COVID Vaccine Equity: Where Does India Stand And How Can We Tackle Global Inequity Amid Rising Coronavirus Cases

New Delhi: “The best way to end the COVID-19 pandemic, stop future variants and save lives is to limit the spread of the virus by vaccinating quickly and equitably, starting with health workers”, tweeted the World Health Organisation on April 2, urging people to support vaccine equity. In January 2021, WHO issued a call to all countries to work together in solidarity to ensure that within the first 100 days of the year 2021, vaccination of health workers and older people is underway in all countries. This call to action is at the heart of the WHO’s campaign for vaccine equity – equal distribution of vaccines worldwide.

Also Read: COVID-19 Pandemic Long Way From Over, Virus And Its Variants Can Be Stopped: WHO Chief

In a video shared by WHO, Dr Mariângela Simao, Assistant Director-General, WHO Access to medicines and health products explained that to end the acute phase of the COVID-19 pandemic, it’s important to ensure vaccines reach every country. She added,

We need to have access to vaccines in all countries reaching health care workers because without health care workers, you don’t have health care. And this is extremely important. And also to prevent people from dying. We have known for some time that some people are at higher risk of dying if they acquire this new coronavirus. And we are talking about people over 65 and also people who have co-morbidities, which means have associated diseases.

Vaccine Inequity And COVAX Initiative

On April 14, speaking at a panel focused on the World Trade Organisation’s role in vaccine equity, Dr Tedros Adhanom Ghebreyesus, WHO Director-General addressed the issue of existing vaccine inequity and said,

More than 800 million vaccine doses have been administered globally, but over 83 per cent have gone to high income or upper middle-income countries, while low income countries have received just 0.2 per cent.

Also Read: Public Health And Social Measures Remain The Key To Stop Coronavirus Transmission: WHO South-East Asia Region

To bridge this gap and ensure everyone in the world has access to COVID vaccines, in April 2020, the WHO, Gavi Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations (CEPI) had launched COVAX. The COVAX initiative aims to accelerate the development and manufacture of COVID-19 vaccines, and to guarantee fair and equitable access for every country in the world. COVAX’s aim is to procure and deliver 2 billion doses of vaccines to 190 countries by the end of 2021.

As of April 14, COVAX has delivered almost 40 million doses to 110 countries, supplied by three manufacturers, AstraZeneca, Pfizer-BioNTech and the Serum Institute of India (SII). Of the over 100 economies reached, 61 are among the 92 lower-income economies receiving vaccines funded through the Gavi COVAX Advance Market Commitment (AMC).

COVAX had been expecting to distribute almost 100 million doses by the end of March, but due to a marked reduction in supply, only 38 million doses have been distributed. In March, Gavi had reported of delay in delivery for vaccines from SII and AstraZeneca.

The Serum Institute of India (SII), the world’s largest vaccine maker by the number of doses produced produces 60 to 65 million doses of Covishield per month presently against the target of 100-110 million doses. SII has so far given around 100 million doses to the centre and exported 60 million.

Also Read: WHO Issues Five Calls For Urgent Action To Combat Global Inequity In Health

Impact Of Lack Of Access To Medicines, Treatments To Vaccines Around The World On The Fight Against COVID-19

WHO’s Dr Mariângela Simao said that the discussion on equity in healthcare is an old one and the COVID-19 pandemic has just made what was bad, worse. She added,

We are seeing huge inequities in access to health care in many, many countries, within countries and across the world. And we are seeing the problems that were chronic in some countries, like the oxygen provision to patients with pneumonia, for example, have become much more acute right now because of the issues with the number of cases increasing so much. We also see that we know more than we knew one year ago on clinical care. And we see that medications that are not under patent or anything that are actually quite cheap may not be available in some countries. And they make a difference when you have a severe case of COVID-19.

Also Read: Universal Health Coverage In India Is Still A Long Way To Go, Say Experts

Second Wave Of COVID-19 In India, Vaccine Shortage And Variants

India has supplied more COVID-19 vaccines globally than vaccinated its own people, the country had told the UN General Assembly earlier in March but the reports state that there is a vaccine shortage within the country. States including Maharashtra, Rajasthan, Delhi, Odisha, Andhra Pradesh, Jharkhand and others have flagged vaccine shortage.

In an interview with NDTV, Adar Poonawalla, CEO, SII informed of production capacity being ‘very stressed’ and unable to meet the requirements of every Indian. Mr Poonawalla said that even if SII could increase its capacity to around 100 million doses per month, India needed other manufacturers to also scale up in order to meet requirements.

With the rise in COVID-19 and cases of reinfection in India, the country has decided to prioritise inoculation of its own population but has not banned commercial export yet.

Talking about why India is facing a vaccine shortage, AIIMS Director Dr Randeep Guleria said, it’s possibly the issue of distribution and the surge in demand of COVID-19 vaccine in certain areas. He added,

In certain states, because of the surge in cases, there is a sudden increase in people wanting to get themselves vaccinated. It’s a good sign. We need to adjust our vaccine distribution.

Also Read: Equitable Access To COVID-19 Vaccine Critically Important To Fight Pandemic, India’s ‘Vaccine Maitri’ Trying To Ensure Access To All: External Affairs Minister

The experts are calling to contain the spread of the coronavirus so to curtail the emergence of new variants some of which may make the vaccine less effective. As per Dr Guleria, the current COVID vaccines in India are effective against three main variants circulating in India – UK, Brazilian and South African. A double mutant has also been identified in India.

Currently, the data suggests that the vaccine efficacy may come down to some extent but they may still be effective as far as severe disease or mortality is concerned. Having said that, I think there is a need for scientists to really start working on sequencing the variants as they emerge not only internationally but even in our country and see the variants – that are emerging and will emerge – going to really decrease the efficacy of the vaccine and do we need to tweak the subsequent vaccines to cover for the variants, said Dr Guleria.

Also Read: The Scare Of Coronavirus Continues: Grim Milestones Of Covid Pandemic India Crossed Recently

How To Tackle Global Vaccine Inequity

To understand the vaccine inequity and vaccines not reaching poorer nations, NDTV’s Dr Prannoy Roy spoke to Professor Paul Milgrom, Winner, Nobel Prize 2020 and Professor Michael Kremer, Winner Nobel Prize 2019. Talking about rich countries getting more than their fair share of vaccines, while over 100 countries await vaccines, Professor Milgrom said,

The need to invest in plants to produce these vaccines, there’s got to be a return to that. And the rich countries are naturally going to gain some advantage from that, but the poor countries are just, right now, I think everybody, it seems so unfair the way the poor countries are getting much too little. So, exactly how we can maintain the incentives for the rich countries to invest in the production facilities and the research we need, and yet to treat people around the world fairly, there’s a real tension there that needs to be resolved. And, this is not the last pandemic, and we need to be thinking about how we’re going to do this in the future.

Also Read: Do You Still Need Both Doses If You Have Already Had The Infection? WHO Expert Answers COVID-19 Vaccination FAQs

Further talking about a global inequality in the distribution of vaccines and what can be done to rectify this inequity Professor Kremer says increasing the capacity can promote equity. Explaining the same through a pipe analogy and the wait analogy, Professor Kremer said,

Imagine it’s going to take with the existing pipe, the existing supply, it’s going to take two years to vaccinate everyone in the world. Now imagine we could reduce that to one year, if we put in more capacity. Well, for the people who are last in the queue, you’ve just reduced the wait by one year. For the person who is first in the queue, well then, you’re only reducing the wait by half a day or something like that. So, increasing more capacity is itself something that promotes equity. I think that’s something that hasn’t been properly appreciated.

Though WHO is working towards providing vaccines to poorer nations under the COVAX, what is needed is the country’s preparedness to accept these vaccines as many countries in the world have no experience in vaccinating adults. Dr Simao said,

In children, it’s more on the routine, countries know how to do that, but how to bring adults to the health care and how to reach out to adults and also how to guarantee because, you know, we are talking mostly about two-dose vaccines, that they will come back to receive their second dose. So, there’s a lot of preparation and many countries are responding very proactively to this.

Also Read: COVID-19: Vaccines May Need Regular Updates As Coronavirus Evolves, Say Scientists

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.