Vaccine Economy: Random Shots

The more time we spend as a country dealing with the coronavirus pandemic the less smart we end up looking. Even after a year of combatting the deadly virus, we have yet to get our act together, the official response to the challenges thrown up by the deadly second wave has thus far been somewhat ad hoc and lacking in planning, if not outright tardy.

The piecemeal official reaction has been evident at every stage of the crisis during the second wave. As the creaky public health infrastructure reeled under a severe shortage of hospital beds, oxygen and medicines, as well as lack of patient management, the official machinery most of the time in most parts of the country, were left looking clueless as the death toll soared and the bodies of corona victims filled the wards and corridors of hospitals and even spilled out on streets.

Similarly, India’s vaccination strategy has lacked consistency. Even as record daily new Covid cases and casualties in April and May made India the epicenter of the pandemic, the only way to stem the tide was by speeding up the vaccination drive and increasing the coverage. The official response to this was tardy and smacked of panic in the face of rising new cases and soaring deaths. The government, in a swift move, threw open the vaccination drive to 60 crore adults by extending it to the 18-plus cohort group, without ensuring the requisite supply of vaccine doses. Until then, the government had procured all the vaccine doses and shared them with the states for free vaccination of people. It now put the onus of procuring the vaccine partially on the states, and that too at price points that would be exorbitant and put pressure on state finances.

All this had exactly the opposite effect. Instead of actually speeding up the vaccination drive, the official response ended up slowing it down in the absence of availability and supply of requisite vaccine doses.

In fact, vaccine distribution and pricing has become a major issue of contention of late. For a smooth and speedy vaccination drive, a central body should have taken up the monitoring of these two aspects. Sandeep Nayar, Senior Director & HOD, Chest & Respiratory Diseases, BLK-MAX Super Speciality Hospital says that while healthcare is a state subject but during a pandemic such a division between the states and the Centre doesn’t make sense. “A central body would have been better for monitoring and distributing vaccine. In fact, that might have helped curb wastage of the vaccine to some extent also,” he says.

Nayar also feels that the vaccine should be administered free of cost to all citizens of the country as the majority of Indians are poor and can ill-afford the vaccine shots.

While we grapple with all this, a new twist in the tale seems to be black fungus, which has been declared a notifiable disease following a directive by the central government in view of the massive increase in cases across the country. By making it a notifiable disease, hospitals across the country will be required (by law) to report all cases. Like in the case of key antiCovid medications like Remdesivir and Fabiflu that most people could find only on the black market and at exorbitant rates, the drug used to treat black fungus too has reportedly vanished from pharmacies. However, the government is working to procure medication to treat this deadly disease that has a mortality of over 50 per cent.

Interestingly, while there has been a massive rise in cases of black fungus in India recently, it isn’t so in other countries. Apparently, this is being correlated with the environment, hygiene and the treatment being given. Overuse of steroids and oxygen cylinders and ventilators not being cleaned/disinfected appropriately are some of the culprits.

Says Archana Chatterjee, Dean, Chicago Medical School & Vice President for Medical Affairs, Rosalind Franklin University, United States, “It is an ‘opportunistic pathogen’, which means that it takes hold in patients who have certain risk factors. One of these is diabetes, which is very common in India. Antibiotic use kills many of the normal bacteria that prevent the overgrowth of opportunistic pathogens. Even though they have been shown to be ineffective, many Covid patients in India are still being treated with antibiotics. This practice should be discontinued unless there is a specific indication for antibiotics to treat an identified or suspected bacterial infection.”

These issues continue to plague us because we do not have the right data and have not invested in research. We had one year between the last spike and the one that took place in April-May to get our act together - data should have been collected about the number of deaths, the cause of death and the response to the treatment being given. “While this is an evolving disease and we are doing our best, the sad fact remains that healthcare has never been a priority for any government in our country thus far. Data is not being collected and there is hardly any research being carried out. This pandemic we hope will be a wakeup call,” says Nayar. He further stresses that if post-mortem on all Covid related deaths is not possible, at least those deaths that are occurring after being given two doses of the vaccine should be investigated and studied.

The Cure The vaccine is being looked at as the only saviour. There have been reports of people catching the infection and subsequently passing away despite taking the twin shots of the vaccine. This has led people to question the efficacy of the vaccine — it was always understood that the vaccine was no cure but rather a shield that would reduce the impact of the disease. And this also underscores the urgency of getting the population vaccinated before the next mutation takes hold.

Currently in India, 20.06 crore people have been vaccinated (as of 26th May). Of these, 15,71,49,593 have received the first dose while 4,35,12,863 have been administered the second dose.

In the budget presentation in February, Finance Minister, Nirmala Sitharaman set aside Rs 35,000 crore for the production and distribution of the Covid-19 vaccine. In April, the central government approved a grant of Rs 45.67 billion to help both Covishield and Covaxin manufacturers boost their production capacity.

In an earlier interaction with BW Businessworld, Serum Institute’s chief Adar Poonawalla had stated, ‘We have invested our own funds to the tune of about $250 to $300 million. And we have raised another $450 million from the Gates Foundation, Gavi and also other countries (that gave advance payments). So, the whole project is worth about $800 million for four different vaccines, not just one vaccine.”

In a statement in May, Poonawala disclosed that they had been contracted to make 26 crore doses so far, of which they had supplied more than 15 crore doses, and the remaining 11 crore doses would be ready in the next few months.

Bharat Biotech, the producer of Covaxin, too has implemented capacity expansion across multiple facilities in Hyderabad, Bangalore and even Gujarat, to ramp up production to 1 billion doses per year.

In addition to Covishield (Serum Institute) and Covaxin, we now have the Russian Sputnik V available in India. Made by the Gamaleya Research Institute of Epidemiology and Microbiology, the vaccine has been reported to have an efficacy of 91 per cent. It is being distributed in India by Dr Reddy’s. In September last year, Dr Reddy’s partnered with the Russian Direct Investment Fund (RDIF) to conduct clinical trials of Sputnik V and for its distribution rights in India. The imported doses are available at Rs 995 a dose at the moment, the price might see a dip once local manufacturing of the vaccine begins. Covaxin, the indigenous vaccine being produced by Bharat Biotech is available to private hospitals at Rs 1200 a dose and to states at Rs 400 a dose. Covishield is the cheapest at Rs 600 per dose to private hospitals and Rs 300 for a dose to states.

Additionally, there is the anti-Covid drug 2-DG or 2-deoxy-D-glucose, developed by the Defence Research and Development Organisation (DRDO) in collaboration with Dr Reddy’s Laboratories, which has received approval from the Drugs Controller General of India’s (DCGI) recently. Clinical trials of this drug have shown that it helps in the faster recovery of hospitalized patients and reduces supplemental oxygen dependence.

But this drug too is not without controversy and highlights the government’s shoddy approach to all measures related to the pandemic. Critics have raised concern over the fact that the study group for the clinical trials of 2-DG were not an adequate number as well as the efficacy of the drug. “This drug inhibits the metabolism of glucose, it was developed for cancer. Cancer cells have a higher metabolism and divide faster than normal cells. Stopping glucose metabolism affects cancer cells more since they have more glucose needs. This is not the case with SARS-Cov2.

It will kill not only the virus but also the body’s normal cells. It will be like the old saying, the operation was successful, but the patient died,” says Ketan Desai, Founder & CEO of IMC Radiology, Founder & CMO, LeVolta Pharma USA.

Global sentiment

It is only when a significant part of the global population is vaccinated that the virus will lose some of its stings. India had started exporting vaccines to its neighbours, but the second wave put the brakes on it as the country needed to take care of matters at home first. In fact, when the second wave came about, the United States was asked to donate spare vaccines to India. The need of the hour is to send vaccines to countries that are running out of supply – reports coming in from Africa suggest they are running out of vaccine supplies. The World Health Organisation is working to supply vaccines to the region through its COVAX programme.

So far, more than 38 million doses of vaccines from manufacturers such as AstraZeneca, Pfizer-BioNTech and Serum Institute of India have been delivered. The COVAX programme urgently needs 20 million doses during the second quarter of 2021 to cover interruptions in supply triggered by increased demands for vaccines in India where COVAX’s main supplier of the AstraZeneca product is based.

Sweden recently announced that it would share 1 million doses of the AstraZeneca vaccine with COVAX. Lauding this, WHO Director General Tedros Adhanom Ghebreyesus said, “Such support will ensure that people in vulnerable countries, especially, in Africa, will be able to receive their second doses through the COVAX initiative. Sweden’s generous support is very timely as it comes at a time when the world needs it most.”

Ensuring equitable access to Covid-19 vaccines is the only way to reduce the economic impact caused by the pandemic. According to a report by the Bill & Melinda Gates Foundation and the Eurasia Group, ensuring equitable access to Covid19 vaccines would benefit not just the global economy but would help the world’s ten major economies significantly, giving them a boost of $466 billion by 2025.

The future

It was reported recently that a Dubai-based travel agency has launched a package for Rs 1.3 lakh for people to go to Russia for 20 days and get the two Sputnik V jabs. The idea of vaccine tourism was brought up sometime back as well, when the United States and the United Kingdom had approved vaccines while India was yet to do so. The reality of this depends on the availability of vaccines for foreigners in these countries and the status of flights to and from such countries. Most countries are first trying to get their own citizens vaccinated and are not allowing flights from countries where the infection rate is high. Vaccine tourism will probably come into play once every country has vaccinated their citizens, most likely for foreigners who would like to travel to get their booster shots.

While vaccine tourism will take some time to truly become a reality, vaccine passports for international travel will be a reality very soon. Taking this a step ahead, the United Kingdom is debating the use of a domestic vaccine passport where it is used for events and gatherings. This could actually be a good idea if infection spread is to be curtailed and the economy is to be healed.