Vaccine Diplomacy of India in the COVID-19 Pandemic

1024 683 Rahul Wankhede

Introduction

ॐ सर्वे भवन्तु सुखिनः ।

सर्वे सन्तु निरामयाः ।

सर्वे भद्राणि पश्यन्तु ।

मा कश्चित् दुःख भाग्भवेत् ॥

ॐ शान्तिः शान्तिः शान्तिः॥

May all sentient beings be at peace, may no one suffer from illness,

 May all see what is auspicious, 

may no one suffer. 

Om, peace, peace, peace.

This altruistic shloka from an ancient Sanskrit text reflects the broadness and depth of thinking of our ancestors. Bharat being one of the oldest civilizations has a rich culture; with health and wellness being an important aspects of it. This land gave the science of Ayurveda, Yoga, and Sadhana (meditation) to the world. The beauty lies in the fact that these traditions have stayed till date, without any single agency or person patronizing or enforcing it down on someone else and the knowledge has been shared happily with the outside world without asking for any credit, or claims of authority. 

That’s an important lesson for today’s world – create something that adds value to other lives without expecting any benefits in return. So, when a deadly invisible virus struck the world, the people of Bharat were as clueless and unprepared for the calamity as any other country. The scientific community joined hands with the private sector to develop preventive tools against the virus and then it was decided by government support to extend the help to other countries. Most of the nations who asked for help were badly affected by the virus, lacked the technical knowledge and funds to make a vaccine, and were totally at the mercy of vaccine suppliers. Some were not even in a position to buy the doses at market prices.

But the subconscious tradition of helping out others in times of distress did not die out in this country. We played our cards well, taking a bird’s eye view of the entire situation highlighting the fact that either all of us together will triumph over the virus or none of us would ever. It was a brave decision on their part to do so, looking at our huge population which wasn’t yet vaccinated. But how was India able to work this out is an interesting story. This analysis attempts to look at all the important aspects of this entire process and how it unfolded. It is not an expert piece of writing on the subject but a genuine attempt to bring out nuances of the entire process of “vaccine diplomacy” from a student’s perspective. All the information mentioned in this paper has been aptly cited and references mentioned for further readings on the subject. 

  •  What is Vaccine Diplomacy 

‘Vaccine diplomacy’ is the use of vaccines to improve a country’s diplomatic relations with other countries. Though the term is being used popularly today, the act of vaccine diplomacy has been there for centuries. It includes sharing medicines, trained personnel, and scientific knowledge to support and further foreign policy goals, unlike traditional diplomatic tricks. This is very important since the world is dealing with a tiny invisible virus and not every nation has the capability to counter it effectively. This imbalance creates an opportunity for one state and dependency for the other. Vaccines have been used as a bargaining tool to further national interests by nations in conflict even in the past. Globalization has created a huge pharmaceutical industry and vaccines form a crucial component of this, as they are used before the disease strikes you. 

“Prevention is better than cure”, is achieved in practice through vaccinations. Since this directly affects the life of a common man there’s enough scope to channelize it the way we want, in the interest of self and others. A good understanding of history will surely help here.

  • Historical Background

Ancient Sanskrit texts mention about microbes (sukshma jeev jantu) living in all kinds of environments like water, fire, marshes, etc. Some yadnas (fire sacrifice) were also prescribed as a preventive measure from them. The word vishanu has been used for viruses and jeevanu for bacteria, where anu means atomic size. Acharya Sushrut has mentioned microbes causing diseases, which today we know by the names of Typhoid and Cholera.

Today, these texts just survive in bits and pieces scattered across museums and libraries and we have not yet known them completely, for possible remedies. An online news report mentions corona-like viruses being described in ancient texts by Acharya Sushrut. Viruses have created huge destruction many times in the past – be it through the Europeans who killed Native Americans or the spread of epidemics of plague and smallpox or the Spanish invasion of South America that killed millions of native tribal people. Uses of viruses to wipe out the local populations was a popular strategy used by colonizing powers like Britain back then, could the same be said about China in present times is a controversy, beyond the scope of this paper.

All these incidents have forced humanity to relook at the concept of national security as well, in a much broader sense. Advanced research has ensured that these micro-organisms can be created or manipulated in labs under controlled environments – but their risk of going out of control is always there and since we yet do not have complete knowledge about them – situations like the one we are facing now are created. The credit for making the first-ever vaccine goes to Edward Jenner who made the smallpox vaccine in 1796. 

Jenner is quoted to have said “The sciences are never at war” and convinced Napoleon to help the British by supplying vaccines, with whom they were at war.

During both world wars, vaccines were supplied to the USA through Cuba and other countries. One interesting aspect of the present pandemic was that the world came together to help each other and fight the virus highlighting the idea of collective freedom. Global supply chains, funds, data, and resource-sharing mechanisms were used to their maximum to counter the virus effectively. Here as well Indian behavior proved to be an exception as we went for ‘vaccine diplomacy’ rather than ‘vaccine nationalism’. 

  • How did we do it – Role of Government

The virus genome sequencing was done by many labs the world over and was uploaded to a global database called GISAID by Germany.

Once this was known, vaccine research was started in April-May of 2020, by private firms as well as government labs. In our case, the National Institute of Virology Pune, AIIMS, ICMR, etc. were leading the research efforts on vaccine making, which was almost completed in six months, and the data was shared with vaccine makers.

 The government took over the role of supplying research funds, training medical teams, gathering global data, and other macro management activities that also included accepting requests from foreign countries for vaccines. Ministries of Health, External Affairs, Finance, and even Defence were roped in for coordinated operations. The NDMA Act and the Epidemics Act were enforced to control the situation more effectively.

 Pricing of vaccines and increasing production of PPE kits, masks, sanitizers, etc. was also supervised by the government. Digital technology (Arogya Setu, CoWin) was widely used to analyze data, and monitor healthcare services, and resource distribution. This project set a benchmark as one of its kind ever digital health initiative in the world. Some foreign countries also requested India to allow them to use this technology for carrying out their own vaccination drives.

 Armed forces, police, railways, paramilitary forces, etc. were also deployed at many places to provide the necessary facilities. The experiences of the first wave were used to make more comprehensive strategies and it was a tricky situation for the government to balance domestic needs with foreign assistance. Since Indian vaccines were the lowest priced and more effective, the world looked towards India as the only hope. This opportunity was used quite well by the government which has been following a neighborhood-centric policy. The table below shows the number of counties and total vaccines supplied to them by India.

Around 35000 crore rupees were also sanctioned by the government in its annual budget for the year 2020 for its multi-phased vaccination drive. With its advanced cutting-edge healthcare facilities and reputation as a health tourism destination, India attracts thousands of people from the world over, at a fraction of what it costs in the West. So it was quite obvious that many countries would look up to India for supplying a few million vaccine doses (India being the largest vaccine producer in the world). Once vaccine production started, number of doses to be used for domestic purposes and those to be sent outside the country were decided upon and help requests were grouped into three as mentioned in the table below: 

Total Countries Grants Supply Commercial Supply Under COVAX Total in Lakhs
95 107.15 357.92 198.628 663.698

The initiative was named “Vaccine Maitri”. Prices for domestic use were kept lower than the export doses to cover the production costs. SAARC countries were the first to receive their packages, mostly as grants. Supplies were done as per the client demand and this helped many countries like Bhutan to vaccinate their entire population within almost a month.

While some rich countries were busy bargaining for prices, signing advance contracts directly with vaccine producers, Bharat was quietly on its mission to help as much as possible. The government also worked on traditional medical systems (AYUSH system) along with modern medical knowledge to understand the virus and minimize its impact.

Before the vaccine production started India had supplied food, medicines, PPE kits, etc. to many countries and those supply chains were used for sending out vaccines. It was a good synergetic operation on the part of all stakeholders. The Indian Navy, Airforce, and Air India did a commendable job in transporting back our diaspora and distributing relief material to foreign countries.

How did we do it – Role of Non-State Actors :

Serum Institute (the largest vaccine maker in the world) was already in touch with Oxford scientists for many years for the malaria vaccine program. As soon as the genome sequence for COVID-19 became available both of them started research work on vaccine making. AstraZeneca, a British firm was also roped in and Serum agreed to supply 1 billion doses to Britain and a few million doses later on as a part of global vaccine alliances. The initial plan was to develop one billion doses.

Bharat Biotech tied up with ICMR and NIV to make an mRNA-based vaccine. Both vaccines were ready within a few months and were supplied to the central governments as per orders. The government had blocked foreign countries from signing direct orders with these companies.

The vaccines were also supplied to the global alliance, COVAX as a part of Serum’s agreements. A huge stockpile of vaccines was created by Serum Institute for human trials, which when successful was used for the first vaccination drive in India. It was a huge entrepreneurial risk on their part as the losses would have been billions of dollars if the trials had failed.

By late March 2021, India had produced 125 million doses of COVID-19 vaccines and had exported 55 million doses. Private firms including start-ups and MSMEs also got engaged in making medical devices which reduced the demand-supply gap in a short time. The excess goods were then exported to other countries. Since the Indian medicines and devices were of good quality and lower priced, it became easy to supply the huge demands well within time.

This took care of the required funding and encouraged further development. But the process also led to overburdening of the entire healthcare infrastructure in the country.

Vaccines & Geopolitics

As the virus spread all over the world it was evident that the first country to make a credible vaccine would get an advantage over the remaining ones to vaccinate their populations and use the vaccine as a bargaining tool.

Russia was the first to announce successful trials of its Sputnik vaccine which was used for their population and later exported to countries like Hungary. This was seen by the European Union as a challenge to European unity.

The “vaccine competition” increased as the Chinese President announced a healthy silk road as a part of the BRI initiative. Chinese vaccines were rejected by Brazil as they wanted to conduct trials on the Brazilian population and had only 50% efficacy. 

Several Latin American nations got Chinese vaccines for free, but countries such as Honduras and Guatemala that have good relations with Taiwan did not (for obvious political reasons). 

 Meanwhile, India had already dispatched millions of doses abroad, with no expectation of reciprocity or political bargaining in a fair and transparent manner. India also joined hands with South Africa to urge the WTO to waive off patent rights on vaccines and raw materials required to make them; an initiative later supported by the USA also. 

All these efforts did not go unnoticed as the UN Secretary-General praised India for its good work. A significant gesture was to send two lakh vaccine doses separately to the UN Peace Keeping Forces which earned a lot of goodwill and respect. Indian vaccines proved to be effective in all the countries with no side effects. 

By May 2021, over 6.6 crore doses had been supplied under various agreements by India to more than 95 countries. Many countries heaved a sigh of relief as Indians became the first responders in this crisis thereby highlighting our age-old philosophy of “Vasudhaiv Kutumbakam”. This was in tune with our cultural philosophy of doing what is needed the most, in times of crisis, without expectations.

The Positive Aspects

India gained huge soft power, influence, goodwill, and respect from its proactive vaccine diplomacy. As first responders, we were able to help as much as we could and without any strings attached. Optimum use of all the available data and resources was done and the nation worked as one single unit. This will surely help us in the long term to gain votes at UNSC and other international platforms. Recipient countries could clearly see through the vaccine hoardings and malpractices by other countries as compared to India’s transparent and straightforward help. It generated favorable public opinion even in Pakistan where Indian vaccines were supplied, notwithstanding the mutual political rivalries.

The process also highlighted the potential and capacity of our private sector and the way it works when given a free hand, but with strict regulation. The UNO was able to vaccinate Syrian people through the Vaccine Maitri policy, as Syria was facing a dire situation compounded by winterization and food insecurity.

The pandemic also opened up new areas of research, business modeling, and capacity building for India. It also strengthened our position as a dominant player in South Asian geopolitics. The world acknowledged this small shift in the balance of power and influence, quite happily. It could also help counter the propaganda of anti-India forces in our neighborhood. India’s help was reciprocated by many countries very liberally in the second wave when we needed help and had to stop vaccine exports, without an official request for doing so.

Negative Aspects – Losses & Lessons

A recent RTI reply has revealed that the Central government does not have data on how the number of doses supplied to each country was decided and there was no fixed criteria on the same.

A Kerala High Court affidavit filed by the Centre also mentions that only 58% of the total vaccines produced were actually reaching the common people.

The virus proved to be more dangerous as a result of ignoring core issues like population growth, lack of public health infrastructure & budget spending for a long time. The government has also been criticized for supplying vaccines before inoculating its own population, especially in case of them being given away as free grants. Differential pricing of the vaccine also saw controversy. Mismanagement of resources and the lack of a single decision-making body increased people’s hardships. Technological development is not going to solve our management issues and we need to take a more comprehensive view of the same.

Also, soft power has a short shelf life unless backed by hard power – consistent efforts to maintain that goodwill. The failure to create a strong anti-China sentiment and the apathy shown toward tracing the origins of the virus also deserve some attention. A more proactive approach was expected on the government’s part to invite manufacturing companies moving out of China which mostly went to Vietnam, Singapore, and other countries. The ‘One China Policy’ of India has also come under scrutiny due to increasing border tensions with China.

The vaccination success is a result of collaboration with the West, and not ‘self-reliance’ or the much-hyped ‘AatmaNirbhar Bharat’. It must be remembered that the vaccine research was done originally by Oxford University while Serum Institute only had the know-how of how to produce the vaccines. The serum has been criticized in the past for not paying attention to basic research and profiteering from vaccine sales.

Serum Institute of India (SII), which produces Covishield and Novavax vaccines, had also raised concerns about raw material shortages. Though the Indian pharmaceuticals are lower priced and of good quality, we do not have patent rights over most of them – we only have the paid licenses – even for the life-saving drugs. 

In the case of Bharat Biotech, the government gave a paltry sum of just 65 crore rupees for vaccine research while other countries were spending billions of dollars, quite liberally. The bureaucratic laziness was exposed as no official orders had been placed by the government with Serum or Bharat Biotech till November 2020, and the companies made their own calculations for stockpiling and vaccine prices.

This led to further delays in starting our vaccination drive. Also opening up vaccinations for all age groups without considering the vaccine production capacities and their shelf life created procedural hurdles and wastage of precious resources. The rampant use of drugs used for other diseases has also come under scrutiny after the Indian Medical Association disapproved of their usage in the second wave.

The pandemic is not going away anytime soon and we need to be cautious about the same. Issues of mismanagement and lack of coordination were clearly visible in vaccine allocations, lack of SOPs, and the multitude of agencies giving out contradictory orders. The experience of the three waves seems to be lost somewhere leading to misinformation and confusion among the masses. The role of social media as a double-edged weapon once again was highlighted as it was used to help those in need, but also saw widespread rumors and all kinds of fake treatments being prescribed by users.

Conclusion

Billions of such Corona-like microorganisms exist, most of them have been around since the planet was formed and we must not create situations that will bring us into conflict with them. The coronavirus has turned the world upside down and caused a lot of destruction. The world would never be the same again as the virus has changed our living patterns. 

It has also burst the bubble of our individuality and made us realize that we are not the rulers of planet Earth, but just one of its billion residents, and have to live with various organisms that we don’t even know, exist. So it’s better to adopt more sensible and eco-friendly lifestyles and take care of the only home we have in this universe. That would make this planet a better place to live in. 

References 

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Rahul Wankhede
Rahul Wankhede

Rahul Wankhede is a PhD candidate at the Special Centre For National Security Studies, Jawaharlal Nehru University, New Delhi.

Author

Rahul Wankhede

Rahul Wankhede is a PhD candidate at the Special Centre For National Security Studies, Jawaharlal Nehru University, New Delhi.

More work by: Rahul Wankhede

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