India’s coronavirus vaccination drive is faltering just when the country needs it most

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NEW DELHI – As India confronts a devastating coronavirus outbreak where thousands are dying each day, the country desperately needs to vaccinate its population as soon as possible.

Yet the vaccine drive is stumbling just when it is most crucial.

Over the past six weeks, the number of vaccinations per day has fallen by about half, from a high of 4.2 million per day on April 2 to 2 million on Thursday.

Vaunted as the largest in the world, India’s vaccine program is being hobbled by supply shortages and an abrupt shift in procurement policy that appears to be without parallel. The woes of the inoculation drive are especially striking given India’s unique advantages, including a large vaccine industry and a record of mass immunization campaigns.

Just months ago, public health experts were counting on India to play a crucial role in supplying coronavirus vaccines to the developing world. The government was so confident of its ability to meet domestic demand for vaccines that it allowed more than 60 million doses to be exported or donated to other countries between January and March.

Now the vaccine exports are a source of increasing anger. In Delhi, posters appeared with a question for Prime Minister Narendra Modi: “Why did you send our children’s vaccines abroad?” Police arrested and questioned more than 20 people in connection with the posters over the weekend.

Faced with surging infections, India suspended exports at the end of March and has begun importing Russia’s Sputnik vaccine to try to alleviate the shortfall in local production. Last week, the government acknowledged that vaccine shortages in India will persist at least until July.

“To cover the entire nation, please remember it will take a little while,” V.K. Paul, a senior health official, told reporters on Thursday. “We should accept that as a reality with humility.”

The inability to accelerate the vaccination drive in the short term means that immunizations will do little to blunt the ferocity of the current wave of infections: To date, only 10 percent of Indians have received at least one shot.

A spokeswoman for India’s Health Ministry and a senior official involved in the vaccination effort did not respond to requests for comment on the slowing inoculation drive.

Vaccinating India’s more than 1.3 billion people was always going to be a monumental task. But experts say that India’s present predicament is the product of miscalculations and optimistic predictions by policymakers and manufacturers.

Serum Institute of India, one of the largest vaccine makers in the world, struck deals early in the pandemic to make hundreds of millions of doses for India and the developing world. In an interview with The Washington Post last year, Adar Poonawalla, the firm’s chief executive, said the company hoped to boost its production of the AstraZeneca vaccine to 80 million to 100 million doses a month by the start of 2021.

That target has remained elusive. Serum’s current monthly production of the AstraZeneca vaccine hovers around 65 million to 70 million doses a month. Poonawalla has cited shifting reasons for the company’s inability to increase production further, including a lack of funds and a fire that broke out in January at a newly constructed building. (At the time of the fire, he had said it would not affect the manufacturing of coronavirus vaccines.)

The fire pushed back the ramping up of production by “a few months,” said a spokesman for Serum Institute in written responses to questions, commenting on the condition of anonymity to adhere to company policy. He did not cite previous curbs on exports of raw materials by the United States as a factor affecting the production of the AstraZeneca vaccine, something Poonawalla implied in a tweet last month. The company now says it will start manufacturing 100 million such doses a month in July.

Serum Institute and Bharat Biotech, the maker of a locally developed vaccine called Covaxin, were probably too confident, said K.V. Balasubramaniam, the former chief executive of another Indian vaccine maker. “There would be a tendency for these companies to exaggerate their capabilities.”

Meanwhile, the Indian government displayed little urgency about buying large amounts of vaccines in advance, unlike governments in the United States and Europe.

When coronavirus cases plummeted in India late last year, health officials seemed content with more limited quantities of vaccines, thinking the worst was over and they might not “need to immunize the whole country,” said one vaccine executive who spoke on the condition of anonymity to discuss the matter candidly. The government “didn’t take us seriously when we said you cannot expand overnight.”

India did not place its first purchase orders – for just 16 million vaccines – until January. Its first large-scale purchase came in March, when it ordered 100 million doses from Serum Institute and 20 million from Bharat Biotech. Late last month it ordered 160 million doses from the two companies to be delivered by July.

Instead of placing large advance orders, the government is “buying vaccines like monthly groceries,” wrote Partha Mukhopadhyay, a senior fellow at the Center for Policy Research in Delhi, last week.

What’s more, India has flung open eligibility for vaccines without a concomitant increase in supply. Last month, the government announced that everyone 18 and older – a population of roughly 950 million – would become eligible for inoculation.

The move was accompanied by a major policy shift. Half of the vaccine supply is being reserved for the national government and will go toward vaccinating people 45 and older. The other half would be sold at higher prices to state authorities and private players to vaccinate people younger than 45.

The result has been acute shortages and supply breakdowns that have led several states to suspend altogether the vaccination drive for people younger than 45. In Delhi, city authorities shut down certain vaccination centers after their supply of Covaxin, the vaccine produced by Bharat Biotech, ran out.

Manish Sisodia, a senior Delhi official, made public a letter from Bharat Biotech chief executive Krishna Ella in which he wrote that the company was unable to provide additional supplies to the city. “We are unable to keep up with demand,” Ella wrote. Spokespeople for Bharat Biotech did not respond to requests for comment.

The government is “splitting up the same amount of available vaccines” into two different procurement streams, with no clarity about how Serum Institute and Bharat Biotech are allocating the doses, said T.S. Singh Deo, the health minister of the state of Chhattisgarh. “This is not an acceptable or healthy situation.”

Frantic for supplies, nine Indian states and two cities – Delhi and Mumbai – have said they will attempt to buy vaccines directly from global manufacturers, pitting them against each other in the international market. K. Sujatha Rao, a former top official in the Health Ministry, called the situation “totally unprecedented” and “bizarre.”

The Washington Post spoke with health officials in three Indian states who said the major constraint on vaccinations was supply.

In the northern state of Punjab, about 100,000 vaccinations were taking place each day a month ago, said Rajesh Bhaskar, a state health official. Now that figure has fallen by about half, he said. The cause is a supply crunch both in the vaccines being provided by the central government and those the state is procuring by itself, he said.

“We are facing a quite acute shortage,” added Bijay Panigrahi, a health official in the eastern state of Odisha. Except for the lack of supply, the other logistics were going smoothly, he said.

For many Indians younger than 45, the joy of being eligible for a vaccine has given way to intense frustration. Obtaining an available slot for that age group on the government’s vaccination website is difficult or impossible. People in cities have traveled long distances to receive shots in rural areas, sometimes to the ire of local residents.

Paul, the senior Indian health official, told reporters last week that the country had a large supply in the pipeline from multiple local vaccine manufacturers, with as many as 2 billion doses potentially available from August through December. Experts, however, say such projections are optimistic. (It will be “a miracle” if that target is reached, the vaccine executive said). India is also in talks with Pfizer, Moderna and Johnson & Johnson, Paul said, but the three have indicated that they will not have supplies available for several months.

The government is rushing to ramp up production, but it “underestimated the magnitude of this crisis,” said Balasubramaniam, the former vaccine executive. “In a situation like this, you cannot afford to be optimistic.”