Why we need an Aatmanirbhar booster strategy

A year ago, I asked if intellectual property rights (IPRs) could be part of the COVID-19 solution, rather than the problem. I had assumed that a pandemic would change entrenched positions of various stakeholders on IPRs.

However, a year later, we still do not have consensus on a TRIPS waiver for COVID-19 essential medicines, vaccines and diagnostics test kits. With a highly infectious variant Omicron on the loose, some countries have organised booster shots while others are struggling to reach the first shot to all citizens. Thus, 2022 will continue to be a year of inequality on the healthcare access front.

As of January 3, India had 1700 cases of the Omicron variant, of which 639 had recovered, as per health ministry data. While the severity of Omicron cases seems low, for now, we cannot afford to let down our guard.

India’s health officials have emphasised coverage of as many citizens within the existing vaccination drive, rather than diverting resources to start a booster campaign. As per ministry data, 90 per cent of the adult population of the country has been covered with at least one dose and 62 per cent of the adult population has been covered with both the doses.

This stance was validated by the WHO’s statement of December 22, that introducing booster doses should be ‘firmly evidence-driven and targeted to the population groups at highest risk of serious disease and those necessary to protect the health system.’ India’s booster strategy as expected has followed these lines, expanding the vaccination campaign to children in the age-group of 15-18 years (from January 3) and prioritising precautionary/booster shots for healthcare and frontline staff, and the 60+ population with comorbidities (from January 10).

Policy decisions are like seeds; they need time to deliver a harvest. They need to be nurtured, and it could be years before they bear fruit. Do we have the luxury of time to wait? Unfortunately, we don’t have a choice.

Take the Production Linked Incentive (PLI) Scheme, where Rs150 billion will be distributed over six years (FY23-FY28) to incentivise the selected 55 pharma companies to invest in crucial  manufacturing capabilities. Schemes like the PLI Scheme are part of the government’s Atmanirbharta campaign, to make India self-reliant in key medicines and their ingredients.

But what can be done to ensure that India has enough vaccines for our citizens today?

An October 2021 WTO report on COVID- 19 vaccine production and tariffs on vaccine inputs, showed that of the top 27 vaccine manufacturing economies, India was one of three nations, which have sensitive/critical “choke points” at varying levels in all 13 product groups of vaccine inputs. The report defined a choke point as a product group with at least a five per cent tariff.

This means that India’s vaccine manufacturing supply chain is still very vulnerable to disruptions due to tariffs and logistics. Vaccine makers will need to plan procurement of vaccine inputs months in advance to meet the country’s projected needs. Yet, with no fresh orders from the government, one major vaccine company warned that they were cutting production of their COVID-19 vaccine.

To be fair, the central government’s analysis shows that states do have enough doses for now. Speedy deployment of these doses before their expiry date is now the focus.

The government also seems to be waiting for the next lot of vaccines under trial to submit data for approval, as most agree that boosters will have to be vaccines using a different platform technology from those used so far in the vaccination drive. Given that other countries have already booked supplies for their booster dose campaigns, it is logical that India will turn to vaccines developed indigenously for its booster strategy, as time, cost and logistics are crucial factors. An Aatmanirbhar booster strategy will save lives. As a bonus, it will also boost long-term development programmes at local biopharma companies.

However, we will need more than vaccines to fight this virus. Many citizens have not come forward to take their second shots, including those in urban areas where there is no shortage of vaccines. Many more see the pandemic as a hyped-up health risk, an opportunity for companies to profit, disregarding the fact that as per WHO data, the global COVID-19 toll this year (of December 29) was 5,411,759 people. This toll exceeded last year’s deaths from HIV/AIDS, tuberculosis, and malaria combined. With these sobering numbers and predictions that India’s third wave could peak in February 2022, it promises to be another year of learning to live with COVID-19.