India hit another grim milestone Saturday with the daily new Covid-19 cases topping 400,000 as the central government officially opened up its vaccination drive to all adults, a promise that several states were unable to fulfil due to shortages in the world’s largest producer of vaccines.
Authorities reported 401,993 new cases in the past 24 hours, the world’s highest daily count since the pandemic started. Deaths from Covid-19 jumped by 3,523, taking the total toll in India to 211,853, according to federal health ministry data. Experts, however, say the real figure is very likely to be much higher.
The country’s vaccination drive on Saturday was extended to all adults above the age of 18, making around 600 million people eligible for the jab, even though many states said they have insufficient stocks to do so.
In the capital, New Delhi, that has experienced the worst of the second surge coupled with the collapse of the public health system, there was further confusion by the government’s decision to ask states and private hospitals to order vaccine supplies on their own.
“We have contacted Serum Institute of India that has said they will be able to provide doses only after six months,” DS Rana, chair of the leading Sir Ganga Ram Hospital in Delhi, told the Hindustan Times.
Meanwhile in the western state of Gujarat, a fire broke out in the Covid-19 ward of a hospital, killing 18 people.
Thirty-one other patients at the Welfare Hospital in Bharuch were rescued by hospital workers and firefighters and their condition was stable, said a police officer.
Indian Prime Minister Narendra Modi, a former Gujarat chief minister, said in a tweet he was “pained by the loss of lives due to a fire at a hospital in Bharuch”.
Pained by the loss of lives due to a fire at a hospital in Bharuch. Condolences to the bereaved families.
— Narendra Modi (@narendramodi) May 1, 2021
India’s healthcare system is struggling to cope with the coronavirus crisis, which has infected more than 19 million people.
‘No logic’ in vaccination plan
India’s vaccine programme has also been hit by a shortage of critical supplies — the result of lagging manufacturing and raw material shortages that delayed the rollout in several states. And even in places where the shots were in stock, the country’s wide economic disparities made access to the vaccine inconsistent.
Only a fraction of India’s population will be able to afford the prices charged by private hospitals for the shot, experts said, meaning that states will be saddled with immunising the 600 million Indian adults younger than 45, while the federal government gives shots to 300 million health care and front-line workers and people older than 45.
So far, government vaccines have been free, and private hospitals have been permitted to sell shots at a price capped at 250 rupees, or around $3 (€2.5). That practice will now change: Prices for state governments and private hospitals will be determined by vaccine companies. Some states might not be able to provide vaccines for free since they are paying twice as much as the federal government for the same shot, and prices at private hospitals could rise.
Since state governments and private players compete for shots in the same marketplace, and states pay less for the doses, vaccine makers can reap more profit by selling to the private sector, said Chandrakant Lahariya, a health policy expert. That cost can then be passed on to people receiving the shots, increasing inequity.
“There is no logic that two different governments should be paying two prices,” he said.
Less than 2 percent fully immunised
Concerns that pricing issues could deepen inequities are only the most recent hitch in India’s sluggish immunisation efforts. Less than 2 percent of the population has been fully immunised against Covid-19 and around 10 percent has received a single dose. Immunisation rates have also fallen. The average number of shots per day dipped from over 3.6 million in early April to less than 2.5 million right now.
In the worst-hit state of Maharashtra, the health minister promised free vaccines for those ages 18 to 44, but he also acknowledged that the shortage of doses meant immunisation would not start as planned on Saturday. States say the paucity of shots is one reason why immunisations have declined.
India thought the worst was over when cases ebbed in September. But mass gatherings such as political rallies and religious events were allowed to continue, and relaxed attitudes on the risks fuelled a major humanitarian crisis, according to health experts. New variants of the coronavirus have partly led the surge. Deaths officially surpassed 200,000 this week, and the true death toll is believed to be far higher.
The country’s shortage of shots has global implications because, in addition to its own inoculation efforts, India has promised to ship vaccines abroad as part of a United Nations vaccine-sharing program that is dependent on its supply.
Indian vaccine makers produce an estimated 70 million doses each month of the two approved shots — the AstraZeneca vaccine made by the Serum Institute of India and another one made by Bharat Biotech.
The federal government is buying half of those vaccines to give to states. The remaining half can then be bought by states and private hospitals to be given to anyone over 18, but at prices set by the companies.
The federal government is buying shots at 150 rupees each, or $2. The Serum Institute will sell the shots to states at 300 rupees each, or $4, and to private players at 600 rupees each, or $8. Bharat Biotech said it will charge states 400 rupees, or less than $5.50 for a shot, and private players 1,200 rupees, or more than $16.
By comparison, the European Union paid $2.15 per dose for the AstraZeneca vaccine. The company says that price is discounted because the EU contributed to the vaccine’s development.
The strain is mounting on the Serum Institute, which in addition to being India’s main supplier is also a critical supplier of the UN-backed initiative known as COVAX, which more than 90 countries are depending on. The institute paused exports in March.
“The urgent demand for vaccines in India is bad for the rest of the world,” said Ravi Gupta, a professor of clinical microbiology at Cambridge University in the UK.
Mass vaccination could worsen surge
Some experts warned that conducting a massive inoculation effort now could worsen the surge in a country that is second only to the United States in its number of infections — more than 19.1 million.
“There’s ample evidence that having people wait in a long, crowded, disorderly queue could itself be a source of infection,” said Dr Bharat Pankhania, a senior clinical lecturer specialising in infectious diseases at Britain’s University of Exeter. He urged India to first stop the circulation of the virus by imposing “a long, sustained, strictly enforced lockdown”.
Pankhania cautioned that immunisation efforts alone would not help immediately stem the current spike of Covid-19, since shots “only start to bear fruit in about three months’ time.” Vaccination would help prevent future waves of infection, he said.
India is also importing shots from the Russian makers of Sputnik V. The first batch was due to arrive Saturday. Another 125 million doses of Sputnik V will be distributed by an Indian pharmaceutical company later this year.
Given the urgent need for vaccines, some experts said rationing available doses is critical.
“Vaccines need to be delivered to the areas with the most intense transmission,” Gupta said, explaining that vaccines should be used as “emergency control measures” in specific regions of India rather than offering doses to all adults across the subcontinent.
Pankhania said the widely seen images of Indian virus patients gasping for air and smoke billowing from makeshift funeral pyres should spur rich countries to share their vaccines more freely. He criticised the approach taken by many Western countries that are attempting to vaccinate all citizens, including younger people at low risk, before sharing any doses.
“It is better globally to immunise all the (vulnerable) people that need to be protected rather than to immunise entire populations in only some countries,” Pankhania said.
(FRANCE 24 with AFP, AP and REUTERS)