Wuhan Coronavirus Resource Thread

[Uttam]

Was there a dip in vaccinations yesterday, or the data will be updated later? 1.92 million were till 7 pm yesterday.

[sudeepj]

5 million will happen and probably soon. 10M/day would be awesome

10M/day is unlikely, but 4-5M/day is. Sunday is a big slow down in government hospitals and clinics.

If we involve our primary healthcare infrastructure, and use 'private' healthcare providers fully, 10M a day is possible. Provide vaccinations at railway stations, bus stations, large markets places etc. at a nominal fee of Rs 50 or 100 and we can even exceed this number. Forget about aadhar verification and bureaucracy.. Who in their right minds is going to get vaccinated more than the required number? What is at stake is the physical AND economic health of the country!! Every two weeks, reduce the age bracket for vaccinations by 10 years. Sure, some resourceful people are going to jump the line, so what? Let people behave in their own interests and rely on that free market spirit to get the numbers up instead of this bureaucratic game of triple checking, app based nonsense. People who need the vaccine most because they meet other people, have some health vulnerability etc. will get the vaccine by themselves. The govt. should just focus on increasing the supply and the infrastructure, not policing who gets vaccinated first and ensuring a complete moral/disciplined line.

Its a mistake to think this virus is a cakewalk for everyone under 45. A very healthy friend around this age got the virus, and suffered a 10 day period of 100+ fever! The weakness, lethargy, out of breath etc. lasted for a month! This is what is classified as a mild or moderate case.

[Suraj]

Was there a dip in vaccinations yesterday, or the data will be updated later? 1.92 million were till 7 pm yesterday.

2.2 million up to EOD according to MoHFW data. Not sure why it wasn't much more for the full day.

[Uttam]

2.2 million up to EOD according to MoHFW data. Not sure why it wasn't much more for the full day.

Just my hunch. I think it has something to do with EU chatter about Covidshield. Don't have data to support it but heard from people that the vaccine hesitancy has gone up.

[Suraj]

2.2 million up to EOD according to MoHFW data. Not sure why it wasn't much more for the full day.

Just my hunch. I think it has something to do with EU chatter about Covidshield. Don't have data to support it but heard from people that the vaccine hesitancy has gone up.

I don't think so. I think it's a data collection issue. Why would people be enthusiastic until 7pm and hit almost 2m, then suddenly disappear ? Pretty consistently, we've added anywhere from 300K-1M after 7pm .

For Wednesday, the PIB PR indicates 1.4 million up to 7pm:
https://pib.gov.in/PressReleasePage.aspx?PRID=1705628

[Ambar]

35k new cases and 170 deaths today,we are doubling every 4 days now. I don't know if its good news or bad news but i saw police baton charge people who were quite literally falling over each other outside a government vaccine center in a small town in Karnataka. As always it takes a crisis to get our citizens moving, and it doesn't matter if one is literate, semi-literate or ill-literate, people refuse to listen to reason until they get a kick on rump. I hope it is clear that we are in a 2nd wave, right on cue for the annual flu season. Making sure that everyone, especially the vulnerable gets vaccinated asap is a priority but so should be the supply of oxygen, ventilators and covid wards.

I genuinely hope the government won't take the lockdown route once again because it won't help. Instead continue to educate the people on getting vaccinated, send a message to private companies to allow staff to work remotely and continue with online schools atleast until August. We are in for some rough few months ahead.

[disha]

The following graph from racist nytimes https://www.nytimes.com/interactive/202 ... cases.html is very informative.

Most of the cases are coming from Mah, Delhi and Kerala, followed by Kar and TN

For example, Mah shows infection at 1 in 48 and fatality at 1 in 2120. Neighboring Gujarat has 1 in 216 infections and case fatality at 1 in 13,653.

That is, if you are in Gujarat, your average chance of catching an infection is 4x lower and in case you unfortunately catch it, your chance of surviving is 6x compared to your immediate neighbouring state.

It just shows that the overall numbers in India is from states which are completely mismanaged viz Mah (1/48, 1/2120), Kerala (1/31, 1/7555), Delhi (1/26,1/1534). Karnataka has the unfortunate situation of bordering Mah and Kerala with a very large urban conglomerate in Bengaluru.

In contrast look at UP and Assam. The infection rate is 1/330 and 1/143 and the fatality is 1/22,836 and 1/28,395.

So yes, the case numbers are rising fast, but they are in select clusters within specific states. It is that state economy that will suffer if they do not catch up on vaccinations. However India by itself is a very large country and loss of economic activity in one state is actually a gain for economic activity in another! This is UP, Bihar and Assam's chance to shine.

[disha]

I genuinely hope the government won't take the lockdown route once again because it won't help. Instead continue to educate the people on getting vaccinated, send a message to private companies to allow staff to work remotely and continue with online schools atleast until August. We are in for some rough few months ahead.

Ambar'ji, I think it is upto state governments now. If Gujarat, UP, Bihar and Assam are managing well then why would they agree to national or state lock downs even if proposed? If they have a good vaccination drive and proper health care facility and responsible citizens, why will they even agree to partial lock down?

So it all boil downs to which state can manage the situation well.

[ranneel]

Just my hunch. I think it has something to do with EU chatter about Covidshield. Don't have data to support it but heard from people that the vaccine hesitancy has gone up.

I don't think so. I think it's a data collection issue. Why would people be enthusiastic until 7pm and hit almost 2m, then suddenly disappear ? Pretty consistently, we've added anywhere from 300K-1M after 7pm .

For Wednesday, the PIB PR indicates 1.4 million up to 7pm:
https://pib.gov.in/PressReleasePage.aspx?PRID=1705628

2.03 million on 17th as per cowin dashboard till 11 p.m

[Uttam]

2.03 million on 17th as per cowin dashboard till 11 p.m

And that's really not enough for India's size. It needs to go up to 5 million on average a day. Here is what should be done now (most of this is based on posts on this forum):

1) Allow the private and public-sector employers to start buying vaccines and vaccinating their employees.
2) Drop the age requirement to say 55 for now, and be ready to drop it further if enough people are not showing up.
3) Put a dashboard showing performance state by state as well as district by district. They have the data. It is just a matter of putting the dashboard together.
4) Increase public messaging about the need for vaccination.
5) Increase the compensation for vaccines provided by private medical facilities. The money incentive works, we know that and seen it work many times. The Rs 100 per vaccination is not enough. Double it. Money spent this way will come back many times over because of increased economic activity.
6) Create camps to take vaccines to people rather than waiting for people to show up. The number of adverse events is really insignificant and the side-effects not that bad that cannot be handled in an ambulance by a trained nurse.
7) Need more aggressive messaging to block the bull-**** coming out of EU. They have had a ****ed up strategy to control Covid since the beginning and their stance against the AstraZeneca vaccine is just ludicrous.
8 ) Approve Pfizer as well as Moderna vaccines immediately and allow them to be marketed and sold by the private sector. If a few rich people can afford and arrange to buy it then so be it. There is no reason to try to have a uniform distribution strategy.
9) Once the result for Sputnik V and interim results for Zycov-d phase-3 (similar to those of Covaxin) are out and are positive, approve them immediately. Also, allow them to be purchased by the private sector immediately. (Probably by late April)

[Anybody wants to tweet these, then be my guest. No attribution needed. I am not on twitter.]

[Suraj]

For two weeks now, the Monday data is really good, then Tuesday and Wednesday drops off, before good data on Friday (and sometimes Thursday). Saturday also tends to report good data.

Given that currently mostly >60 folks are being vaccinated and they're being accompanied by younger children or family, it seems a bottleneck here is the ability to do things midweek. I also think they should permit anyone accompanying someone in the high risk group to also be vaccinated. That'll avoid the same people having to come back later for their own shots.

[disha]

For posters worried on rising case counts, 75% of the new cases are from two states alone. Maharashtra and Kerala.

Here is the link https://timesofindia.indiatimes.com/ind ... 558784.cms

Curiously the infographic in the above link does not mention Kerala, but does provide this data point

For instance, Nagpur (with 2,698 cases) alone surpassed the of the four states, which recorded cases in four digits — Puunjab (2,039), Gujarat (1,122), Kerala (2,098), Karnataka (1,275). With 2,698 fresh cases, Nagpur city, for the first time in pandemic, registered more...

And the second infographic is even more informative. It is ~125 districts in India are leading the coronavirus surge. Given that there are ~740 districts in India, millions of people in ~600 or so districts believing Coronavirus is gone is as much true as millions of people scared that the coronavirus is surging rampantly.

At an aggregate level it helps to mass immunize 20-30 lakhs per day. The best strategy is to immunize in the ~125 or so districts first and then ring those districts at the transit points.

Instead of a scatter fire, it will help to concentrate the fire.

[Suraj]

The COVID-19 Media Briefing on March 17 after the status meeting had this visual:

[Raja]

For posters worried on rising case counts, 75% of the new cases are from two states alone. Maharashtra and Kerala.

Cases are surging in several other states. There will be other hotspots. Soon.

Lockdowns are not too far away. Hopefully, this will motivate everyone involved to get it together to avoid the next wave.

[vera_k]

Looks like SII has its hands full. Good idea to create a second supplier in the state.

Allow Maharashtra firm to make Covaxin

[Suraj]

I wish the reporting was better. UT says Haffkine can produce 126 million doses, but it's not clear in how much time. In general, raising Covaxin production rate is a great objective. However, MH seems to want 25% of the production for itself. I don't think this kind of state level control over production is helpful - it should be coordinated at the national level.

[vera_k]

Of course, but that's a detail. If they can get the Haffkine institute back into the game, it will be a good change. The article says it would take a year to produce vaccines.

[nandakumar]

For two weeks now, the Monday data is really good, then Tuesday and Wednesday drops off, before good data on Friday (and sometimes Thursday). Saturday also tends to report good data.

Given that currently mostly >60 folks are being vaccinated and they're being accompanied by younger children or family, it seems a bottleneck here is the ability to do things midweek. I also think they should permit anyone accompanying someone in the high risk group to also be vaccinated. That'll avoid the same people having to come back later for their own shots.

Suraj
I can speak about Chennai from personal knowledge. The Chennai corporation has placed vehicles and municipal staff escorts for those above 60 who are not able to make the trip on their own. They have provided emergency numbers similar to public ambulance service. Those in the poorer and lower middle class sections of the society are availing of it. The numbers are still small.

[venkat_kv]

10M/day is unlikely, but 4-5M/day is. Sunday is a big slow down in government hospitals and clinics.

Forget about aadhar verification and bureaucracy.. Who in their right minds is going to get vaccinated more than the required number? What is at stake is the physical AND economic health of the country!! Every two weeks, reduce the age bracket for vaccinations by 10 years. Sure, some resourceful people are going to jump the line, so what? Let people behave in their own interests and rely on that free market spirit to get the numbers up instead of this bureaucratic game of triple checking, app based nonsense. People who need the vaccine most because they meet other people, have some health vulnerability etc. will get the vaccine by themselves. The govt. should just focus on increasing the supply and the infrastructure, not policing who gets vaccinated first and ensuring a complete moral/disciplined line.

sudeepj Saar,
I think you are underestimating the thought process in a section of people. In my extended family people think taking tablets for normal ailments is a good sign (they always ask/demand for medicines when they go to the doctor for any common ailments). granted covid is a different beast, all it would take one news report quoting US or Europe saying you need to take x number of doses and a section will make a run for it.

the problem with non aadhar verification will be hoarding or black marketing. A few state govts can say they need more vaccine doses to put pressure on supply chains and make a mess of vaccination drive. looking at some complaints from MH and Raj, i would not put it past the respective govts to cut their nose to spite the face, to say the least.

[Suraj]

Thanks nandakumar. Yes I think transporting people is not necessarily efficient. Keep in mind that each patient is still communicable and therefore the vehicle needs cleaning after each use. This is a good gesture, but not likely to drive speed and efficiency much.

The low Sunday figures reflect an opportunity cost here. I think GoI should at least host mass vaccinations (5-10k if not more per site) on Sunday for he general population. Not hospitals but major stadia or other locations with space.

Apparently it’s just been notified that 45+ are now eligible regardless of comorbidities, If true, this should significantly scale up numbers,

[Suraj]

Transcriot of PM Modi’s speech to meeting with Chief Ministers on Covid , March 17

[sajo]

3) Put a dashboard showing performance state by state as well as district by district. They have the data. It is just a matter of putting the dashboard together.

The existing dashboard is rather excellent. Not only I can see data for India, I can very well see the figures for the neighbourhood hospitals as well.

Apparently it’s just been notified that 45+ are now eligible regardless of comorbidities, If true, this should significantly scale up numbers,

Not mentioned anywhere on the mohfw website as well as not being applied at any site currently. It was merely a recommendation which is not approved yet.
What they can do is drop the age barrier by 5 years every 15 days upto age 40 or so to scale up the vaccination.

[sampat]

Translated by someone from danish to English on Reddit
Reddit Link

Is it really the way AstraZeneca vaccines have been administered that has triggered fatal blood clots in several people in Europe? Niels Høiby suspects so.
"It may explain the few cases where it has gone completely wrong," he says.
Use of AstraZeneca has now been suspended in several European countries following the deaths, including in Denmark after the death of a 60-year-old woman. But the professor of clinical microbiology at Rigshospitalet [National hospital] has now zoomed in on the jab itself rather than the vaccine.
Coronavaccines have to be injected deep into the muscle, intramuscularly it is called. This means that the skin must be stretched before the needle is inserted, as is also stated in the guidelines of the Danish Health Authority. To make sure that the needle does not enter or damage the blood vessels, the plunger should be pulled back slightly to check for blood. If this happens, you should insert the needle somewhere else.
However, Niels Høiby has found that this does not always happen. Instead, for example, people's skin has been squeezed between their index finger and thumb prior to vaccination, which in extremely rare cases can have fatal consequences.
"This can mean that some of the vaccine can go into the bloodstream instead, if the needle has damaged the blood vessels, and from there on to the heart and lungs. And in the worst case, it can cause such a violent inflammatory reaction that it can cause several small blood clots in the lungs, among other places, which is what we have seen," says Niels Høiby, who has also been contacted by several nurses and general practitioners with similar concerns about the vaccine technique.
Nanna Wulff was also puzzled when she had to be vaccinated with AstraZeneca a few weeks ago.
"I was completely shocked, to say the least. I thought no one would believe this," says Nanna Wulff, who is a dentist herself and therefore experienced in injecting her patients.
So she knew the vaccine had to be inserted deep into the muscle. Instead, the vaccinator squeezed her skin while Nanna Wullf protested. A doctor was therefore called in, who confirmed the dentist was right.
"The nurse just stood there shaking her head and saying, 'I didn't learn that. I've given so many vaccines and I've never done this'. Then I sit there and think 'shut up', because it was pretty scary for all three of us to find out that the person had obviously been taught wrong. And no one has ever corrected or helped," says Nanna Wulff, who has sent a so-called concern letter to the Patient Safety Agency.
Niels Høiby is not really surprised that an incorrect technique may have been used to administer coronavaccination.
"The technique is not good enough, but unfortunately it is a technique that is accepted by many because it is so rare that it really goes wrong," says the professor, who stresses that he is working with a thesis that cannot be proven immediately.
However, he has done some reading up on the issue and has come across an article in the scientific journal The Lancet in which a 65-year-old American woman had similar side effects to those in Denmark, but after being vaccinated with either Moderna or Pfizer - the study does not say which of the two it is.
He therefore does not really believe that the problem of incorrectly injected vaccines relates only to AstraZeneca.
"If it was only AstraZeneca, I would be more inclined to believe that it was only related to the particular vaccine, but when it has also happened with the others, then it is more likely to be related to the vaccination itself," says Niels Høiby, whose thesis has also been described in the Health Policy Journal:
"And we know that when there are so many people to be vaccinated all over the world, there are also people who are not so used to vaccinating who will do the job."
At the same time, he believes the problems have been particularly evident at AstraZeneca because it has been quickly given to younger healthcare workers, unlike the other vaccines - many countries including Denmark initially chose not to use the UK vaccine for over-65s. And the immune system simply reacts more weakly the older you get, so the side effects are weaker, while the strong reactions are seen mainly in younger people. And this is where a vaccine given incorrectly could potentially provoke the deadly blood clots.
"It's deeply tragic and it makes a huge impression that people die when they really need to be vaccinated to protect themselves. We can now see that this has happened in Denmark and Norway, but at the same time the risk is so extremely small compared to how many millions have already been vaccinated," says the professor.
B.T. has been in contact with the Danish Health Authority, which does not wish to comment on Niels Høiby's theory. It refers to the announcement that the use of AstraZeneca was put on hold in the wake of the 60-year-old Danish woman's death.
'The Danish Health Authority is now waiting for the pharmaceutical authorities in the EU to carry out a closer investigation into a possible link between the Covid 19 vaccine from AstraZeneca and the serious cases of blood clots that have been reported,' it said at the time.
FACTS
How a coronavaccination should be administered
The 'Guidelines for the management of covid-19 vaccination' outline the procedure to be followed when administering coronavaccines:
The vaccine should be given intramuscularly. The recommended injection site is in the deltoid muscle (the large shoulder muscle), where it is thickest. A sterile single-use syringe attached to an intramuscular needle (size 22-23 G) is used. A needle length of 20-25 mm would typically be appropriate. The length should be adapted to the size of the person and the thickness of the subcutaneous fat layer. If there are contraindications to vaccinating in the deltoid muscle, or if the patient has a preference, the vaccine can be given in the middle part of the vastus lateralis muscle.
Skin disinfection is performed before injection. Before disinfection, the skin must be visibly clean and dry. The disinfectant must dry before the skin is perforated and the skin must not be touched after the skin disinfection has been carried out and the disinfectant dried.
The skin over the injection site is stretched between the thumb and the other fingers. The syringe is held like a dart between the thumb and forefinger. The needle should penetrate the skin at a 90 degree angle.
After insertion into the muscle, light aspiration is made on the cannula before injecting vaccine to ensure that the vaccine is not inappropriately administered intravenously.

original article in Danish

[Uttam]

COVAXIN production expected to reach 700 million doses per year by the second half of this year.

[saip]

In US the injections are generally given at 90 degree angle while in India they are given at 45 -60 degrees. Is there a reason for this and which is the right way?

[Suraj]

COVAXIN production expected to reach 700 million doses per year by the second half of this year.

Great news !

Update: 1.78 million vaccinated until 7pm on Thursday:
https://pib.gov.in/PressReleseDetailm.aspx?PRID=1705896

[Mort Walker]

In US the injections are generally given at 90 degree angle while in India they are given at 45 -60 degrees. Is there a reason for this and which is the right way?

There is a larger fat layer with Americans. Going in at an angle means going further to reach muscle tissue. If that was done with Indians, or anyone else, a higher probability of hitting a blood vessel.

[disha]

In US the injections are generally given at 90 degree angle while in India they are given at 45 -60 degrees. Is there a reason for this and which is the right way?

Thick skinned vs Thin Skinned.

I am concerned about the political football Mah is making of this pandemic. It does look like the CM of UT is clueless. He just is wishing that the problem go away without doing anything about it.

On the other hand, 12% wastage in vaccinations in Telangana/AP! That is criminal. I do not understand why the "district collector" and the "district magistrate" be hauled up and locked up for this! And no news paper talks about it.

[Uttam]

On the other hand, 12% wastage in vaccinations in Telangana/AP! That is criminal. I do not understand why the "district collector" and the "district magistrate" be hauled up and locked up for this! And no news paper talks about it.

Is it wasted OR being sold on the black market? If you sell on the black market, you can't log into the system as being administered!

[Suraj]

As long as it's sold and consumed domestically, it's 'ok' - vaccinated people in any case are a good thing. The black market is symptomatic of supply issues and the solution is to fix the supply. Wasting police on chasing people down is pointless here. Too much of a waste of time , effort and public resources.

[Uttam]

As long as it's sold and consumed domestically, it's 'ok' - vaccinated people in any case are a good thing. The black market is symptomatic of supply issues and the solution is to fix the supply. Wasting police on chasing people down is pointless here. Too much of a waste of time , effort and public resources.

I totally agree. Getting the know the exact cause of "wastage" will help in not wasting effort to reduce the so called waste. If anything, this is good news and the Govt. should immediately lower the age requirement so that more people are eligible to get vaccinated through the regulated market.

[disha]

It is a difficult question. Yes, even on black market somebody is vaccinated. However the ask is, is someone deserving getting vaccinated? Take the case of say a bus conductor <45 years of age and no comorbidity. Or the gig-worker. It will be helpful both to the economy and to that individual to get a vaccine at either free of cost or reduced rate. Compared to say a Dia Mirza or Gul Panag or Disha Ravi Joseph getting a vaccine out of turn using black market. All of those celebrities can isolate themselves for few more days polishing their toolkits.

Corruption hurts. Corruption hurts poor disproportionately more than the rich. The burden of both the opportunity cost and the health-care cost is several magnitude times more for the poor and the lower economic class than the upper economic class. And some of it is felt for generations.

In this case, yes supply issues should be plug'ed and some of the black marketeers need to be caught and made examples of. It is not wasting police resources, since police is for all people.

[vijayk]

Correction in the above Figures.

Day 62: India #vaccination update on 18-Mar till 7 PM

Total Vaccinated: 3,89,20,259 Up-pointing triangle 17,83,303

Dose1: 3,20,77,099 Up-pointing triangle 14,83,156
Dose2: 68,43,160 Up-pointing triangle 3,00,147

[Uttam]

It is a difficult question. Yes, even on black market somebody is vaccinated. However the ask is, is someone deserving getting vaccinated? Take the case of say a bus conductor <45 years of age and no comorbidity. Or the gig-worker. It will be helpful both to the economy and to that individual to get a vaccine at either free of cost or reduced rate. Compared to say a Dia Mirza or Gul Panag or Disha Ravi Joseph getting a vaccine out of turn using black market. All of those celebrities can isolate themselves for few more days polishing their toolkits.

I respectfully disagree with you in this case. Agreed that people should not get out of turn vaccination. That would have been really bad if millions of people were waiting in line to get their vaccine. What I have heard from various places in India is the opposite is true. Most places are accepting walk-ins and no one I know is not able to get a vaccine if they are eligible and they want to get it. Right now, we have a problem of access supply and not enough allowed demand. Lower the age limit will fix a lot of these problems immediately.

[anmol]

So the UK has 3 factories producing 2 million Oxford vaccine doses per week, they have Pfizer and Moderna vaccines too. EU is sitting on top of 40 million doses of Oxford and the U.S. is also holding onto tens of millions of doses which both have deemed unsafe to use.

But the real baddie is India for causing so much chaos with delay in shipment of mere 5 million doses.

www.dailymail.co.uk/news/article-9375499/Coronavirus-UK-Vaccine-hold-caused-AstraZeneca-delivery-delay-Indian-factory.html

Coronavirus UK: Vaccine hold-up 'caused by AstraZeneca delivery delay from Indian factory'

Sam Blanchard, James Tapsfield, Jack Maidment

PUBLISHED: 09:04 GMT, 18 March 2021 | UPDATED: 16:39 GMT, 18 March 2021

Tories lashed out at ministers for 'overpromising' on the vaccine rollout today after Matt Hancock finally admitted a delayed shipment from India is behind a shortage set to hit the UK.

Frustrated MPs said the government had got 'carried away' talking up an impending surge in supplies, with the Health Secretary having hailed the prospect of 'bumper' numbers of Britons being jabbed. Hopes of the scheme being extended to under-50s before May now seem to have evaporated.  

Following 24 hours of ducking and diving, Mr Hancock finally clarified the source of the problems is India, amid anger that the authorities appear to be following the EU's lead in undermining legal contracts.  

The UK was expecting another 5million doses of the AstraZeneca vaccine from the Serum Institute of India, the world's biggest vaccine manufacturer - completing its order for 10million jabs - but the 'scheduled' delivery has been pushed back.

Narendra Modi's government in New Delhi is in control of exports and blocked the shipment, the Serum Institute's CEO Adar Poonawalla said, to keep them for their own citizens with the country facing the prospect of a second wave. Mr Poonawalla said the company has committed only to helping the UK 'as and when it can'. 

Last month Mr Poonawalla asked other countries to 'be patient' and said it had been asked to 'prioritise the huge needs of India' and poorer nations. 

Coronavirus cases in India are currently at about a third of their peak 2020 levels and the foreign minister said in parliament this week that 'adequate availability at home' was top of its priority list, the Financial Times reported.

Mr Hancock — who last night dodged questions about the source of the shortage at a shambolic briefing and insisted the NHS had only issued a 'technical' letter — told the House of Commons today: 'We have a delay in the scheduled arrival from the Serum Institute of India.'

He also revealed that a further batch of 1.7million doses has been held up because experts need to 're-test its stability', although he did not say which vaccines this affected, nor when the delay happened or how long it will be. 

[..]Whitehall insiders have denied India purposely delayed the shipment in response to British criticism of allegations about Mr Modi's Government using force on farmers staging peaceful protests over proposed plans that workers fear would hurt their incomes.

Panic about the UK's lockdown plans erupted last night when NHS officials wrote a letter to vaccine teams saying there would be a 'significant reduction' in supplies and they must all but stop giving out first doses next month. 

In the UK, a bump in AstraZeneca's vaccine was set to give ministers room to continue the roll-out and move onto jabbing 40-somethings, with pre-ordered supplies of AZ and Pfizer's jabs reserved for second doses. But the NHS is now not expecting to have any jabs to dish out to first-timers, stalling the rollout that has reached a massive 25million people already. 

[..] The role New Delhi has played in this specific shipment delay remains unclear but coronavirus cases in the country are surging towards a second wave – currently at about a third of their peak 2020 levels – and the foreign minister said in parliament this week that 'adequate availability at home' was top of the list, the Financial Times reported.

[..] The shortage came as Brussels issued a string of extraordinary threats to grab 'Europe's fair share' of vaccines from Britain. 

Whitehall sources were adamant, however, that any disruption to the UK's supply had nothing to do with the EU row. 

[..] Mr Hancock confirmed in the Commons today that it was in fact the Serum Institute, manufacturing Oxford and AstraZeneca's vaccine, that was partly behind the delay.


He said: 'We have a delay in the scheduled arrival from the Serum Institute of India.

'Now, I want to put on the record my gratitude to the Serum Institute of India for the incredible work that they're doing producing vaccine not just for us in the UK, but for the whole world.

'Their technology and their capability, which has been approved by the MHRA, is remarkable. The Serum Institute of India producing a billion doses of the Oxford AstraZeneca vaccine this year, it truly is partnership that we can be proud of.'

The company has been open about the fact that its top priorities are supplying Covid vaccines to India's own one billion citizens and then to a programme that sends life-saving jabs to poor countries with bad healthcare.

The CEO, Mr Poonawalla, said in a tweet in February: 'I humbly request you to be patient'.

In an interview with The Telegraph today Mr Poonawalla hit back against attempts to shift the blame for a hiccup in Britain's rollout onto the Institute.

He said: 'There is no stipulated contract period and time in which I am supposed to deliver these doses. I am helping as I can and when I can AstraZeneca and UK to supply these doses.'

Mr Poonawalla denied that there was a shortage of the vaccine or that there was ever a commitment to supply the UK on a deadline, and said the firm had already sent five million doses to Britain.

He added: 'The balance doses will be decided to be given to the UK at an appropriate time by the Indian Government. While balancing India and all its needs at the same time...And of course, don't forget we are primarily supplying the CoVax to poorer nations as they are the ones who have not got the doses.' 

Tory MP Peter Bone told MailOnline that examples of vaccine nationalism were 'disappointing'. 

He said: 'The UK pretty much led the world on vaccine research and putting money into projects which have now turned into vaccines but we put considerable amounts of money on faith, the risk, and we ordered the vaccines as part of that process and they should be delivered because that is what they are contracted to do so I would be very surprised if any government tried to interfere with that process.'

He added: 'I would be very disappointed if any government suddenly decided that they were, for national reasons, they were going to interfere with commercial contracts that were entered into, especially as the UK put money up front to help develop these vaccines.' 

Another Tory MP said: 'It is a very dangerous precedent to set. Governments have a duty to their populations to make sure their procurement works properly.

'If governments don't really put in place the right procurement arrangements they can hardly bleat about it if companies then deliver orders in the order they were placed.'

An AstraZeneca spokesman said: 'Our UK domestic supply chain is not experiencing any disruption and there is no impact on our delivery schedule.'

The two operations are separate and AstraZeneca does not control the Serum Institute's production nor pay it to carry it out, it simply provides the blueprint for making the doses as part of a licensing agreement for the common good. 
[..]

Although the Serum Institute agreed to supply 10million doses of vaccine to the UK, Britain gets most of its AstraZeneca supplies from factories within the country. Most manufacturing is done in Keele and Oxford, with the finishing process completed in Wrexham in North Wales.

Some doses were imported from a facility in Leiden, Netherlands, at the very beginning of the rollout, but the company vowed to become self-sufficient within the UK after that. 

There are also suggestions of manufacturing issues with the Moderna and Johnson and Johnson vaccines, according to sources. 

News of the shortage came as Brussels issued a string of extraordinary threats to grab 'Europe's fair share' of vaccines from Britain.

Whitehall sources were adamant, however, that any disruption to the UK's supply had nothing to do with the EU row. 'We are not giving supplies away and AstraZeneca are not redirecting our supplies to the continent,' the source said. 

[..] EU STILL HAS 40% OF ITS VACCINES 'IN STORAGE'

Alexander Stubb, the former prime minister of Finland, has claimed that 40 per cent of the vaccines bought by the EU are 'laying around in various storage in European member states'.

More than a dozen countries have halted their use of the AstraZeneca vaccine meaning they are just sitting on supplies while the European Medicines Agency gets set to announce its verdict on the blood clot scare today. 

Mr Stubb argued that EU president Ursula von der Leyen's sabre-rattling was actually an attempt to motivate member states to 'get their act together' and accelerate the rollout of jabs.

Mr Stubb said the export ban threat was simply reflecting the 'political reality' as he claimed the EU is 'by far the biggest producer of the vaccines', with companies shipping millions of doses to countries all around the world.

Ministers yesterday condemned Brussels' 'brinkmanship' after Ms von der Leyen complained the bloc is sending millions of doses to other countries while receiving few in return as she warned of action to ensure 'reciprocity'.

Speaking as the EU's vaccine rollout descended deeper into chaos, Ms von der Leyen called on Britain to begin sending AstraZeneca jabs overseas.

But Labour's shadow health secretary Jonathan Ashworth urged Mr Hancock to explain what these supply issues were and how the Government was aiming to resolve them.

'Trying to dismiss or downplay the legitimate concerns of anxious people waiting for a vaccine is simply not good enough,' Mr Ashworth added. 

In other vaccine news, the EU's shambolic vaccine rollout also descended deeper into chaos as a rattled Ursula von der Leyen, the president of the bloc, complained it is sending millions of doses to other countries while receiving few in return —warning of action to ensure 'reciprocity'.


She called on Britain to begin sending AstraZeneca jabs overseas and lashed out at the drug-maker for 'under-producing and under-delivering' doses, saying it is to blame for the slow place of Europe's roll-out.

That is despite the fact that a dozen European countries, including France, Germany, Italy and Spain, have halted the use of AstraZeneca jabs over unfounded fears they cause blood clots, meaning around 7.5million doses are currently sitting unused.

England's deputy chief medical officer, Professor Jonathan Van-Tam, offered a sharp rebuke to European decisions not to use the jab, saying: 'Vaccines don't save lives if they're in fridges. They only save lives if they're in arms, and that's a really important fact.' 

Under-50s now won't get a jab before MAY: But with three AstraZeneca factories in Britain why do we need to import vaccine from India anyway? 

Millions of over-40s won’t be vaccinated against Covid before May because of a supply shortage which Matt Hancock today blamed on a delayed shipment of 5million doses of AstraZeneca’s jab from India.

Senior Government sources last week sparked hopes of a faster route out of lockdown, saying that everyone over 40 could be offered their first dose by Easter because stocks were expected to double.

But with the delivery delay from the Serum Institute of India and the hold-up of another batch of 1.7million doses that need to be re-tested, ministers have had to kill hopes of a faster roll-out next month.

The Health Secretary last night said the mammoth NHS inoculation drive will need to focus on second doses, using first dose supplies to mop up over-50s who have yet to accept their invite.

But it means that No10's unofficial targets that Britain's vaccine roll-out could move onto over-40s by Easter were seemingly based on the hope of getting an extra shipment of Covid vaccines from India.

Ministers were expecting the other half of their 10million ordered doses to arrive this week from the Serum Institute of India, the largest jabs manufacturer in the world, after penning a deal at the start of March.

But the Institute has pushed back the shipment amid mounting pressure from the Indian Government to ensure it supplies them first. The firm also claims it did not agree a timescale for any deliveries — even though Mr Hancock today said it was 'scheduled'.

The jabs shortage means millions of people under 50 will now have to wait until May for their first vaccine appointment, much later than ministers had hoped. One Department of Health source said it still hopes to do people in their forties next month.

No10 insists it is still on track to offer 32million Britons in the top nine priority groups their first dose by April 15.

Where do our vaccines come from? 


The vast majority of the UK's AstraZeneca vaccine supply is manufactured on home soil in factories in Oxford, Keele and Wrexham.

These are thought to be making at least 2million doses per week between them and have been mass-producing throughout most of January and February and March.

Some doses at the start of the rollout were imported from a facility used by the company in Leiden, Netherlands, and a shipment of 10million was ordered from the Serum Institute of India, which is producing the vaccine with AstraZeneca's permission.

All the Pfizer vaccine doses used in Britain come from a plant in Puurs, Belgium. 

Is the Indian factory delay to blame for April's vaccine shortage?   

No10 sources claimed last night that the shortage was down to a delayed shipment of 5million doses of AstraZeneca's vaccine from India.

Britain was expecting 10million shots from the Serum Institute of India, the largest jabs factory in the world, after securing a deal at the start of March.

Its boss said today that the first half of the shipment — 5million doses — had already arrived and that there was 'no stipulated contract' for when any of the doses needed to be delivered. 

Adar Poonawalla claimed the firm was helping the UK 'as and when' it could, while prioritising their own country and poorer nations around the world.

The Institute has pledged one billion doses to low and middle income countries, with experts saying it is crucial they get the jabs to end the pandemic. The SII was also told last month to prioritise Indian demand. 

Mr Poonawalla told the Daily Telegraph: 'There was never a commitment to supplying doses to the UK in any stipulated time. We just said we will offer our help.

'India has allowed 5million doses to go to the UK. The balance doses will be decided to be given to the UK at an appropriate time by the Indian Government.'

Supply figures for the vaccines were always expected to dip in April and May, according to projections published by the Scottish Government in January — before the UK had struck a deal for 10million doses from India. Therefore, the India delivery delay is believed to be separate from these figures

[..] Are other factors involved? 

Communities Secretary Robert Jenrick today said the Government had learned of Covid vaccine supply issues 'in the last few days', and suggested the problem is not due to reductions from a single nation.

'We have learned from some of our manufacturers that there are going to be some supply issues in the last few days,' he told BBC Radio 4's Today programme.


'A number of global manufacturers are experiencing issues.'

Pressed if the issue was vaccine coming from India, he said: 'It's not that there's any one factory responsible for this or any one country.'

AstraZeneca jabs are mostly being supplied by factories in the UK - in Staffordshire, Oxford and Wrexham, and the pharmaceutical giant has said supplies from these are not an issue.

Deliveries from a factory in Leiden, the Netherlands, and one in Germany, were also received before the start of the year. It is thought these factories are no longer sending shots to the UK.  

Pfizer is supplying all its doses from one factory in Puurs, Belgium, and says it is on track to meet its commitment of supplying 40million by the end of this year. 

A leaked Scottish supply document suggested its deliveries would be reduced from the start of April, and are mostly expected to be reserved for second doses.  

Why is the UK even getting AstraZeneca doses from India?

Britain has ordered 100million doses of the Oxford vaccine to be supplied by Anglo-Swedish company.

The majority of these shots are being produced at three factories in the UK, with some also coming from Belgium and Germany before the start of the year.

But seemingly in order to speed up the roll-out, the UK also penned a deal to get 10million doses from the Serum Institute of India.

Charities warned the agreement would likely stir concerns that rich nations were taking jabs from poorer ones. 

But the UK Government said the agreement followed assurances from the Institute that the delivery would not impact supplies for poorer countries.

A spokesman said: 'The UK has ordered 100million doses of the AstraZeneca Covid-19 vaccine, of which 10million doses will come from the Serum Institute of India.' 

Is Pfizer's supply affected too?

Health sources warned yesterday that deliveries of the Pfizer vaccine would be 'challenging' from April.

A leaked Scottish supply document also suggested deliveries would be affected from next month. 

It shows Pfizer would be sending 1.5million doses a week throughout March. But by April this was expected to tail off, dropping to around 950,000 shots every seven days.

The fall, however, coincides with when deliveries of the Moderna vaccine are expected to begin. These will start at 50,000 a week, the figures suggest, before rising to 160,000 a week in May. 

[..] The MHRA said an estimated 10.7million first doses of the Pfizer-BioNTech vaccine had been dished out by February 28, compared to 9.7million of the Oxford-AstraZeneca jab. If the same 54/46 per cent split is still being used, it would suggest the Pfizer figure now stands at 13.6million

Why is supply so challenging? 

Ministers have repeatedly warned that vaccine supply will be the 'limiting factor' in Britain's national roll-out.

Health Secretary Matt Hancock said last night that they were expecting deliveries to remain 'lumpy' in the coming weeks.

And Deputy Chief Medical Officer Jonathan Van Tam last month claimed it was like 'brewing beer', with every yield producing a different amount. 

AstraZeneca is makes its doses using living cells, which create different amounts of the vaccine each time. 

This process was behind the delay in deliveries to the EU, with the company's chief executive Pascal Soriot saying the same issues initially did not affect the UK because the factories were set up earlier meaning there was more time to 'iron out' issues.

Pfizer's vaccine is produced in Belgium, and then shipped to the UK. But work to expand production capacity at the factory last month meant that deliveries were temporarily reduced.

The EU has threatened to stop sending vaccines to the UK unless it starts to receive more doses of the AstraZeneca jab — despite 19 countries on the continent suspending its use based on unproven blood clot fears. 

The UK is also expecting to start rolling out the Moderna and Johnson and Johnson vaccines in the coming weeks.

The Moderna jab is billed to start arriving from April, and the UK has ordered 17million doses. 

Johnson and Johnson's one-shot vaccine is also expected to become available in a matter of weeks following successful trials.

The Medicines and Healthcare products Regulatory Agency (MHRA), which polices the safety of drugs in the UK, is currently reviewing the vaccine.

The UK has secured 30million doses of the jab, with the option of getting another 22million doses if needed later down the line.

[..] Are delivery delays linked to EU vaccine supply threats?


Brussels yesterday threatened to block exports of coronavirus vaccines from the EU and complained about a shortage of AstraZeneca supplies. 

European Commission chief Ursula von der Leyen said she wanted 'reciprocity and proportionality' in exports, pointing out that 10million doses of vaccine had gone from the EU to the UK.

Although Pfizer jabs were crossing the Channel to the UK, AstraZeneca vaccines are not heading the other way, she indicated.  
She warned the bloc would 'reflect on whether exports to countries who have higher vaccination rates than us are still proportionate'.

But Government sources last night insisted the two issues were not connected. The UK is not volunteering any of its supplies to the EU and none of its orders are being siphoned off by AstraZeneca, insiders insisted.

Mr Hancock said the supply of vaccines to the UK from EU production facilities was 'fulfilling contractual responsibilities and we fully expect those contracts to be delivered on'.

Is the UK exporting vaccines to the EU?

There is no evidence the UK has exported any vaccine doses to the EU and there has been no public announcement about a deal.

The Department of Health said it didn't know whether there had been a deal between AstraZeneca and the EU to ship doses from Britain and the vaccine maker has refused to comment. 

Boris Johnson told the House of Commons last week that 'we have not blocked the export of a single Covid vaccine or vaccine component'.  

However, Mrs von der Leyen claimed yesterday: 'Indeed the UK is producing AstraZeneca. In our contract with AstraZeneca there are even two sites in the UK that are put in the contract for potential deliveries for the European Union.

'We are still waiting for doses to come from the UK, so this is an invitation to show us that there are also doses from the UK coming to the European Union so that we have reciprocity.'

India has already handed out more than 37million doses, mostly using AstraZeneca, but PM Narendra Modi has asked state leaders to increase testing and vaccinations.  

The Serum Institute is the world's largest vaccine manufacturer and has partnered with various developers including Novavax and Codagenix as well as AstraZeneca. 

It is aiming to ramp up production to 100million doses per month by April, making India a major competitor with Russia and China in the global vaccine market.   

[..] Around half of Serum's production capacity has been promised to the Indian government, but it is also exporting AstraZeneca shots to numerous countries. 

These include Britain, where health secretary Matt Hancock said a delayed arrival from the Serum Institute was to blame for a sudden shortfall in supplies. 

It means that people under 50 potentially face a longer wait to get their first dose, although the government says there will be no delay to second doses.  

Downing Street did not deny the suggestion from Poonawalla that the Indian government was temporarily blocking exports of the AstraZeneca vaccine.

Poonawalla told Bloombergthat countries including the US and India were hoarding not only doses but the ingredients required to make them. 

'We had to dedicate a lot of our capacity, which was not originally planned for India,' he said. 

'We're trying to balance it out as much as possible, but again for the first few months we have been directed to prioritise supplies to India and certain other countries that have a high disease burden.'  

He also told the Telegraph: 'It is solely dependent on India and it has nothing to do with [us]. It is to do with the Indian government allowing more doses to the UK.'

A No 10 spokesman said: 'I would point back to what [Serum] have said and the fact that they are one of the manufacturers of the Oxford/AstraZeneca vaccine.

'We produce it here in the UK and it's produced elsewhere as well so we will continue to work with the manufacturers of the vaccine.'

Asked if ministers were in talks with the Indian government, No 10 said: 'We're in constant contact with other governments around the world'. 

AstraZeneca said its 'UK domestic supply chain is not experiencing any disruption', but made no mention of possible problems in India. 

Britain's current other vaccine provider is Pfizer, which denied any issues with its UK delivery schedule.

Hancock told parliament that jabs from a third supplier, Moderna, were expected 'in the coming weeks'. [..]

[Suraj]

It is a difficult question. Yes, even on black market somebody is vaccinated. However the ask is, is someone deserving getting vaccinated? Take the case of say a bus conductor <45 years of age and no comorbidity. Or the gig-worker...

The reason I don't quite see this as 'corruption' is that vaccination is not zero sum. Vaccine is not being taken from one entirely at the cost of another. That whoever-it-was who was vaccinated is now a lower transmission risk and a lower viral load carrier if they get infected - which they are now at lower risk of.

In fact if there was leakage of vaccines, I hope the people who interact with the most number of people manage to get it. Cutting down transmission rate is about maximizing vaccination of the highest transmission nodes of human interaction. You won't cut down case counts by vaccinating all the grandparents who sit at home all day - they interact with very few people.

So there's a tradeoff here between risk to the high risk group independently, and risk to everyone from rapid growth in case counts.

[disha]

Well Suraj'San, we cannot rely on hope when we have a meaningful solution. Can we?

Downside to black market is how do we know that the person who is getting the vaccine is in the high risk or high transmitivity zone? It is a black hole of data. You will never have the data of the person vaccinated is high risk or high transmitivity or both and one can only hope. Such black holes in data actually undermine any new efforts. If the data is out there in the open, then one can come back and provide meaningful solutions.

Even the GOI is cognizant of that and has called it out in the national meet. It specifically called out two states. It also pointed out that the wastage of vaccines is wrong.

For example, when AIDS was a booming pandemic in Africa, it was argued that India will be the next hot zone. What NIHFW found was that targetting truck drivers and the red-light clusters around major truck stops with safe sex methods to cut down the transmission. And that worked. Point is NIHFW had the data and they identified solutions.

Hence wishing that the vaccines going out through black market is indeed reaching the right people is just a wish. As you say, we can only hope that it reaches the right person.

PS: You may not want to see it as corruption. But such leakages is indeed corruption and efforts must be made to control such corruption.

[Suraj]

We won’t know, and even an organized process cannot answer these . The current phase 2 focuses on inherent high medical risk over transmission risk anyway. As Uttam pointed out, the reason for the black market is there are more people who want it than are eligible for it , but no one who is eligible is being turned away . Lower the threshold or increase eligibility and the black market will also end .

[vera_k]

For example, when AIDS was a booming pandemic in Africa, it was argued that India will be the next hot zone. What NIHFW found was that targetting truck drivers and the red-light clusters around major truck stops with safe sex methods to cut down the transmission. And that worked. Point is NIHFW had the data and they identified solutions.

This is a good point. Targeting vaccination to zones with high transmission is possibly needed again given that it will taken a year or more to vaccinate the country. Something like last years model can be used to validate whether such a tactic will work.

[Uttam]

The point here is not whether corruption is good or bad. Corruption is BAD (period.) The point is to look at what is causing this corruption. Are there any market distortions that make corruption lucrative? In my opinion, this corruption is happening because there is a distortion between allowable demand and supply. Rather than wasting resources at catching people taking vaccines out of turn, why not use the same resources to bring more people to the vaccination centers. Today's figure of 17.5 lakhs is not enough. We need more vaccination for 1) the elderly, 2) people with comorbidities, and 3) people who come in contact with a lot of other people. This last group is particularly important not because they are likely to suffer from Covid but because they are likely to be silent careers (something similar to NIHFW's AIDS prevention campaign).