What We Know About India's Vaccine Preparations
Where do the various vaccine candidates stack up for India, and how might they be distributed once approved?
Hi there, I’m Aman Thakker. Welcome to Indialogue, a newsletter analyzing the biggest policy developments in India. The aim of this newsletter is to provide you with quality analysis every week on what’s going on in India.
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Prime Minister Modi Reviews COVID-19 Vaccine Strategy
On December 4, Prime Minister Narendra Modi hosted an “All Party Meet” with representatives of India’s political parties to discuss the government’s COVID-19 vaccination strategy. With the COVID-19 pandemic likely to remain a fact of life going into 2021, the recent interim results released by several vaccine manufacturers have offered a glimmer of hope of life returning to normal.
So, what do we know about India’s vaccine strategy? What vaccines may be available to Indians, and how soon? How will the vaccine be distributed?
What We Know About Possible Vaccine Candidates
What we know so far is that seven major vaccine candidates have been publicly reported as being options for India, with Indian firms involved in several.
The first two options are the most discussed so far: Pfizer and Moderna. Both released their interim data in November, boasting a 95% and 94.5% rate of effectiveness respectively. Earlier today, several news sources reported that Pfizer had approached the Indian government to obtain an emergency use authorization (which the UK granted Pfizer a few days ago, and which is likely to be granted in the coming days by the U.S. Food and Drug administration).
However, the main logistical drawback for the Pfizer (and Moderna) vaccines in India is that they require the vaccines to be stored at extremely low temperatures in commercial deep freezers (-70°C for Pfizer, and 20°C for Moderna). While Pfizer has promised that it will ship the vaccines in “specially designed, temperature-controlled thermal shippers” which can also be used as storage units, the government remains mid-stream in its efforts to set up a cold storage chain at airports in order to receive these vaccines.
Then there is the AstraZeneca-Oxford vaccine, which does not need the same cold storage requirements that the Moderna and Pfizer vaccines need, and can be stored in regular refrigerators at between 2°C and 8°C. Moreover, the Serum Institute of India has already entered into a partnership agreement with AstraZeneca and Oxford to manufacture 1 billion doses of the vaccine. The Serum Institute has also sought emergency use authorization, with CEO Adar Poonawalla announcing the move earlier today.
However, recent reporting has shown that the initially promising results of this vaccine do not hold up under closer examination. While the initial results said the vaccine could be up to 90% effective (with an average effective rate of ~70%), there were serious problems with the data. As The New York Times reports:
The regimen that appeared to be 90 percent effective was based on participants receiving a half dose of the vaccine followed a month later by a full dose; the less effective version involved a pair of full doses. AstraZeneca disclosed in its initial announcement that fewer than 2,800 participants received the smaller dosing regimen, compared with nearly 8,900 participants who received two full doses.
The biggest questions were, why was there such a large variation in the effectiveness of the vaccine at different doses, and why did a smaller dose appear to produce much better results? AstraZeneca and Oxford researchers said they did not know.
Crucial information was also missing. The company said that the early analysis was based on 131 symptomatic Covid-19 cases that had turned up in study participants. But it did not break down how many cases were found in each group of participants — those who received the half-strength initial dose, the regular-strength initial dose and the placebo.
Later revelations also showed how participants in the Phase Three trials for the AstraZeneca-Oxford vaccine were never intended to receive a half-dose, which was an error by researchers, further undermining the 90% effectiveness rate that the vaccine promised.
India has four more candidates: Novavax, the Russian vaccine Sputnik V, and two indigenously developed candidates: Covaxin (jointly developed by Bharat Biotech and the Indian Council for Medical Research), and Zydus Cadila. However, these candidates aren’t as strong contenders. Although India has reserved a billion doses of the Novavax vaccine, it remains in Phase Three trials with no data yet on its rate of effectiveness. The Sputnik vaccine, while reportedly supposed to have a 92% rate of effectiveness, has not had its results published or peer-reviewed, which goes against scientific processes. Finally, while Covaxin is in Phase Three trials now, Zydus Cadila is planning to launch its Phase Three trials at some point this month.
What We Know About Vaccination Strategy and Distribution
The PM’s recent meeting with political party leaders gives us some limited insight into how the government is planning to distribute the vaccine once it is ready.
The government has announced that, in line with best practices of several other countries, the central and state governments will coordinate to create a systematic order of vaccination, with the priority being healthcare and frontline workers, as well as vulnerable populations and the elderly. The central government is also creating a “National Expert Group” that will include “technical experts and officials of both the Central Government and State Governments” that will be tasked with taking decisions regarding the vaccine campaign. Moreover, the central government is working to ensure adequate supply of syringes and needles so that vaccines can be administered quickly once they are approved. Finally, the central government is creating a digital platform to post information about vaccine administration and distribution, called the COVID-19 Vaccine Information Network.
However, outside of these details a number of question remain. The biggest one that has emerged this week is whether or not everyone will be vaccinated. While the Prime Minister had promised in October that vaccines will reach every single citizen, India’s health secretary Rajesh Bhushan said last Tuesday that “The government has never spoken about vaccinating the entire country.” Rather, the government may follow advice from the World Health Organization, which says a vaccine coverage rate of 65%-70% may be enough to create a “herd immunity” among the population.
However, that still leaves open the questions of how effective the vaccines will be in creating long-term immunity, and whether the vaccines will only prevent people from getting sick or actually stop the transmission of the virus. Answers to those questions will depend on how future trials will proceed.
The good news remains that we are closer to a vaccine that we ever have been in this pandemic, and the broad strokes of a plan to distribute the vaccine are publicly available. However, we’re still far from the end, and continue to look forward to when the glimmer of hope we currently see can become light at the end of the tunnel.
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External Affairs Minister Interview with The Hindu
Minister of External Affairs Dr. S. Jaishankar sat down with Suhasini Haider for The Hindu for a wide-ranging interview on the major foreign policy topics of the day. I’ve highlighted some of the most important aspects of his interview (and you can read the full interview here).
On the ongoing standoffs with China in Eastern Ladakh:
The bottom line right now is that we have bilateral agreements that commit both countries not to amassing a large number of forces along the LAC. Without credibly explaining why, the Chinese have chosen to violate that compact. The second aspect of it is that the progress in our bilateral ties have been very much predicated on peace and tranquillity along the LAC. If that is disturbed, as has been the case this year, then obviously, the rest of the relationship cannot be unaffected.
We are not saying that progress in ties depends on solving the boundary question, but it clearly does on maintaining peace and tranquillity, while seeking a solution.
On how long it might take to reach a resolution:
I don’t know if you remember Sumdorong Chu [India-China standoff in 1986 that ended only nine years later]. I mean, I know in this day and age, there’s a lot of media pressure on you and on me. But you know, there are complicated issues [that] will take time and I will go for what is my interest and my bottom line. I mean, I will not be stampeded into accepting something which is less.
On Pakistan:
Look, our challenge with Pakistan is this desire for better ties was evident from day one. I mean, from the fact that, you know, the Pakistani Prime Minister was invited to be swearing in 2014. We tried very hard to make it work, including [in] that the Prime Minister actually visited Pakistan. But the fact was that what we saw from the other end, where, you know, [there were] egregious acts of cross border terrorism. Now, the fundamental issue to my mind is, you know, the question with Pakistan is not, you know, will it be this format of talks with that agenda? I think there is a basic underlying issue — are you as India willing to accept the reason as something normal? Is it a legitimate diplomatic instrument? I think it’s not.
On relations with the United States:
Whether it is President Trump or President Biden, I don’t think it is a sharp binary option. I think there will be certain policies, which are American policies, because again, bear in mind is not just a President, there’s also Congress, and sometimes administrations carry on with the policies of those before. When it comes to the United States, there will be strong elements of continuity. Obviously, there will be elements of change because at the very least, the storyline, the method, you know, the modality of dealing with others, would be different. But none of this should really worry us. Because when I look at the potential administration, I mean, I see familiar figures with whom we have worked for many, many years, including the period when I was Ambassador, and then Foreign Secretary. Secondly, if you look at the debates in America, you know, serious policy debates, a lot of it is actually centred around other geographies: China, Russia and the Middle East. I think there is a general consensus on India. There are no very sharply different policy views. So, I am reasonably confident that we will pick up and carry on.
On India’s withdrawal from the Regional Comprehensive Economic Partnership:
Number one, just look at your trade figures with RCEP countries and draw your own conclusions. Secondly, this is the Lutyens debate which I mention. Go out there, go and visit an industrial district and see what the last 15 years has done, the kind of problems our MSMEs face. See how they feel competition, fair or unfair, is affecting their business…
This is about standing up for Indian producers, it is about standing up for Indian employment, it is about not allowing your economy to be flooded by people using unfair advantages, it is about getting fair market access abroad, it is a clear message to the world that I will strive for optimal results.
A Visualization of Indian Parliamentarians by Generational Breakdown
Last week, Reid Wilson of The Hill posted a visualization of the generational breakdown of the incoming 117th Congress in the United States, created by his colleague Ashley Perks. I mused on Twitter that I would love to see one of India’s Parliament, which I generally assumed would have far too few millennials.
In response, Akhil Bery, the South Asia analyst at the political risk consultancy Eurasia Group (and a dear friend!), published a fantastic visualization of Indian parliamentarians by which generation they belong. He’s borrowed from the U.S. breakdown (millennials, Generation X, Baby Boomers, and The Silent Generation) in his chart, and focused on the Lok Sabha for now.
Without further ado, here is the breakdown:
Please give Akhil a follow on Twitter as thanks, and so that you two can get more such insights from one of the rising stars analyzing South Asian politics!
Have thoughts about the policy issues I have covered in this newsletter? Please consider sharing a comment.
News Roundup
The issue regarding the shortfall in compensation to states under the Goods and Services Tax appears to headed towards a resolution (for a background on this issue, please read this issue of Indialogue).
As part of the process to resolve this issue, the GST Council agreed on August 27, 2020, to allow states to choose between one of two options to make up the revenue shortfall.
Option 1 would allow states to borrow the amount of the shortfall calculated as emanating from the implementation of the GST (originally estimated at Rs. 97,000 crore ($13.15 billion) and then raised to Rs. 1.1 lakh crore ($14.9 billion)) by issuing debt, which would be overseen by a special window created by the Ministry of Finance.
Option 2 would give states the option to borrow the entire shortfall in GST compensation (which also includes the shortfall due to COVID-19, and is calculated separately from the shortfall created because of the actual implementation of the tax) of Rs. 2.35 lakh crore ($31.85 billion) by issuing debt.
The Ministry of Finance recently announced that, as of December 5, all 28 States and 3 Union Territories in India had agreed to proceed with Option 1, and that the special borrowing window proposed in Option 1 has already been created and operationalized as of October 23, 2020.
The Indian Navy undertook a Passage Exercise (PASSEX) with the Russian Navy in the Eastern Indian Ocean region on December 4-5. The exercise comes after Indian diplomats have been making a push for Russia to engage more deeply with the Indo-Pacific construct in which India is increasingly playing a central role.
Indian officials from the Narcotics Control Board at the Ministry of Home Affairs met with their U.S. in the White House Office of National Drug Control Policy, the Department of Homeland Security, and the Department of Justice as part of the U.S.-India Counternarcotics Working Group.
Following the visit of the Chief of Army Staff, Gen. Manoj M. Naravane, to Nagaland, the National Socialist Council of Nagaland - Isak-Muivah, which has been engaged in negotiations with the Government of India over the Naga political issue, criticized the centre as demonstrating “weakness and insincerity” in its approach to negotiations, which they also described as “ambivalent.”
Yohei Hirose and Akihiro Ota of Nikkei Asian Review report that the India nad Japan are reportedly close to signing a Memorandum of Understanding to deepen cooperation between the two governments on issues such as 5G wireless networks and submarine fiber-optic cables, among other technologies.
The Government of India has constituted a 17-member “Apex Committee for Implementation of Paris Agreement” which will ensure India’s commitments under the Paris Climate Accords will be fully integrated with India’s development agenda, and will further ensure that India’s progress on those commitments are reported back to the United Nations Framework Convention on Climate Change (UNFCCC).
The Election Commission of India (ECI) has reportedly written to the Ministry of Law and Justice seeking permission to allow non-resident Indian (NRI) citizens living abroad to vote in Indian elections. While the ECI has reportedly said that it is “technically and administratively ready” to undertake this proposal and requires only an amendment to the “Conduct of Election Rules 1961” (and not an Act of Parliament), it remains to be seen whether this step can be implemented. For one, the government has proceeded along a different route, proposing a bill during the 16th Lok Sabha to allow proxy voting for NRI citizens, which lapsed following the dissolution of Parliament ahead of the 2019 general election. Furthermore, the Ministry of External Affairs has insisted that it does not have the capacity to attest and certify the postal ballots of the nearly 60 lakh (six million) Indian citizens living abroad that may be eligible to vote in elections.
The Department for Promotion of Industry and Internal Trade of Ministry of Commerce and Industry has signed a Memorandum of Understanding on Intellectual Property Cooperation with the United States Patent and Trademark Office of the U.S. Department of Commerce.
Three to Read
From cogent analysis to potentially big news that you should keep an eye on, here are a few commentaries and other pieces of writing that I found particularly enlightening:
Dr. Rajeswari Pillai Rajagopalan, Distinguished Fellow & Head of the Nuclear and Space Policy Initiative, at Observer Research Foundation, argues: “Last week, Colombo hosted an India-Sri Lanka-Maldives trilateral maritime security dialogue. The meeting saw the revival of the national security advisor (NSA)-level dialogue among the three countries, which began almost a decade ago in 2011. That the meeting took place six years after the last edition in 2014 is significant. Both Sri Lanka and the Maldives are critical maritime neighbors to India in the Indian Ocean region and there have been continuous efforts by both India and China to win friends and favors in Colombo and Male. The NSA-level talks are also a demonstration of the Indian intent to push subregional diplomacy, which has been gaining traction in India’s foreign policy in the last few years. The Modi government has made efforts to engage in subregional diplomacy as a useful track following the near-complete halt in regional diplomacy in South Asia under the South Asian Association for Regional Cooperation (SAARC).”
Dr. Rudra Chaudhuri, Director of Carnegie India, writes: “More urgently than before, India needs to consider what exactly it wants out of the fast-changing geopolitics around technology. This goes beyond banning Chinese apps or considering how India can absorb the slow move to diversify global supply chains. This is about ensuring India’s evolving domestic data architecture supports its international interests, with the clear view to benefit from the same. The aim must be to negotiate its weight in data and find the right balance for India’s future between localisation and internationalisation.”
Dhruva Jaishankar, Director of the U.S. Initiative at the Observer Research Foundation, argues: “The facts do not support the popular notion of India as a particularly closed economy, certainly when it comes to non-agricultural goods trade, although the liberalization of its services sector is arguably overdue. [Secondly], smart industrial policy is the way forward in a post-pandemic global economy. Whether Atmanirbhar Bharat and its associated policies produce the necessary results is still an open question. But if India is to be better positioned to compete in an open global economy, it will have to industrialize. Third, while India’s recent restrictive trade measures have been motivated by both genuine trade-scepticism and China-scepticism, India will have little choice but to remain globally integrated in many areas, even if on selective terms. Approaching trade in terms of national competition is necessary in a competitive international environment. But India should not lose sight of the fact that international trade – if truly free and fair – will ultimately be to its benefit.”
Thank you for reading this latest edition of Indialogue. Please let me know if you have any thoughts or feedback by emailing me at aman@amanthakker.com.