India Is Carrying the Burden of Vaccinating the World

India’s official coronavirus statistics are harrowing. Its total recorded infections exceed 33 million, the second highest in the world after the United States. The virus has so far killed more than 449,000 Indians. And the country’s vaccination drive has not been fast enough. India has so far vaccinated 65 percent of the eligible population with at least one shot. In some ways, that’s a promising figure, reflective of a country with experience carrying out mass vaccination drives. But only 200 million of India’s 1.4 billion people have received the full two-dose regimen. 

That has raised fears of another wave of the pandemic this fall or winter, coinciding with the gatherings of the festival season. Some experts believe the virus has already spread so far in India that natural immunity will offer significant protection; a seropositivity survey by the Indian Council for Medical Research [ICMR] has found that two-thirds of Indians already have antibodies against the virus. But the uncertainty has sparked a debate about the Indian government’s plans to resume its exports of vaccines to other countries. 

The looming specter of renewed outbreaks, especially in poorly vaccinated areas of the country, has stirred uncomfortable memories of Prime Minister Narendra Modi’s earlier ill-fated attempts at vaccine diplomacy. As the delta variant spread rapidly through India this spring, at a time when only 2 percent of the country was inoculated and shots were hard to access, Modi came under severe criticism for allowing Indian companies to export some 66 million vaccines. 

More recently, however, India, unlike the poorer countries it would be exporting to, hasn’t struggled with a shortage of vaccine supplies. Indian manufacturers have multiplied their production in recent months and are expected to produce 300 million shots a month in the near future. That ought to be sufficient supply to meet both domestic and foreign demand. That’s why most experts now seem to agree that it’s wise for India to resume vaccine export to low-income countries—albeit slowly at first, if only for political reasons. 

The Indian government has placed a priority on providing vaccines to neighbors in need and COVAX, the global vaccine-sharing platform. The country’s health minister, however, added that only excess supplies would be exported. 

It is a question of “balancing local needs and [the] commercial commitments” of India’s vaccine-makers, said Shahid Jameel, an Indian virologist and academic. Poonam Khetrapal Singh, the Southeast Asia director for the World Health Organization (WHO), underlined the need to vaccinate the vulnerable everywhere. “There is a need for equity of vaccination administration globally to ensure that the most vulnerable, such as the front-line workers and the elderly, are fully vaccinated in all countries,” Khetrapal Singh told Foreign Policy. “At the moment, several low- and lower-middle-income countries are lagging behind in vaccinating their vulnerable populations.”

If the Indian government continues to vaccinate Indians at its current pace, and if the worst tragedies that befell India this spring can be avoided in the weeks and months ahead, then public acceptance for vaccine exports will undoubtedly grow, removing the political barriers to expanded vaccine diplomacy. And that could have important diplomatic benefits for India. Its contributions to combating vaccine inequity will likely build a favorable global image for the country and its pharmaceutical industry.

The first vaccines to combat COVID-19 were approved nearly a year ago, but 80 percent of the 5.5 billion vaccines administered thus far have been in high- and upper-middle-income countries, while a large part of the world’s poorest people are still deprived of the lifesaving jabs. India can play a major role in reducing the disparity in vaccine distribution and save lives.

WHO Director-General Tedros Adhanom Ghebreyesus said in a press conference early last month that more than 50,000 people had died of COVID-19 every week since October 2020 and that number had climbed to 70,000 a week the past month. He said WHO would continue to support every country to vaccinate at least 40 percent of their populations by the end of this year and 70 percent of the world’s population by the middle of next year. But vaccine disbursement has tilted toward the wealthy, who could pay the top buck. Poor countries had less than 1.7 percent vaccine coverage until early September. 

India was meant to contribute 30 percent of the total COVAX quota to meet the target in low-income and conflict-ridden countries. WHO says India’s decision to resume vaccine supply is vital to meet the targets. But it has urged others to do the same. 

Two billion doses of vaccine are required to cover 40 percent of the population in every single country by the end of this year and meet WHO’s target for this year. The overall production of coronavirus vaccines stands at 1.5 billion per month currently, according to the International Federation of Pharmaceutical Manufacturers & Associations, a Geneva-based trade association that represents pharmaceutical companies from around the world. 

Experts say that, with sufficient political will, vaccines should soon be available to anyone who wants them at the current rate of vaccine production. Vaccine hoarding, they add, has exposed not just the divide between haves and have-nots but also shortsighted decision-making by the world’s political elite that will negatively affect us all. “Whether deadlier variants will emerge can’t be predicted, but you increase that possibility by leaving millions exposed but not protected,” Jameel added. “An equitable vaccine distribution will also help check the emergence of variants by halting the spread of the virus,” Khetrapal Singh said. “We must remember that no one is safe till everyone is safe.” 

But even a global catastrophe of the magnitude of the coronavirus has failed to build the camaraderie that humanity urgently needed. Instead of encouraging companies to supply to the dispossessed, rich and powerful nations have now begun to hord millions of doses to offer booster shots, a third jab, to their populations. 

WHO has pointed to a lack of compelling evidence for the need for the third jab and called for a global moratorium on booster shots. Despite that, the Biden administration has reportedly said that as soon as it gets a nod from the U.S. Food and Drug Administration, it will roll out these shots, which are already being given to immunocompromised individuals in the United States, to the general population. 

The Serum Institute of India is the largest manufacturer of Covishield—the Indian-made version of the AstraZeneca coronavirus vaccine. It is keen to fulfill its commitment to COVAX and now has a go-ahead from the Indian government, which wants to portray India as a reliable partner during crises like these and advertise that India is, after all, the biggest vaccine manufacturer overall in the world. At the United Nations General Assembly in late September, Modi invited global companies to manufacture their vaccines in India. “Come, make vaccines in India,” he said. 

The same week, U.S. President Joe Biden announced that the four members of the Quadrilateral Security Dialogue (the United States, India, Japan, and Australia) would produce a billion vaccine doses in India to boost the global supply by the end of next year. It is unfair, however, for the United States to stockpile booster shots for domestic consumption while asking India to share its vaccines with the world before it vaccinates nearly a billion Indians waiting for their second jab.