The TLDR: We are all waiting for a vaccine to rescue us from our pandemic woes. But even when it arrives, delivering that golden jab to a country of 1.38 billion people will not be easy. We took a close look at each stage of the vaccine delivery chain to assess the enormity of the challenge. This is the first of our two-part series.

Will we have enough vaccines?

The model for distribution: The Fair Priority Model drawn up by a team of global medical experts calls for prioritising regions that have higher infection rates to prevent spread. The WHO’s Global Access Initiative aims to cover at least 3% of every country’s population at the outset—and gradually increase to 20%.

But the US, China and Russia have opted out of WHO’s initiative, and the richer countries—US, UK, EU and Japan—have reserved 1.5 billion doses in advance.

The good news: India is one of the largest manufacturers of vaccines in the world—supplying 60% of those distributed to the developing world. The Serum Institute is stockpiling the Oxford vaccine, and plans to make one billion doses if it works—and  is reserving half of those for India and other developing countries. The company claims it can make 60 million to 70 million doses a month at full capacity.

Point to note: Serum Institute is also testing four other vaccines. A number of other Indian companies like Biologicals E are working on other candidates. And there are two ‘Made in India’ vaccines under development as well.

Can we afford to pay? 

Experts estimate that India will need $10 billion in just the first year. 

The pricetag: Take the Oxford vaccine, for example:

“The Serum Institute has priced the Oxford vaccine at 225 rupees (US$3) a dose. That means the cost of vaccinating 400 million people [who are at greatest risk] will be at least $1.2 billion. Typically, the government buys vaccines for less than the price of bottled water — 60 rupees. ‘We have never paid $3 for a vaccine,’ [virologist Gagandeep] Kang says.”

The government’s bill: will include more than just the cost of the vaccine. In September, Serum CEO Adar Poonawalla tweeted: "Quick question; will the government of India have 80,000 crores available, over the next one year? Because that's what @MoHFW_INDIA needs, to buy and distribute the vaccine to everyone in India.” 

The threat: When asked about that number, the Health Ministry flatly said it “did not agree with that calculation”—without offering a counter-estimate or explaining why. But a leader of an RSS-affiliated group openly threatened: 

"May it be known to you @adarpoonawalla that India's Patent Act has a section on Compulsory Licensing and we can force you and your peers to produce vaccine free from exploitative royalty."

But those threats are meaningless for foreign-patented vaccines. The government will have far less leverage in determining the price of AstraZeneca’s vaccine than a Bharat Biotech-made Covaxin. And that’s why many economists worry: 

“Amir Ullah Khan, a professor of development economics, felt that the philanthropic route appears to be closed. ‘Therefore, the money can come from the PM Cares Fund or through a covid cess. There doesn’t seem to be any other way to raise a lakh crore,’ he said. ‘Borrowing could be tough. The government could also put half the burden on the states and ask them to raise the money,’ he added.”

Who gets it first?

Most countries, including India, plan to target those most at risk: frontline workers, the elderly and those with underlying conditions. That’s around 30% of India’s population—or 400 million people. In the first phase, the government aims to vaccinate 250 million. 

But even here, there will be some key challenges in identifying that first 250 million. 

One: As StatNews points out, it is very difficult to determine who has underlying conditions anywhere in the world. This will be even tougher in India where poorer Indians do not have proper health records—and that criteria will inevitably favour the rich. 

Two: The vaccines are not being tested on elderly people in human trials. So we have no clue how they will react to an approved vaccine.

Coming up: Once the vaccines are bought, they have to be stored, transported and finally administered. Do we have a sufficient number of cold storage facilities—and are they cold enough? How about vials and syringes? Most importantly, do we have enough people who are trained in actually administering the vaccine? In our next installment, we look at the Covid vaccine’s big delivery challenge.

Reading list

Nature and Mint offer two deep dives on India worth your time. StatNews points to the biggest questions about who will qualify for the first phase of vaccination. Science Magazine has more on the WHO plan to equitably distribute the vaccine. Also handy: The Conversation’s primer on vaccinations for kids.