India's vaccine diplomacy places image over self-interest

India has greater love for neighbours and friends than own citizens, its Vaccine Maitri diplomacy reveals. As of  March 23, India has supplied Covid-19 vaccine to more than 70 countries and administered just over 50 million jabs to its own citizens.

The external outreach was through a mix of grants, sales, and supplies through Covax, the global vaccine alliance that comprises CEPI, GAVI, Unicef and the World Health Organisation. CEPI is the Coalition for Epidemic Preparedness Innovations based in Oslo and funded by Germany, Norway and the Bill & Melinda Gates Foundation. It was launched in 2017 to develop vaccines for stopping future epidemics. GAVI is a Geneva-based alliance of public-private healthcare organisations to enhance poor countries’ access to immunisation.

Of the jabs India has supplied, 14% were grants while 29% were Covax entitlements. Bangladesh got the most at 9 million million of which two million were as grants. Myanmar followed, while Sri Lanka got half a million doses for its health workers. Pakistan preferred the vaccine of its ‘all-weather friend’ China but the jab did not prevent Prime Minister Imran Khan from contracting the infection. Morocco, Brazil, Saudi Arabia and South Africa have bought seven, four, three and one million vaccines each from India.

Indians are “naturally internationalist,” the External Affairs Minister told Parliament by way of explanation. India has supplied the vaccines to 72 countries; it has set up a SAARC Covid-19 Fund for South Asian countries and trained more than 1,100 medical professionals from 42 countries. African nations are big Covax beneficiaries.

China and Russia are also playing the game of vaccine one-upmanship. A New York Times’ (NYT) report says Moscow’s Gamaleya Institute has partnerships with producers from Kazakhstan to South Korea, and Unicef. Chinese vaccine makers, it said, have made deals in the UAE, Brazil and Indonesia.

China’s Global Times said China had administered 75 million doses of Covid-19 vaccines to its citizens. It has developed five vaccines which have been approved for emergency use. China has ramped up plans to vaccinate 560 million people or 40 percent of China’s population by end of June and another 330 million people by end of the year covering 64 percent of the total population.

Global Times reported on 1 March that China had donated vaccines to 53 developing countries and exported them to 27 nations. Lebanon, Uzbekistan and the Philippines were among the recipients of its outreach, but the government mouthpiece did not provide a number. Bloomberg news wire reported on the basis of publicly available information that China had pledged to donate 3.9 million doses, which would be a fraction of its own use.

India is alone in privileging image over self-interest. Of the 400 million vaccines delivered so far globally, 90 percent have been to wealthy countries, the NYT reported. US President Joe Biden said, “We are going to start off making sure Americans are taken care of first,” before helping the rest of the world.

But India is being constrained to ramp up domestic vaccinations with the resurgence of the infection in states like Maharashtra and Delhi. It has approved two vaccines, one of Oxford AstraZeneca called Covishield (which is also being supplied through Covax) and the indigenously-developed Covaxin which was approved for use even before Phase 3 trials had been completed. Covishield is being produced by the Serum Institute, the world’s largest vaccine manufacturer whose CEO has said that he plans to make 1.5 billion doses available by the end of the year. The institute had taken a risky chance on Covishield and had begun production months before regulatory approval. But that gamble paid off. Serum Institute had a stockpile of 70 million doses of Covishield when it was cleared for emergency use in January.

But domestic compulsions are unlikely to come in the way of diplomatic outreach. At a meeting on 12 March the Quad nations promised to provide 1 billion vaccines to countries in China’s neighbourhood. The Quad comprises the US, Australia, India and Japan with a shared interest in containing China. India will do the manufacturing while the other three will provide financial and logistical support.

The goodwill generated by vaccine diplomacy could dissipate if India’s domestic majoritarian push makes it a regional bully and also less of a democracy. Bangladesh has been miffed by India’s discriminatory Citizenship Amendment Bill and the shrill rhetoric on ‘infiltrators’ from that country. Nepal has also been needling India.

But India as leader of the developing countries needs to push for fair and equitable access to Covid-19 vaccines. The US and the EU have poured billions of dollars into vaccine development and fast tracked regulatory approval but have failed to use their leverage to persuade drug makers into providing poor countries with easy and affordable access to the vaccines. Health officials and advocacy groups have been calling upon western governments to pressure drugmakers into publishing vaccine blueprints, sharing know-how and stepping up production. But they have resisted believing this would disincentivise innovation, unlike the Bill & Melinda Gates Foundation, a major public health financier, which has included language in contracts to ensure equitable access.

At the World Trade Organisation, India has been pushing for compulsory licensing. This is a waiver of patents to deal with public health emergencies which the global agreement on intellectual property rights allows. But Western nations have been blocking it.

Compulsory licensing has been invoked earlier. In 2005, Roche agreed to compulsorily license its drug Tamiflu after pressure mounted on it following a surge in bird flu.

India drug companies like Cipla have also used their capability to reverse engineer drugs to provide inexpensive antiretroviral drugs to combat Africa HIV/Aids epidemic, after advocacy groups shamed price-gouging Western drugmakers into voluntarily licensing them.