When It Comes to Vaccines, Govt Tells Us One Thing, Supreme Court Another

On May 13, the government told us that between August and December this year, the covid vaccine availability/production will be ramped to around 216 crore doses. Tweets were published by several government handles. (You can take a look here and here).

Many media reports were also published regarding the same. As the Mumbai edition of The Times of India reported on May 14: “Setting out its roadmap to vaccinate the around 95 crore 18-plus population, the Centre said on Thursday India should be able to access nearly 217 crore doses between August and December.”

The following table shows how the 216-crore number was arrived at.

Source: Ministry of Health and Family Welfare. In case you are unable to see the table, click here.

Several ministers reiterated this message. Prakash Javadekar, who holds multiple portfolios in the government, said: “India will get 216 crore new vaccines by December. India will be able to vaccinate more than 108 crore people with the help of these vaccines.” The health minister Dr Harsh Vardhan also made a similar statement.

The underlying message here was that the vaccine shortage, if any, would not be a problem in the months to come. Over the next few days, WhatsApp and other social media kept buzzing with this message. The above table was shared over and over again. The Be Positive crowd had a field day. So far so good.

The trouble is that the numbers in the table are just that, numbers. Allow me to explain.

75 crore doses of the Covishield vaccine are expected to become available between August and December, a period of five months. This implies a production capacity of 15 crore doses per month on an average.

In a submission to the Supreme Court on May 9, the government had said that the manufacturing capacity of the Serum Institute, the company which manufactures Covishield, is expected to go up from 5 crore doses per month to 6.5 crore doses by July 2021. Increasing production capacity from 6.5 crore doses per month to 15 crore doses per month is going to be some task.

Of course, the government always has the option of importing the Astra-Zeneca vaccine doses (which is locally manufactured as Covishield). But even if the government decides to import, the difference between the local production capacity and the projection of 15 crore doses per month on an average, is huge. Further, any imports will come at the expense of denting the atma nirbharta narrative.

When it comes to Covaxin, the estimated production between August and December has been assumed to be at 55 crore doses. This implies a production of 11 crore doses per month on an average.

The central government told the Supreme Court on May 9 that the manufacturing capacity of Bharat Biotech, the company which currently manufactures Covaxin, is expected to go up from 90 lakh doses per month to 2 crore doses per month, and further increase to 5.5 crore doses per month by July 2021. So, 5.5 crore doses a month is half of the 11 crore doses per month that is required as per the government’s calculation.

Of course, it needs to be remembered that the intellectual property for Covaxin is shared between Bharat Biotech and the Indian Council of Medical Research. Hence, Covaxin will also be manufactured by three public sector manufacturing facilities. These are Indian Immunologicals, Hyderabad, Haffkine Biopharmaceuticals, Mumbai, and Bharat Immunologicals and Biologicals, Bulandshar.

Based on this, the government told the Supreme Court: “This is projected to enhance Covaxin‟s current manufacturing of 1 crore doses/month to nearly 10 crore doses/month in the next 8-10 months.”

So, Covaxin’s production is expected to touch 10 crore doses per month only in 2022. At least, that’s what the central government told the Supreme Court. Nevertheless, that did not stop them from telling you and I, that 11 crore doses per month of Covaxin will be produced on an average between August and December. Given this, the vaccine production projections made by the government, don’t pass the basic smell test. 

And we aren’t done with this yet. A close look at the above table tells us that it also includes doses from vaccines which haven’t been cleared for production. In fact, this was precisely the point made by the two amici appointed by the Supreme Court ( Jaideep Gupta and Ms Meenakshi Arora) in the Suo Moto writ petition that the Court is currently hearing.

As Wikipedia points out: “An amicus curiae (literally, “friend of the court”; plural: amici curiae) is someone who is not a party to a case who assists a court by offering information, expertise, or insight that has a bearing on the issues in the case.”

As the Amici told the Supreme Court:

“The [central government] has claimed that it will be able to vaccinate a substantial number of persons (around 100 crore persons requiring 200 crore doses) by December 2021. However, no projections have been shared with this Court regarding how this target would be achieved. Based on reports, it appears that the [central government] has factored a number of vaccines that are currently in their development stages to reach its projected number of 200 crore doses. This approach would be misguided as the success and efficacy of vaccines that are currently in the stage of clinical trials is uncertain and cannot be guaranteed.”

The interesting thing is that the central government hasn’t presented any projections of vaccine availability to the Supreme Court and in an affidavit submitted to the Court on May 9, it said: “It is difficult to predict the projections for vaccines given that it depends on variable factors such as introduction of new foreign vaccines, capability of increased production by existing manufacturers, among others.”

Of course, the variable factors did not stop the government in confidently telling us that 216 crore vaccine doses would become available between August and December, later this year. Something, it didn’t have the confidence to tell the Supreme Court on May 9, it told the country on May 13, four days later, and has been saying it over and over again since then.

What this tells us is that the submissions to the Supreme Court are clearly not good WhatsApp material and hence, things can be said as the way they are.

Nevertheless, the Solicitor General, during the course of his oral submissions to the Supreme Court, did say: “He is in a position to address these concerns of this Court and that the UoI aims to vaccinate approximately 100 crore persons by the end of December 2021.”

Nonetheless, there is a huge difference between an aim, a plan, and a projection, as we have seen in the calculations earlier in this piece. Numbers are just numbers and can easily be tortured to arrive at what one wants to say. The table accompanying this piece is an excellent example of this phenomenon.  

But then on WhatsApp who is bothered about the details and the nuance. So, the main aim of the government was to project a confident be positive narrative and it did just that.

To conclude, it is safe to say that there is one truth out there for the Supreme Court and another for the country at large.

The Real Story Behind India’s Covid Vaccine Exports

Chintan Patel and Vivek Kaul

India began administering covid vaccines on 16 January 2021. Within a week, the Indian government had sent almost 50 lakh free doses to Bangladesh, Bhutan, Nepal, Myanmar and other countries. The Modi government calculated that it could raise India’s global stature by pursuing a covid vaccine diplomacy strategy – dubbed vaccine maitry.

By the end of March, India had exported more vaccines than administered to its own population. In fact, India’s ambassador to the United Nations (UN) wore this fact as a badge of honour. In an UN general assembly meeting on March 26, Ambassador Nagaraj Naidu claimed: “In fact, as of today we have supplied more vaccines globally than have vaccinated our own people.” (The statement clearly hasn’t aged well).

Of course, as we know, India was hit by a massive second wave of covid in early April, which has caused widespread loss of life, health and wealth.

As India continues to grapple with the devastation, the government’s export strategy has come under scrutiny. Even the Serum Institute of India (SII), manufacturer of the Covishield vaccine, has been criticised for vaccine exports. Taking note of this criticism, SII came out with a statement defending the vaccine roll-out in India, including the rationale behind exporting vaccines before the second wave set in.

Let’s look at the underlying data to examine the public discourse on this issue, including some of Poonawalla’s claims. 


Source: Summary of a larger table available at https://www.mea.gov.in/vaccine-supply.htm.

The above table presents the data for the total covid vaccines exported – both by month, and by category. Vaccines sent abroad are divided into three categories: a) grants made by the Indian government, b) purchases made by the foreign governments (under commercial), and c) SII vaccines sent to COVAX – the international consortium that is coordinating the distribution of covid vaccines to low-income countries.

Central to the vaccine export debate, is this simple question: Did the government’s vaccine diplomacy effort contribute to India’s vaccine supply crisis?

The data presented in the above table provides some clues. Let’s look at them point wise.

1) A total of 1.07 crore vaccines were sent as donations to other countries. Of this, most of the vaccines were sent before April, when the second wave started. This category comes with nuance attached to it. The government of India purchased the covid vaccines from vaccine makers (almost exclusively from SII) and decided to send over 1 crore doses to other countries instead of making them available to Indian citizens.

Helping other countries who are also in need is a noble idea and can earn valuable diplomatic capital and goodwill. But it also comes at a cost. Clearly, the government thought that the benefits accrued by this act of benevolence outweighed the potential cost.

Making judgment calls on future events is an intrinsic part of leadership. Deciding to donate over one crore vaccines while most of the country was still not vaccinated was one such judgment call made by PM Narendra Modi and his government. The obvious alternate use of the vaccines that were given away to other countries – or what economists call ‘opportunity cost’ – was to inoculate Indian citizens.

Of course, one can always argue that one crore doses wouldn’t have made much of a difference in the overall scheme of things, given that India needs to vaccinate a total of 94.3 crore adults (people aged 18 and above). 

Nevertheless, the opportunity cost of the one crore vaccines was the increased immunity of many Indian citizens. Or as the old cliché goes, something is better than nothing.

Given both the severity of the infections and the lack of supply that has slowed down the vaccination drive since early May, there can be no doubt that the decision to give away vaccines wasn’t a great judgment call.

While one can argue (like Poonawalla does) that the intensity of the second wave of covid blindsided many, any government’s primary responsibility is to keep its citizens safe. If it fails to prepare for an event that leads to mass death and destruction, it has failed in discharging its primary duty.

As we had explained in a previous piece, the Indian government was caught napping, while other countries were stocking up on vaccine doses through the second half of 2020 and early 2021. (You can see the table here). The government got caught believing its own rhetoric. Using the surprise element of covid as an excuse would have worked at the point when the first wave struck. It doesn’t really hold when talking about the second wave. 

In many ways, the covid pandemic is a war-type scenario. Donating life-saving vaccines when our own population is still vulnerable is comparable to giving away body armour that could protect soldiers on a battlefield. That the enemy struck with more ferocity than expected, is not an acceptable excuse.



2)
Nevertheless, there is much more to this story. A total of 3.58 crore doses were exported from January to March as part of purchase agreements between vaccine makers and foreign governments. The Serum Institute of India (SII) was the main player here, with Bharat Biotech (BB) having exported only 3.25 lakh doses abroad.

3) Another 1.99 crore doses were sent to the COVAX consortium by SII. COVAX is the global effort to procure vaccines for low-income countries led by Gavi, the Vaccine Alliance, Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization (WHO). Over 1.70 crore of these doses were sent in March alone. SII has contractual obligations to deliver vaccines to COVAX as part of its licensing agreement with Astra Zeneca and collaboration with Gavi.

Given that over 5.5 crore doses (3.58 crore plus 1.99 crore) sent abroad were a part of private contracts and licensing agreements between SII and foreign entities, can the Modi government really be held responsible for allowing the export of these vaccines? Supporters of the government will say no, while detractors will say yes. We, on the other hand, can only offer some nuance.

1) It is incorrect to group the vaccines which the government gave out as grants in the same category as the vaccines that were sent as part of commercial/COVAX agreements. The government is directly responsible for the former being sent abroad, and only tangentially responsible for the latter. Across all categories, vaccine manufactures (SII or BB) should not be targeted for exporting vaccines.

They were either selling to the Indian government, who then decided to share its stocks with the world, or fulfilling their contractual obligations – both perfectly reasonable and legitimate actions.

That said, in February and March, when the Covid situation seemed under control in India, the Modi government was happy to claim credit for all exported vaccines, including the ones being sent as part of private contracts. Hence, by their own logic, the administration should be held accountable for all 6.6 crore vaccines exported. But their logic was flawed when they claimed credit, and it would be flawed to pin equal responsibility to all export categories.

2) The 3.58 crore vaccines that foreign entities could buy from SII and BB was only made possible because the Indian government had not been proactive in placing vaccine orders. The government could have placed much larger advance orders, like other countries did. It could have done so especially with SII, to ensure that it got the lion’s share of the company’s production capacity, outside of its obligations to COVAX.

The government gave the first order for vaccines in January 2021 when it procured one crore shots from SII and 55 lakh shots from BB. After this initial order, the government has been ordering vaccines in a piece-meal manner.

An order of 12 crore doses (10 crore from SII and 2 crore from BB) was placed in March. The exact dates for other intermediate orders is not in the public domain, but around 16.5 crores doses were ordered before April 28. In early May, the government issued a statement clarifying that a new order of 16 crore doses (11 crore from SII and 5 crore from BB) was placed on April 28. The timing and quantity of these orders meant that vaccine makers were not given the fillip to prioritise maximum production with an assurance that their supplies will be purchased by the Indian government.

Prioritising your own citizens in a time of crisis is not selfish. In fact, it is the right thing for an elected government to do. The United States (US) which has the most robust vaccination drive in the world has been doing that, and justifiably so. The US chose not to export any of its vaccines, including ones that were not even authorised for domestic use till its vaccine supply exceeded local demand.  

3) Lastly, it is not entirely correct to claim that the government is in no position to interfere with vaccine manufacturers’ contract commitments to foreign countries or agencies. India has placed a restriction on vaccine exports since late March – so the provision exists to take such an action. Of course, placing such a restriction before the second wave hit, would have been difficult to justify.

These export restrictions bring up an interesting dilemma of vaccine exports vis a vis the role that the government has in the execution of private contracts. As mentioned earlier, SII has contractual obligations to other countries and COVAX to deliver a certain quantity of vaccines. In fact, SII may have already received advanced funding as part of those contracts. So, it seems only fair that the SII should be able to deliver on those contract terms.

However, SII needs export permission from the government to be able to ship vaccines out of the country. The government has temporarily halted all exports of covid vaccines given the domestic lack of supply and severity of need. In fact, last week it again denied SII’s request to export 50 lakh doses to the United Kingdom.

The situation in India may not improve in the months to come, and there is also the warning of a third wave that needs to be taken into account. A recent report suggests that this restriction may now last till October.  On the other hand, Gavi, the vaccine alliance, has made it clear that it views the agreement with SII as a legally binding contract that has to be enforced. Astra-Zeneca has also sent legal notices to SII for delay in shipments. The international community has bet heavily on India’s vaccine manufacturers and extended import restrictions may not be taken too kindly.

Given this backdrop, a potential international legal wrangle looms ahead. A vaccine initiative that promised friendship may end in acrimony.

India’s Vaccine Demand-Supply Math Shows a Royal Govt Screwup

Earlier in the day today, I published a detailed thread on the demand-supply scenario of the vaccines against covid, in India.

If you have read that thread, this piece is not for you. If you haven’t, do keep reading.

Up until today (April 30), vaccines against covid were only available for those aged 45 and above.

The number of people aged 45 and above in India is around 35.6 crore. This projection can be accessed from the Youth in India 2017 report. Of this, 12.4 crore individuals have taken only one dose of the vaccine and 2.6 crore have taken both the doses. (This number was as of the time of writing and keeps changing).

This basically means that 20.6 crore Indians (35.6 crore minus 12.4 crore, who have taken one dose, minus 2.6 crore, who have taken both the doses), aged 45 and above, are yet to take even a single dose of the vaccine.

In order to vaccinate them, the number of vaccines required will be 41.2 crore (20.6 crore multiplied by 2 doses each). Over and above this, 12.4 crore individuals who have taken just one dose, need to take a second dose as well.

Hence, the number of vaccines required, for those aged 45 and above stands at 53.6 crore (41.2 crore, who haven’t taken any dose, plus 12.4 crore, who have taken one dose).

From tomorrow (May 1), vaccination is open even for those aged 18 and above as well. As per the Youth in India report, the number of people in the age bracket 20-44, stands at around 55 crore. It doesn’t have a break up for the age bracket 18-44. So, it’s only fair to assume that the number of individuals in the age bracket 18-44, will be around 60 crore. In fact, that is the assumption I worked with in my Twitter thread.

One of the readers pointed out that economists Renuka Sane and Ajay Shah in a piece estimate that the number of individuals in the age group 18-44 stand at 62.2 crore. I will work with this number here. (I am trying to workout a ballpark estimate here and not write a research paper). 

The number of vaccines required for those in the 18-44 bracket stands at 124.4 crore (62.2 crore multiplied by two doses). The overall number of vaccines required to vaccinate everyone aged 18 and above, is, 178 crore (124.4 crore plus 53.6 crore).

This is where things get interesting. In May, Serum Institute (Covishield) is expected to produce 7 crore vaccines. Bharat Biotech (Covaxin) is expected to produce 2 crore. That’s 9 crore vaccines, when 178 crore vaccines are required. If we take vaccine wastage into account we are looking at a number higher than 178 crore and closer to 190 crore vaccines.

Serum Institute’s capacity is expected to go up to 10 crore vaccines by June and Bharat Biotech’s capacity is expected to go up to 6 crore by July. By July we will have 16 crore vaccines being produced per month.

Of course, other vaccines like Sputnik and Pfizer will also come in, and thus the supply will increase and go up to more than 16 crore.

The point is that the supply of vaccines will continue to be a problem for the next few months. There are only two companies and there is only so much they can produce.

What does this tell us? It tells us that the authorities assumed that there will be no second wave and hence, had no plans to vaccinate a large section of the population quickly. The government has been caught napping at the wheels.

Also, even with the availability of 20 crore vaccines a month, it will take at least five to six months, for a significant portion of the population to be vaccinated, so that the population can achieve herd immunity.

One reader on Twitter told me that the capacity may also be used to fulfil commercial export commitments of the vaccine suppliers. I have no idea about whether that is the case. If that is the case, vaccination of a significant portion of the population will take even longer.

This easily explains why state governments are running out of stocks. The supply is very low in comparison to the demand. This is a problem that is not going to go away at least for the next two months. This is also explains, why even though vaccination for those over 18 is now allowed, there aren’t vaccines available to vaccinate them.

Of course, there will be a great fight for access to vaccines, not just between state governments, but also between state governments and the private sector. That is what the current vaccine strategy will lead to.

I have already heard stories of corporates throwing money to ensure that their employees are vaccinated and can get back to work quickly. For them, it is the cost of doing business, which can be easily passed on to their consumers. Of course, this evidence is anecdotal, but many corporates, especially those in the services business, have an incentive in doing so. If this plays out at a significant level, it will make vaccines even more inaccessible for the common man. 

Basically, it’s a royal screwup, which cannot be corrected quickly. Give it another five to six months and hope for the best.

Meanwhile, don’t step out if you can, and if you do, stay doubled masked!