Big steps forward

New authorisations should boost India's fight against Covid

The Omicron variant, which may well be now circulating in India, given the sharp increase in positivity rates in many parts of the country, has shaken up the government’s approach to the vaccination programme. The authorities seemed to have been content to let the roll-out happen on autopilot rather than being proactive. That is clearly no longer an option—though ideally it should never have been. On the heels of the announcement that a booster dose would become available to sections of the population and that those between the ages of 15 and 18 would also become eligible for vaccines came fresh emergency-use authorisations for two new vaccines and an antiviral pill. All three of these are being manufactured in India following technology transfer from abroad. The antiviral Molnupiravir has been licensed by its developer, the multinational Merck, to the United Nations’ Medicine Patent Pool, which has eased the transfer of rights to generics manufacturers in the developing world, including India. Molnupiravir reduces hospitalisation or death once infected by between 30 and 50 per cent.

The two vaccines that have been granted emergency-use authorisation are known in India as Corbevax and Covavax. Both are exciting possibilities for scaling up vaccinations not just in India but in the broader developing world. Covavax is the trade name in India for the variant of the Novavax vaccine, which is being manufactured under licence by the Serum Institute of India, which started doing so in the middle of this year. In various studies, it has shown greater effectiveness against variants, including Omicron, than most other vaccines. Its booster shot has similar effectiveness, increasing immune responses manifold. Further, it can be stored comfortably long-term in refrigerators and for three months at room temperature. 
 

Corbevax, meanwhile, may have even more potential. It was originally developed by Baylor University and Texas Children’s Hospital in the US, and co-developed subsequently by Telangana-based Biological E, which already has 150 million doses in stock and is capable of 100 million more a month. The intellectual property is open, and the technology has been transferred to manufacturers in Bangladesh, Indonesia, and Botswana. It is a useful combination of effectiveness and ease of production and storage: It performs better than the Oxford/AstraZeneca or Covishield vaccine against the Delta variant, preventing over 80 per cent of symptomatic infections. It is based on fairly mature science, unlike the messenger RNA vaccines; the technology that has been used in hepatitis B vaccines for decades and thus may diffuse with greater ease and at prices as low as $3 a shot.

These authorisations reveal the need for Indian regulators to stay on top of the science and continue to build linkages with global pharmaceutical research hubs. There is no reason, in addition, for India to be so late to approve Covavax, which is already being handed out in countries like Indonesia; or Molnupiravir, which was approved in Bangladesh in November. Greater speed and flexibility are essential. Now that these approvals are in, the government must also ensure that it makes advance purchases on the right scale, ensuring funds are transferred to manufacturers in advance. It should also ensure an open supply chain and minimise export restrictions. There is now a real chance to accelerate the completion of India’s vaccination programme and also open up the booster dose to all adults.