HONG KONG – Laboring under the burden of a new wave of COVID-19 infections that have raised its case total to 15.3 million, second only to the U.S., India is ramping up its vaccination efforts by opening up COVID-19 vaccine availability to citizens 18 years or older from May 1, according to the Ministry of Health and Family Welfare. However, ensuring a steady vaccine supply for the world's second most populous country, with nearly 1.4 billion people, might prove to be an issue. So far, India has administered just over 124 million COVID-19 vaccine doses.

After recently greenlighting the Sputnik V vaccine, India now has three vaccines authorized for COVID-19, including Covishield (AZD-1222, Serum Institute of India Ltd.) and Bharat Biotech International Ltd.’s Covaxin.

India has also fast-tracked reviews for international vaccines, suggesting those developed by companies such as Pfizer Inc., Moderna Therapeutics Inc. and Johnson & Johnson could receive a nod of approval soon. Competition could further intensify with the launch of foreign vaccines and Cadila Healthcare's ZyCov-D soon in India.

The new additions may provide much a needed boost to supply. "Against this backdrop, supply issues for Covishield and Covaxin are negatively impacting the vaccination drive," said Prashant Khadayate, a pharmaceuticals analyst at Globaldata. “Considering this, the approval of Sputnik V will further ramp up the overall vaccination efforts in India.”

Yet “vaccination drive dynamics are not expected to change in India as Covishield will continue to lead the overall vaccination drive, followed by Covaxin in terms of the daily doses administered,” he said.

Furthermore, Dr. Reddy's Laboratories Ltd., the Indian manufacturer for Sputnik V, will only receive the vaccine from the Russian Direct Investment Fund in May, with local production expected to happen in the July to September timeframe.

Production ramping up

Previously, Indian vaccine makers had fallen short of providing supplies to meet the demand. As part of the latest vaccination expansion, the government has approved a payment of about INR45 billion as an advance to the two vaccine makers. On Twitter, The Serum Institute of India’s CEO Adar Poonawalla thanked the government for its “decisive policy changes and swift financial aid which will help vaccine production and distribution in India.”

The move is expected to help the vaccine makers ramp up production. The Serum Institute is expected to receive INR30 billion in advance while Bharat Biotech will receive INR15 billion.

Indian authorities are also hopeful that the U.S. will help ease a supply chain crunch. Following talks between Indian Foreign Minister Subrahmanyam Jaishankar and U.S. Secretary of State Antony Blinken, Jaishankar said on Twitter that "issues pertaining to our health cooperation” were under discussion. In particular, an easing of the ban on vaccine material exports tied to invocation of the Defense Production Act that reserved raw materials for American companies, could help. The Serum Institute of India’s Poonawalla has appealed to U.S. President Joe Biden to reverse the decision and has pointed out that this went against the global goal of sharing vaccines equitably.

A dynamic market

Another factor that may affect how Sputnik V and other new entrants fare in India is pricing. Sputnik V is expected to be slightly more expensive than Covishield and Covaxin, which go for around INR150 ($2) per dose. However, Sputnik V boasts a higher efficacy than the other two competitor vaccines in India, as it has shown over 90% efficacy rate in clinical studies.

"Even though Sputnik V has better efficacy, its overall market penetration will depend on competitive pricing, government orders and the ability to meet soaring demand through timely supply," said Khadayate.

India’s Union government has been supplying vaccines to states free of cost. Authorities have been purchasing supplies from The Serum Institute and Bharat Biotech at the subsidised price INR150 and INR206 per dose, respectively. However, both companies have been advocating for the price ceiling to be removed and for the freedom to sell vaccines in the open market, even though Poonawalla had previously confirmed to media that the subsidized price still provides a normal profit per dose.

Observers welcomed the addition of more vaccine options in India given the surge in infections it has seen of late. “India is witnessing the second wave of COVID-19 with over 270,000 confirmed cases reported on April 19, the highest so far in a single-day,” said Khadayate.