LyrArc Article Gist
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. ...

LyrArc Article Gist
The Indian variant B.1.617.2 is beleived to be 50% more transmisable than the UK variant B.1.1.7 variant of the coronavirus. It is expected to be the dominant strain of coronavirus in the UK. The government has sent out the army to vaccinate populations in UK where this variant is widespread.

LyrArc Article Gist
States in America's Deep South have a much lower rate of people having taken one shot of vaccination, in the 30-40% range by May 2021. This report says states such as Alabama, Arkansas, Georgia, and others in the South are at risk of seeing a new wave of the coronavirus  because people will spend more time in airconditioned spaces in the summer. In contrast to the north with cold winters and indoor heated spaces people in the southern states can spend more time outdoors because of the warmer weather in winter. This may have protected southerners during the winter and spring months. This may reverse with more time spent in airconditioned indoor spaces in close proximity where the coronavirus infections can increase. This report comes as new reports show the Indian coronavirus variant becoming more prevalent in the UK and other countries. This variant spreads about 50% more rapidly than an earlier UK variant, say experts. Another analysis in The Times of London shows that the imperceptible rise phase of the new coronavirus variants is the most dangerous part of the coronavirus as it dulls the sense of danger in the population that makes it take notice and prepare countermeasures early enough. India is an example of how this can happen as the sudden rise actually started with a first imperceptible increase in March and early April 2021 that changed into a rapid escalation of the virus in the population by May 2021. The vaccinations give a strong sense of confidence, however the vaccination rates vary widely state by state in the US. ...

LyrArc Article Gist
The variant first identified in India called the Delta variant is 60% more infectious than the Kent variant found in the UK. The Delta variant is now the dominant variant in the UK. There is concern that this could lead to another wave just as the UK is reopening in the summer. There are over 6000 daily cases in the UK this week. The estimated R number is now 1.00 to 1.2 following the number being 1.00 to 1.1 in the earlier week. A R number over 1.0 suggests greater spread of the coronavirus. An R number of 1.1 suggests the number of cumulative cases is taking off meaning that the UK is at risk of a sudden surge in the coronavirus in June or July 2021. India faced a wave from the new variant's higher rate of infectious spread. leading to a sudden surge in May 2021 to 400,000 daily cases before it was brought down by June 1 to about 100,000 The number of hospitalizations in such a wave is estimated to be higher in UK than the previous waves, requiring the government to be more vigilant today. Restrictions on travel from Portugal are being put in place in UK as a precaution. After repeated waves as a consequence of complacency with the coronavirus the lesson now is to take steps early and take aggressive action in advance. ...

LyrArc Article Gist
European Union countries, Britain and the US face the risk of a resurgence of coronavirus through the Delta variant and other variants. The Delta variant detected in India is 40% to 80% more transmissible than the Alpha variant detected in the UK, with the Alpha variant 50% more transmissible than the original coronavirus that originated in Wuhan.    Virologists in Italy feel they are flying blind at this time because of the lack of genetic sequencing in Italy, Spain, France and across most European Union countries. The UK has done genetic sequencing on 27% of recent covid positive tests. The figure drops to 1% for Italy and is tiny for most of the EU countries including Spain and France. Without genetic sequencing it is hard to predict and take steps. Another problem in the EU is that the southern economies Spain, Portugal, Greece, Italy, Croatia are dependent on summer tourism for the economy. The UK economy can handle a delay to a full opening for 6 weeks without serious impact to the economy, says WSJ. Southern European economies can afford only short delays to full reopening. Croatia acted as a door to spread of coronavirus into central Europe when Germans and Austrians went to vacation spots in Croatia in summer 2020. This situation could be happening again in 2020 with British and other tourists visiting vacation areas in Portugal, and Germans visiting Greece and other summer tourism spots. Portugal's national health institute says the Delta variant represents 60% of new cases in the area around Lisbon based on early data. The government of Portugal is facing criticism for letting a Champions League soccer final to take place in Porto, Portugal between two English teams. Thousands of English fans watched the game at the stadium. Other problems are in relaxing of mask rules in France and Italy, last week in France and in the coming week in Italy. French nightclubs open July 9 without mask requirement. Germany is maintaining some social distancing measures and this includes mandating medical masks in closed public spaces and on public transport. Half of French, Italians, Germans are vaccinated and quarter fully vaccinated. Yet the gaps of unvaccinated people is large enough to cause serious concern of another wave. The relaxation of mask rules- the entire stadium in Budapest was packed for a recent game between Hungary and Italy for a soccer Euro 2021 game with no masks to be seen. Stadiums played a key role for the spread of the original coronavirus in Italy with a game in Bergamo, Italy, in the area near Milan. All this makes health officials concerned about the risks of still another wave of the coronavirus.   ...

LyrArc Article Gist
China faces risk of a surge inthe coronavirus in June 2021. The area in and around Guangzhou appears to be seriously affected. The city tested almost its entire population of 18.7 million between June 6 Sunday and June 8 Tuesday. This report shows pictures of a deserted Beijing airport, strict restrictions on foreign travel. The SinoPharm vaccine effectiveness against the Delta variant in India and UK is unknown. The government is locking down entire neighborhoods rather than entire cities or provinces.  As the risks of the Delta variant and other new variants increases most of the population even in the US and Europe have either no dose or one dose. Researchers at the University of New South Wales in Australia show the Astra Zeneca vaccine effectiveness with one dose at only 30%, only after two weeks following the second dose does the vaccine effectiveness reach about 70%. The population of China and India are so large that much larger parts of the population remain unvaccinated. In China with 1.3 billion people and even if the figure of 800 million doses stated by the government is accepted- it could be an overestimate as the US has only managed 300 million doses with many vaccines- most of the population is unprotected. Vaccine skepticism is high in China making vaccination an uphill task. SinoPharmvaccine is not as effective as Pfizer, Moderna, Astra Zeneca, or Covaxin vaccines, making the task even more of an uphill kind. ...

LyrArc Article Gist
With vaccine hesitancy in the US the goal of vaccinating a large part of the US population is still elusive. Less than half of the US population is fully vaccinated as of July 30. The vaccination rates in the US are now much slower than India even taking into account the population difference. The vaccination in India is at the rate of 4 to 5 million a day for the past week in India. In the US this report in The Guardian shows 4.7 million vaccinated in the past 2 weeks. On July 30 856,000 people were vaccinated in the US compared to over 5 million in India.  Newspaper reporting that encourages vaccine hesitancy people to delay getting vaccinated because of poorly reported headlines is adding to vaccine hesitancy in the US. This has led to much frustration at the White House. The threat of the Delta variant is making more people to take vaccination. Southern states are seeing a jump in vaccinations. Many prominent Republicans are now endorsing vaccination.  One of the problems in tackling the Delta variant is the confusing nature of the CDC guidance on masks. On May 13 CDC issued guidance saying masks were not necessary indoors and outdoors. Now 3 months later in July the CDC says the threat of Delta variant means mask wearing is essential particularly indoors because of the higher transmissibility of the delta variant.  ...

LyrArc Article Gist
India's new vaccine policy and how it will vaccinate fully with 2 doses India's entire population by December 2021 is  outlined in the federal government's affidavit to the Supreme Court. The vaccine supplies of about 1880 million doses will be supplied by 5 Indian pharmaceutical vaccine manufacturers. 1350 million doses will be supplied by the manufacturers between August and December with 500 million doses made available by July 31 to the government. This is a monumental task for the vaccine manufacturers and the federal government which is being courageously tackled at every level. The new variants have shown how critical this task is and the challenge is being taken up vigorously.

LyrArc Article Gist
A drop in the positivity rate to below 5% and cases dropping to below 100,000 after peaking at 400,000 in May. This report in the Indian Express looks at the details behind India's successful effort at bringing down the cases that was done over a period of 30 days with a combination of effort from the central government, state governments and healthcare workers. The turnaround was achieved effectively in Uttar Pradesh a state of 210 million people so that per thousand population had dropped to below that in the US state of Michigan about 2 weeks before that was achieved in Michigan. This was the result of an extraordinary effort at all levels in India.

Risks of the new variant exist in all countries that are reopening aggressively. Talk about huge open air concerts and filled sports stadiums in the US show that complacency can happen as countries reopen.

LyrArc Article Gist
The Biden vaccination target of 70% of American adults at least partially vaccinated with one dose by July 4, 2021 remains elusive as vaccination rates have dropped. From a high of 2 million a day vaccinations have dropped to 400,000 a day during the first week of June 2021. Vaccination skepticism particularly in the south and western part of the US is making it harder to vaccinate the rest of the US population. This poses increasing risks as the new variants of the virus such as the Delta variant found in India, and now the most widely prevalent strain of virus in the UK, remain a serious problem. The unvaccinated population in the US is too large for any degree of safety in numbers vaccinated. Consider that at the press briefing given by the White House on June 3, 2021, only 28 states out of 51 states have fully vaccinated 50% or more of their population. There is a large variation between different states with states in the south such as Mississippi as low as 34% at least one dose and a similar situation in Alabama. In Arkansas, Georgia, Carolinas, and Louisiana  it is higher at about 50% with at least one dose. Even these figures are deceiving as in some parishes in Louisiana only 20% have even one dose. Studies show that only after the second dose are enough antibodies released to protect well against coronavirus. This is why vaccine experts at Baylor College of Medicine cited in NYT foresee a second wave in the southern US because of the South so underachieving in the case of vaccination.  ...

LyrArc Article Gist
This WSJ podcast looks at the Fedspeak, the language, the use of specific words that telegraph the US central bank's carefully thought out message to markets. Th topic is inflation. Is it persistent or transitory? Fed chairman Powell's word for it was "transitory." Then transitory" but longer than we thought, because our Fed models did not include supplychain bottlenecks.  In reality every new variant brings new lockdowns and slows the rise or reverses the increase in gas and fuel prices that are a main driver of inflation. Wage increases are a good thing after decades of lack of leverage of workers and economic distortions from this, this may be termed constructive inflation.  Supplychain bottlenecks are likely to ease and not be permanent so that the Fed could be right on that point. A less noticed aspect of the Fed's decision to raise interests without careful thought is that this will impact the ability of poor and moderate income countries to afford medicine and food as exchange rates make their currencies worth less. At the time of variants this is both a practical and a human consideration. What are called emerging markets in finspeak (financial language) are really countries that Stephanie Nolan is writing about on the frontlines of the pandemic in the NYT- South Africa, Zambia. Then there are other poor or moderate income countries- Brazil, Mexico, Russia, India, Pakistan, Bangladesh, Indonesia, Philippines, Vietnam, Malaysia. Today the Fed needs to think about them also. How much vaccine, medicines, or food imports can they afford with weakening currencies as the Fed raises interest rates? At the same time some accomodations for inflation are necessary, but carefully thought, with a lot of thought given to the current state of the world with new variants and weakened economies and no stimulus payments in large parts of the world to offset weakness. ...

LyrArc Article Gist
An India like surge is feared for Indonesia with the spread of the Delta variant and rising cases. Sudden spikes in Jakarta, central Java, and Bangkalan on the Java coast are straining hospitals. A nation of 270 million Indonesia has only a small vaccination program dependent on Sinovac vaccine from China, and only 5% are vaccinated.

Doctors say whether you are young or old have co-morbidities or not you can catch the coronavirus delta variant. Several members of a household can catch it and the deterioration happens quickly. Doctors in India made similar comments during the surge there in May 2021. Kudus region in central Java is typical. At first cases were declining from a January peak by May. Then cases jumped in June. A third of cases turned up positive for PCR tests.

LyrArc Article Gist
So far Covax Africa is proving to be a failure. Consider the numbers 1 billion people only 31 million vaccines given. Another wave of the virus is underway with 130% rise in cases in Uganda, increase taking place in DRC, Namibia. About 30% increase in cases for all of Africa this week. The new Delta variant that is twice as contagious as the original virus is widespread in the UK and is an unacceptable risk in Africa and in Europe and the US.


 By comparison India has 1.2 billion people and 230 million people vaccinated with at least one dose.

US has 330 million people and has adminstered 300 million doses. UK and Brazil have each adminstered over 70 million doses.

LyrArc Article Gist
Jenny Strasbourg of the WSJ provides this much needed report from London about the courageous decision by AstraZeneca and Oxford University to give vaccines away at no profit to the whole world, to billions of people in Africa, Asia, and Latin America. Without this brave decision by a British company and a British University the world would be a lot poorer, more variants could have happened, making us realize the great contribution Britain has made and how indispensable it is to the planet. Add to this the effort of Indian companies including Serum Institute that provided the manufacturing facilities and capabilities for making most of the British vaccine. AstraZeneca delivered 2.3 billion doses of the vaccine globally as of mid-December, according to the company. The International Monetary Fund estimates that low and middle income countries received 3.25 billion vaccines as of Dec. 11, About half of this or 1.6 billion doses were Astra Zeneca shots. This is a bigger share than any other vaccine by far and a life saver to the world. AstraZeneca stepped up early in a true to the best ideals in Britain to meet the needs of the world-  aiming to deliver 3 billion doses in 2022 and sell them at no profit as long as the pandemic continues. As the shot does not need cold storage it is ideal for India and other Asia, Africa and Latin America. "We are all very proud throughout the company of the impact we have had," says AstrZeneca CEO Pascal Soriot. By far the biggest manufacturing was done at Serum Institute of India which supplied 1.3 billion doses of the AstraZeneca vaccine to 70 countries. Mr. Modi pushed forward the export of vaccine made in India to the world from the beginning in the same spirit of cooperation and the best ideals that Britain was living upto. Serum Institute can produce as much as 250 million doses of vaccine a month making it possible for India to tackle the vaccination population of 1.3 billion people.   None of this could have happened without Oxford University and AstraZeneca and Indian companies with Mr. Modi's active support living up to the best ideals of Britain and India for the world. "When you add up the benefits to humanity, I think you'll find the vaccine holds up pretty well in terms of the ill health it has prevented, and the deaths it has prevented," says John Bell, a senior Oxford academic who in 2020 guided the University through its vaccine-partnership talks with Astra Zeneca. Because in the real world AstraZeneca shot has held up so well it is also a choice for booster shots. ...

LyrArc Article Gist
Contrast the slow US vaccine export response with that of India, Russia, EU and China. Only in May 2021 after India's daily Covid cases were close to 400,000 a day did the US make a serious offer of vaccines to other countries in need of assistance. U.S. president Biden says that 80 million vaccine doses would be exported by the end of June 2021. The WSJ says citing Airfinity, a London research firm, as of May 10 more than 333 million doses of vaccine were produced by the US and only 3 million vaccine doses were exported. Contrast that with the European Union which has shipped 111 million doses overseas one third of its total production, Russia which has exported 27 million doses.  India has exported 66 million doses according to the Ministry of External Affairs website as of May 17, 2021. This includes 4 million doses to Brazil, 4 million to Nigeria. Within its own region Bangladesh received 10 million and Sri Lanka 1.2 million doses, Afghanistan 1 million. Mexico received about 1 million doses. In Africa the Democratic Republic of the Congo which has suffered from many epidemics including Ebola virus received 1.7 million doses, Nigeria 4 million doses, Kenya 1 million, Uganda 1 million. Of the 66 million about half of it is a direct grant assistance and Brazil, Mexico, Morocco received all vaccine as grant assistance, 70% of Bangladesh's is grant assistance. The list on the Ministry of External Affairs site of the Government of India shows 95 countries including many of the most struggling nations of Latin America and Africa, bringing hope to countries which are struggling to hold onto hope for a better life beyond the pandemic. Sending help overseas through vaccine supplies is suspended for the moment but will resume in July after India has pulled in all of its pharmaceutical manufacturing industry under a government guided effort to go all out. Never has so much help bringing much needed hope gone to so many countries of the world in the twentieth or twenty first century from a nation that is struggling to meet its own needs. The US in pursuing a US first policy of vaccinating all its citizens has not taken into account the need to bring this evolving vaccine technology into the hands of as many qualified pharmaceutical manufacturers as possible. This in a rapid response to expand manufacturing capabilities to meet world wide demand. The risks of not doing so were not taken on early- the very same way the virus spread in January to March of 2020 can be repeated as people travel around the world particularly for tourism, business family reasons. This risk takes on anew dimension of contagious mutations of the virus which are 50% more- the Indian variant being 50% more contagious by some estimates than the UK variant, which itself was estimated to be 50% more contagious than the original one.  The result a pandemic that stretches out indefinitely unless billions of doses are made in a short timetable to beat the timetable of Nature through the coronavirus. India is doing this for the first time with plans to produce billions of doses by engaging the whole of the Indian pharmaceutical manufacturing industry in the effort in a rapid response so that July to December would see 1.2 billion people vaccinated. The US effort, the European effort is left to the individual effort of pharmaceutical makers in the US and Europe, not a government guided effort to engage the entire pharmaceutical industry of the US and Europe in a rapid response timetable of 2-6 months.  ...

LyrArc Article Gist
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.

 

LyrArc Article Gist
Young people are the major source of transmission of coronavirus in the US with school sports as a major cause. Michigan, New York, Florida, New Jersey, Pennsylvania, makeup 42% of cases on April 11. Adults ages 20 to 39 are affected the most in Michigan. With cases for children under 19 quadrupling from a month ago. 301 reported school outbreaks in Michigan alone. A big problem is that the spread of the variant B.1.1.7  from the UK started in clusters earlier in February. It now has spread to the general population. India has seen a surge in the past 5 days and public health officials are learning from this experience in Europe and the US. The focus  should be on micro containment zones, prime minister Modi told state chief ministers in a virtual meeting on April 10, with screening, testing, tracking, and that health officials should not let higher numbers affect their persistent effort to screen, test and track as with the unceasing effort the results will come. ...

LyrArc Article Gist
For the regions hardest hit by the coronavirus and its variants- the US, Brazil, India, Europe, Russia, China and Africa, the researchers and the frontline workers in South Africa are doing an incredible job. This report by Stephanie Nolan in the NYT shows the work of researchers at KRISPS advanced medical research center and the frontline workers in South Africa, who are making a difference. Shown are researchers and scientists at KwaZulu Natal Research Innovation and Sequencing Platform in Durban, South Africa on whom the world depends for stepping up the fight against the coronavirus- Dr Tulio de Oliveira, principal investigator of the national genetic monitoring network, and Saleem Abdul Karim, epidemiologist. On the frontline workers who visit patients homes to make sure immune compromised patients have access to their medications is Sizakele Mathe, community health worker. Stephanie Nolan has provided a much needed account of what work is being done on the frontlines to keep us all safe. ...

LyrArc Article Gist
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?   ...

LyrArc Article Gist
Some of the coverage such as this report in the WSJ looks at the empty stands and the loss of ticket sales, the strict rules that limited movement and the restrictions, seeing the Tokyo Olympics as a strange sporting event. Yet for the billions of viewers on television around the world the Olympics brought some relief and sense of exhilaration from the daily news of the delta variant and the pandemic. In many countries such as India, Britain, Canada, the US and Japan, viewers followed their favored athletes for 17 days. The Japanese government was able to pull this off precisely because they took the safe and tested route of empty stands and televised viewing around the world. This was also a needed precaution because of concern within Japan and fears of spread of the Delta variant.  The restrictions produced results- as 400 infections were confirmed for 190,000 people working at the games. Few clusters emerged from infection in the Olympic village as daily testing and rules for social distancing and hygiene were enforced for 11,000 events. Nine out of ten Japanese watched Japan win 58 gold medals including 9 in judo alone. In terms of grit and resilience, and keeping a glimmer of hope and revival during the pandemic, yet not letting its guard down even for a bit, accepting moments of doubt at times, Japan has shown the way when things are tough.    ...

LyrArc Article Gist
South Africa feels a sense of relief as omicron cases follow a pattern of very steep upward increase, followed by a short period of a month, and then a very steep decrease. Cases in South Africa with a population of 60 million, about the size of Britain, dropped from 27,000 at the peak to about 15,000 on December 21, 2021. The area around Johannesburg was hardest hit. The median age is 27 years in South Africa, 40 in UK and 43 in Italy. With younger populations in India and parts of Asia South African population demographic is closer to India than it is to Europe where populations are much older. Scientists do not want to extrapolate from the South African experience with Omicron for this reason. Immunity from vaccination and prior infection could be contributory causes to the less severity of omicron say NCID scientists. "In South Africa this is the epidemiology. Omicron is behaving in a way that is less severe," says Dr. Cheryl Cohen, of the National Institute for Communicable Diseases (NCID). "Compellingly together our data really suggest a positive story of a reduced severity of omicron compared to other variants," he said at a conference with other scientists on Wednesday, Dec. 22.  ...

LyrArc Article Gist
Novax vaccine could be a game changer for the poor countries in Africa, Asia and Latin America. Novax has 90% efficacy overall and 93% effectiveness against the UK, South Africa and Brazil variants. The Delta variant was not there during the trials. Novavax has signed an agreement to provide 1.1 billion doses to Covax, the organization which is designed to send vaccines to poor countries. India has contracted through Serum Institute of India to make 100 million doses. UK has ordered 60 million doses that may be sent to the developing world.

Novavax vaccine goes for regulatory approval in the third quarter of 2021.

LyrArc Article Gist
India recorded 100,000 cases in one day on April 5, 2021. About half of these cases are in one state Maharashtra. Most of the cases are in about 6 states. Super spreader events such as cricket matches, weddings and social gatherings, political rallies with elections in states of Tamilnadu, Kerala, West Bengal, and Holi festival, are increasing the rate of infection. People have become lax in wearing masks and following the safety protocol after cases dropped to less than 15,000 for the whole country in February. This report says variants also are playing apart. Google Mobility Reports have shown that movements around retail areas dropped to about 80% below regular levels in the middle of the national lockdown in spring of 2020, and have come back up to about 20% below normal levels. When the winter surge did not happen, and the vaccination drive started in January in India people became less vigilant, allowing infections to increase. The vaccination drive is accelerating and open to everyone over 45 years. About 80 million doses have been given and the target is still for 300 million doses by August.  ...

LyrArc Article Gist
On the first day of the new vaccine policy on June 21, 2021, India has vaccinated 6.9 million people. India has now vaccinated 287 million people out of a population of 1.2 billion. This is a race against time as new variants caused the second wave of coronavirus in April and May of 2021 with cases peaking at over 300,000 a day.  The shortcoming of the old vaccine policy are being corrected. The entire vaccine supply process and the vaccination drive is now being handled by the federal government. Earlier during the second wave vaccine supply and the vaccination drives were under an arrangement with no clear overall responsibility. States shared responsibility with the federal government and target vaccination goals were missed, vaccine supplies were inadequate.  A similar arrangement in Germany failed and Germany's vaccination supplies were inadequate and vaccination drive stalled. This caused immense frustration in Germany in April-May 2021. Germany's troubled history before World War II led to a reliance on decentralized actions, and state governments imposed different rules in a relatively small country compared to India. This was corrected with the federal government taking on the entire responsibility for the vaccine supply and vaccination drive leading to good results today in vaccines. With India's huge population and political process of different state governments, some lacking experience in administration for a complex process, and others failing to coordinate well with the federal government, the lack of overall responsibility at the federal government posed serious risks of missing targets for vaccines and letting the coronavirus wreck the economy and public confidence. Complex negotiations with other governments in Europe and the US for vaccine manufacture in India could only be handled at the federal level. The resources and planning at the federal level were already in place in India for infrastructure and other projects, experience and setting targets in that area at the federal level could now be transferred to this task in vaccines. Somewhere in the range of 8 million vaccines a day need to be reached and sustained from August to December 2021 for India to reach the goal of vaccinated all 1.2 billion people ahead of any further attack from a third or fourth wave, say experts. This is not a choice for the federal government, it is simply something India has got to accomplish to be a healthy nation that can grow with neighbors in Europe, the US, Australia and Japan and build confidence in its Asia-Pacific region. The entire Asia-Pacific region has a lot resting on how well India achieve this goal and moves on to the next phase of assisting its neighbors in the region.  ...