India's indigenously developed Covaxin Covid-19 vaccine was recently approved by the WHO. Image: Twitter

JAIPUR – India is increasingly at the center of the global debate over how to get more Covid-19 vaccine shots in developing world arms.

Last week, the World Health Organization granted emergency approval to India’s indigenously developed and produced Covaxin vaccine, a long-awaited designation that has cleared some of the controversy around the jab.

The WHO said the jab’s benefits far outweigh its risks. The approval comes as global health body aims to rejuvenate its COVAX vaccine distribution platform, which seeks to improve access to poor global countries.

WHO chief Tedros Adhanom Ghebreyesus said on Friday that COVAX had the money and the contracts to buy vaccines for low-income countries but “manufacturers have not played their part” – a jab some saw as directed partly at India, which stopped exports in April to prioritize its local population.

COVAX in September cut its 2021 delivery target by nearly 30% to 1.425 billion doses.

Developed by Bharat Biotech International and the Indian Council of Medical Research, the vaccine was approved controversially by the Indian government in January this year while third-phase clinical trials were still ongoing, sparking concern about its safety and efficacy.

Prime Minister Narendra Modi took a first jab of Covaxin in March and a second in April to encourage Indians to get vaccinated, at a time India was seen as the disease’s global epicenter, with thousands dying per day in the country at the time.

The Indian-made vaccine has been found to have a 78% efficacy against Covid-19 of any severity, 14 or more days after the second dose is administered.

Covaxin was evaluated through neutralizing antibody responses against several variants of concern including B.1.617.2 (Delta), B.1.617.1 (Kappa), B.1.1.7 (Alpha), B.1.351 (Beta), P2- B.1.1.28 (Gamma).

Reports have suggested it could be especially suitable for low and middle-income countries due to its comparatively easy storage requirements.

A health worker inoculates India’s Prime Minister Narendra Modi (L) with the Covaxin vaccine at AIIMS hospital in New Delhi. Photo: AFP / PIB

The WHO’s approval could open the way for India to resume Covid-19 vaccine deliveries to the WHO’s global vaccine-sharing COVAX program, which aims to improve access to poor countries. India stopped exporting vaccines in April amid a devastating Delta variant outbreak.

Daily infections have since fallen to about 12,000 per day, from about 42,000 four months ago, according to recent official figures. Deaths have fallen by around half, to about 400 per day.

So far, over 120 million Covaxin shots have been administered across India. India recently announced the delivery of its one-billionth dose, but only an estimated 37% of India’s massive 1.09 billion population is fully vaccinated, with worrying signs that uptake is slowing.

Before the WHO’s emergency approval, few countries recognized Covaxin, leaving many Indians who wished to travel abroad in limbo.

The WHO’s emergency approval is thus good news for international travelers, as Covaxin will soon be added to the WHO list of approved jabs for visiting foreign countries. Some countries, including the UK, US, Switzerland, Oman and Sri Lanka, have already approved it.

Yet doubts have also hounded Covishield, India’s version of the AstraZeneca vaccine produced under a license agreement with the Serum Institute of India (SII) which accounts for most of India’s one billion-plus jabs. The UK, for unclear reasons it has since dropped, initially refused to recognize Covishield.

The SII has reportedly nearly quadrupled its monthly output of Covishield to 240 million doses since April. India’s health ministry said this week that Indian states now have stores of over 159 million unused doses of various vaccines as inoculations have slowed despite a 37% full vaccination rate.  

SII CEO Adar Poonawalla told Reuters in October that the company could send 20 million to 30 million doses a month to COVAX in November and December, which would increase to “large volumes” from January once India’s own needs were met.

Bharat Biotech joint managing director Suchitra Ella suggested Covaxin shots could also soon be delivered to COVAX.

Men stand near burning pyres of victims who lost their lives due to the Covid-19 at a cremation ground in New Delhi on April 26, 2021. Photo: AFP/Jewel Samad

“Covaxin is a great example of a successful public-private partnership in developing a world-class Covid-19 vaccine,” Ella said. “We look forward to playing a larger role to help the efforts by both the developed and developing nations to control the pandemic.”

But some Indian critics are thus asking why the WHO took so long to approve Covaxin’s emergency use, with some insinuating the global health body favored Chinese-made vaccines over Indian ones to give the former a head start in shipping their shots worldwide.

Questions are rising about the efficacy of China’s Sinovac and Sinopharm vaccines, which some developing countries have stopped using after initially administering the shots.

Prominent commentator Brahma Chellaney tweeted that emergency use approval had come months after WHO began its review and after more than 100 million people had been given the vaccine.

“Contrast that with the relative speed with which WHO granted emergency use listing to two similar inactivated Chinese vaccines,” Chellaney said.

Twitter in India was flooded by anti-WHO tweets the day after the approval listing, with some commentators describing the WHO as “paid poodles” of China.

Others retweeted a message saying, “Who cares about WHO? It lost its credibility in March 2020. Everyone knows WHO is a Chinese stooge.”

India has administered the second-highest number of doses in the world, trailing only China.