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Lack of vaccine supplies and differences between the European Union Commission in Brussels and the German, French governments is slowing the vaccination drive in both countries. The lack of a national concerted effort with the whole country, local and federal governments in agreement, is restricting the effectiveness of the vaccination drives. The failure to contract for more vaccine supplies adds to the problems. By contrast India has coordinated its drive for vaccinations, with the local and federal governments in agreement, and the whole population largely behind the effort to vaccinate. Very critical for a population of 1.4 billion when one includes Bangladesh which has received 2 million doses of vaccine. India has gone one step further with supplying of vaccines to Brazil, Morocco, and other countries. BBC says India has exported 60 million vaccine doses to 76 countries. This is an amazing story and much credit goes to the concerted government effort at all levels local, state and federal and public support. Germany and France can gain by looking at the Indian experience in vaccination drives, just as India has gained by looking at the vaccination drive in the UK, Israel and the US. ...

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A Kyodo News poll shows about 60% of Japanese want the Olympic games cancelled. Japan faces another wave of the pandemic with a surge in Osaka and other cities. The government's handling of the pandemic is disapproved by 71% of Japanese in a Kyodo News poll. Over 80% are unhappy with the slow vaccine rollout.   India faces a surge in cases public dissatisfaction that is similar to Japan and other countries in Europe. France and Germany have a slow vaccine rollout. In India vaccination drive is affected by a lack of supplies as in France and Germany with shortages of vaccine. The European Union in April signed contracts for over a billion doses with Pfizer and India has plans for ramped up supply of its Covishield and Covaxin vaccines to 2 billion doses by December 2021. This shows how difficult it is for advanced countries and major pharmaceutical producing countries such as as India to vaccinate their populations quickly in the initial stages of the vaccination effort. In July the vaccine effort would be in its 7th month and vaccine supply constraints are expected to ease as a result of aggressive action by governments in EU, France, Germany and India. This will also enable addressing needs in Latin America, Africa and South East Asia. ...

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As the coronavirus surges in India with over 300,000 cases a day on April 26, a clear picture on the vaccination drive in the country is critical. The following is the picture of the vaccination progress from Union Health Ministry in India as shown in The Hindustan Times. India has vaccinated 140 million people with at least one dose says this report in The Hindustan Times.  On Saturday 24th April 2.4 million doses were given for that day at 8 pm. This was done over 99 days. This means about 12% of the population of 1.2 billion has been vaccinated.  This compares with the vaccination in Germany for about 21% of people vaccinated with over 18 million getting the first dose in Germany by around April 25. Both Germany and India have suffered from vaccine shortages, some skepticism about vaccinations. Gradually sentiment is shifting in both countries so that once skeptical Germany now has about 75% of people willing to take vaccine on April 25, 2021. In India about 6 million healthcare workers have 2 doses of vaccine, and about 9 million have 1 dose. About 6 million frontline workers have 2 doses and 12 million frontline workers have 1 dose of vaccine.  There is a shortage of vaccine supplies and a bold decision was made by the Indian government on April 25th 2021, after the surge of cases to a world wide maximum of over 300,000 cases a day. The decision was to give immediate regulatory approval for the three major vaccines in the US to be brought and used in India. And delivery will be speeded up - no customs duties and fast processing of supplies access to speedy logistical supply routes. This is a huge step forward for the vaccination drive as this means Pfizer, Moderna and J&J vaccines can now be used in India. The government is also urging the companies to make in India or export to India with prices that provide flexibility in pricing for the private market. The locally produced Covishield Astra Zeneca based vaccine produced by Serum Institute will be allowed to be sold to the private market at 600 rupees or close to about $10. Pfizer and Moderna, J&J can price in a way that would be somewhere around this price range. The access to more vaccines and the ability of the companies to make a reasonable profit in the Indian private market means that vaccine supplies should open up in May and June.  This could give a huge boost to vaccination numbers so that India's vaccination percentage of population vaccinated should keep up with that in countries like Germany and France that were slower to get started in Europe but are now catching up quickly. This is a massive achievement because the population numbers are huge compared to Europe. ...

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From now on the vaccination program in India will be run nationally by the federal government. This will ensure fair access to vaccines to all parts of the Indian population. Earlier vaccine costs were bid up as states and private hospitals bid up prices. Under the new national program 75% of vaccines will be given out by the federal government and 25%  by private hospitals and other private health institutions. The government in New Delhi under prime minister Modi will offer adults free vaccinations. Modi said "We will increase the speed of procuring vaccines and also increase the pace of the vaccination program." Even in private hospitals the cost of vaccine will be kept at Rupees 150 or $2.06. Experts say this is the right policy and the government has learned from errors in letting states and other private institutions run vaccine policy, which made it too fragmented and subject to too many variables, resulting in inequity, and slowing vaccination drives. The Supreme Court stepped in asking for clarity, leading to the clear policy from the federal government announced today.  Advantage of the new policy is that the responsibility lies in one place, and the federal government also has the clout to make things happen, to negotiate with companies and other parties involved effectively. India has vaccinated 222 million people but because of the population being so large at 1.2 billion this comes out to be a small fraction of the population. This puts the task of getting vaccine supplies and getting the vaccination drives to work in the only place that has the determination and the resources to deliver results by vaccinating 1.2 billion people by December 2021. It has never been done before in history says Mr. Modi, and it is a challenge that India is now taking up for itself and for the global community. It also lays the ground for India to help its neighbors in Asia and in Africa, Latin America in 2022.   ...

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Stephanie Nolan's reports from Africa provide the few glimpses one can get today of the situation in Africa where variants are growing as a result of lack of vaccines (vaccine inequality) and the faltering vaccination drive, shortage of medicine and food supplies. Her report from South Africa showed how healthworkers and scientists in South Africa are working hard on the frontlines. This one from Zambia looks at the vaccination centers and vaccination workers as vaccination drives falter. The African continent with 1.4 billion people received 404 million doses. Today only 7% of the population is vaccinated in Zambia and the rest of Africa. People in Zambia do not have car transport so they have to walk 3-6 kilometres to get to a vaccination center, when they turn up at a center and it is out of vaccines they stop coming. Other problems are the social media accounts that show the vaccination drives as harmful to people, or CNN and other news that talk about blood clots that when carefully understood affect a tiny fraction of people. There are other issues also. Ida Musonda, a nurse in a clinic near Lusaka says after not many people turned up that she should go to markets and churches, but says there is no fuel for the vehicle to get clinic workers there. Bernadette Kawango is shown with her children. She works at an auto parts store and lives in a low income neighborhood in the edge of Lusaka. She ignores all the social media accounts that scare people from vaccines, yet she says she worries more about cholera, TB and malaria, and also HIV, AIDS. And she does not know anybody diagnosed with coronavirus.  The result is that there is vaccine shortage resulting in a kind of vaccine indifference (why walk miles to a center if it may not have vaccines), compounded by other problems such as the other diseases that also pose a threat in Africa, and the low incomes in a shrinking economy. And with about 8% vaccinated in Africa, the problem of variants can only be tackled by consistent and not erratic supply of vaccines. ...

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India is providing additional financing to Serum Institute of India and vaccine manufacturers to increase vaccine supplies. It is also importing Sputnik vaccine from Russia and approving production within India of Sputnik vaccine. These steps are being taken to accelerate vaccinations. By early May vaccination will be open to anyone over 18 years.

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Bellman and Dayal in WSJ give this amazing report of how vaccine travels from Pune to remote region of Mizoram hills in India's northeast near Burma. This is the story of the largest vaccination drive in the world that aims to have the vaccine supplies by July to vaccinate the entire population of 1.2 billion people by December 2021. It all began with Oxford University and Astra Zeneca with the decision to make the vaccine available to such a vast population and to people in all parts of the world not just Europe and the US. Bharat Biotech and India's pharmaceutical manufacturers have now joined efforts with the help of the Indian government to produce enough vaccine at affordable cost and make vaccine supplies ample and accessible. This will then be extended to all parts of the world.

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The Indian prime minister reviewed progress of the vaccination drive. On July 26, in the last 6 days about 38 million doses of vaccine have been adminstered in India. In a separate affidavit to the Supreme Court the government laid out its plan for making enough vaccine supplies to vaccinate the entire population over 18 by December 31, 2021, over 940 million people requiring over 1880 million doses.  "Out of this requirement for 1880 million doses 516 million doses will be made available by July 31, 2021, in about 34 days. The remaining 1350 million doses for complete vaccination to the eligible population" says the government information provided to the Supreme Court. The breakdown of vaccine supplies manufacturing is also given to SC. Of the total of 1350 million vaccine doses the following is how it will be manufactured in India in the next 6 months. Covishield  vaccine     500 million Covaxin vaccine          400 million Bio E Subunit vaccine  300 million Zydus Cadila DNA vaccine  50 million Sputnik V  vaccine          100 million The government told the Supreme Court that the procurement of Bio E Subunit vaccine and Zydus Cadila DNA vaccine will be subject to approval that is expected in the near future. From this new vaccine supplies picture it is clear that Covaxin and Bio E Unit will play a major part in the second half of 2021 in vaccinating India's entire population with 2 doses. This would be a historic achievement for the federal government after the lessons learned and the action taken with a new vaccine supplies policy for India in June 2021. There is also the challenge to be overcome of maintaining the vaccination drive at 6-8 million doses a day which would be another historic achievement for the federal and state, and local governments in India working with community education and logistical setup, medical staff.  ...

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The problem facing Africa is whether vaccine supplies will run out before new vaccine supplies come from America, Britain and France. Only less than 1% of African people have been fully vaccinated out of a population of 1.3 billion people. US president Biden said America will provide 500 million doses of Pfizer vaccine to poor nations before the G-7 meeting in Cornwall, UK. Britain added 100 million and France 30 million doses. With new more transmissable variants out there Africa is in considerable danger today. The Delta variant from India has been shown to be about 70% more contagious than the Alpha variant from Kent UK. It is already the dominant variant for new cases in the UK. The new variants are now spreading in Africa. Cities such as Johannesburg, South Africa, and Kampala, Uganda are seeing a surge in cases. Another problem in Africa is that governments are increasingly reluctant to impose strong lockdowns because of the economy. Already it is believed that Africa's middle class has been severely affected during the last 18 months. ...

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RFK Jr's views on reducing the overuse of pesticides and agricuture that harms human health are positives. Will the RFK noimnation for Secretary of Health and Human Services make America's health and well being worse? WSJ and business thinks it will if it makes people skeptical of all vaccines. Covid vaccine being made compulsory brought RFK Jr. to public attention as some states closed too soon for too long prolonging the economic effects and not leaving an option for some groups to not get vaccinated. WSJ points out that RFK skepticism for all vaccinations is dangerous. It points to polio vaccine, and to the local areas where measles has increased where vaccination was turned down. Other risks are in betting so much on organic food that the benefits of the green revolution of adequate food supplies from the use of fertilizer for output increases per acre are lost. Sri Lanka is an example of a nation unable to feed itself as it bet everything on organic overnight. ...

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Dipti Deshpande writes in the Economic Times that how India's economy recovers depends a lot on how well the government tackles the problems of vaccine supplies, vaccination staff and incentives for vaccination to the public, vaccination logistics, and vaccination skepticism. Vaccination plays a large role in the reduction of fear and permits resumption of normal activity as seen in the US, UK and France. Government education of the public on vaccine safety should be conducted on an organized basis across the country starting now for the gaol of vaccinating the entire population by December 2021. In the 200 days remaining in 2021 the government would have to administer over 1000 million doses or at the rate of 5 million doses a day just for the single dose population, with the second dose meaning additional supplies and logistical effort, organized health staffing, all to be organized.  The thrust of this article is that the economy and especially laggard sectors such as services would gain a fully powered recovery if the problems of vaccine supplies and vaccination drives are resolved early with preparation, lessons learned, and proactive action all taking place immediately. The period after the decline in cases to below 50,000 a day which is fast approaching for India is one that needs to be used to take deep yogic breaths, and prepare the Indian mind for the next challenge for government and nation.   ...

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Angela Merkel of Germany and other EU leaders decided to back "global supply chains" and declined to support the EU Commission in Brussels at a virtual summit attended by 27 leaders of the EU states. It was also attended briefly by Joe Biden. Ursula von Leyen said 21 million doses of vaccine had been shipped from EU to Britain, of which 1 million were from Astra Zeneca and the rest from Pfizer and other makers of vaccines. A total of 77 million doses made in the EU wer shipped to 33 countries since 1 December 2020. Governments of Netherlands, Ireland, Belgium and Sweden were not in favor of blocking shipments from the UK because of the effect on supply chains. Pfizer is strongly opposed to the move to block shipments. Merkel emphasized the need to respect the global supply chains while making efforts to ensure EU countries get a fair share of vaccine supplies. The problems of UK vs Britain on vaccine supplies comes from the yield problems at a Belgium plant of Astra Zeneca and the company's refusal to divert supplies from the UK. Of the 120 million promised only 30 million could be delivered to EU. The UK's contract with Astra Zeneca states that supplies from its plants in Oxford and Staffordshire must be delivered to Britain first. The UK is facing an acute shortage of second doses even though it has given 31 million jabs. At this time 45 out of 100 people in the UK have jabs, compared with 13 out of 100 in the EU.   ...

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In some countries such as Tanzania and Chad the vaccination drives have not even begun says this report in the DW.com. A new surge now underway in Africa as cases increase by 30% in June comes at abad time with African vaccination drives stalled. Only 31 million doses adminstered in Africa for a population of 1 billion people. Less than 1% of world vaccine supplies are going to poor countries in Africa and Latin America.

Vaccine companies chose to sell their vaccines to the highest bidders, putting Covax  behind. Aims of Covax are also coming down and watered down to vaccinating 20% or 30% of the population in poor countries, says this report in DW.com.

This means new variants could develop and move back to Asia and Europe, the US in 2022. It means the coronavirus could affect African economies in 2022 and beyond.

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The death toll from coronavirus reaches 200,000 in Mexico, the third highest after the US and Brazil. Vaccine supplies are low in Europe affecting the vaccination drive. 

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The UK and the European Union compete for limited vaccine supplies as a plant in Belgium has production problems and Astra Zeneca says it can only supply half of what it promised to Europe.

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Plans for the Quad countries to launch a new effort in the last quarter of 2021 to produce 1 billion vaccines in 2022 for adding to supplies in the Indo-Pacific region that includes Indonesia, Malaysia Thailand and Vietnam. Japan would provide the financing for the manufacture of vaccines in India using American technology and raw material supplies. Australia would help with delivery in the Indo-Pacific region. The foreign ministers of the Quad countries, US, Japan, Australia and India, will meet on June 29 in Matera, during a G-20 foreign ministers meeting in Italy. 

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How a deficiency in trust is affecting the US effort to vaccinate its whole population in 2021. The US government took steps early to build vaccine supplies, and was one of the first countries with the UK to begin its vaccination drive. Then after 6 months something went wrong. The deficiency in trust led to about 80 million people many of them young, to avoid getting vaccinated. US president Biden said the country was losing patience with these people. He setup a vaccine mandate and required all employees in private sector in companies with more than 100 employees to get vaccinated. This applied to about two thirds of American workers. All federal government workers were also required to get vaccinated. Yet even after the vaccine mandate the number of vaccinations has not exceeded 900,000 a day. By contrast India was doing 20 million a day. By September 2021 the US had fallen behind all nations in the G-7 in percentage of people vaccinated with one or two doses, behind Italy, France, UK, Germany, Japan, Canada. Trust was also needed, not just vaccine supplies to make a vaccination drive effective. By September the US passed the 675,000 deaths that happened in 1918 pandemic. The deficiency in trust leads one expert to call it breakthrough without followthrough. Other experts see the entrenched social forces that had diminished American health and life expectancy since the 1970's also affecting the vaccination drive. ...

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Joe Biden, US president says the US will have 300 million vaccine doses by the end of July. 200 million more vaccine doses, with 100 million from Pfizer and 100 million from Moderna are part of new finalized purchases by the Biden government in February 2021. Biden says vaccine supplies were in much worse shape than he thought after the last 2 months of the Trump administration led to distractions that affected handling of the pandemic. 

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The lack of vaccine supplies is affecting countries such as the Philippines, Bangladesh, Brazil and Mexico as cases rise. Porto Alegre and Manila are being hit particularly hard.

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US president Biden makes a pledge that the US will send vaccine doses overseas to other countries after it has met American needs. This is hugely important because the US has contracted with pharmaceutical companies for a major part of the world's vaccine supplies. It is part of the humanitarian assistance the US will soon be in a position to provide to African, Asian and Latin American countries. It is also in the American interest to reduce the potential for new variants and new sources of the virus entering the US through airline travel by helping vaccinate a large part of the world's population in 2021-2022.

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This report in The Guardian says what India urgently needs is for the US to lift export restrictions on supplies for India's vaccine factories, and tools such as genome sequencing to identify and control emerging variants of the coronavirus.

The report also points out that of the 1 billion vaccine jabs about half are in the US and Europe and the low income countries have only a tiny fraction of vaccinations. India which sent 64 million vaccine doses to countries including Brazil and Morocco, Bangladesh, in 3 months prior is reported to have sent only 1.2 million doses this month.

The crisis in India also shows the need says The Guardian for an international approach to the crisis no a country by country approach. It says the Bush plan for Aids and the the 2014 plan for Ebola in West Africa are models of an international approach that is needed now.

 

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The need for a global response to a global problems not a lot of local solutions is the subject of this article by Dr. Larry Brilliant, who for 7 years 1973-80 worked with the World Health Organization to eradicate smallpox globally. 1. Action for a global response-The WHO can act as the vehicle for action globally-  restructure it and empower it to do the job. Put the right people in place who have the confidence globally. Set a new pandemic treaty and put it in place. 2.  Get a more advanced version of the mRNA vaccine which does not need a cold chain. India is reportedly working on one. Put funds and people in place for vaccine drives in poor countries.  Other action needed is learning from the situation in South Africa where the HIV patients are reported by Stephanie Nolan in NYT to have been more susceptible to mutations of the new variant. How can resources be put in place in poor countries so that patients in vulnerable populations get their medicines regularly, and are vaccinated. Overall how can these populations have the vaccine supplies needed- including ones without cold chain suggested by Larry Brilliant, potentially through vaccine work in India. Can international teams be developed with developed countries in Europe and US financing the effort and India offering its manpower and knowhow?   ...

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European Union countries reopen for travel this summer. A new travel pass or digital Covid certificate is approved to promote freedom of travel as more people get vaccinated. About a third of people are vaccinated for first shot in France and about 40% in Germany, which means in coming weeks they will have the second shot and enough antibodies to make a return to normal life possible. The EU has negotiated this time with Pfizer for 1.8 billion doses and is building enough vaccine supplies. For the first time governments are stepping up with plans and resources allocated - in India the government now has plans to create supplies of 2 billion doses by the end of the year. This means there is new hope if the vaccination is accompanied by efforts to build booster shot supplies this time planning ahead. Managing the risk of those who are vaccine skeptical remains a problem to be tackled. Masks and other essential precautions also need to be followed in crowded spaces as this was neglected where there was a second or third wave. Public education for this is essential to better manage the pandemic. ...

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Italy faces tighter restrictions and a national lockdown at Easter for the coronavirus, Italians who were the first to go into lockdown on March 10, 2020, now think they will be the last to exit lockdowns. The mood in Europe is of frustration with the slow vaccination drive and the failure to procure enough vaccine supplies and to approve vaccines in time. The US and Britain have vaccination drives that are moving rapidly leading to a reduction in cases and deaths. In Europe new cases are rising since mid February 2021, and there is the spread of the new variant first detected in the UK.  The variants make up 70% of new cases in France says Health Minister Olivier Veran. ICU's in France are 80% full. Elections in France in 2022 and in Germany in September 2021 are leading to government reluctance to impose tighter restrictions. The government strategy is now being questioned. Only 30% of Germans now have confidence in chancellor Merkel's ability to make competent decisions. The CDU's partner in the government, the SDU socialists have even less trust with SDU getting less than 10%. There are signs of a third wave of coronavirus in Germany resulting from variants of the virus, slow vaccinations, and reopenings. ...

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The two waves of the coronavirus in India can be compared looking at the graphs and this report in the Times of India. The case volume and deaths in the worst hit state Maharashtra is shown here. The case volume increased by about 50% in the second wave but deaths were about half that in the first wave. Most of the deaths were in the people over 65 and most of the cases in the ages below 40 years. In the over 65 age only 5% have been vaccinated which means that medical management is still the best way of tackling the coronavirus. Vaccine supplies are the bottleneck and this is beginning to change- so that by August ample supplies of the vaccine should make the difference in bringing down cases and deaths.  Lockdowns are managed carefully so that the economy can recover in the second half of 2021 and in 2022.  Any assessment of the crisis management must take into account the speed of the response, its effectiveness, and keeping in mind the economic recovery needed following the pandemic. ...