India could play an important role in vaccine production

India could become the world’s second largest producer of Covid vaccines, and analysts say the country has the capacity to produce for its own population as well as for other developing countries.

Most of the world’s vaccines have traditionally come from India. Even before Covid-19, the South Asian country produced up to about 60% of the world’s vaccines – and it can do so at a relatively low cost.

“India was a vaccine manufacturing hub … even before the pandemic, and should therefore be a strategic partner in global COVID-19 vaccination,” JPMorgan analysts wrote in a report last month.

Consulting firm Deloitte predicts that India will take second place this year after the US in terms of coronavirus vaccine production. PS Easwaran, a partner at Deloitte India, said more than 3.5 billion Covid vaccines could be made in the country by 2021, compared to about 4 billion in the US.

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

“We are expanding our capacity on an annual basis to deliver 700 million doses of our intramuscular COVAXIN,” said Indian firm Bharat Biotech, which has developed a Covid vaccine together with the state-led Indian Council for Medical Research.

Covaxin is approved for emergency use in India, but has been mired in controversy for criticism that there was a lack of transparency in its approval, and also for not having published enough data on its efficacy.

Another vaccine – known in India as Covishield and co-developed by AstraZeneca and the University of Oxford – has also received an emergency permit in India. It is locally produced by the Serum Institute of India (SII).

According to Reuters, SII makes about 50 million doses of Covishield every month and plans to ramp up production to 100 million doses per month by March.

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

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

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

Those vaccines will require “stringent cold chain requirements” that will be difficult, or even “out of reach,” 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 the demand in the developing world, he added.

India’s massive manufacturing capacity also gives analysts confidence that the country can deliver vaccines to other countries.

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

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

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

Solomon added that the country is keeping an eye on domestic needs before making export decisions.

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

However, challenges will come as the country tries to meet the demand for vaccines in India and abroad.

Jefferies’ equity analyst Abhishek Sharma wrote in a note that the introduction of vaccines in India has been slow. Even assuming the vaccination rate will increase, Sharma estimates that only 22% of India’s 1.38 billion population can be vaccinated in a year.

That is roughly the number of people that India wants to vaccinate in July or August.

“Vaccine delivery is not as much of a problem as vaccine storage, distribution and uptake,” said Solomon of CPPR.

“India does not have the capacity to store and distribute to the masses on such a large scale,” she said, adding that the country should “strategically” choose vaccines that do not require storage at extreme temperatures.

The vaccines that India currently produces require normal refrigeration, but those produced by Pfizer-BioNTech must be stored in extremely cold temperatures of minus 70 degrees Celsius (minus 94 degrees Fahrenheit), while those of Moderna must be stored at minus 20 degrees Celsius ( minus 4 degrees Fahrenheit).

The “real challenge” is 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 that an adult vaccination program has been conducted on such an unprecedented scale,” he told CNBC.

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

Reddy suggested that the existing food cold chain could be used for vaccines, and hoped this problem could be solved.

“I would say that [these challenges are] more like speed breakers that will slow down the… program, rather than actual roadblocks that will force the program to stop, ”he said.