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From Delay In Purchase To Slow Production: The Fault In India’s Vaccination Policy

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This post is a part of YKA’s dedicated coverage of the novel coronavirus outbreak and aims to present factual, reliable information. Read more.

This article is the second part of a series. You can read the first part here.

Vaccine Regulation

India on April 13th announced that it will fast track the approval of vaccines tested in western nations and Japan. This would set it in a position to import these vaccines and reach deals to manufacture some in India, in partnership with home manufacturers. The question here is, why was this not done before? Why wait until we are at the peak of the second wave of the pandemic to grant them approval when it was obvious that we would need a massive amount of vaccines to immunise the population?

A Covaxin vaccine vial
The lack of foresight of the government delayed the vaccination drive of trial-passed vaccines, and initiated the vaccination drive for the untested COVAXIN. Image Credit: Getty Images. Representational Image.

If these vaccines have passed regulation and testing in other nations and the World Health Organization (WHO), why waste time on local tests? The earlier they are fast-tracked, the earlier they can be imported or manufactured for use. In a population of more than 1.3 billion, it was always known that we would need at least 2.5 billion vaccine doses to reach an acceptable immunity threshold. So, why the delay?

India gave approval to its own locally developed COVAXIN before the phase 3 trials were completed in January, drawing criticism from the scientific community. The All India Drug Action Network (AIDAN) expressed shock and concern over the move, and even wrote to the Drugs Controller General of India (DCGI), requesting a revoke of the approval. And there is a very good reason why this move may be risky and prove costly.

There exists a community of ‘anti-vax’ people in the world, including India. These people reject vaccines based on fake news, misconceptions, and conspiracy theories. The entire point of a vaccine is that people take it to immunise the public. A single mistake or safety concern can affect not just India, but beyond as well. It may add fuel to the fire of the anti-vax ideologies. This is why governments in countries like the USA spend so much time and effort to encourage people to get vaccinated.

These concerns are backed by surveys, like one from December which found that a majority of Indians were hesitant to get vaccinated.

All of this, while the government failed to approve international vaccines that had already passed trials, and unnecessarily withheld approval for local trials. Now after realising the expanse of the second wave of the virus, they are retracting from this position. This lack of foresight delayed the vaccination drive of trial-passed vaccines, and initiated the vaccination drive for the untested COVAXIN which was, in all probabilities, unsafe. While the Sputnik vaccine is now being granted emergency approval, other major vaccines are still miles away from use.

 

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Vaccine Purchase

In January, the Serum Institute of India (SII) had a stockpile of 50 million vaccine doses ready. The government showed no urgency in signing contracts for supply, letting them sit in storage. Even after deciding to sign up, it only bought 11 million vaccines. There is no answer to why the delay was there.

How the government intended to vaccinate India’s 1.3 billion people with 11 million shots is a mystery. Having 50 million vaccines sitting in storage, SII pushed the brakes on further production due to storage being full. The CEO of SII, Adar Poonawalla remarked that he would have to store any more vaccines at his own house. So basically, we had the vaccines, approval was granted, and yet they were not used, forcing a halt in production.

Why? Maybe our ‘esteemed’ Prime Minister could answer that if he chooses to ever hold a press conference. (It is important to remember that Modi has not appeared for a single press conference in which he actually spoke, in his two terms in office.)

The government has also been criticised for not allowing the private sector in its vaccine drive. This would have been a way to circumvent the sluggish pace of government drives hindered by bureaucracy and politics. It could also have raised money from the rich who choose to go the private way at higher prices, and this money then could have been used to further expand production capacities.

We obviously cannot rely only on the private sector, and the government needs to provide vaccines for free to the poor and the underprivileged. Like the government announced recently that they would allow 50% of vaccine production to be used by the private sector, we could have done a similar thing previously to gain significant boosts, economically and time-wise.

Vaccine Production

Can we consider this to be another shocking overlook by the government? Despite knowing that the world was bound to face a shortage of vaccines considering the demand, we did nothing to prepare and plan for this predictably massive vaccine gluttony. This has not only resulted in unnecessary infections in India, but taking into account the entire world’s dependency on India’s and China’s vaccine manufacturing capacity, it also slowed the fight against COVID globally.

Right now, our vaccine production capacity is around 60 to 70 million per month. This, however, is just the base capacity that can be drastically increased with careful planning and correct priorities. Instead, we have a production capacity that won’t be enough even for our own country, let alone the entire world. On top of that, SII is now facing legal battles for not being able to fulfil its vaccine promises to COVAX.

Even in the midst of the second wave, the government is taking its sweet time to fulfill requests by SII and Bharat Biotech for grants to ramp up its vaccine production. So, we could be producing a lot more vaccines but are not being able to do so, because the government is slow in providing funds for this. First, they squeezed off funds from both manufacturers by restricting their prices to INR 150 per dose. While that is not a bad idea, it has resulted in the fact that both manufacturers are struggling to raise money to expand their production, which is why they sought grants from the government.

No Fresh Registrations For Healthcare Workers For COVID-19 Vaccine, Says Centre
Representational Image. Image Credit: NDTV.

Remember, it was always known that vaccinating the world would be a difficult task and production capacities were limited. Even as far back as in the first wave, experts were warning us that even after making a vaccine, we would not have the logistics to actually manufacture it and distribute it due to great demand. Despite this, the government showed no hurry and took no steps to increase our production capacities.

Forget working on expanding capacities themselves, they are not even providing funds to the companies for this even in the second wave. On the 19th of April, they finally agreed to provide funding, a decision that could have and should have been made earlier. Yet, their PR machinery is working in full force to convince people otherwise. If you read any news recently, the health ministry has said that they are pumping cash to ramp up production. What it fails to mention is that the funds being provided by the government are a tiny percentage, compared to what the companies are asking for, and even more importantly, what we need.

For example, SII has asked for grant of USD 400 million, while the government is offering peanuts. And that is only what the companies are asking for. Even if the production is increased due to government grants that would still not be enough to be a game changer and would take time to build up. At this time, the government should be providing five times what is asked for, along with quick fast tracking through the infamous Indian bureaucratic red tapes and use emergency provisions to help where needed.

Imagine where we would be now if the government had heeded the warnings of a production shortfall and decided to grant access to limitless funds to start expanding capacities during the first wave or atleast by the end of it. We had a reprieve of months in between the first and second wave. That was a golden opportunity to build production capacities, get raw materials, and infuse massive funds. But no.

Not only did the government fail to act at the time, they are still not treating the problem with the urgency and importance it deserves. To everyone following the news, it has been pretty apparent that manufacturing vaccines for the world and distributing them would be a hard task. Why then was there no preparation by the government? When a problem is sudden, excuses can be made as they were in the first wave. However, we had plenty of time and resources to prepare for the second one.

Representational image.

What about human resources? I am certain that if the government made an announcement of the need of skilled and unskilled labourers, in a country with more than 1.3 billion people, they would find no shortage of manpower.

What about raw materials? It is only now in the midst of the second wave in India that western countries like the US have imposed restrictions on the export of raw materials. The SII has requested for that ban to be lifted, or else it would affect vaccine production. Nevertheless, the question stands, why exactly did we wait till the last possible moment to obtain raw materials? We could have stocked up on raw materials since the first wave struck, and imported whatever was needed well in advance to avoid facing the kind of shortage we face today.

Plus, in domestic industries, the government has emergency provisions to use to redirect all raw material usage to vaccine manufacturers, from private companies. Why have they not been used?

What about financial constraints? Nope. Not a good excuse. No matter how much the government spends on vaccine production, it will be a tiny fraction compared to the economic destruction wrought by lockdowns and curfews. Not only this, but if we had sufficiently ramped up production capacities during the time we had, we could have exported vaccines without shortage at home, and actually earned money commercially and gained diplomatic power.

What about the law? The constitution provides for a wide array of emergency provisions to the union government, from national and financial emergencies to the President’s rule. Few of these have been used. The government could direct every single resource in the country, no matter what kind if it wanted to. So, legality is no stopper.

 

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Why Is There No Transparency?

I wrote above that the government failed to purchase 50 million doses of vaccines just sitting around. Unfortunately, that is not the end. The Modi government, even when purchasing them, relied on ad hoc, impulsive decisions rather than a transparent, long term plan over it. This led to companies having no idea of when, how, how many, and the pricing of the doses to be purchased.

Further on, such lack of planning has and can lead to confusion in corporations about imports, exports, domestic needs, and so on. This long term and practical plan was a much needed thing and should have been formulated in December 2020 by latest.

Additionally, a plan and process to decide allocation of vaccines and other necessary equipment and drugs, statewise, could have prevented the political blame game going on and accusations of partiality by state governments.

An even more ambitious step could have been a transparent all India plan, discussed with states and opposition leaders, to lay down a pragmatic path to end the pandemic. This plan could have included everything from drug production to equipment distribution to vaccine production.

The need of the hour to promote a transparent response along with accountability would be a commission or group of government officials tasked with holding regular press conferences and spreading awareness about the pandemic. This commission must be required to answer any questions asked by the public. This shall allow the citizens and experts know the reasoning behind the government’s thinking.

Writer’s Note: If my article enriched your knowledge the tiniest bit, please consider upvoting and sharing it. I will be writing the third part soon, which shall cover topics like Remdesivir shortage, beds, oxygen, and the implementation of the lockdown. Follow me by clicking on my profile to get updates on future articles.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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