India, Bill Gates, and Narendra Modi: Partners in Fighting COVID-19
Last week, Indian Prime Minister Narendra Modi had an unusual visitor in his bunker-like office in New Delhi: the world’s second-richest man, Microsoft co-founder Bill Gates. The conversation between the two men, who are the wealthiest and third wealthiest individuals respectively in India, was about everything from the ongoing protests against farm laws to the fight against COVID-19, but it was the latest outbreak of infections in India that dominated the discourse.
In an interview with TIME, Gates, who is co-chair of the Bill & Melinda Gates Foundation, said that “India has to accept a situation like the U.S. and Europe,” where thousands of people die every day, with the pandemic that has already killed over 250,000 people in India. “The only way for it to not go catastrophically is a very large-scale vaccine program, and it’s just starting,” he said.
As India grapples with the devastating second wave of the pandemic, the world’s largest vaccine maker is getting pulled in multiple directions, trying to fulfill its commitments to its domestic market where a serious shortage of vaccine has caused turmoil, while also sending out millions of doses to more than 90 other countries. The lethal surge in infections has not just raked up criticism against Prime Minister Modi’s handling of the pandemic but has also highlighted the dwindling vaccine supplies, making the country a onetime exporter now reliant on the global market, like every other nation. This has forced India to turn around on its vaccine policy—from exporting vast quantities abroad as recently as February, into indefinitely suspending supplies to other countries to tackle the crisis at home.
The U.S. has recently announced that it was providing 60 million shots to India. That is set to bolster India’s supply in May, as the U.S. is likely to dispatch all of its initial purchase of 60 million doses in May, followed by 80 million more by the year’s end. This is a significant shift from last April when the U.S. did not give out a single vaccine dose to any other country, except its territories, such as Puerto Rico or U.S.-organized zones, like in Quetta, Afghanistan. The new vaccine-sharing scheme by the White House, led by President Biden, has taken inspiration from one of India’s most prominent entrepreneurs, Gates.
In December, as the administration then led by President Donald Trump was drawing down stockpiles of shots, three of the top four vaccine-science philanthropists – Gates, Tedros Adhanom, director-general of the World Health Organization (WHO), and Prince Charles of Wales – contacted the Biden team to gauge their interest, according to two sources know about the matter. The following month, Gates met virtually with Biden as well as members of the Biden COVID-19 Advisory Board, and offered his vaccine- distribution proposal that was momentously picked up by Biden at a call with United Nations Secretary-General António Guterres and German Chancellor Angela Merkel two days later, the sources said. The four of us, as well as President (Franklin) D. Roosevelt, spoke about the prospects of cooperation with the U.S. and at the end of the call, I committed to getting vaccines from the U.S. to India – and President Biden promised,” Tedros told TIME a few days ago.
Officially, the White House has never acknowledged Republican Gates’ involvement in what is probably the single-largest episode of America’s vaccine diplomacy to date. “President Biden decided – based on conversations with scientists and experts – that it was the right thing to do,” responded White House press secretary Jen Psaki, in response to a question from TIME about the declared involvement of three international leaders in the new U.S. vaccine-sharing plan. Psaki also added that “the President is committed to doing everything in his power to fight this global pandemic.”
During the Gates-Biden meeting, says one of two sources, Gates deftly remained in the background, suggesting that the Biden administration focus on vaccines made in America. This explained the administration’s decision to assist countries with doses made in the U.S., primarily Johnson & Johnson’s single-shot vaccine, and not those produced in other parts of the world, such as India’s Covishield, which is a version of the AstraZeneca vaccine manufactured by the Serum Institute for global exports.
As of now, India is facing a bottleneck in getting the raw materials called active pharmaceutical ingredients (APIs) as well as pre-assembled vaccine components, such as stoppers and syringes, from abroad, prompting the Indian government to look at possible tweaks to the patent law to allow for the local manufacturing of vaccines and their components. “It’s an important way for India to supply itself and contain variants,” said Gates last week, citing the Oxford-AstraZeneca vaccine, which was manufactured in India. A Public Health Foundation of India (PHFI) analysis released Tuesday shows that allowing India to produce essential components will not only improve local manufacturing capacity for the vaccines but will also, in a longer term, promote the production of future vaccines.
The paper estimates that it will cost India $65 to manufacture one dose, including profits and external costs. The total costs to manufacture the vaccine that includes both the cost of raw materials as well as the cost of production and essential items like syringes and injectable delivery systems come to about $103 or 7,400 Indian rupees per dose. This, the researchers believe, will bring the benefits of economies of scale for producers such as the Serum Institute.
Of the 160 million doses India is set to produce by the end of June and an additional 550 million doses it aims to achieve within a year, more than 900 million doses would satisfy India’s own requirements, the authors suggest. “A very large proportion of these doses could be sold at lower prices to neighboring countries with net importers facing a supply shortage during the ongoing outbreak,” the analysis suggests.
With the current shortages of components in India, and the looming threat of coronavirus variants, the U.S. and another Gates proposal has come as great relief. “The early steps the Administration has taken to make U.S. vaccines and future U.S. vaccine doses available to other economies is really important,” Gates told TIME. “India and Brazil, with 2.5 billion people, cannot be left out of what we might call vaccines for all.”
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