When COVID-19 vaccines first started becoming available end of last year, the Indian government seemed all set to roll out a free and universal vaccination campaign in the country.
It set apart Rs 35,000 cr ($4.7 bn) for COVID-19 vaccination in its budget for the year 2021-22, enough to vaccinate all Indians above 10 years of age. Leaders of the ruling Bharatiya Janata Party too started making promises of free and universal COVID-19 vaccinations, even if some of these promises were made in the heat of election campaigning.
Shortly after, the government signed an agreement with two vaccine suppliers — Serum Institute of India and Bharat Biotech — to purchase an initial tranche of an estimated 100 million (10 cr) vaccine doses at a reported price of around Rs 150 (around $2) each.
However, soon after India crossed the 100 million vaccination mark, the supply of these vaccines started to dwindle.
As if on cue, market experts started taking the government to task for “starving the vaccine makers” of funds by imposing “an unfair” price of around Rs 150 only. On various media outlets, experts blamed the government for the scarcity of the vaccine, pointing out — with some justification — that vaccine makers did not have funds to invest in expanding their vaccine making capacity, and the government’s $2-per-dose pricing was partly to blame.
The government’s response to the criticism was been two-pronged: First, it gave credit of Rs 3,000 cr (around $400 million) to Serum Institute of India and Rs 1,500 cr to Bharat Biotech to help them ramp up their production capacity.
Secondly, it gave in to demands from vaccine makers — including those yet to start production due to pricing uncertainties — to free up vaccine pricing.
Following this, Serum Institute of India — the biggest vaccine maker in the world — announced that it would sell its vaccines at Rs 400 to governments and Rs 600 to private hospitals. Including service charges, the end-price of the vaccine at private hospitals could range Rs 700 to Rs 850.
While government of India’s position seems ‘progressive’ and in keeping with the reformist and market-friendly policies of the Narendra Modi administration, it may have an unexpected impact that has repercussions far beyond India’s boundaries.
This especially the case if other vaccines, including Covaxin and Sputnik V, are also priced in the Rs 500 plus range per dose.
At these prices, many state governments are unlikely to be able to afford the vaccine, leaving the people in those states at the mercy of private hospitals and clinics.
AN UNPREDICTABLE CUSTOMER
As the scientific and medical community grapple with the second wave of COVID in India, they have also been able to obtain a greater degree of insight into the nature of this virus, and make propagation models that are far more realistic than they were able to last year.
When the SARS-CoV-2 virus first entered the country, it was assumed that a lock-down of 2-3 weeks would be enough to arrest the pandemic and restrict the virus to isolated hotspots, which could then be tracked down and eliminated.
However, the virus turned out to be more resilient than experts believed, and instead of two to three weeks, it took four to five months for the number of cases to start coming down.
Nevertheless, by January this year, it was clear that SARS-CoV-2 was on a slow, but steady, slide towards extinction in India, as cases fell to around 15,000/day from a peak of around 100,000, and continued to go down.
People were able to relax and started lowering their guard. Books and articles were written and speeches made about how India achieved ‘herd immunity’ against COVID-19 without undergoing the pain and suffering seen in other countries.
However, what the policymakers and researchers failed to take into account was the tendency of such viruses to mutate.
Starting from late 2020 in countries such as the UK, new strains of SARS-CoV2 — more contagious than the original — started emerging.
The first, so-called UK variant was soon joined by a South Africa variant and a Brazil variant.
Since these were not exact replicas of the original SARS-CoV-2 virus used to make vaccines, the vaccines were found to be less effective against these new variants.
Instead of protecting 95% of the inoculated population as in the case of the original variant, these vaccines were reported to reduce cases by only 20% to 55%, depending on the exact variant and the vaccine.
However, India’s problem was not related to the reduced efficacy of vaccines against these new variants. For India, the key concern was that some of these variants were not being identified as SARS-CoV-2 by the human body’s immune system either.
It is only if the body’s immune system correctly identifies the intruder as COVID-19 virus that the body can leverage its previous experience in fighting the virus to kick out the intruder. If it fails to identify the intruder as the same virus that had attacked it last year, it would not be able to launch the same tools and weapons (antibodies) that worked the last time.
When the quantum of mutations in the virus is extensive, the body is usually unable to make the connection, and starts fighting it as a new virus. This leads to a full-blown disease, or a re-infection.
Because of this, India has started seeing a large number of reinfections in the second wave. In other words, the ‘herd immunity’ that had been built up over the previous year was lost almost overnight due to the mutations, and it was back to square one in the country’s fight against COVID-19.
This is the situation that India finds itself in right now, with various mutants dominating in various states.
The prevalence of a large number of mutants, each with its own unique genetic signature that helps evade preexisting immunity, is what makes India’s situation particularly precarious.
It has also made the second wave far more challenging to control. While the original COVID-19 virus could have been arrested using a single vaccine, the current cluster of different variants are likely to require multiple vaccines, or at least a broad-spectrum vaccine.
What should concern us even more is that each day of unchecked pandemic increases the chances of more such variants and mutants emerging in some corner of the country, making it even harder to target via vaccines.
Eventually, the genetic drift could produce a virus that is so far removed from the original that none of the existing vaccines work against it.
If this virus then reaches any country or population that has successfully eliminated COVID-19 using vaccination, it would cause a new round of the pandemic in that population, given that the pre-existing immunity from the vaccine would be useless against this variant.
REPLICATION = MUTATION
Mutations or changes to the virus’ genetic code are the results of imperfect copying of the virus’ genetic material when the virus replicates itself in the human body.
The greater the number of infected patients, the greater the number viral replications that take place, and the greater the chances of mutation.
India, with its 1.4 billion population, offers great scope for the coronavirus to replicate, and mutate.
This should be a major cause of worry for the rest of the world.
If the virus is allowed to spread unchecked in the Indian population, soon or later, new variants will emerge that will be potent enough to restart the pandemic even in fully vaccinated countries.
Of course, before that, such mutant viruses would also cause repeated rounds of the pandemic in India. Even those who pay Rs 800 or 1000 to get themselves vaccinated now would not be safe from all of these new variants.
The only way to prevent this from happening is to ensure that the number of infections is brought under control — thus reducing the number of viral replications and controlling the pace of the genetic mutation.
However, to do this would require quick and effective healthcare interventions in India, including rapid vaccination and failsafe adherence to COVID-appropriate practices, such as masking and social distancing.
This is where free and universal anti-COVID vaccination right now would pay great dividends, not just for the country, but for the whole world.
In short, free vaccination is not about being kind to the poor, but ensuring the safety of everyone, because if you leave the virus free to ‘roam around’ among the poor, it is only a matter of time before it mutates into a deadlier form and attacks you.