A frightening second wave of Covid-19 has begun to sweep over the world's second-biggest nation. Case numbers and deaths are spiking in India, threatening to overwhelm hospital systems; the financial capital Mumbai has re-imposed stringent lockdown rules. The government, which had earned global goodwill by exporting Indian-made vaccines to over 80 countries, is now holding back supplies for domestic use.
With less than 70 million doses delivered thus far, though, and a population of more than 1.3 billion, India faces a staggering challenge. It doesn't just need more vaccines - it needs to find a way to get them into arms faster.
Prime Minister Narendra Modi's government is aware of the urgency and the limited policy options in its toolkit. It's opened up vaccinations to anyone over the age of 45 and has mandated that all public and private vaccination centers stay open every day. As one of the world's largest vaccine manufacturers, the country is lucky not to face the supply constraints many other countries do.
Still, production of the two vaccines approved by the government - Covaxin, from Bharat Biotech International Ltd., and Covishield, the Oxford-AstraZeneca vaccine manufactured by Serum Institute of India Pvt. - cannot meet both Indian and global needs quickly enough. The first thing the government should do, therefore, is accelerate approval of some of the vaccines in use in other countries, including those from Pfizer Inc., Moderna Inc. and especially the logistically easier, single-shot Johnson & Johnson vaccine. If those companies can't expand production quickly enough, the government should pursue licensing agreements to make their vaccines in India.
Next, the government needs to rethink how it allocates supplies. The foreign vaccines may be too expensive for the state to purchase and distribute freely. That's why the government should allow vaccine-makers - including AstraZeneca and Bharat Biotech - to sell doses on the private market.
Allowing these companies to profit will increase supplies and help scale Indian manufacturing efforts for exports and the future. Meanwhile, the government can continue to offer doses that it has purchased for free or, in private vaccination centers, at subsidized prices (currently under $4 per shot).
Millions of Indians can afford to pay for faster access to vaccines, maybe hundreds of millions since private companies are keen to vaccinate their employees and charitable institutions have pledged large amounts to support the effort. The government would be foolish not to leverage this private-sector capacity, not least because getting affluent young Indians vaccinated quickly would help kickstart the economy.
Finally, India should adopt the "First Doses First" strategy outlined by economist Alex Tabarrok. The idea is to delay the second dose of two-shot regimens, under the assumption that it's better to raise two Indians from 0% to 76% percent protection than to save a second dose to raise one Indian from 76% to 82% protection. Indeed, the AstraZeneca vaccine is actually more effective if the second shot is delivered 12 weeks after the first, rather than six weeks.
Recent findings confirm that vaccinating twice as many people also helps slow down mutations, contrary to fears that lower immunity would increase the number of variants. Author and surgeon Atul Gawande recently recommended delaying second doses in the U.S. as well. Canada's National Advisory Committee on Immunization has strongly favored delaying second shots to 16 weeks. And the U.K. has been an early leader, offering second doses at 12 weeks rather than four weeks. India can easily do the same.
As it rethinks its vaccination strategy, the government shouldn't neglect other safety measures, namely the need to encourage social distancing and wearing masks. Indians experienced the most severe lockdown in the world last year. They are fatigued and, with local fatality rates at much lower levels than other countries, a little complacent. The euphoria surrounding vaccines may also have engendered what's known as the Peltzman Effect, where people take greater risks when they perceive a situation to be safer than originally expected.
Personal precautions are at an all-time low. Concerning pictures of tens of thousands of Indians attending cricket matches without masks, joining political rallies for the upcoming elections or participating in holidays such as Holi have spread just as cases are rising. While masks are admittedly uncomfortable in the hot Indian summer, they should be mandatory at such events.
The alternative is worse. The government has few other tools to prevent a calamity. Another nationwide lockdown would devastate the economy. And it might not even work: Evidence suggests that in most states, last year's brutal shutdown was either unnecessary or unsuccessful at curbing transmission. Until more vaccines arrive on the market, Indians cannot afford to forget just how dangerous Covid-19 remains.
(Shruti Rajagopalan is a Senior Research Fellow at the Mercatus Center at George Mason University.)
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