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NEW DELHI (AP) – In hopes of taming a monstrous spike in COVID-19 infections, India opened vaccinations to all adults on Saturday, launching a huge vaccination effort that was sure to tax the limits the federal government, the country’s vaccine factories and the patience of its 1.4 billion people.

The world’s largest vaccine maker was still short of essential supplies – due to manufacturing delays and raw material shortages that delayed deployment in several states. And even in places where vaccines were in stock, the country’s wide economic disparities made access to the vaccine inconsistent.

Only a fraction of the Indian population will be able to afford the prices charged by private hospitals for the shooting, experts said, which means states will be grappling with vaccinating 600 million Indian adults under the age of 45 years old, while the federal government hits 300 million. health and frontline workers and people over 45.

So far, government vaccines have been free and private hospitals have been allowed to sell vaccines at a price capped at 250 rupees, or around $ 3. This practice will now change: Prices for state governments and private hospitals will be determined by the vaccine companies. Some states might not be able to provide vaccines for free because they pay twice as much as the federal government for the same vaccine, and prices in private hospitals might go up.

As state governments and private actors compete for vaccines in the same market and states pay less for doses, vaccine manufacturers can reap more profits by selling to the private sector, Chandrakant Lahariya said. , an expert in health policy. This cost can then be passed on to the people receiving the vaccines, increasing inequity.

“There is no logic that two different governments should pay two prices,” he said.

Fears that pricing issues could worsen inequalities are just the most recent issue of India’s slow vaccination efforts. Less than 2% of the population has been fully immune to COVID-19 and about 10% have received a single dose. Immunization rates have also fallen. The average number of shots per day has fallen from over 3.6 million at the start of April to less than 2.5 million today.

In the worst-hit state of Maharashtra, the health minister has promised free vaccines for those aged 18 to 44, but he also acknowledged that the dose shortage meant the vaccination would not start as planned on Saturday. States say vaccine scarcity is one reason vaccinations have declined.

India believed the worst was over when cases eased in September. But mass gatherings such as political rallies and religious events were allowed to continue, and relaxed attitudes about the risks fueled a major humanitarian crisis, according to health experts. New variants of the coronavirus have partly driven the outbreak. The death toll officially exceeded 200,000 this week, and the actual death toll is believed to be much higher.

The country’s vaccine shortage has global implications as, in addition to its own immunization efforts, India has pledged to ship vaccines overseas as part of a United Nations vaccine-sharing program. which depends on its supply.

Indian vaccine makers produce around 70 million doses each month of the two approved vaccines – the AstraZeneca vaccine made by the Serum Institute of India and one made by Bharat Biotech.

The federal government buys half of these vaccines to give them to the states. The remaining half can then be purchased by states and private hospitals to be given to anyone over the age of 18, but at prices set by companies.

The federal government buys projectiles at 150 rupees each, or $ 2. The Serum Institute will sell the shots to the states at 300 rupees each, or $ 4, and to private players at 600 rupees each, or $ 8. Bharat Biotech said it would charge states 400 rupees, which is less than $ 5.50 for a shot, and private players 1200 rupees, or more than $ 16.

For comparison, the European Union paid $ 2.15 per dose for the AstraZeneca vaccine. The company claims that this price is reduced because the EU contributed to the development of the vaccine.

Pressure is mounting on the Serum Institute, which, in addition to being India’s main supplier, is also a critical supplier to the UN-backed initiative known as COVAX, on which more than 90 countries depend. . The institute suspended exports in March.

“The urgent demand for vaccines in India is bad for the rest of the world,” said Ravi Gupta, professor of clinical microbiology at the University of Cambridge.

Some experts have warned that conducting a massive vaccination effort now could worsen the outbreak in a country second only to the United States in number of infections – more than 19.1 million.

“There is a lot of evidence that the fact that people wait in a long, crowded and messy queue could in itself be a source of infection,” said Dr Bharat Pankhania, clinical lecturer specializing in diseases. infectious diseases at the British University of Exeter. He urged India to stop the circulation of the virus first by imposing “a long, sustained and strictly enforced lockdown”.

Pankhania warned that vaccination efforts alone would not help stem the current peak of COVID-19 immediately, as the injections “don’t start to bear fruit for about three months.” The vaccination would help prevent future waves of infection, he said.

India is also importing pictures from Russian manufacturers of Sputnik V. The first batch was due to arrive on Saturday. An additional 125 million doses of Sputnik V will be distributed by an Indian pharmaceutical company later this year.

Given the urgent need for vaccines, some experts said rationing the available doses was essential.

“Vaccines should be delivered to areas where transmission is most intense,” Gupta said, explaining that vaccines should be used as “emergency control measures” in specific regions of India rather than offer doses to all adults on the subcontinent.

Pankhania said the widely viewed images of Indian patients with the virus breathless and smoke leaking from makeshift funeral pyres should prompt wealthy countries to share their vaccines more freely. He criticized the approach taken by many Western countries that attempt to immunize all citizens, including low-risk young people, before sharing doses.

“Globally, it is better to immunize all (vulnerable) people who need to be protected rather than immunizing entire populations in some countries only,” Pankhania said.


Cheng reported from London. Associated Press editors Daria Litvinova in Moscow and Krutika Pathi in New Delhi contributed to this report.

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