India Cuts Back on Vaccine Exports as Infections Surge at Home

Residents of the Dharavi slum getting coronavirus vaccine in Mumbai, India. Photo Courtesy: Divyakant Solanki/EPA

NEW DELHI (The NewYork Times): With its own battle against the coronavirus taking a sharp turn for the worse, India has severely curtailed exports of Covid-19 vaccines, triggering setbacks for vaccination drives in many other countries.

The government of India is now holding back nearly all of the 2.4 million doses that the Serum Institute of India, the private company that is one of the world’s largest producers of the AstraZeneca vaccine, makes each day.

India is desperate for all the doses it can get. Infections are soaring, topping 50,000 per day, more than double the number less than two weeks ago. And the Indian vaccine drive has been sluggish, with less than four percent of India’s nearly 1.4 billion people getting a jab, far behind the rates of the United States, Britain and most European countries.

Just a few weeks ago, India was a major exporter of the AstraZeneca vaccine, and it was using that to exert influence in South Asia and around the world. More than 70 countries, from Djibouti to Britain, received vaccines made in India, with a total of more than 60 million doses. From mid January into March, not more than a few days passed between major vaccine shipments leaving India.

But the size of its shipments abroad has greatly diminished in the past two weeks, according to data from India’s foreign ministry. And Covax, the program set up by donor agencies to purchase vaccines for poorer nations, said on Thursday that it had told those countries that nearly 100 million doses expected in March and April would face delays because of “increased demand for Covid-19 vaccines in India.”

The Indian government has not publicly commented on what’s happening, and would not when reached by The New York Times for this article. But health experts say the explanation is obvious: India is drawing up its gates as a second wave of infections hits home, holding tight to a vaccine that it didn’t develop but that is being produced in huge quantities on its soil.

The government of Prime Minister Narendra Modi, a heavy-handed nationalist, has regulatory control over how many vaccine doses can be exported at any given time, and it seems India is going in the same direction as the European Union, which is moving to curb exports.

Adar Poonawalla, the chief executive of the Serum Institute and scion of the billionaire family that runs the company, finds himself in a highly uncomfortable spot. The Serum Institute has a reputational interest in keeping its word to its foreign customers and to AstraZeneca, and fulfilling the contracts it has signed.

But Mr. Poonawalla has been careful not to say anything negative about Mr. Modi or the pressure Mr. Modi’s government is putting on him. Instead, he has appealed for patience.

“Serum Institute of India has been directed to prioritize the huge needs of India and along with that balance the needs of the rest of the world,” Mr. Poonawalla tweeted in late February. “We are trying our best.”

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The Serum Institute, based on a sprawling campus in the city of Pune, agreed to provide vaccines to middle- and low-income countries, according to a deal it signed last year with AstraZeneca, the pharmaceutical giant that teamed up with the scientists at Oxford who developed its vaccine.

Production issues at other AstraZeneca facilities in Belgium and the Netherlands have led to wealthier nations like Canada, Saudi Arabia and Britain to rely on Serum Institute’s doses as well, making the company even more critical to the global supply chain of AstraZeneca’s vaccine.

Up to now, India has still exported more doses of vaccines than it has given to its own people, unlike the United States, Britain and member states of the European Union.

India — with a population of more than the entire African continent, and hundreds of millions of people living below the poverty line — is completely reliant on its own supply of vaccines, unlike many other countries that have sourced vaccines from different suppliers around the world. The country produces a second Covid-19 vaccine developed by Bharat Biotech, an Indian company, though the global demand for that vaccine is much lower than the demand for the AstraZeneca vaccine.

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But with many poorer countries already unlikely to get broad access to vaccines until 2023 or 2024, an extended halt on exports from India could push those dates back even further, said Olivier Wouters, a professor of health policy at the London School of Economics who has been studying the global vaccine supply chain.

With new variants spreading, he said, it’s in the interests of all countries to work together to vaccinate the world.

“Many countries around the world, poorer ones in particular, are counting on India,” Mr. Wouters said. “Vaccine nationalism hurts us all.”

Nepal, one of Asia’s poorest nations and next door to India, has had to halt its vaccination campaign. It was heavily reliant on doses of the AstraZeneca vaccine made at the Serum Institute, but with its national stockpile running low, Nepal stopped administering vaccines on March 17.

Dr. Jhalak Sharma, chief of the immunization department within Nepal’s health ministry, said the country had received a donation of one million doses from the Indian government and had already paid 80 percent of the price for the next two million but that didn’t seem to have made a difference.

“We couldn’t get the vaccine in time,” Dr. Sharma said.

India’s export restrictions, he added, “will affect us and the entire world.”

One of Prime Minister Boris Johnson’s chief aides, Eddie Lister, used a trip to India this week to try to secure Britain’s promised supplies, officials said. Mr. Johnson is set to visit India next month, and some diplomats here have referred to his trip as a high-profile mission to secure millions more doses.

At the same time, the Serum Institute has told Morocco, Brazil and Saudi Arabia to expect shipment delays, according to Reuters. Morocco is now scrambling to secure more of Russia’s Sputnik V vaccine or get doses from other sources, Moroccan news media reported.

The Serum Institute’s manufacturing capacity was always central to a plan to get vaccines to the poor. A spokesman for AstraZeneca would not disclose exactly what percentage of the global supply of its vaccine that Serum manufactures, but a recent AstraZeneca statement called the contribution “substantial.” Serum has committed to making around a third of the total 3 billion doses that AstraZeneca said it will produce by the end of 2021, though meeting that timeline seems increasingly unlikely.

The alliance between Serum, which started out as a ranch that made serums from horse blood, and Oxford-AstraZeneca has resulted in the world’s cheapest Covid-19 shot: just $2. The vaccines developed by Pfizer and Moderna, by comparison, cost much more and require extreme cold storage, adding to the difficulty.

Serum is also playing a huge role in the Covax program for poorer nations. Documents from the World Health Organization show that the Indian company was expected to contribute 240 million doses by the end of June.

But the data from the Indian foreign ministry, and the statement Thursday from Covax, indicate that vaccine drives around the world are likely to be further delayed.

The Serum Institute has supplied Covax with 28 million doses so far, according to the international program. India’s foreign ministry showed that 18 million doses had been shipped abroad under Covax, suggesting that about 10 million doses of India’s domestic vaccination also came from the program, which lists India as qualifying for a share.

In contrast, about 34 million doses have been supplied in commercial deals and about 8 million donated by the government of India as part of its vaccine diplomacy.

On April 1, India will expand eligibility and allow anyone 45 or older to get a jab.

“It’s a fluid situation,” said K. Srinath Reddy, a health policy expert at India’s nonprofit Public Health Foundation. “But at the moment, given the fact that vaccine supply and Covid situation is dynamic, I think it’s only appropriate that government of India takes a pause and says, ‘Let’s hold onto the stocks.’”