The gift of the jab

As the world’s biggest vaccine producer, India was first off the mark with vaccine diplomacy in January by shipping millions of doses to neighbouring countries in South Asia.

At the time, China was making forays with gifts for South American and African countries. It also made bulk sales of its Sinovac or Sinopharm vaccines – more than 150 million doses to Indonesia, 100 million to Turkey and 85 million to Mexico.

New Delhi used its AstraZeneca Covishield brand for Prime Minister Narendra Modi’s ‘Neighbourhood First’ diplomacy with high-profile gifts to Bangladesh, Bhutan, Nepal and Sri Lanka. In fact, Sri Lanka rejected the Chinese donation, and Bangladesh was refused vaccines by China because it did not agree to trials.

However, the second wave is now surging in India with the daily infection rate exceeding 82,000, which is nearing the peak in September of 99,000 per day. The Indian government came under criticism for shipping out more vaccines than it was giving its own citizens, and last month banned the export of Covishield made by Serum Institute of India and its other Covaxin brand manufactured by Bharat Biotech.

This has left countries like Nepal in a lurch. It had already used the 1 million Covishield gifted by India in January for the first phase of inoculation of about 460,000 in high-risk groups. Although Nepal has enough in stock for their second dose starting 22 April, it has put its vaccine drive on hold because of the Indian ban. Another 300,000 people above 65 who got Covishield will have to wait for future shipment for their second dose.

Nepal is yet to receive a further million doses it has already paid for from the Serum Institute of India. The Indian export ban has also delayed the next batch of Covishield shots under the COVAX initiative, which is now not expected till May. Nepal received its first batch of 348,000 doses of Covishield under COVAX on 7 March, and is supposed to get another 1.92 million by May.

The COVAX Facility is funded by the governments of Australia, Finland, France, Germany, Japan, Korea, Norway, Qatar, Saudi Arabia, Switzerland, the United Kingdom, the United States and the European Union as well as foundations and corporations, and is targeted for poorer countries in Africa and Asia. It sources its AstraZeneca shots from Serum Institute of India.

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Meanwhile, India announced on Thursday that anyone above 45 would be eligible for vaccines, as it diverted all domestic production to counter the second wave. Indian officials have said they will continue to supply vaccines under the COVAX commitment, but that the volume would be “recalibrated”. India is getting urgent requests from Canada, EU and UK for AtraZeneca, but export has dropped from 30 million a week in February to less than 6 million by late March.

Meanwhile, China has now become the top exporter of Covid-19 vaccines as it has its domestic coronavirus spread under control through aggressive enforcement of precautions, testing and tracing.

China first promised a gift of 500,000 doses of Sinopharm, and increased this to 800,000 in March. A Nepal Airlines plane brought those doses from Beijing on 30 March, and the government says it will use them to inoculate those between 45-59 years.

Chinese Ambassador Hou Yanqi handed over the 800,000 doses to Health and Population Minister Hridayesh Tripathi on Tuesday at a ceremony at Kathmandu Airport. Ambassador Hou said: "This batch of vaccines is not only an implementation of the solemn commitment of China to make Chinese COVID vaccine a global public good, but also a vivid manifestation of our two countries' joint construction of a community with a shared future."

India made another donation of 100,000 doses of Covishield last week, but it was a goodwill gift from the Indian Army to the Nepal Army. The doses were handed over to Nepal Army Chief Purna Chandra Thapa by Indian Ambassdor Vinay Mohan Kwatra on 30 March during a video conference with the Indian Army Chief M M Naravane.

So far, Nepal has inoculated 1.6 million people and needs to vaccinate 20 million more under its target to immunise 70% of its population. For this alone, the government needs to look into other certified vaccines in the market such as Russian Sputnik V, Bharat Biotech’s Covaxin and Chinese vaccines.

With government-to-government deals in jeopardy, the Ministry of Health is now trying to get private importers involved to import doses. Suppliers of India’s Covaxin and the Russian Sputnik are said to be interested, and the government has approved Covaxin for emergency use.