines, despite exporting Pfizer jabs to Britain.

The UK is expected to start exporting vaccines when a raft of other developers and manufacturers, which are currently putting their jabs through late-stage tests, come on stream.

Experts are yet again pointing to the need to plan for future pandemics, to make sure life-threatening interruptions to vaccine supply, like a potential block on exports from one of the biggest jab makers in the world, won’t continue to harm people in years to come, should a new form of COVID appear, or any other virus.

Dr Head said: “It shows another good reason as to why pandemic preparedness is so important. At the minute we’re trying to resolve a pandemic while running around firefighting. If we had vaccine logistics nailed down prior to the next pandemic starting, then it will make issues like this less likely and probably be easier to resolve in the longer run.

“The lessons we should be learning from this to take forward is planning ahead of the next big pandemic.” Sky News