The global vaccine supply chain, already under extreme pressure, has been thrown into disarray by the COVID-19 crisis devastating India.
India is the world’s biggest manufacturer of COVID-19 vaccines, and the Serum Institute of India had been earmarked to produce a third of the global supply of the AstraZeneca vaccine in 2021.
As India’s healthcare system collapses under the second wave of infections, the Indian government has virtually halted vaccine exports, instead keeping supplies onshore to inoculate its own population.
“As India did that, the pipeline of vaccines dried up for COVAX,” said Leena Menghaney from Médecins Sans Frontières (MSF) based in New Delhi.
“I don’t know who did the maths, but someone did the maths wrong,” Ms Menghaney said.
“And the decision to go exclusively with the Serum Institute of India and not provide the licence to more manufacturers has proved deadly for the developing world.”
Salim Abdool Karim is an epidemiologist at Columbia University and works on the vaccine rollout in Africa.
Africa has a population of about 1.3 billion people and is particularly dependent on COVAX. But Dr Abdool Karim said India was doing the right thing.
“I think the highest priority, you know, to be quite frank, has to be India,” Dr Abdool Karim told ABC RN Breakfast this week.
“I mean, their situation is so desperate and the cases continue to rise.
“This is a crisis now at a global level,” said Dr Abdool Karim, who is also on the Africa CDC’s Taskforce for Novel Coronavirus.
Most of the world’s population is reliant on vaccines distributed by COVAX — a collaboration of organisations, including the World Health Organization, that was set up to share vaccines fairly around the world.
It had aimed to deliver 2 billion vaccines to about 140 mostly developing countries by the end of 2021 so they could vaccinate at least 20 per cent of their population — frontline healthcare workers and their most vulnerable people.
Prior to India’s second wave, the scheme was already short on the number of doses it had delivered worldwide. Now, it will be thrown further behind.
So far, India is about 80 million doses short of the total vaccines it had agreed to provide to other countries via COVAX — and this number too will grow, as long as the nation needs to prioritise domestic vaccinations.
“It’s crazy that so many low-income countries should be relying on one vaccine manufacturer to supply just enough doses to vaccinate 20 per cent of their population,” Deborah Gleeson, an associate professor in public health at La Trobe University, said.
“Drastic action needs to be taken to expand the production of vaccines globally.”
When India began limiting the export of vaccines, the head of the Africa Centers for Disease Control and Prevention (CDC) said such moves could be “catastrophic” for African countries.
“If the delay [of vaccines from India] continues — I hope it’s a delay and not a ban — that would be catastrophic for meeting our vaccination schedule,” John Nkengasong, director of Africa CDC, said at the start of April.
That delay has continued and is likely to continue for some time.
India’s vaccine bottleneck
Prior to the current crisis, India’s ability to produce enough vaccines was already being hampered by the actions of rich countries.
In February the United States, under then-president Donald Trump, limited the export of raw materials for vaccine production.
Earlier this month, the CEO and owner of the Serum Institute of India, Adar Poonawalla, appealed to US President Joe Biden to lift the export limits.
“[On] behalf of the vaccine industry outside the US, I humbly request you to lift the embargo of raw material exports out of the US so that vaccine production can ramp up,” he said on Twitter.
The message was echoed by others, including Milind Deora, a politician from Mumbai, which has been very badly hit by the second wave.
This week, Mr Biden announced the US would start shipping raw materials to India to help it ramp up vaccine production.
Pharmaceutical companies’ intellectual property slowing production
Also limiting India’s ability to produce more vaccines are intellectual property rules that are being enforced by wealthy countries and stop the vaccine-manufacturing powerhouse from producing vaccines other than AstraZeneca.
As far back as October last year, India and South Africa asked the World Trade Organization (WTO) to waive rules allowing pharmaceutical companies to keep their intellectual property to themselves.
They wanted vaccine manufacturers all over the world to have access to the technology and know-how to make COVID-19 vaccines, so production of the crucial drugs could ramp up.
But so far, wealthy nations, including Australia, have blocked efforts to relax the Trade-Related Aspects of Intellectual Property Rights (TRIPS) rules.
Sixty former heads of state and 100 Nobel Prize winners have written to Mr Biden to back the waiver.
More than 80 members of the WTO also support it.
To put pressure on the Australian government to support the move, more than 700 health professionals and academics have sent an open letter to Prime Minister Scott Morrison urging him to help remove legal and technical barriers that are limiting the production of COVID-19 vaccines.
The letter, signed by 207 doctors, 177 academics and 111 public health professionals calls on Mr Morrison to take a leadership role in accelerating the rollout of vaccines so repeated outbreaks can be contained and the emergence of new variants addressed.
“The world has been relying on the pharmaceutical industry to sort this out,” Dr Gleeson said.
“Governments haven’t been getting involved to date in actually forcing the pharmaceutical industry to share.”
In March, Trade Secretary Dan Tehan told ABC Radio the government would not back the move, but was working with the WTO on the issue.
“We’ve got to make sure that there are some protections in place for the millions of dollars that has gone into the research to create these vaccines,” he said.