Vaccination program in India stalls as nation faces deadly third wave

India has sadly joined the United States and Brazil as only the third country in the world to reach the grim milestone of 400,000 lives lost to Covid-19.

The news comes as experts caution that even this fatalities figure may be an underestimate and predict that the country – which has recorded 30 million cases – could soon suffer a deadly third wave unless its vaccine campaign is significantly accelerated.

A huge task lies ahead, however. Less that 5 percent of India’s population has been fully vaccinated since the program began in January. Although the government has pledged to vaccinate 900 million citizens by the end of the year, the campaign has so far been hampered by the slow pace of rollout, supply shortage and vaccine hesitancy. All these shortcomings will need to be addressed if India is to avert a humanitarian disaster.

Vaccine supplies aren’t keeping pace with demand.

India needs more vaccines, period. The nation has yet to receive its share of the doses donated from the US and, at the same time, has failed to ensure enough home-grown supplies, leading to dramatic shortages. India’s domestic producers, including Serum Institute of India (SII), need urgent support to ramp up production.

So far, the government has been deploying the Oxford-AstraZeneca vaccine (branded Covishield), together with its own domestically developed vaccine, Covaxin. Russia’s Sputnik vaccine and the Moderna vaccine have also been greenlit recently by drugs regulators. A local version of the Novavax vaccine is in the pipeline for production by the SII.

Part of the problem lies in the fact that the government didn’t order enough doses at the right time: the order for the first batch of vaccines from the SII in January numbered just 11 million, in a country of almost 1.4 billion. What, in retrospect, appears like appalling complacency, probably looked more like effective tactical management at a time when production levels were buoyant and Covid infections were at record lows.

However, with Covid cases – and panic – rising in April and May, the stories hitting the international headlines weren’t of India’s successful vaccine manufacturing operation but of ambulance services being overwhelmed and hospitals running out of oxygen. With Covid testing collapsing, observers could only guess the number of fatalities – acknowledging that the real figures were likely to be higher still.

As the death rate climbed, the Indian government rapidly re-routed SII-produced vaccines to its domestic inoculation program, rowing back on a previous commitment to supply the WHO’s COVAX initiative. It still wasn’t enough to meet burgeoning demand.

The vaccine approval process needs to accelerate

A multi-faceted approach is needed to increase vaccine supply in the mid-term. Swifter approval of vaccines already in widespread use elsewhere – like Pfizer – is essential. In order to expedite vaccine rollout, overseas manufacturers are requiring that purchasing governments agree to protect them from any legal liability over vaccine complications. It’s this indemnification process that’s holding up the vaccine supplies that India so desperately needs.

India also needs to prioritise the rapid adoption of new, so-called ‘second-generation’ vaccines from a variety of manufacturers deploying multiple vaccine technologies. Specifically, India needs vaccines which can be rapidly and affordably produced and stored at room temperature for areas with infrastructure gaps – such as the promising candidate by Akston Biosciences.

Akston recently announced positive results for the Phase I trial of its second-generation vaccine, AKS-452. Following the successful conclusion of the 60-subject Phase I trial, which found that the vaccine was generally well-tolerated and yielded a 100% seroconversion rate following a single 90 microgram dose, AKS-452 will now move into a Phase II trial of both one- and two-dose regimens at the University Medical Center Groningen, one of the Netherlands’ largest hospitals.

Akston’s second-generation vaccine is expected to be shelf stable at ambient temperatures for extended periods—even able to be kept at 37°C for a month—a factor that’s likely to be critical if vaccination programs are to be successful in areas where refrigeration is unreliable or unavailable. Furthermore, the Akston vaccine’s low-cost antibody manufacturing techniques allow optimal dose capacity on standard production lines, meaning that a single 2000 litre production line could produce more than one billion doses a year.

Overcoming vaccine hesitancy

It’s not just vaccine availability that’s threatening India’s Covid response, though. Vaccine hesitancy among the country’s vast population is also proving an intractable problem.

A recent survey showed vaccine hesitancy rates of between 19 and 40 percent across India’s states. The reluctance of some to engage with the national vaccination program stems largely from lack of trust in the safety and efficacy of the vaccines, as well as concern over potential side-effects, fuelled by a low-risk perception of Covid itself.

Unfounded rumours – such as those suggesting that people are dying or becoming impotent as a result of receiving the vaccination – are damaging and persistent, especially in India’s many rural districts. That the vaccine could cause individuals to fall ill and forfeit their income are very real concerns for those already struggling to make both ends meet.

Threats to withhold food rations or restrict access to public areas for the unvaccinated are likely to exacerbate existing structural inequities, further punishing families who are already among the most marginalised.

Overcoming these fears will, instead, require a targeted approach that addresses anxieties and misconceptions in individual communities through better public health communication. A bespoke public health campaign on a massive scale, designed to overcome the barriers and misunderstandings that are preventing people from getting lifesaving vaccines, is urgently required.

Only carefully coordinated efforts – between the government, health care providers and community leaders – that empower citizens to make more informed decisions have a chance of improving the picture for India. The survival of millions may depend upon it.

Disclaimer: No Deccan Chronicle journalist was involved in creating this content. The group also takes no responsibility for this content.