The Covid-19 pandemic has presented us with an unprecedented challenge. However, it has also given us the opportunity to ensure access to high quality, affordable medicines. In the initial stages of the pandemic, researchers worked tirelessly to increase access to treatment options such as the antiviral remdesivir and favipiravir, mAbs (monoclonal antibody) medicine, and even older medicines such as the corticosteroid dexamethasone.
Now in the last leg of their fight, government, regulators, pharmaceutical companies and ancillary industries must once again collaborate to bring an efficacious vaccine to the people in the shortest possible time. As per recent vaccine trackers, there are about 74 vaccine candidates in clinical trials, of which six have received approval for limited use.
As per trial results, some of these vaccines have demonstrated 90-95% effectiveness. This is as good as it gets. While the development of multiple vaccine candidates in such a short span of time is a great scientific feat, the question is how we can ensure last-mile delivery of the vaccine in a safe and efficacious manner. This is where the Indian pharmaceutical industry has a significant role to play.
Pharma companies in India have expertise in large-scale manufacturing and distribution of generics, and are also well-equipped to manufacture and distribute vaccines. The country accounts for 60% of the world’s vaccine production, and contributes 40-70% of the World Health Organisation’s (WHO) total demand. Further, it has a robust and resilient supply chain with specialised patientcentric distribution channels that enable last-mile delivery.
The time has come to strengthen this further and ensure it is ready to meet the demands of vaccine distribution.
In the Indian context, there are some specific and critical challenges we need to take note of.
Cold chain capabilities: Most Covid-19 vaccine candidates require cold temperatures (from –70° C on the lower end to 2-8° C on the higher end) to remain stable in storage. India, like other countries, does not have existing cold chain infrastructure to handle this from plant-to-patient at such scale.
An effective immunisation programme: Though India has an immunisation programme for children, penetration of vaccines in the adult population is low. GoI must work with NGOs, leverage corporate social responsibility (CSR) programmes and prepare a sensitisation plan to increase awareness about the vaccine, and ensure that people take the vaccine properly — that is, take both doses at the correct interval.
Pricing: GoI must subsidise the price (by bearing most of the cost itself) at which the vaccine is available to the general public to increase penetration. Further, a bulk of the vaccine procurement must be done centrally to leverage economies of scale and get the best possible prices.
Prioritisation: The final question is who will get the vaccine first. While the initial rounds of immunisation will be for healthcare professionals and front-line workers, we must subsequently ensure a just distribution model to ensure that people from all economic backgrounds have equal access. GoI must work on checks and balances to track pilferage, corruption and flawless execution to deliver maximum value. Each consignment must be tracked in real-time to ensure that it is delivered to the people who need it the most.
Various committees are working to understand the availability timelines for different vaccines in the country, obtaining commitments from vaccine manufacturers to build inventory, and prioritising high-risk groups. State governments are being guided by the central government to submit details on cold chain facilities and other related infrastructure down to the block level.
Going forward, we need to identify what parts of our existing cold chain infrastructure — such as that used in food and agro-based industries — can be redeployed with suitable upgrades to undertake and execute this huge task. Finally, it is imperative that intellectual property (IP) laws do not act as a hindrance to accessibility of medicines, and that global cooperation should take precedence in helping patients in these unprecedented times.
Providing effective treatments at affordable prices will be the key to ensure that countries are able to fight this pandemic. As ‘Pharmacy of the World’, India will have to be at the forefront.
The writer is chairman, Dr Reddy’s Laboratories