We Are Out Of Vaccine Panic Mode; Pfizer, Moderna Can’t Dictate Terms Any More

In many ways, despite some missteps and bungling in placing adequate orders for vaccines earlier this year, the Narendra Modi government has achieved one major objective: it has ensured that the global vaccine suppliers, Pfizer and Moderna among them, are in no position to blackmail us.

With the vaccine pipeline now rapidly scaling up, the government has told Pfizer and Moderna that it will buy from them only at a special price. And it may offer them a limited form of indemnity from legal cases if the vaccines result in adverse outcomes with some recipients.

The fact is this indemnity cannot be given only to Pfizer and Moderna; it will have to be given to all Indian manufacturers too. So, the government has time on its hands to negotiate a sensible form of indemnity with the foreign and domestic players.

We had a vaccine drought in April and May, and there will still be a gap between supply and demand at least till July end. But after that it will be relatively smooth sailing.

Around mid-May, the government announced that it was expecting vaccine supplies to touch 216-220 crore (enough for two doses for every adult in this country) by December, but even if we achieve only three-quarters of that projection, we will be sitting pretty.

We can pick and choose who we buy from, and also focus attention on procuring vaccines for teens and younger children, who may become more vulnerable as adults develop herd immunity. The focus of procurement must be on vaccines for children to protect them during wave three.

As things stand, government has already placed orders for 440 million doses with Serum Institute (250 million) and Bharat Biotech (190 million), and another 300 million doses with Biological E, which adds up to advance orders for 740 million doses — enough to vaccinate 350+ million adults comfortably, even accounting for some wastage.

These orders could go up as the year proceeds, and do not include the doses that may be made available from Sputnik V (156 million), Novavax (200 million), and the Zydus Cadila DNA vaccine (50 million). More may be in the pipeline as we move towards the third quarter of this financial year.

However, here’s the point: it is not reasonable to assume that all adults will indeed want a jab, given the residual amount of vaccine hesitancy among many groups of people, and also in some religious communities.

As in the middle of April, barely 37 per cent of healthcare and frontline workers had received both jabs despite being prioritised for the vaccine. It is difficult to know how much is because of the subsequent vaccine shortage, and how much due to vaccine hesitancy.

The numbers would surely have gone up by now, but one can be certain that it will never get to 100 per cent. Punjab and Andhra Pradesh seem to be laggards among healthcare workers.

Now consider some numbers, including guesstimates.

One, as at the end of 8 June, as against registrations of 271 million adults on the Co-win app, 235 million jabs have been given, 189 the first dose, and another 45 million the second, too. The gap between registrations and jabs is barely 36 million now, though this could be a function of the presumed shortage and long waits for jabs.

Even if registrations, both online and offline, accelerate, one has to ask how many more will seek the jab by December without lots of propaganda and push from governments.

Two, the current officially recognised confirmed Covid cases is just a bit shy of 29 million. Assuming three times as many did not report the infection, we already have nearly 120 million people with immunity for this year. They have been advised to wait a while before going for the jab.

Three, if we assume that vaccinations during the monsoons will slow down in some states, and if we additionally assume that vaccine hesitancy will be relatively high in the rural hinterland of the poorer states (like Uttar Pradesh, Bihar, Jharkhand, Rajasthan and Odisha), our actual jab requirements will be much lower than the 2.2 billion we have pencilled into the supply equation.

Four, if we assume that all those given one jab (189 million) will get their second doses by July end, we are talking of nearly 300 million people already immune by August (ie, adding those with two doses, and those who have already got Covid, maybe another 120 million).

Add an unknown number of vaccine 'avoidees', and it is doubtful if we are going to need more than 1.2 billion doses between August and December. Pfizer and Moderna are not going to get any special treatment. Their best bet would be to get off their high horses and offer the vaccine at a decent price so that at least the rich in India, who like anything “phoren”, can take them at hospitals instead of flying to Dubai to get them.

The government has been hauled over the coals for its own vaccine procurement hesitancy, but this delay has put it in a strong position to avoid being blackmailed by vaccine makers, both domestic and foreign.

In the third quarter, vaccine supplies may exceed demand, and we should be in a position to export by early January 2022. But a caveat: this time we should maintain an adequate stockpile and orders in the pipeline to rapidly scale up vaccinations, especially for children, if we get a third wave. We are back on track.