Delhi’s harsh new Covid restrictions are an attempt to keep the latest wave of infections from spiraling out of control, but hint at a deeper issue the country is facing: insufficient infrastructure for the vaccination of its 1.4 billion people. The week-long lockdown comes at a time when India is in the midst of a veritable health crisis; not only are many of its ICUs being overwhelmed by an exponential surge in cases of the virus, but the problem is also being compounded by significant vaccine shortages.
Its AstraZeneca donations to Covax have been put on hold, while Serum Institute India (SII) – the biggest manufacturer of vaccines in the world – has said it will not be able to ramp up production before June because of a destructive fire at the beginning of the year and a subsequent lack of funding. As a result, the country is now under pressure to accelerate the adoption of other vaccines that have been approved by the WHO but which are not yet administered in India, including Pfizer, Johnson & Johnson, Novavax and Moderna. However, the cold chain logistics which these candidates demand mean that those in charge may well be forced to pin their hopes on second generation vaccines for a viable means of inoculating the population and defeating the disease.
Shortages and speedbumps
As recently as the beginning of March, India’s Federal Health Minister Harsh Vardhan announced that the pandemic was in its endgame in the country. However, complacency regarding precautionary measures (such as social distancing, mask wearing and mass gatherings) provided the kindling that was set alight by a rapidly spreading new local variant of Covid-19, named B.1.617. The fallout has seen the country endure an average of 90,000 new cases daily since April 1, peaking at a record high of 261,500 half-way through the month, climbing up to over one million new infections.
That unexpected outbreak has been exacerbated by the fact that India is lagging far behind its vaccination targets. The government had hoped to fully inoculate 300 million people by the end of August, but the present tally stands at just 17.5 million. This, despite the fact that the country is home to an estimated 60% of all vaccines manufactured worldwide. Financial difficulties at SII mean that there is a massive shortfall in available doses, prompting the government to pause exports of the AstraZeneca vaccine originally destined for international aid efforts. That U-turn has compelled the UK-based pharmaceutical company to issue India with a legal notice of complaint.
For their part, Delhi politicians, including Prime Minister Narendra Modi, have insisted that there is no deficit and that delays in the vaccination program are down to mismanagement at state level. It’s certainly true that vaccine wastage has been unsustainably high in some parts of the country, with Telangana recording particularly concerning percentages of 17.6% – that’s almost one in five vaccines going unused. The reasons behind the profligacy are manifold, but a cold chain infrastructure that’s only capable of handling 600 million doses annually is thought to be a chief contributing factor. Based upon that blueprint, experts say mass inoculation of the country won’t occur before the close of 2023.
Second generation solutions to world problems
Clearly, something has got to give. The fact that millions are still being allowed to attend Bengal election rallies or worship at the banks of the River Ganges on holy days is hardly helping to slow infection rates, but for the country to make inroads into its vaccination drive, it may be necessary to look elsewhere. Fortunately, there are over 270 novel candidates in development as part of a so-called second generation of vaccines, which could solve the logistical problems posed by the already approved alternatives.
In the Netherlands, for example, Akston Biosciences are beginning clinical trials for their new candidate, named AKS-452. Capable of retaining its potency in temperatures of up to 25°C for four months and remaining shelf-stable at 37°C or below for 30 days, the vaccine could offer a substantial selling point in India’s sweltering heat. What’s more, the fact that AKS-452 dispenses with a live or weakened form of the virus in favor of conventional, low-cost manufacturing methods means that its creators claim a single, 2,000-litre production line would have the capacity to churn out over one billion doses per year. There were over 1,500 applicants for the vaccine’s 176-participant study, the first round of which kicked off last week.
Elsewhere, German pharma firm CureVac has signed an R&D partnership with the UK government to investigate new mutations and strains of the virus, backing up that research with a $180 million deal with GlaxoSmithKline to manufacture the second-generation vaccines aimed at vanquishing them. According to experts in the field, this kind of proactive, preemptive vaccine development may well be vital in anticipating and nullifying new variants of Covid before they are allowed to wreak the same kind of havoc that has devastated India in the last few weeks.
A wide-angle approach
The government must accept some responsibility for grossly underestimating the threat posed by coronavirus and celebrating their victory over the disease prematurely, especially when other countries continued to be ravaged by it. The fact that they ordered a mere 11 million doses to service a 1.3 billion populace in the same time period that the USA reserved 600 million doses for its 300 million inhabitants is particularly inexcusable. However, even with the appropriate foresight in terms of vaccine production and retention, it’s highly likely that the inadequacy of the country’s storage and distribution infrastructure would have resulted in a similar (if perhaps less severe) situation.
For that reason, adopting a forward-thinking approach which accommodates all potential outcomes and anticipates worst-case scenarios is the best way to beat this pandemic – especially in places like India, Africa and other developing parts of the globe. Thankfully, several new vaccine paths appear to be in the pipeline, so it would befit Modi and Vardhan to keep fingering their pulse as they plan their recovery strategies going forwards. Only by taking advantage of the latest scientific and technological breakthroughs can India avoid crises like the current one and drag India into its Covid endgame, in deed as well as in word.
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