As the COVID-19 pandemic raged on in 2020, a bit of hope began to emerge. Scientists across the world collaborated on developing a vaccine, and a number of leading candidates emerged, including vaccines developed by Pfizer, Moderna, and Oxford-AstraZeneca. While this was an aggressive timeline, significant government investment, such as Operation Warp Speed in the United States has ensured that vaccines began rolling out within a year of the pandemic, much faster than the normal vaccine development timeline.
While India was not a part of the initial research and development efforts, it was a foregone conclusion that it would eventually have a significant role to play in vaccine manufacturing and development. India is known as the “pharmacy of the world,” and manufactures about 60 percent of all the world’s vaccines. India is also home to the Serum Institute of India, which is the world’s largest vaccine manufacturer. The Serum Institute has signed multiple deals with vaccine developers, including with Oxford-AstraZeneca and Novavax. After signing the deal with Oxford-AstraZeneca to manufacture one billion doses of Covisiheld, Adar Poonawalla, the CEO of the Serum Institute announced that the doses will be split 50-50 between India and the rest of the world.
With the Serum Institute selling doses around the world, the door is wide open for India to play a constructive role in ensuring the world gets vaccinated, especially as higher income countries focus on taking care of their own citizens first. And, with India in competition with China in the immediate neighborhood, India can effectively use vaccines as a mechanism to pushback against Chinese influence.
India’s Vaccine Diplomacy Takes Shape
Besides the manufacturing deal, Poonawalla also signed a USD $150 million contract with the Bill and Melinda Gates Foundation to supply 100 million vaccines to the Global Alliance for Vaccines and Immunizations (GAVI) and its COVAX facility, which will benefit 92 low- and middle-income countries. This was a powerful message to send, especially because at that time the United States had declined to join the COVAX vaccine initiative. In addition, it highlighted India’s continued commitment to humanitarian efforts, as well as an acknowledgement of the role it will play in ensuring the world gets vaccinated.With the Serum Institute selling doses around the world, the door is wide open for India to play a constructive role in ensuring the world gets vaccinated, especially as higher income countries focus on taking care of their own citizens first.
Fast forward to January 2021, and India’s importance to global vaccination efforts is fully visible. Once India’s domestic vaccination campaign started on January 16, a wide range of countries began asking the country for vaccines. Given that India has set an ambitious target of vaccinating 300 million citizens by July 2021, politically, it would be easy for Prime Minister Narendra Modi to impose export controls on vaccines. However, as was seen with India’s exports of hydroxychloroquine, India is managing to balance both the needs of its citizens while fulfilling its global responsibilities. While there are commercial benefits, vaccine diplomacy is an extension of Prime Minister Modi’s continued investment in promoting India’s soft power abroad.
Furthermore, the Covishield vaccine is much more manageable for lower income countries. Vaccines developed by Pfizer and Moderna require being stored at extremely cold temperatures, at -70 degrees Celsius and -20 degrees Celsius respectively. In contrast, Covishield only needs to be stored at a range of 2-8 degrees Celsius, which for countries that lack significant cold chain infrastructure, is much more manageable.
Neighborhood First Means Vaccine First
Soon after India’s vaccination campaign kicked off, the Ministry of External Affairs announced the start of the Vaccine Maitri campaign, as part of which India has donated vials of Covishield to Afghanistan, Bangladesh, Bhutan, the Maldives, Mauritius, Myanmar, Nepal, Seychelles, and Sri Lanka. Since the initial donations, India has also sent doses to Oman, and will send to various CARICOM countries. Beyond those donations, the Serum Institute has been selling doses at a lower rate to low-income countries, and a number of countries have signed up to purchase vaccines made in India, including Bangladesh, Bahrain, Brazil, Morocco, Mongolia, Myanmar, Nicaragua, Saudi Arabia, and South Africa.
That India has focused on its immediate neighborhood first is no surprise; it is constantly jockeying with China for influence in the region, and Modi has prioritized a “Neighborhood First” policy. While China aimed to get ahead of the pack with its vaccine diplomacy efforts, India continues to remain the preferred option for many countries. Part of this is concern over the effectiveness of some of the vaccines developed in China; a vaccine developed by Chinese biopharmaceutical company Sinovac, was recently found to be only 50.4 percent effective against the coronavirus, and there are questions about China’s transparency with trial data. This is in contrast to the Oxford-AstraZeneca vaccine, which was found to be about 90 percent effective, and published its phase three trial data.
Furthermore, India has donated the vaccines, while in contrast, China has tried to make some countries pay for costs associated with the vaccine. Further, India is offering a World Health Organization (WHO) approved vaccine, which is vital for countries such as Sri Lanka which lack the institutional capacity to conduct vaccine trials, but are still grappling with the pandemic (no Chinese vaccine has been approved by the WHO yet).
Outlook Bright for Indian Diplomacy Efforts
Besides Covishield, there are two other vaccines in the pipeline that will benefit India’s diplomatic efforts. First is Covaxin, India’s indigenous vaccine manufactured by Bharat Biotech. While it has been granted emergency use authorization in India, the lack of published phase three trial data has raised concerns that India is also promoting vaccine nationalism in the spirit of the aatmanirbhar bharat (“self-reliance”) campaign, even if the vaccine is potentially not effective. However, if the phase three trial data shows a high-level of effectiveness, this will be another arrow in India’s diplomatic quiver.While there are certainly risks, so far, there has been limited backlash within India regarding offering Covid-19 vaccines to other countries while the country is still vaccinating its own.
Similarly, the recent disclosure that Novavax’s vaccine candidate was 89.3 percent effective in phase three trials conducted in the UK and the near 90 percent effectiveness also bodes well for India. The Serum Institute has partnered with Novavax to manufacture two billion doses of this vaccine (Covovax), and has already signed a deal with the Philippines to supply 30 million doses in the second half of this year. As more vaccine candidates are found to be effective, India will be in a position to expand the Vaccine Maitri campaign and donate/sell more vaccines to the rest of the world. And, as the Serum Institute expands its manufacturing capacity, more vaccines will become available.
India’s willingness to purchase vaccines and donate them to the immediate neighborhood, increasing commitments to the GAVI alliance, and also allow the exports of vaccines stands in stark contrast to the United States, Canada, the European Union, and other high-income countries who have reserved doses that far exceeded the number of citizens they have. This reflects the continued evolution of India’s foreign policy under Foreign Minister S Jaishankar, where he has made it a priority to reach out to countries beyond India’s normal partners; this will undoubtedly generate significant goodwill for those efforts. As Jaishankar has stated, “the scale and intensity of our global engagement would be difficult to recognize for someone dealing with it even a few years ago.”
While there are certainly risks, so far, there has been limited backlash within India regarding offering COVID-19 vaccines to other countries while the country is still vaccinating its own. As Prime Minister Modi said in his recent speech at the World Economic Forum at Davos, “India has also fulfilled its global responsibility at this time of crisis by practicing thousands of years old invocation of सर्वे सन्तु निरामया i.e. may the entire world remain healthy. […] [R]ight now there are only two ‘Made in India’ Corona vaccines, but in the coming days, many more vaccines will come. These vaccines will help us support other countries at greater scale and speed.”
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Image 1: Ministry of Health and Family Welfare, India via Press Information Bureau