A Report by BCG on Vaccine Manufacture in India Status and Support

December 3, 2021

Demand Projection
To protect the entire country from another wave of COVID, it is estimated that India needs to vaccinate its entire adult population, or at least 70% (critical mass) of its total population. Unless single dose vaccines like J&J enter the market, the total vaccine requirement (excluding doses
already administered and accounting for wastage) is estimated at about 1.86 billion doses. While this needs to be done as soon as possible, the current target is the end of 2021.

Supply Projection
Domestically manufactured supplies: From August to December, 2021, it is estimated that a supply of 2.17 billion doses will be available.

Imported supplies: With limited information in the public domain, current reports suggest that Pfizer has offered 50mn doses for use between July and October, 2021. Similarly, talks are underway to bring the Sputnik Light vaccine to India as soon as possible. Other potential sources for import include some of the US’ distribution through the Covax program, currently reported to be around 25mn doses for the world.

(Note: While J&J has contracted India’s Biological E for manufacturing up to 1 billion doses of its
vaccine, none of this supply is currently meant for the Indian market.)


Community Based Care & Support for COVID-19

Swasti works with the most poor and marginalized communities in India partnering them to make health and well-being real. To break the chain of COVID-19 transmission, it is imperative to provide the most marginalized with practical solutions to isolate and receive care through, Community Care Centers, Home quarantine kits and HelloSwasti

Immediate term support:
Regardless of the planned manufacturing going as per schedule or not, there is an immediate gap in the demand and supply of vaccines for Jun-Aug. It will be critical to bridge this gap to expedite the end of the ongoing second wave of Covid.
There are two potential ways to plug this gap:

1. Increased imports of vaccines: (in addition to existing commitment of 25m) especially AstraZeneca, given that it already has government approval and public acceptance in
India. Unused stockpiles from the US and other developed countries that have bought the vaccine or manufactured it, can be shared with India.

2. Registry of suppliers: USAID could curate a list of vaccine suppliers post due diligence and regulatory clearance, who can potentially supplement vaccine supply to India via private agencies. USAID can also facilitate negotiations between these suppliers and the government of India to ensure smooth on-boarding and clearance for vaccine production.

Case 1: Vaccine manufacture proceeds as per plan
Assuming that the efforts for ramping up manufacturing and improving vaccine availability are successful as per plan, there does not seem to be a need for domestic manufacturing support if only short term interventions are being considered.
The assumptions range from the ability to ramp up manufacturing for existing vaccines, to successful trials and clearances for new ones. To keep these assumptions from
becoming hindrances, external agencies such as USAID might need to step in and provide support in the form of funding for manufacturing capacity, compliance assistance with
international standards, facilitation of trials and regulatory clearances, and so on.

Case 2: Vaccine manufacture does not proceed as per plan
While the government is optimistic of meeting its supply targets, some reports suggest that this is a significant over-estimation and different sources have projected an availability of only ~ 1.1 to 1.3 billion doses.

This plan of action can be activated if, by the first week of July, additional vaccines have not been approved after clinical trials, or if the ramp-up plans of existing manufacturers are delayed/missing production targets.

In this case, USAID can supplement vaccine availability in India through interventions such as:

Knowledge and technology transfer: Fast-track the process to bring in Pfizer and Moderna to produce in India, in collaboration with domestic manufacturers. This would involve:
1. Negotiating with the Government of India for license, permissions and indemnity clause and Pharma companies for production and delivery (currently companies are in talks with GoI for certain relaxations on liability, data etc.)
2. Import of equipment and technology.
3. Designing and delivering knowledge, talent and expertise transfer processes.

Long Term Support: In the long-term, USAID can bolster India’s capacity for vaccine production after the pandemic. In addition to inoculating 100% of her citizens, it will also allow
India to contribute to the global vaccination effort. Additionally, the enhanced biotechnical capacity can help India build vaccine capacity for non-COVID diseases and continue acting as a hub for global vaccine manufacturing.

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