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India launches vaccine drive against backdrop of growing scepticism

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Narendra Modi has kicked off one of the world’s most ambitious inoculation drives in the midst of growing vaccine scepticism over the contentious approval of an indigenously developed jab.

The Indian prime minister launched the campaign with an emotional live address on Saturday, saying “the nation has been desperately waiting for this moment” and warned against “false propaganda” about vaccine safety.

India, a country of 1.4bn people, has the world’s second-highest number of coronavirus infections at 10.5m. Lockdowns have had limited effect in controlling the spread of the virus and contact tracing has faltered, making a successful inoculation programme essential. The first phase of the vaccination rollout targets 30m healthcare and frontline workers, with the goal of inoculating 300m people by July.

The outcome of the drive will determine if India can inject confidence into an economy that has struggled to recover following one of the world’s most severe and disruptive lockdowns. After a gruelling recession, growth remains tepid and millions of Indians have been plunged into poverty.

At a Max Healthcare hospital in Saket, a neighbourhood in New Delhi, Chacko, a 42-year-old nurse in the emergency department in mint-green scrubs said he was “was happy to be the first to take the shot. This will change our lives.”

But New Delhi’s approval of Covaxin, a vaccine developed by Hyderabad-based Bharat Biotech, before phase 3 trial data was released has been criticised by healthcare experts and stoked vaccine scepticism. A survey this month by pollster Local Circles found that 69 per cent of respondents were hesitant about getting a jab.

“I think it’s impossible to develop a vaccine in one year,” said Ravi Agarwal, a 45-year-old who runs a small kiosk selling tobacco and sweets in New Delhi. “My son has a blood disease. If they ask me to inoculate him, I would be very worried.”

As was the case with Russian and Chinese vaccines, Covaxin was fast-tracked without completing phase 3 trials. Experts argue that the growing doubt surrounding the vaccine, developed in partnership with India’s government, risks undermining the vaccination drive.

Some states are already pushing back: the health minister of Chhattisgarh, for example, has refused to accept Covaxin until the phase 3 trials are completed.

“What Indian regulators have done is pulled us down to Russia and China’s level,” said Dinesh Thakur, a former pharma executive in India who now works as a public health activist in the US.

A healthcare worker in Kolkata receives a dose of the vaccination. India has the highest number of coronavirus cases after the US © REUTERS

“India has never had an anti-vax movement until now,” he said. “The country has gotten over polio and smallpox, people are compliant. But this shady process has given rise to anti-vaxxers.”

Civil society activists allege that Bharat Biotech did not follow proper guidelines at a phase 3 trial study site in Bhopal, a city in the central state of Madhya Pradesh, where a trial volunteer died in December.

Jitendra Narwaria, a 37-year-old sawmill labourer, was given the shot in December. “They said that free medicine was being offered that would cure us of our cough and cold,” said Mr Narwaria, who received Rs750 ($10) for taking the jab.

Like other trial subjects, Mr Narwaria said he suffered side effects. “A few days later I started vomiting and I was feeling very weak, too. I went back to the hospital but no one listened to me and I just came back home,” he said.

“We were not given the complete information. If they had told us it was for corona, I would have said no.”

Bharat Biotech has said that it conducts clinical trials “in compliance with the study protocol” and “the focus at all times is on patient safety”. The company said that the death in December was unrelated to the trial.

Krishna Ella, the Bharat Biotech chairman and managing director, rejected criticism of the vaccine. In an interview with India Today TV this week, Mr Ella said he would not mind giving the vaccine to his six-year-old grandson, even though the jab has not yet been approved for children.

Pushing aside the domestic controversy, Mr Modi has hailed the vaccine as a triumph of Indian science and his self-reliant “Make in India” policy. His government is also leveraging the country’s vast manufacturing capacity to supply the developing world with shots.

On Tuesday, Bharat Biotech announced that it had signed a deal to supply vaccines to Brazil’s Precisa Medicamentos, a drug company. The Serum Institute of India, the world’s largest vaccine manufacturer, has a contract with the UN-backed vaccine alliance Gavi to provide 200m doses of the Oxford/AstraZeneca vaccine.

In New Delhi, healthcare workers welcomed the vaccine with relief. At Max Healthcare hospital, staff were recovering from the city’s third and deadliest wave of coronavirus cases in November after the festival season. Officials warn against complacency even though the capital region’s active caseload has fallen from a peak of more than 40,000 to less than 3,000.

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“The only end to the pandemic is masks and vaccination,” said Dr Sandeep Budhiraja, group medical director at the hospital.

“Delhi is probably out of the worst of it, but there is no way to rule out a next wave. Look at what is happening in the UK. It can happen anywhere in the world.”



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Narendra Modi’s popularity slips as Covid crisis hammers India

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Narendra Modi’s popularity has fallen during India’s deepening Covid crisis, according to an opinion poll, as the country reports more than 400,000 daily infections in a brutal second wave.

The prime minister’s approval rating fell to 65 per cent on May 4, down from 74 per cent at the end of March, according to Morning Consult, the US data company — the lowest level since the agency began tracking Modi’s rating in August 2019.

The Indian leader’s disapproval rating also rose to its highest level since the tracker was launched, climbing to 29 per cent from 20 per cent.

Modi’s approval rating remained high compared with other global leaders, but the country’s health and humanitarian crisis has taken a toll.

The prime minister has a strongman reputation but has been accused of indifference in the face of the Covid-19 disaster as he campaigned in state elections even as the outbreak worsened.

“One of the things that Modi has really been good at is perception management. He’s always been very good at messaging,” said Ronojoy Sen, senior research fellow at the Institute of South Asian Studies in Singapore. “This is the first time I would say that his messaging has been awry.”

India’s death toll from the second wave has reached about 4,000 people per day © AP

Modi’s government has sought to deflect blame for the calamity on to state governments and the public for failing to follow pandemic protocols.

As deaths have risen, Harsh Vardhan, the health minister, has also cited official data to boast that India’s fatality ratio was lower than those of richer countries.

However, in a stinging letter to Modi on Friday, Rahul Gandhi, leader of the opposition Congress party, sharply criticised the government for a “lack of a clear and coherent Covid and vaccination strategy as well as hubris in declaring premature victory”.

The letter called for more decisive action to control the spread of the virus, as well as greater scientific tracking of the virus and its mutations.

“Allowing the uncontrollable spread of this virus in our country will be devastating not only for our people but also for the rest of the world,” Gandhi wrote, adding that India was a fertile ground for the virus to mutate into “a more contagious and a more dangerous form”.

India reported a record 414,188 infections and 3,915 deaths on Thursday. There have been more than 234,083 confirmed deaths from the disease in the country.

However, most experts believed the figures severely undercounted the magnitude of the crisis because of a lack of testing, especially in small towns and rural areas.

“Right now, data is very corrupted,” Gautam Menon, a professor of biology at Ashoka University, told a recent seminar. “It’s good in some states and it’s very bad in other states.”

Many epidemiologists believe India’s latest outbreak is set to peak in the coming weeks and caseloads will gradually fall, partly helped by lockdowns implemented by some state governments.

The country’s vaccination campaign is losing momentum, however, because of an acute shortage of jabs. The Modi government has been accused of failing to adequately plan its inoculation campaign.

India administered 1.6m vaccines on Thursday and the seven-day moving average of daily vaccinations has fallen to 1.4m, down from a peak of 3.6m in mid-April.

Many Indians were incensed to see Modi boasting of the huge sizes of crowds gathered for his recent election rallies in West Bengal state as the country struggled to access life-saving drugs, hospital beds, oxygen and vaccines.

The prime minister’s Bharatiya Janata party lost its bid to seize power from the Trinamool Congress party in Sunday’s election despite Modi’s efforts.



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Africa celebrates suspension of Covid vaccine patents

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African health officials were on Thursday celebrating what one called a “bold and wonderful” breakthrough after the Biden administration threw its weight behind a temporary suspension of intellectual property rights on Covid-19 vaccines.

African Union officials hope that at least three countries — South Africa, Senegal and Rwanda — will develop the capacity to produce vaccines for the continent, including the mRNA-type vaccines that emerged as an innovative technology against Covid-19.

John Nkengasong, director of the Africa Centres for Disease Control and Prevention, welcomed the US administration’s backing of an IP waiver, a position that is supported by dozens of developing countries led by South Africa and India.

It would, he said, “definitely be a great influence to facilitate the mRNA manufacturing agenda”, adding that there are “very focused discussions” about producing vaccines on the continent.

South Africa has some of the continent’s most advanced vaccine knowhow, including Aspen, a Durban-based company that plans to “finish and fill” — though not make from scratch — 300m doses of Johnson & Johnson’s vaccine this year. The Pasteur Institute in Dakar, Senegal, also has vaccine-producing experience, making small quantities of yellow fever jabs each year.

John Nkengasong, director of the Africa Centres for Disease Control and Prevention, welcomed the Biden administration’s backing of an IP waiver © Zacharias Abubeker/FT

In addition, Paul Kagame, president of Rwanda, suggested Kigali could become a vaccine hub. “It is important for Africa to forge public-private partnerships for vaccine manufacturing on our continent,” he said last month, adding that Africa needed to accelerate a continental approach to medicines regulation. “Vaccine equity cannot be guaranteed by goodwill alone,” he said, adding that it was time for African countries to stop “being sorry for ourselves” and act.

Africa is extremely dependent on India for its vaccine production, a weakness that has been exposed by a temporary Indian government ban on the export of Covid-19 jabs. Less than 1 per cent of Africans have received a single dose of Covid-19 vaccine and new supplies have all but dried up.

Officials warned there was still a long way to go before African manufacturers could start production. “The fact that the US has indicated it is willing to waive IP rights does not mean that it is actually going to happen,” said Ayoade Alakija, co-chair of the Africa Vaccine Delivery Alliance, who anticipated pushback from pharmaceutical companies and perhaps other countries in the EU and elsewhere.

The first step, said Rebecca Enonchong, a Cameroonian technology entrepreneur and board member of the World Health Organisation Foundation, was to “ensure the patent issue was not an issue”. But even then, she said, it would take time to build up the physical and skills capacity necessary to make mRNA vaccines. There is also a global shortage of vaccine inputs, including nucleotides, enzymes and lipids as well as of vials, caps and syringes. “I think it is unlikely that we will be able to ramp up for this pandemic,” Enonchong said.

Kiran Mazumdar-Shaw, chair of Biocon, a Bangalore-based biotech company, said she did not see IP as the biggest obstacle. “Today, everybody is talking about patents, patents and patents. Even if they don’t enforce patents, how many people can produce Moderna vaccines at scale?” she said, referring to one of the mRNA vaccines.

Building manufacturing capacity in the developing world was “the next big issue”, said Fatima Hassan, founder of the Health Justice Initiative, a South African campaigner for access to vaccines. There had been at least 50 applications already to a WHO hub for transferring mRNA technology, she said, which “indicates that there is definitely interest around the world”.

Two decades ago, South Africa led the battle, along with Brazil, against pharmaceutical companies’ defence of patents on HIV medicines. Legal victories finally forced companies to slash prices of antiretroviral drugs for developing countries, but not before millions of people had died of the disease. South African diplomats pressing for the temporary suspension of patents on Covid-19 vaccines said that “passing this waiver makes ethical, epidemiological, and economic sense”.

Additional reporting by Amy Kazmin in New Delhi



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A harrowing brush with Covid as India is ravaged

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As a foreign correspondent, my job is to tell India’s stories, not be part of them. But when I started feeling feverish while writing an article about Covid-19 vaccine policy last month, I had a gut feeling that the Sars-Cov-2 virus had found me.

I hoped it was exhaustion that I’d sleep off but the next day, still feverish, I was urged to take a Covid test. A leading diagnostic lab chain, which earlier had run an efficient home-testing service, had stopped answering its phones and responding to online requests. But a doctor friend persuaded one of the lab’s phlebotomists to collect my sample. Two days later, the results confirmed I was part of the ferocious coronavirus wave battering India and pushing its healthcare system to breaking point.

Over the following days, my physical symptoms remained mild. But it was still harrowing to be sick from a notoriously unpredictable virus knowing that drugs, hospital beds and oxygen were scarce. I suffered constant anxiety knowing I’d struggle to get medical help if I took a turn for the worse.

I quickly discovered that I’d been so focused on avoiding infection that I had no clue what to do once sick. A friend connected me to a Kolkata-based infectious disease specialist, who felt I was at low risk for severe illness. I’d had the first dose of a Covid vaccine 10 days before my fever started. But the doctor urged me to treat the illness aggressively from the start, given the chaos at hospitals.

He prescribed the antiviral drug, favipiravir, now undergoing clinical trials in the UK as a potential Covid-19 therapy but already approved in India for emergency use. Many of his patients had taken it, he said, and none suffered severely, including people in their 90s.

Normally, I’m reluctant to medicate. I knew favipiravir’s effectiveness as a coronavirus treatment wasn’t yet scientifically validated. But with hospitals turning away ailing patients, the logic of taking an experimental drug made sense. The challenge, I discovered, was to get hold of it.

I called five pharmacies, but all had run out of stock. A friend called six more to no avail. I panicked — the doctor wanted me to start the drug fast and Delhi was hours from the start of a weekend curfew. Then a friend, who’d heard I was Covid-19 positive, called.

“I’m looking for this drug,” I told her. “Any idea where I can get it?” She said she’d check. It turned out that people with foresight had prepared small emergency drug stashes. Her friend had such a stash and was willing to share it.

I was elated to get the pills to start treatment that night. But it wasn’t enough for the prescribed course. Days later I spent hours calling pharmacies in an unsuccessful hunt for more, before finally begging an industry friend to help.

My difficulties pale in comparison with the desperation, anger and grief beyond my sickroom. My Twitter feed was filled with pleas for hospital beds, oxygen cylinders, the antiviral remdesivir, plasma or a place in an intensive care unit. Top hospitals begged on Twitter for refills of dwindling oxygen supplies. Friends and many professional contacts were fighting for their lives. Doctor friends were weeping with impotent rage.

There was much grim news of death. A former Indian ambassador died after hours waiting in a hospital parking lot for admission; inpatients whose oxygen ran out; a top politician’s 34-year-old son, young journalists. Crematoriums struggled with an unprecedented flow of bodies.

I decided I had to tune out of the unfolding crisis, to ensure my physical recovery and to protect my mental health. I stopped checking Twitter. Newspapers piled up, unread.

Once I felt better and tuned back, I saw Narendra Modi’s government had cynically expanded eligibility for vaccination to all over the age of 18, despite an acute shortage of jabs.

And with thousands dying daily, often for want of medical help, the health minister was callously citing dubious official data to claim India’s Covid fatality rate was lower than richer countries — hardly consolation to grief-stricken families.

Today, I’ve recovered from my encounter with the virus. It will take far longer to get over the trauma of watching this calamity engulf the place I call home.

amy.kazmin@ft.com



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