Public Health

India might play an necessary position within the manufacture of vaccines

A medical professional holds Covid-19 vaccine Covaxin vial during the nationwide vaccination campaign in Jaipur, Rajasthan, India, Saturday, February 6, 2021.

Vishal Bhatnagar | NurPhoto | Getty Images

India could become the second largest Covid vaccine maker in the world, and analysts say the country has the capacity to manufacture for both its own people and other developing countries.

Most of the world’s vaccines historically came from India. Even before Covid-19, the South Asian country was producing up to 60% of the world’s vaccines – and at relatively low costs.

“India was a vaccine manufacturing center before the pandemic and should be a strategic partner in vaccinating against COVID-19 worldwide,” JPMorgan analysts wrote in a report last month.

Consultancy firm Deloitte predicts India will rank second after the US in terms of coronavirus vaccine production this year. PS Easwaran, partner at Deloitte India, said more than 3.5 billion Covid vaccines could be produced in the country in 2021, compared to around 4 billion in the US

In addition, companies in India are currently increasing production to meet demand.

“We are expanding our annual capacity to deliver 700 million doses of our intramuscular COVAXIN,” said Indian company Bharat Biotech, which worked with the Indian State Council for Medical Research to develop a Covid vaccine.

Covaxin was approved for emergency use in India, but was controversial due to criticism that the approval was not transparent enough and because not enough efficacy data was published.

India vaccines suitable for developing countries

Another vaccine – known in India as Covishield and jointly developed by AstraZeneca and the University of Oxford – has also been approved as an emergency in India. It is made locally by the Serum Institute of India (SII).

SII manufactures around 50 million cans of Covishield every month, according to Reuters, and plans to grow production to 100 million cans per month by March.

Other Indian companies have agreed to make vaccines for developers such as the Russian Direct Investment Fund and the US company Johnson & Johnson. To be clear, these vaccine candidates have not yet been approved for use.

“Even without successful vaccine development from our own pipelines, the available capacity offers the opportunity to work as a contract manufacturer with approved vaccine developers in order to meet the supply needs, particularly for India and other countries [emerging markets]”said the JPMorgan report.

With a proven track record on the scale that vaccines are made, India should be able to ramp up production to meet international demand as well.

Nissy Solomon

Center for Policy Research

India’s vaccines are likely to be more suitable for developing countries, said K Srinath Reddy, president of the Public Health Foundation of India.

Some of today’s leading vaccines, such as those from Pfizer-BioNTech and Moderna, use messenger RNA (mRNA) technology, which uses genetic material to trigger the body’s infection control process.

These vaccines require “stringent cold chain requirements” that will be difficult or even “out of the realm of possibility,” for most health systems, Reddy said.

Vaccines made in India are easier to transport and cheaper, putting the country in a better position than the US and Europe when it comes to meeting demand in developing countries, he added.

India’s “proven record”

India’s enormous manufacturing capacity also gives analysts confidence that the country can provide vaccines to other nations.

New Delhi has pledged to send vaccines to its neighboring countries and has already delivered 15.6 million doses to 17 countries, according to Reuters.

“India’s manufacturing capacity is sufficient to meet domestic demand,” said Nissy Solomon, senior research associate at the Center for Public Policy Research (CPPR).

“With a proven track record of the same scale as vaccines, India should be able to ramp up production to meet international demand as well,” she told CNBC.

Solomon added that the country is monitoring domestic needs before making decisions about exports.

For its part, Bharat Biotech said it was “fully prepared to meet the needs of India and global public health”.

Vaccine storage and distribution challenge

However, there will be challenges as the country attempts to meet vaccine demand in India and beyond.

Jefferies stock analyst Abhishek Sharma wrote in a note that vaccine adoption in India has been slow. Even assuming the speed of vaccination will increase, Sharma estimates that only 22% of India’s 1.38 billion people can be vaccinated in one year.

That is roughly the number of people India would like to vaccinate by July or August.

“The supply of vaccines is less of an issue than the storage, distribution and intake of vaccines,” said Solomon of CPPR.

“India is unable to store and distribute such large quantities to the masses,” she said, adding that the country should “strategically” choose vaccines that do not need to be stored in extreme temperatures.

I would say that [these challenges are] more like speed limiters slowing the program down than actual roadblocks where the program must be stopped.

K Srinath Reddy

Public Health Foundation of India

The vaccines India is currently manufacturing require normal refrigeration. However, the vaccines manufactured by Pfizer-BioNTech must be stored at extremely cold temperatures of minus 70 degrees Celsius, while those made by Moderna must be stored at minus 20 degrees Celsius (minus 4 degrees Fahrenheit).

The “real challenge” lies in the sheer number of people who need to be vaccinated, said Reddy of the Public Health Foundation of India.

“This is the first time an adult vaccination program has been carried out on such an unprecedented scale,” he told CNBC.

He said vaccination programs usually focus on vaccinating children and mothers, and the logistics network may not be prepared to handle vaccines for entire populations.

Reddy suggested using the existing food cold chain for vaccines, hoping this could be resolved.

“I would say that [these challenges are] more like speed limiters slowing down the program than actual roadblocks where the program has to be stopped, “he said.

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