The UK-India Vaccine Spat: When New India Meets The Old World

Recently, a diplomatic spat has ensued between India and the United Kingdom. It centers upon a COVID-19 vaccination status-checking programme for visitors released by the British government in mid-September. The rules govern unvaccinated, partially vaccinated and fully vaccinated travelers. This article focuses on the latter.

These guidelines are a bureaucrat’s dream. It divides the handling of vaccinations by country, by vaccine type and even by formulation and manufacturer. It then proceeds to define what permutations of vaccine type, formulation and certifying nation are acceptable. Let us overview these.

Vaccine vs Vaccine

While there are 22 vaccines that have received EUAs in at least one country, the British policy recognizes only four - Oxford/AstraZeneca, Pfizer BioNTech, Moderna or Janssen. No scientific reason is offered for this choice.

Cumulative J&J/Janssen production has stalled at 45 million doses to date, less than the number of doses India vaccinates in a typical week. The Biden White House wrote off Johnson&Johnson as an option back in April, due to a string of production problems. Incremental use of this vaccine in both the US and EU are currently negligible.

Selectively approving vaccines has no scientific basis, when each and every one of them has to go through multiphase approval trials.

Manufacturer vs Manufacturer / Formulation vs Formulation

The original policy only approved formulations produced in the UK, EU and US. This meant that Astra-Zeneca in the UK (brand name Vaxzevria) was approved but the production in India (Covishield) was not. This has the same scientific foundation as asserting that paracetamol in Bangalore will not work but one in Birmingham will. The UK imports paracetamol from India.

India currently exports $25 billion worth of generic pharmaceuticals. In any given year, the UK is the second or third biggest importer of Indian made pharmaceuticals. The UK was the recipient worth $280 million between Apr-Aug 2021, $610 million in FY 2020-21 (ended March 2021), $446 million in FY2019-20 and $524 million in FY2018-19, as per data from the Commerce Ministry FTPA database. Drug exports to the US for the trailing three fiscals read $7.3 billion, $6.25 billion and $5.2 billion.

Despite this, the UK proceeded to first decline Covishield - which is not even a generic variant, but the AZ vaccine contract made - then did an about face and changed its mind. All of this makes one wonder how they deal with someone in the UK who received Covishield when the UK had manufacturing problems in April (UK to import vaccine doses from India amid global jabs race).

It’s not clear how the processes work. Let’s say there are 190 countries, 25 approved vaccines, each with 3 manufacturing sites. Their own rules compel them to navigate 190*25*3 = 14,250 possible permutations for each and every visitor. To ‘simplify’ this, they use red-amber-green lists and various other ad hoc choices.

This is a carryover of the WHO EUL controversies where prequalification isn’t just by vaccine but by manufacturer/formulation, as the latest WHO EUL status document shows. As with the British rules, the WHO processes are a case of bureaucrats running amuck - tortuous months long ‘reviews’ after a vaccine has both cleared phase 3 and been administered under EUA - effectively the Phase 4 - more than 100 million times, as is the case with Covaxin.

Certification vs Certification

This is perhaps the most controversial part of the diplomatic spat. Alex Ellis, the UK High Commissioner in India, waded in with the assertion that the problem lay with the CoWin platform and that efforts were underway to resolve it, as detailed in another great article here.

This is curious. The UK guidelines approve US proof of vaccinations. They are paper cards with the name, date of birth, vaccine name, batch and date of dose handwritten. Sometimes the batch number is pasted. There is no security feature or anti-forgery protection, and fakes are rampant. The data cannot be verified in real time due to US data/health privacy laws. Some US states have a digital certificate. Only two states require their use. Nearly half explicitly ban their use.

The UK also approves Australian proof of vaccinations. These are digital but easily forged for a going sum of A$270 (Rs.15,000). They have no QR code based system like CoWin does.

Mr Ellis proceeded to expand upon his disastrous interview with NDTV with exercise at false equivalence between British and Indian quarantine rules. India is not singling out the UK - not even in the MoHFW guidance that Ellis quotes. Part B(xv) imposes a quarantine of those traveling through the sources of variants Alpha, Beta and Gamma. All three remain official Variants of Concern (VOCs) according to the WHO. The newest two variants - lambda and mu - are still only Variants of Interest (VOIs).

It does not look good on a diplomat to get into disputes on social media when they clearly are misinformed. A diplomat is not an equal participant in any such conversation - their job description literally requires them to present a particular view on behalf of their government, and it is inadvisable to editorialize - again because it’s a clear part of their job description to not publicly insert their foot in their mouth.

For the head diplomat to pick arguments online with private citizens of the host nation, especially well known journalists, reflects poorly on their own professionalism. It would be interesting to see if British diplomats in DC, Beijing or Moscow do this - do they pick fights on Weibo for example ?

Meanwhile, the UK has ditched plans to use their own NHS app - among other options - as an internal vaccine passport (BBC: England vaccine passport plans ditched, Sajid Javid says). To summarise, the UK will:

-Accept paper certificates from some, unreliable non-QR based digital options from others, but not a QR-based digital platform from India.

-It will not accept its own app as an internal vaccine certificate, despite being in discussions with India to ensure CoWin’s interoperability with it.

It’s quite easy to feel offended at all this. ‘Racism’, ‘discrimination’, assorted other words have been used. Viewed in unemotional terms, a racist would love to manipulate their victim. Act arbitrarily. Force an emotional reaction. Offer a small sop. The victim sees some justice done and sees the offender as some sort of benefactor who has turned a new leaf, or has been compelled to repudiate their actions.

It’s true that the British establishment continues to carry a paternalistic view of India. It is unlikely to change soon. But such an emotional response is unwarranted, if one looks clinically back at the UK. A popular phrase goes “don’t ascribe to malice what can be adequately explained by incompetence”. A corollary to this is “when someone demonstrates so much incompetence, it reflects rather poorly on their attempt at maliciousness”.

JAM : The Vast Ecosystem In Which CoWin Sits

The British view of CoWin sees it as some sort of sketchy vanity project pushed by someone whom they characterise as a sort of despot. The reality is quite far removed. CoWin is a small cog that fits into the world’s biggest ID/fintech ecosystem - the JAM project.

This vast authentication, identification and transaction platform connects over 1.25 billion Aadhaar IDs, 800 million smartphones, 440 million Jan Dhan bank accounts, well over 600 million RuPay cards and more. Aadhaar IDs connect to voter ID, ration and subsidy accounts, and more.

The Indian digital Unified Payments Interface is by far the world’s biggest real time ID and payment platform. It reported 36 billion digital transactions in the prior 12 months to September, almost 20 billion more than 2nd-placed China and over a third of the world total. Total transaction value is a likely fiscal year-end $1.2 trillion, given rate of growth and $90 billion in transactions in Sept 2021.

The JAM infrastructure was critical to delivering essential benefits during the Covid lockdown. This infrastructure also underpins the CoWin platform, which uses the mobile number and Aadhaar, though one may use other ID forms (which all can be linked to Aadhaar). The CoWin system maintains vaccination status against the linked ID. The QR code is simply to access the digital certificate.

The CoWin digital interface is public (github). Anyone can write an app to access their records or register for vaccination. Engineering students wrote apps to find vaccination sites in May when vaccines were scarce. The NHS app is not public; only the contact tracing app is, and that is simply built on the Google/Apple GAEN platform.

It’s a little strange to wonder about the authenticity of a certificate on an infrastructure that is on track to handle over $1 trillion (>40 per cent of UK GDP) in digital transactions this year. Of course, the technology could have bugs. There are straightforward processes by which this can be reported and addressed.

99 per cent of Indians have an Aadhaar ID now. Any resident in India is eligible for one. Mr Ellis has been resident for 6 months. He’s eligible. If he has one and has used UPI, he’s already part of a system he has a problem with, but it’s not clear whether he’s aware of that.

This digital ecosystem has replaced large parts of a previously graft and corruption-ridden interface with government. At one time, getting a subsidy or even a birth certificate involved a trip to a public office, lubrication of greedy hands and waiting.

Much of that is gone. Several places don’t even involve a sub-registrar in birth, death and marriage certification. In Bangalore among several other places, one gets a birth certificate online. It involves all particulars printed for free, and an access code to access the website and verify. If you want more copies you do that in the print menu on a computer.

In the UK one gets a certificate from GRO (approx Rs.1,000/copy) and then makes copies by attestation - the old fashioned way using a gazetted person. Authenticated paper is medieval technology; a GRO birth certificate offers no option for real time access-code based authentication on the website, and protects against counterfeiting with only an impressively stern verbal warning at the bottom.

Conclusion

India recognises that many old identification, authorization and transactional processes do not work. It handled the problem by building out the world’s biggest digital infrastructure specifically for this. When Covid hit, this infrastructure was used to transfer tens of billions in benefit payments to the accounts of the poor, electronically. Today, the same infrastructure also accommodates vaccination registration and records.

Britain looks at CoWin today with the same skeptical eye of an Indian man in the early 1800s looking at a strange noisy smoke-belching monstrosity the British called a ‘steam engine’. It has seemingly no idea of the scale of this system and all that it already does. Some talk about things like ‘fake certificates’, apparently unaware the paper in hand is just a means to access the digital certificate and faking the printout serves no purpose. It’s analogous to listening to two Indians describe a steam engine in the 1820s.

From an Indian perspective we should never expect acknowledgment of these advancements. If anything, the very opposition to it is a sign of a good thing on our hands. We’re in a position to independently evaluate them. Rising up the ranks to great power status does not entail a collegial ‘here pull up a chair and join us at the table’ interaction. It’s up to us to apply the costs of getting in our way, and therefore it is heartening that the government understands this (Govt to roll out customised visa policy based on how Indian tourists are treated outside).