A health worker opens a freezer during a dry run of the Covid-19 vaccine in Delhi, Jan. 2.
Photographer: T. Narayan / Bloomberg
Photographer: T. Narayan / Bloomberg
While major countries such as the US and China rush to vaccinate their populations with rapidly approved injections, tens of millions of doses prepared for India are in storage despite authorization for use.
While distribution in other countries began shortly after approval with price agreements signed in advance, New Delhi and Serum Institute of India Ltd. – the world’s largest vaccine producer by volume and AstraZeneca Plc’s local partner – has negotiated behind closed doors for months and has yet to sign a formal supply agreement. That has left at least 70 million vaccine doses in limbo, despite the urgent need in a country facing the world’s second largest outbreak.
Photographer: Dhiraj Singh / Bloomberg
On Sunday, Adar Poonawalla, CEO of Serum, billionaire, said Indian officials have “ verbally ” agreed to buy 100 million doses at a “ special price ” of 200 rupees ($ 2.74) per shot, below approximately $ 4 to $ 5 price tag given to the UK government. The company then plans to sell vaccines privately to individuals and businesses within two to three months at a high cost of 1,000 rupees.
The Indian government may want to put pressure on Serum to cut prices, as evidenced by the controversial decision to give the green light to a rival vaccine developed by a local company that is still recruiting volunteers for final testing, Abhishek Sharma said , an analyst at Jefferies.
The deadlock has cost valuable time in a country where infections have crossed the 10 million mark, and reflects the tension between public interest and private profit-making from pharmaceutical companies looking to quickly recoup their pandemic investments.
While richer, developed economies have so far largely avoided price disputes in their rollout, the question of how much vaccinations should cost amid a pandemic killing more than 10,000 people worldwide is likely to grow as distribution extends to developing countries. .
According to Prime Minister Narendra Modi, every cent spent on the price of a vaccine in a country home to more than 1.3 billion people will have serious financial implications for his administration.
“Obviously, when you buy in large quantities, there is the advantage of being able to negotiate the price,” Randeep Guleria, a member of Modi’s task force for Covid-19 management and director of the All India Institute of Medical Sciences, said in an interview. on Monday. He added that negotiations are underway as part of the procurement policy and “of course they can also decide later what the market price should be.”
Guleria said the purchase agreement can be signed “any day now”. India is ready to roll out Covid-19 vaccines within 10 days of drug regulatory approval, Health Minister Rajesh Bhushan told reporters at a briefing Tuesday. He did not say whether a price or supply agreement had been signed.
It took five to six days for the first jabs to be deployed by the UK after it issued emergency buttons to the Pfizer Inc. and Astra-Oxford vaccines.
‘Bad deal’
In October, people with knowledge of the Bloomberg case spoke about what New Delhi has set aside 500 billion rupees for vaccination efforts, with an estimated all-inclusive cost of about $ 6 – $ 7 per person. A spokesperson for the Indian Ministry of Health could not be reached for comment.
“The government is not so easy to transfer money to the private sector,” said Ramana Laxminarayan, founder of the Center for Disease Dynamics, Economics & Policy, from India’s capital. “They’re just good at playing the game because they’re under pressure on the budget – bureaucrats, if they come back with a bad deal, the minister will send them right back and say ‘give me a better price’.”
According to the vaccination blueprint in India, 300 million people will be vaccinated in the first phase of the deployment, starting with health workers, followed by police personnel and soldiers, and then those with co-morbidities and people over 50. Guleria said this process. would take three to four months.
Workers transport a temperature-cooled container at Indira Gandhi International Airport in New Delhi, December 22, 2020.
Photographer: Anindito Mukherjee / Bloomberg
Local officials across the country have been asked to compile priority vaccination lists, but preparatory work seems uneven, interviews with doctors and local representatives show. Some places also seem to be preparing to give two different vaccines at the same time.
Although AstraZeneca’s inclusion has been tested in global trials and has been granted an emergency license from UK and Indian regulators in recent days, the Hyderabad-based vaccine developer Bharat Biotech International Ltd. has yet to begin analyzing Phase 3 test data, but also received a controversial limited use approval from the South Asian nation this weekend.
“Multiple vaccines will be used,” said Amit Thadani, a surgeon at Nirmaya Hospital in Mumbai. “They are going to assign a particular type of vaccine that can only be used in one district, so if there is a problem, it is easy to find out which specific vaccine is causing it.”
Serum, which has an agreement with AstraZeneca to produce at least one billion doses, has already scaled back its initial production target of 100 million in December due to slower-than-expected approvals.
Poonawalla first began public debates over potential vaccine prices in September, which some health experts saw as part of a lobbying effort.
In Sunday’s interview, Poonawalla was optimistic that a written agreement would be reached within a few days. “We’ve already packed it, we just need to ship it through the states in trucks and have it delivered,” he said, referring to the 70 million doses the company has ready for distribution.
‘Hasty approval’
Meanwhile, India’s decision to grant Bharat Biotech’s limited Covaxin approval despite a lack of definitive data on the efficacy of the tests has confused observers. In August, the company’s chairman, Krishna Ella, told a conference that their vaccine would be cheaper than bottled water – meaning the cost is less than half that for which Serum offers AstraZeneca’s vaccine.
“Covaxin’s hasty approval, even as a reserve candidate, is mainly driven by the Indian government’s commercial considerations,” Sharma, the Mumbai-based health analyst at Jefferies, said in a report on Sunday. If Covaxin “will be able to demonstrate efficacy in the coming months, subsequent vaccines will have to compete on both price and efficacy.”
Bharat Biotech’s swift approval may also be the result of India not wanting to be tied to just one vaccine manufacturer.
In an echo of a long-running debate over the role of private pharmaceutical companies, concerns are growing that Serum’s position as the sole domestic supplier of a potentially life-saving vaccine is too powerful.
Outside of India, AstraZeneca only supplies to governments and has not yet entered into any private agreements with companies or individuals. Still, Serum wants to enter the higher-margin private market within months, where it plans to raise the price of the shot five times, according to the pricing plans shared by Poonawalla.
First mover
The proposed pricing of 1,000 rupees per dose is “absolutely price gouging and leveraging its position as a first mover,” said Malini Aisola, the New Delhi-based co-convenor of the All India Drug Action Network, a health watchdog. “Personally, I think they should not give permission for private use at the moment.”
But for the wealthy in India’s stratified society, waiting for Byzantine public health services to distribute doses is not an option.
A large private bank is awaiting guidance on data and benchmark prices from the government, which could allow it to consider buying the vaccines directly from the manufacturers, said lender officials, who asked not to be identified because the deliberations are private.
For now, Serum is still waiting for its first order from the government. Poonawalla said India needs enough vaccines for the most deprived first. “If we were to sell it as we wanted, it makes sense that some of the most vulnerable people might miss it,” he said.
New Delhi also knows that the vaccine manufacturer cannot easily move those huge volumes elsewhere.
“India buys a lot of vaccines from the Serum Institute every year and they know how to play this game,” said Laxminarayan. “India could wait a little longer, but for Serum it won’t be that easy for them – the government has ways to lean on him.”
– With the help of Ragini Saxena and Suvashree Ghosh