India cuts back on vaccine exports as infections surge at home

The Indian government has not publicly commented on the vaccine export situation and would not do so when reached by The New York Times for this article. But health experts say the explanation is obvious: As a second wave of infections hits home, India is holding tight to a vaccine that it didn’t develop but that is being produced in huge quantities on its soil.

The government of Prime Minister Narendra Modi, a heavy-handed nationalist, has regulatory control over how many vaccine doses can be exported at any given time, and it seems India is going in the same direction as the European Union, which is moving to curb exports.

Adar Poonawalla, CEO of the Serum Institute and scion of the billionaire family that runs the company, finds himself in a highly uncomfortable spot. The Serum Institute has a reputational interest in keeping its word to its foreign customers and to AstraZeneca, and fulfilling the contracts it has signed.

But Poonawalla has been careful not to say anything negative about Modi or the pressure Modi’s government is putting on him. Instead, he has appealed for patience.

“Serum Institute of India has been directed to prioritize the huge needs of India and along with that balance the needs of the rest of the world,” Poonawalla tweeted in late February. “We are trying our best.”

The Serum Institute, based on a sprawling campus in the city of Pune, agreed to provide vaccines to middle- and low-income countries, according to a deal it signed last year with AstraZeneca, the pharmaceutical giant that teamed up with the scientists at Oxford who developed its vaccine.

Production issues at AstraZeneca facilities in Belgium and the Netherlands have led wealthier nations like Canada, Saudi Arabia and Britain to rely on Serum Institute’s doses as well, making the company even more critical to the global supply chain of AstraZeneca’s vaccine.

India has exported more doses of vaccines than it has given to its own people, unlike the United States, Britain and member states of the European Union.

With a population of more than Africa, and hundreds of millions of people living below the poverty line, India relies on its own supply of vaccines, unlike countries that have sourced vaccines from suppliers around the world. India produces a second COVID-19 vaccine, developed by Bharat Biotech, an Indian company, although global demand for that vaccine is much lower than the demand for the AstraZeneca vaccine.

Many poorer countries are unlikely to get broad access to vaccines until 2023 or 2024, and an extended halt on exports from India could push those dates back even further, said Olivier Wouters, a professor of health policy at the London School of Economics who has been studying the global vaccine supply chain.

With new variants spreading, he said, it is in the interest of all countries to work together to vaccinate the world.

“Many countries around the world, poorer ones in particular, are counting on India,” Wouters said. “Vaccine nationalism hurts us all.”

Nepal, one of Asia’s poorest nations and next door to India, has had to halt its vaccination campaign. It was heavily reliant on doses of the AstraZeneca vaccine made at the Serum Institute, but with its national stockpile running low, Nepal stopped administering vaccines March 17.

Britain finds itself in a similar situation. It received 5 million doses from the Serum Institute several weeks ago but has been waiting weeks for 5 million more.

One of Prime Minister Boris Johnson’s chief aides, Eddie Lister, used a trip to India this week to try to secure Britain’s promised supplies, officials said. Johnson is set to visit India next month, and some diplomats here have referred to his trip as a high-profile mission to secure millions more doses.

Serum also plays an important role in the Covax program for poorer nations. Documents from the World Health Organization show that the Indian company was expected to contribute 240 million doses by the end of June.

But the data from the Indian foreign ministry and the statement Thursday from Covax indicate that vaccine drives around the world are likely to be further delayed.

The Serum Institute has supplied Covax with 28 million doses so far, according to the international program. India’s foreign ministry showed that 18 million doses had been shipped abroad under Covax, suggesting that about 10 million doses of India’s domestic vaccination also came from the program, which lists India as qualifying for a share.

In contrast, about 34 million doses have been supplied in commercial deals and about 8 million donated by the government of India as part of its vaccine diplomacy.

On April 1, India will expand eligibility and allow anyone 45 or older to get a vaccine.

“It’s a fluid situation,” said K. Srinath Reddy, a health policy expert at India’s nonprofit Public Health Foundation. “But at the moment, given the fact that vaccine supply and COVID situation is dynamic, I think it’s only appropriate that government of India takes a pause and says, ‘Let’s hold onto the stocks.’”