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    Covid Vaccine – India should take lead on vaccine delivery!

    October 2020

    Now almost in its tenth month, the Covid 19 pandemic is still wreaking havoc on economies and lives around the world.

    India’s leading health experts say the coronavirus is spreading like wildfire as the number of cases in the country tops 7 million, despite government claims that it is making all possible efforts to mitigate the spread of infection. In recent weeks there has been a huge surge in the number of infections, with confirmed cases of 100,000 a day, making India the second most affected country after the US.

    India imposed a lockdown in March to control the spread of the virus, but floundered as the economy slumped despite initial success containing the pandemic. India had just 500 cases when Prime Minister Narendra Modi imposed the world’s most stringent lockdown on March 24.

    The economic pressure increased when government data showed that GDP in India contracted 23.9% in the first quarter, the worst performance in four decades. The anxiety to revive the economy, the rapid opening of cities, shopping areas and malls, has actually made many people somewhat liberal in their attitude to large social and religious gatherings.

    The result is obvious, case numbers have doubled since mid-August, with more than two million recorded in less than a month and the death toll now topping 100,000.

    The trend raises fears that India, with its 1.3 billion people, shaky healthcare system and crisis – hit economy, will crumble under the flood of cases with hospitals unable to cope with the onslaught.

    Government officials say the rapid rise in infections is because of increased testing, but logic says, cases are increasing because of viral spread and testing obviously is just revealing that. Another reason in my opinion is that India is doing zero surveys – testing blood samples for the presence of Covid 19 anti-bodies – to keep track of the infection rate. On top, the India Council of Medical Research released a survey paper that showed the country potentially had as many as 6.4 million infections already in the May and June period.

    To make it short, India is in a desperate need of a vaccine, as the end of the crisis seems as far away as ever.

    The Covid 19 Vaccine Global Access Facility (COVAX), an initiative launched by Gavi, the Vaccine Alliance, the World Health Organization, and the Coalition for Epidemic Preparedness Innovations, represents the best chance we have to provide people in all countries with rapid, fair, and equitable access to Covid 19 vaccines as soon as they become available. The initiative has already achieved an extraordinary scale, with more than 170 countries representing 70% of the global population already signaling their intent to join. At a time when most countries like India are undergoing unprecedented crisis, governments are eager for solutions that will benefit everyone.

    As we head into the fall, and Covid 19 continues to spread the global death toll passing one million, with monthly economic losses estimated at 500 billion US-Dollar. Under these conditions, ensuring fair, universal access to vaccines is not only the right thing to do. It is in my opinion also necessary if we are to bring the crisis to an end. Until everyone is protected, everyone will remain at risk of the disease, its adverse economic effects or both.

    Although there are more than 200 Covid 19 vaccines in development, and at least 35 clinical trials underway, the vast majority are likely to fail. Historically, candidate vaccines at the preclinical stage have less than a 10% chance of succeeding. And of those that do advance to the clinical trials stage, only around 20% will ultimately be approved. Given these odds, even wealthy governments that are currently negotiating bilateral deals (like the US under President Trump – America First) with individual vaccine manufacturers cannot guarantee access to a vaccine on their own.

    By contrast, Covax is specifically designed to maximize the chances of success by investing in the development and manufacture of a large number of vaccine candidates at the same time. With the world’s largest and most diverse vaccine portfolio – which currently comprises nine candidates already in development and a further nine or more under evaluation – Covax will act as a global insurance policy. Under this framework, member countries that have bilateral deals will still have vaccine access options in the event that those gambles fail, and the majority of countries that have no other options will be extended a critical lifeline.

    Covax’s initial aim is to have two billion vaccine doses available by the end of 2021, as that should be enough to protect high-risk / vulnerable populations and frontline health-care workers. But to hit the target, we first need the legally binding commitments of as many countries as possible.

    Priority will be to complete the development and testing process to ensure that all forthcoming vaccines are both effective and safe. Covax will need to put in place agreements with drug manufacturers, so that it can begin delivering vaccines at scale as soon as they are approved. And donor funds will be needed to subsidize the purchase of vaccines for low – and lower – middle – income countries.

    But even with financial solutions in place, the process of distributing vaccines will pose significant challenges. The delivery of Covid 19 vaccines will be the single largest vaccine deployment the world has ever seen.

    The Indian vaccine manufacturer Adil Poonawalla – whose Serum Institute of India plans to produce a billion doses of an eventual vaccine, far in access of any of its competitors – warned that vaccinating “everyone on this planet” poses an enormous governance challenge, as there is no proper plan on paper for distributing any successful vaccine. Serum may well provide 500 million doses to an Indian government that has no way to get them to people. And India’s infant immunization programme has at least given the country some distribution capacity. The problem is far worse elsewhere, in other emerging economies.

    One critical challenge for governments will be storage and transportation. Some of the vaccines that use the new messenger RNA technology will need to be stored at sub-zero temperatures, as low as minus 70 or minus 80 degrees Celsius. The vaccine being developed by AstraZeneca PLC, which the Serum Institute has licensed, can reportedly be stored in standard refrigerated environments. But even managing a regular vaccine cold chain is enormously difficult.

    To anyone with experience of developing world public health infrastructure, the World Health Organization’s recommendations for managing vaccine transport make for depressing reading. The vaccine alliance Gavi’s briefing on the first-choice storage machinery – ice-lined refrigerators – is equally sobering. Each can cost thousands of dollars. Off-grid, solar-driven refrigerators, which might be needed in emerging countries with unreliable power supply, are even more expensive.

    In the developed world, big investments are already being made in scaling up coldchain infrastructure: UPS, for example, is putting millions of dollars into new “freezer farms” near air hubs in the US and western Europe. Companies are unlikely to make similar investments on spec in the developing world.

    Even countries such as India, which have had some experience and success with “mission” projects in health care, might in my opinion struggle at the expense involved in creating single – use transportation and storage infrastructure, at scale, on short notice.

    This is where the economic policy community needs urgently to step in. Getting hundreds of millions of vaccine doses out to the poorest and most remote parts of the globe is in everyone’s interest as “none of us are safe until all of us are safe.” Solutions in my opinion do exist if governments, multilateral agencies, and private capital are willing to explore them.

    In India, for example, the government could collaborate with private capital and multilateral lenders to set up a holding company focused on developing, distributing and installing innovative dual – use cold chain infrastructure. India’s National Centre for Cold – Chain Development – yes, it has one – has long argued that there are “synergies” between agricultural, processed-food, and medical cold-chain infrastructure.

    Done right, a large network of refrigerated storage and transport created for the pandemic could have wider uses. An efficient cold chain would help permanently raise farmers’ access to markets, reduce wastage and control food inflation.

    Of course, this will require ministries to talk to one another better today than tomorrow, arrange de-risking mechanisms and guarantees, and then rope in possible investors. The effort in my opinion will for sure be worth it, though: if a mechanism can be evolved in India, other developing countries should be able to replicate it. Without one, it’s in my opinion hard to see how those emerging nations will escape the pandemic even with a vaccine.

    As the pandemic is far from over, we at least have a global solution in sight. Covax in my opinion represents the best hope that we have for bringing a prompt end to the crisis. When people look back and marvel at how quickly the scientific community and development practitioners responded to the Covid-19 threat, they will be able to point to the speed with which most governments put aside national interests in the name of international cooperation and solidarity. Whatever specific moment future historians choose as the pandemic’s turning point, there will in my opinion be little doubt that the creation and widespread adoption of the Covax framework played an indispensable role in ending it.