India reduces vaccine exports as infections increase

NEW DELHI – With its own battle against the coronavirus taking a turn for the worse, India has severely reduced exports of Covid-19 vaccines, causing setbacks for vaccination initiatives in many other countries.

The government of India is now withholding almost all of the 2.4 million doses that the Serum Institute of India, the private company that is one of the world’s largest producers of the AstraZeneca vaccine, makes each day.

India is desperate for all the doses it can get. Infections are skyrocketing, reaching 50,000 a day, more than double the number less than two weeks ago. And the Indian vaccination campaign has been slow, with less than 4% of the nearly 1.4 billion Indians receiving a vaccine, far behind rates in the United States, Britain and most European countries.

Just a few weeks ago, India was a major exporter of the AstraZeneca vaccine and was using it to influence South Asia and around the world. More than 70 countries, from Djibouti to Great Britain, have received vaccines made in India, with a total of more than 60 million doses. From mid-January to March, no more than a few days passed between the main vaccine shipments that left India.

But the size of its overseas shipments has declined sharply in the past two weeks, according to data from India’s Ministry of Foreign Affairs. And Covax, the program set up by donor agencies to buy vaccines for the poorest nations, said on Thursday that it had told those countries that almost 100 million doses expected in March and April would face delays due to “increased demand for Covid-19 vaccines in India. “

The Indian government has not publicly commented on what is happening, and would not do so when contacted by The New York Times for this article. But health experts say the explanation is obvious: India is closing its gates when a second wave of infections hits its country, clinging to a vaccine that has not been developed but is being produced in large quantities on its soil. .

Prime Minister Narendra Modi’s government, a diehard nationalist, has regulatory control over how many doses of vaccine can be exported at any one time, and it appears that India is moving in the same direction as the European Union, which is moving to contain exports .

Adar Poonawalla, the chief executive of the Serum Institute and a descendant of the billionaire family that runs the company, finds himself in a highly uncomfortable situation. The Serum Institute has a reputable interest in keeping its word to its foreign customers and AstraZeneca, and to fulfill the contracts it has signed.

But Poonawalla was careful not to say anything negative about Modi or about the pressure that Modi’s government is putting on him. Instead, he asked for patience.

“The Serum Institute of India was designed to prioritize India’s enormous needs and, in conjunction with that, balance the needs of the rest of the world,” Mr. Poonawalla tweeted in late February. “We are trying our best.”

The Serum Institute, based on a large campus in the city of Pune, has agreed to supply vaccines to low- and middle-income countries, according to an agreement it signed last year with AstraZeneca, the pharmaceutical giant that teamed up with scientists from Oxford who developed his vaccine.

Production problems at other AstraZeneca facilities in Belgium and the Netherlands have led wealthier countries such as Canada, Saudi Arabia and Great Britain to depend on doses from the Serum Institute as well, making the company even more critical to the global vaccine supply chain of the vaccine. AstraZeneca.

So far, India has still exported more doses of vaccines than it has given to its own people, unlike the United States, Britain and European Union member countries.

India – with a population over the entire African continent and hundreds of millions of people living below the poverty line – is completely dependent on its own vaccine supply, unlike many other countries that have purchased vaccines from different suppliers around the world . The country produces a second Covid-19 vaccine developed by Bharat Biotech, an Indian company, although the global demand for this vaccine is much less than the demand for the AstraZeneca vaccine.

But since many poorer countries are unlikely to have broad access to vaccines until 2023 or 2024, a prolonged suspension of exports from India could further delay those dates, said Olivier Wouters, professor of health policy at the London School of Economics who has been studying the global vaccine supply chain.

With the spread of new variants, he said, it is in the interest of all countries to work together to vaccinate the world.

“Many countries around the world, the poorest in particular, are counting on India,” said Wouters. “Vaccine nationalism hurts us all.”

Nepal, one of the poorest countries in Asia and neighboring India, had to halt its vaccination campaign. It relied heavily on doses of the AstraZeneca vaccine manufactured at the Serum Institute, but with its national stock dwindling, Nepal stopped administering vaccines on 17 March.

Dr Jhalak Sharma, head of the immunization department at Nepal’s health ministry, said the country had received a donation of one million doses from the Indian government and had already paid 80 percent of the price for the next two million, but that did not seem have made a difference.

“We were unable to get the vaccine in time,” said Sharma.

Restrictions on exports from India, he added, “will affect us and the world.”

Britain is in a similar situation. He received five million doses from the Serum Institute several weeks ago, but is expecting weeks for another five million.

One of Prime Minister Boris Johnson’s top advisers, Eddie Lister, made a trip to India this week to try to secure supplies promised by Britain, officials said. Johnson is due to visit India next month, and some diplomats here have referred to his trip as a high-profile mission to secure millions more doses.

At the same time, the Serum Institute has told Morocco, Brazil and Saudi Arabia that they expect delays in shipments, according to Reuters. Morocco is now struggling to secure more of the Russian Sputnik V vaccine or obtain doses from other sources, Moroccan media reported.

The Serum Institute’s manufacturing capacity has always been central to a plan to bring vaccines to the poor. A spokesman for AstraZeneca did not reveal exactly what percentage of the global supply of its vaccine Serum makes, but a recent statement by AstraZeneca called the contribution “substantial”. Serum has pledged to produce about a third of the total 3 billion doses that AstraZeneca has said it will produce by the end of 2021, although meeting that deadline seems increasingly unlikely.

The alliance between Serum, which started out as a ranch that manufactured horse serum, and Oxford-AstraZeneca resulted in the cheapest Covid-19 vaccine in the world: only $ 2. Vaccines developed by Pfizer and Moderna, by comparison , cost much more and require extreme cold storage, adding to the difficulty.

Serum is also playing an important role in the Covax program for the poorest nations. World Health Organization documents show that the Indian company’s expectation was to contribute 240 million doses by the end of June.

But data from India’s Ministry of Foreign Affairs and Covax’s Thursday statement indicate that vaccines around the world are likely to suffer further delays.

The Serum Institute has provided Covax with 28 million doses so far, according to the international program. India’s Ministry of Foreign Affairs showed that 18 million doses were sent abroad under Covax, suggesting that about 10 million doses of domestic vaccination from India also came from the program, which lists India as eligible for participation.

In contrast, about 34 million doses were provided in trade deals and about 8 million donated by the Indian government as part of its vaccine diplomacy.

On April 1, India will expand eligibility and allow anyone aged 45 and over to receive a vaccine.

“It’s a fluid situation,” said K. Srinath Reddy, a nonprofit health policy expert at the Public Health Foundation of India. “But at the moment, given the fact that vaccine supply and Covid’s situation are dynamic, I think it is appropriate for the government of India to pause and say, ‘We will hold stocks.'”

Benjamin Mueller contributed from London, Bhadra Sharma from Kathmandu, Nepal, and Aida Alami from Rabat, Morocco.