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BW Businessworld

“Getting Free, Affordable and Quality Healthcare is a Fundamental Right”

It is now very clear that if you wait two and a half to three months between the first and the second dose, the efficacy is more than 80 per cent for the Oxford-AstraZeneca product

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In an exclusive conversation with Jyotsna Sharma of BW Businessworld, Adar Poonawalla, CEO, Serum Institute of India, makers of Covishield, talks about the challenges of producing the vaccine, the lessons learnt from the pandemic, among other things. Excerpts:

Congratulations on creating the vaccine. With the vaccine drive now having begun, how many doses have been shipped out by the Serum Institute already?

Well, thank you. You know, it’s been a big relief that finally the doses have actually left the factory — 11 million doses left on day one. We could probably ship out that quantity on a daily basis if we needed to. But right now the capacity is pegged at around 50-60 million doses a month. The government is taking 11 million doses at the moment and is hoping to take another 40-50 million doses over the next two to three months. 

Could you tell us a little bit about the efficacy of the vaccine, the dosage schedule and the side-effects, if any? There was a lot of confusion, sometimes people don’t quite understand what’s going on. Let me explain: Firstly, as far as the reactions and side effects go, all vaccines have some side effects and reactions. With the Oxford-AstraZeneca vaccine only fever and mild headaches have been found in the clinical trials globally. It is now very clear that if you wait two and a half to three months between the first and the second dose, the efficacy is more than 80 per cent for the Oxford-AstraZeneca product. Initially, when they vaccinated a few thousand people, the efficacy was around 65 to 70 per cent with a wait of one month. But if you get two full doses, which is what we are recommending with a two and a half to three-month gap, the efficacy is certainty more than 80 per cent. In fact, that was also publicly announced by Pascal Soriot, the CEO of AstraZeneca as well. 

The process of creating the vaccine was hastened, in your opinion. Would that in any way hamper the efficacy at all?

A lot of the processes happened in parallel — the government gave permissions to do that and that is why we were able to get everything done so fast. Of course, the approvals and response time of regulators also was significantly enhanced. I mean approvals, which would take months, came in a matter of four or five days. So, that is why we were able to make the vaccine within a year. Which would have ordinarily taken three to five years. Can I give you another example? Not only regulators, but let’s say, for example, for these large Phase III studies, the recruitment, the ethics committee, the enrollment, all that normally takes long for a large study. We were able to do all this in a timely manner because in a pandemic all this moves up at a super speed. 

What has been the cost of developing the vaccine for Serum Institute?

Well, if you attribute the capital expenditure of the equipment and buildings and the operating expense and other things, we have invested our own funds to the tune of about $250-300 million. 

And we raised another $450 million from the Gates foundation, Gavi and also other countries (that gave advance payments). So the whole project has been about $800 million for four different vaccines, not just one vaccine. 

What have been the challenges while developing the vaccine?

We went through so many challenges — I think the challenges were picking the right vaccines, tying up commercially with countries and companies for the rights to be able to make and sell those vaccines, and then came the science part. The scientific challenges were to prove safety and efficacy in animals and in human beings. We had to do that at a very quick speed without cutting any corners. Of course, there was the challenge of building the manufacturing facility at the same time  and that too in record time, so that by October we could actually start manufacturing the product. A third challenge was getting all the permissions in place to start stockpiling the product, which we did, so that when we got the license, we would have millions of doses to give to the people. Otherwise, it would be August, September of 2021 to get the doses out. This is the position that most other companies are in because they generally don’t stockpile till Phase III clinical trials prove that a vaccine is successful. We bet early on, we took that risk. 

That the vaccination drive is now beginning, what are the key factors we should keep in mind to be able to successfully inoculate the whole population?

We have to involve the private sector in the sense that if hospitals, corporates, other

organisations want to buy the vaccine, we should allow that to happen. Today we are only dependent on government channels, which will take care of the vulnerable people but simultaneously in the next month or so we should focus on using private funds and private channels. A lot of people are willing to pay for the vaccine themselves. A number of corporates are willing to buy it for their employees and their family members. They have CSR budgets that they are willing to use. We just need the permissions to get on with that and do it. So you know once we can enable that we will reach even more people in India. 

What have been the lessons from this pandemic for the healthcare sector, what gaps have been highlighted? When the pandemic hit — at its worst we realised we did not have enough beds, ventilators and other things. Nobody is ready for a pandemic or waiting for such things to happen. However, I have to say we managed well. In record time we addressed a lot of these gaps. I think going ahead, perhaps what we could look at is better health insurance schemes. I’ve always believed that it’s a human fundamental right to get free, affordable and quality healthcare. We could somehow address this between the government and private sector. It is not going to be easy, but I view it as addressing a basic human fundamental need. For instance, if I’m in the UK, I go to the NHS. No matter who you are, you could be rich, on an insurance scheme, or not on one, but regardless, the healthcare quality is assured. So that’s what we need in India. 

What would be the expectation for the healthcare sector from the Union budget?

I think they are doing the best they can with the budget that they have. I would just say that the budget should give more importance and impetus to healthcare compared to other areas. This pandemic has shown us that a country’s healthcare system needs to be robust to be able to survive such adversities.