On Friday, the country reported 217,353 new cases – the highest number in a single day, according to the Indian Ministry of Health. India added a million new cases in less than a week, surpassing a total of 14 million cases on Thursday.

States and cities are imposing new restrictions, including weekend and night curfews in the Delhi capital area, home to 19 million people. Migrant workers are also leaving large cities en masse for their home villages, fearing potential lockdowns will leave them stranded.

Meanwhile, the vaccine supplies on site have dried up. At least five states reported severe bottlenecks and urged the federal government to act.

In light of the crisis, the government and SII have shifted the focus from delivering vaccines to COVAX to prioritizing their own citizens at home.

“The dispensing of doses from the Serum Institute of India will be delayed in March and April,” COVAX, led by a coalition of the international vaccine organization Gavi and the World Health Organization, said in a March 25 press release Securing SII supplies -produced Covid-19 vaccine doses is due to the increased demand for Covid-19 vaccines in India. “

India had so far provided 28 million doses of the AstraZeneca vaccine and was due to release an additional 40 million doses in March and 50 million doses in April. COVAX and the Government of India “continue to discuss the completion of the deliveries”.

It’s not the first time India has had to pause its COVAX contributions: in January, the government restricted exports of AstraZeneca vaccines manufactured by SII “because they want to prioritize the most vulnerable and neediest segments first,” according to it Adar Poonawalla, CEO of SII.

But these repeated delays have hit poor countries hard. The director of the African Disease Control Panel warned India that exports could be “catastrophic” for the continent – while Pakistan, one of the largest beneficiaries of the program, decided to allow private vaccine imports and sales to fill the void.

Vaccination centers that turn people away

India administers two vaccines domestically: that of Oxford-AstraZeneca, also known as Covishield, and that of Covaxin, jointly developed by Bharat Biotech and the government-led Indian Council for Medical Research (ICMR). The country launched its vaccination program for health care workers and priority groups in January with a goal of fully vaccinating 300 million people by August. However, the program got off to a sluggish start, facing logistical issues and vaccine reluctance among the population – particularly Covaxin, which was approved for emergency use before its third phase efficacy data was released. To date, only 14.3 million people have been fully vaccinated – just over 1% of India’s 1.3 billion population, according to Johns Hopkins University.

Public confidence increased, however, as the government stepped up an awareness-raising campaign to calm concerns and the vaccination program gained momentum. As new daily cases accelerated in March and April, several states reported major vaccine deficiencies.

A vaccination center in Mumbai, India that was turned away on April 9 for lack of vaccines.

In Odisha, nearly 700 vaccination centers had to close due to bottlenecks last week, health officials wrote in a letter to the central government, warning that the state would soon exhaust its available supplies.

Rajesh Bhaskar, a Punjab health official, told CNN last week the state had about 450,000 doses of Covishield and 30,000 doses of Covaxin. According to the latest available government statistics, the state is home to more than 27 million people. “We want to vaccinate at least 100,000 people a day, and the current supply is not enough to meet that demand,” he said.

According to state health minister Rajesh Tope, several districts in Maharashtra, the worst-hit state, have had to temporarily suspend vaccination campaigns, including more than 70 centers in Mumbai that closed last week. According to the Indian Ministry of Health, Maharashtra had administered more than 11.1 million doses on Thursday, most of the Indian states.

“We have put together teams in both towns and villages to get everyone over 45 to take the vaccine,” Tope said on April 7th. “People come to the centers, but our healthcare workers have to tell them.” that they didn’t get the vaccine so they should go home. “

There are several challenges that contribute to the shortage – one of which is the supply of raw materials, said former ICMR director general Nirmal Kumar Ganguly.

India “has the ability to produce,” added Ganguly, but supply chains have been disrupted during the pandemic. The vaccine formulas and materials required “cannot be changed overnight, so we have to rely on the imported raw materials.”

The US has put a temporary ban on the export of raw materials essential to vaccine production – and the EU has tightened restrictions on vaccine exports as well. India is now working to “adapt to the materials being made at home or in neighboring countries like Singapore,” but it will take time, Ganguly said.

An additional challenge is the country’s confidence in SII, he added. There are other vaccine manufacturers in the country, such as Bharat Biotech, but SII remains the largest.

“It became clear that we need to expand our capacity,” said Ganguly. “We’re one of the vaccine exporters, but these are currently being run by two or three Indian companies. The rest of them aren’t big players and some of them are completely new to vaccine production.”

The government’s mixed response

Several states have requested more doses from the central government – but federal officials have pushed back, insisting the situation is under control.

Tope’s complaints were “nothing more than an attempt to divert attention from the Maharashtra government’s repeated failures to control the spread of the pandemic,” Indian Health Minister Harsh Vardhan said in a statement last week. Interior Minister Amit Shah also denied the states’ claims, saying their information was “not true” and vaccines were available “as much as needed”.

Prime Minister Narendra Modi praised India’s vaccination efforts as a success. During a meeting with governors on Wednesday, Modi stressed that India is the fastest nation to reach the milestone of 10 crore vaccinations (100 million doses), according to a statement from his office.

It took India 85 days to reach 100 million doses. For comparison, the US took 89 days and China 102 days, according to Modi’s office.

And on Tuesday, Rajesh Bhushan, the secretary of the health ministry, said the problem was poor planning and management – no supplies. “We are making cans available to states in a timely manner,” he said, adding that states “should check how many unused cans are at each cold chain point”.

Their statements met with outrage from local and state leaders. Shah’s claim was “factually completely wrong,” tweeted Rajasthan chief minister Ashok Gehlot on April 10th.

And although a last-minute broadcast by the central government saved Uttarakhand from utter deficiency, this is far from a perfect solution and “supplies are unpredictable,” Health Ministry official Kuldeep Martolia said Monday.

On February 7, 2021, boxes of AstraZeneca vaccines, manufactured by the Serum Institute of India and donated by the Government of India, will arrive in Kabul, Afghanistan.

In a sign that the federal government might be feeling the pressure, it took action this week to open the doors to vaccine imports. On Tuesday, it announced it would accelerate emergency approvals for vaccines already approved by the World Health Organization or authorities in the US, Europe, the UK and Japan.

Companies still need to apply for a permit in India, but do not need to conduct local security trials to expedite the process.

“Once a vaccine has been approved by one of these regulators, the vaccine can now be brought into the country for use, manufacture and bottling,” said Dr. VK Paul, a senior health officer for government-run think tank Niti Aayog, said at a news conference Tuesday. “We hope and invite vaccine manufacturers like Pfizer, Moderna, Johnson & Johnson and others to come to India as early as possible.”

The move is “a calculated move” by the government “to ensure we have more vaccines available,” Ganguly said. The government could also expand its supply through the private market, but this also poses additional challenges, including how to sell vaccines at prices to ensure equitable access for the poor.

But even the ability to import foreign vaccines isn’t a quick fix, as companies like Pfizer and Moderna have to do other jobs first, including delivering vaccines to the United States. India has just given emergency approval for Russia’s Sputnik vaccine – but “it will be five to six months until they build their manufacturing capacity and manufacturing requirements,” Ganguly said.

In the meantime, the government is working to expand local production capacities. A government biomedical institute in Maharashtra received the green light to manufacture the Covaxin vaccine on Thursday through a technology transfer with Bharat Biotech.

A sadhu wearing a face mask takes a holy bath in the Ganges during the Kumbh Mela festival in Haridwar, India on April 12.Meanwhile, the second wave continues, with cases increasing sharply every day. Millions of people across the country travel to the city of Haridwar in Uttarakhand to attend the Kumbh Mela, a Hindu festival and the largest pilgrimage in the world. Despite the warnings of the Covid risks, huge crowds gather to hold prayers, attend ceremonies and take holy baths in the Ganges.

Cases in Haridwar are already on the rise – prompting the state to impose new restrictions on Thursday. At least one religious group participating in the festival, the Niranjani Akhada, has asked those from abroad to withdraw in the face of the increasing number of cases.

“This surge is a very, very ominous sight that is taking place in India right now,” Ganguly said. “We have never seen anything like it.”