The Grand Bargain: We Must Challenge Narrow Nationalism and Vaccine Darwinism in Combating COVID-19

The Indian diaspora, especially those in North America and the UK have been understandably concerned about the out of control COVID-19 pandemics in India.  Financially resourceful community of Indians in the U.S. and Canada are rising to the challenge by sending money, much needed oxygen concentrators as well as providing online medical consultations. A recent report in the Los Angeles Times mentions that two humanitarian groups in the U.S. led by people of Indian descent raised more than $25 million to help India’s overstretched healthcare system. Maybe this amount is rather insignificant considering the potential to give more. It also reported that Indian American doctors, hotel owners and other entrepreneurs have pledged or donated millions more. 

While financial support, supply of medicines and equipment need to continue, the focus of the Indian diaspora should be on the vaccines and their access to all Indians.

 A common refrain we hear these days, from the Head of the World Health Organization (WHO), world leaders including the Indian Foreign Minister who is currently visiting the U.S. and others is that “nobody is safe until everybody is safe”.

While all are referring to the need for effective vaccines to prevent and arrest the spread of COVID-19, what is important is how we can ensure fair and equitable distribution as well as availability. As the virus causing is fast spreading worldwide, the race to secure vaccines has taken on new urgency.

There are at least 18 COVID-19 vaccines that have been approved by or being evaluated within the WHO evaluation process and many are now in clinical trials.

While India is the world’s biggest producer of Covid vaccines it is also facing a major internal shortage. Facing the devastating second wave of coronavirus infections and deaths, there is a cry in unison for rapidly increasing the vaccine production in the country as well as  securing a large amount of vaccine from all available sources.

Serum Institute of India’s (SII) COVID-19 vaccine is called Covishield. This is a version of the Oxford-AstraZeneca vaccine. Another vaccine produced in India through indigenous effort is Bharat Biotech’s COVAXIN. SII has a reported capacity to produce 60-70 million doses a month. Bharat Biotech’s claim is that the company produced 20 million doses in April and would produce 30 million in May. Despite these impressive numbers, there are many media reports indicating that India needs to be giving 3.5 million doses a day. However, as reported by various sources, currently, there is a deficit of 1 million doses that require an immediate attention.

Another vaccine that is making an entry into India is the Russian-made Sputnik V, which is yet to be approved in the European Union (EU). The makers of Sputnik V have already signed manufacturing deals with Indian companies for manufacture soon. In the meantime, though not approved by WHO, India is importing due to the emergency, the vaccine from Russia.

India is also said to be negotiating with Pfizer to resolve the demand being made by the U.S. drug maker for legal protection from any claims linked to the use of its COVID-19 vaccine in India, which obviously is one of the world’s biggest markets. There are also reports that, both Argentina and Brazil were asked by Pfizer to place sovereign assets as collateral as part of indemnification of the company.

Considering the urgency of vaccines, the central government in India has eased the restrictions on the procurement of vaccines, making it easy for state governments and private hospitals to directly negotiate and buy from the two vaccine makers in India as well as from global suppliers. Of course, they must pay far more to procure vaccines from any available source. The premium price must be paid for these vaccines in the open market.

Vaccine Darwinism

While this may seem to be a welcome development to ease the vaccine shortage, it will also open for a kind of “vaccine Darwinism,” or in other words, survival of richer sections of the population. Current vaccine prices in India, especially what India’s private hospitals are charging happen to be some of the steepest rates in the world for administering Covid-19 vaccines.

Initially, the India was procuring both vaccines at $2.1 (Rs. 150) and supplying them to state governments and private hospitals. The private sector could charge $1.4 (Rs. 100) per dose as vaccination charges. Private hospitals had agreed that this amount would cover the cost of administering the vaccine. However, many hospitals are reportedly charging $3.5 to $4.2 (Rs. 250-300 ) per shot of Covishield as vaccination charges. Reports also indicate that the cost of vaccine per injection at private hospitals ranges between $10.5 to $21 (Rs. 700 to Rs. 1,500). The imported Russian Sputnik vaccine, according to Indian Express will cost about $13.27 (Rs. 948) per dose. Covishield, manufactured by Serum Institute of India, is cheaper than Sputnik V now

Also, according to Indian Express, Bharat Biotech’s Covaxin is the most expensive COVID-19 vaccine in India’s portfolio of vaccines so far. It is priced at $ 5.4 (Rs. 400) per dose for States and sold at $16.8 (Rs. 1,200) per dose to private hospitals. Private hospitals which are under moral and professional obligations to save lives and care for the sick, their mercenary approach is reprehensible. 

When it comes to the private sector behavior, the generosity of TATA Group  of companies is worth emulating. It will take care of the families of its workers who have died with Covid. Other companies have pledged benefits, to a lesser extent.

The time has come for the leading business houses and Indian billionaires and millionaires to show their solidarity and use their wealth and clout to source vaccines from all possible sources as well as help  making them at a speed to match the spread of the virus. 

Current vaccine prices in India, especially what India’s private hospitals are charging happen to be some of the steepest rates in the world for administering Covid-19 vaccines.

In most countries, there is no cost to get vaccinated against COVID-19. The vaccine is provided at 100% no cost to recipients. For example, the U.S. federal government is providing the vaccine free of charge to all people living in the country, regardless of their immigration or health insurance status. In the U.S. the health care is based mostly on private insurance. However, “no one can be denied a vaccine if they are unable to pay a vaccine administration fee.”

As the coronavirus that causes COVID-19 spreads in almost all countries, the race to develop a vaccine to prevent the illness has taken on new urgency. In the UK and in most of the countries in Europe vaccination is provided as a right. In the EU this is a Member State responsibility and most of them offer vaccination free of charge.

Indian Diaspora and Vaccine Access

India’s large diaspora while devoting attention and providing resources to India to combat COVID-19, it should also pay attention to ensure that everyone can feel safe. Supporting universal and free vaccination is the answer for the millions of slum dwellers, migrant labourers, urban and rural poor. The United Nations estimated the number of poor in the country to be 364 million in 2019, or 28 per cent of the population, not including those newly pushed in poverty by the pandemic. 

Options include a diaspora vaccination fund to buy as well as produce vaccines that are not bound by cumbersome patent regimes and ingredients export controls as we are witnessing now. The aim should be equitable distribution of vaccines, to those in great need and those who cannot afford it under the current vaccine scarcity. As an immediate step, the diaspora’s role can be advocacy and developing partnerships that can be brought forward while facilitating buying and producing the vaccines should also be given attention.

According to the World Health Organization, 87% of vaccine doses have gone to high- or upper- middle-income countries, while low-income countries have received just 0.2%. In a paper published as recently as 21 May, 2021 IMF chief economist Gita Gopinath pointed out that vaccinating 60% of the global population by mid-2022 would cost just $50 billion. 

The pandemic also produced nine new billionaires in the U.S., Europe and China. They have a combined worth of  $19.3 billion, enough to fully vaccinate some 780 million people in low-income countries, according to the campaigners for vaccine justice. “These billionaires are the human face of the huge profits many pharmaceutical corporations are making from the monopoly they hold on these vaccines,” Anne Marriott, Oxfam’s health policy manager, said in a statement. Also, according to her, “These vaccines were funded by public money and should be first and foremost a global public good, not a private profit opportunity.” For example, BioNTech, received €325 million ($397 million) from the German government for the development of the Pfizer-BioNTech vaccine. As the Economist Jayati Gosh reminds us “though the companies producing the approved vaccines have benefited from public subsidies and publicly funded research, they nonetheless have taken advantage of patent protections to maintain a monopoly”

With just over 3% of the population fully vaccinated in India, the goal of immunizing more people, in more places, in all the states at a greater rate has become more urgent. In the process of rapid rolling out of vaccines in India, the diaspora can play a  catalytic role by mobilizing resources, financial and human in exploring all possible avenues such as partnering with countries such as South Africa, Cuba and the Scandinavian countries that already have equitable and universal health care. 

The Cuban Solution

While the Western world has focused on leading candidates from large multinational drug makers, a small island state, Cuba has developed five vaccines of which two are being rolled out, these vaccines do not need expensive raw materials or cooling requirements.  

South Africa is already part of an alliance demanding a waiver of Intellectual property rights for vaccines, protected by the WTO. India has already a track record of partnering with Norway based Coalition for Epidemic Preparedness Innovations (CEPI),  the Coalition for Epidemic Preparedness Innovations and Biological E Limited, India (Bio E) through a Hyderabad-based vaccines and pharmaceutical company, to advance the development and manufacture of Bio E’s COVID-19 vaccine candidate. 

While patent waiver and free access to technology are very important, the waiver process and vaccine philanthropy will take time to provide vaccines to the people. To rephrase a proverb, “While the grass grows, the cow starves or even dies!”

Avtar Singh, based in Germany wrote in Foreign Policy bemoaned “Watching a catastrophe unfold from afar has left India’s diaspora feeling angry and helpless. This need not be so as it is the time to act on vaccines.

Just like the Y2K situation paved way for a strong Indian IT sector and jobs for Indians abroad, focus on vaccines and vaccine production with concerted efforts from the diaspora can pave way to a new era for the health care system and general economic and social harmony. Economic recovery and reconstructing of system to address other needs of the society, will only be a possible when we vaccinate eighty percent of the population. With that in mind “vaccine” is the need of the hour. Patent free vaccines that all countries do their part to aggressively distribute is the best way out.

As time is of the essence and if vaccines are to be made free and accessible to Indians, all avenues need to be explored, not just the Anglo-American based ones.  And the Indian diaspora is well placed to push for ending the vaccines apartheid.

(Opinions expressed are solely of the author and do not express the views or opinions of the organizations that he is associated with.)

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S. Ananthakrishnan, currently based in Havana, Cuba, has over 40 years of experience in international development work, including over 15 years with the UN in Nairobi Kenya (UNEP and UN Habitat), engaged in urban youth empowerment initiatives, policy and research, advocacy, program management as well as development and implementation of projects. Currently holding the position of Secretary General of Urban Economy Forum, he’s looking at the ways and means to strengthen the economies of cities and towns, supporting the implementation of Sustainable Development Goals at the City level and to deliver services including in the housing and health sectors.