In his article, “Covid’s Silver Lining for India,” published in the April 6, 2025 issue of The Week, Shashi Tharoor, Member of Parliament and noted intellectual, lauded India’s vaccine policy during the COVID-19 pandemic, asserting that it “established its role in global health diplomacy and elevated its stature as a trusted partner in times of crisis.” This assertion, however, reflects a disturbingly selective appraisal, glossing over the significant shortcomings of the Modi government’s vaccine strategy.
Vaccine Diplomacy
Through the COVAX initiative led by the World Health Organization (WHO), several programmes were implemented to provide vaccines free of charge to developing countries. To encourage the development of technologies for COVID treatment, diagnosis, and prevention, and to ensure balanced and equitable access to COVID technology for all countries, the WHO, GAVI (The Global Alliance for Vaccines and Immunizations), and CEPI (The Coalition for Epidemic Preparedness Innovations) jointly launched an organization called ACT (The Access to COVID-19 Tools Accelerator). COVAX is the division of ACT responsible for vaccine research and the equitable distribution of vaccines.
As part of vaccine diplomacy, it is true that India’s Serum Institute provided vaccines to approximately several countries through the COVAX initiative. Following the 2004 tsunami, the representatives of the QUAD (The Quadrilateral Security Dialogue: QSD: QUAD) countries, formed by India, Australia, Japan, and the United States, also decided to produce 1 billion doses of vaccines from India to be provided to Indo-Pacific countries. In addition to this, India directly provided vaccines to many countries through the Maitri initiative
While these initiatives undeniably played a role in global vaccine distribution, they cannot be divorced from the broader context of the Modi government’s domestic vaccine rollout, which was plagued by inefficiencies and inequities. The initial sluggish pace, the chaotic registration process, and the stark disparities in access, particularly for marginalized communities, remain undeniable blemishes on India’s pandemic response.
Disastrous vaccine policy
The vaccine distribution policy implemented by the central government since January 2021 has been fraught with disastrous consequences. Initially, vaccines were prioritized for healthcare and frontline workers, followed by individuals above 65 years, those over forty with serious health conditions, and subsequently those above 45 years. Starting May 1, the decision was made to extend vaccinations to all adults above 18 years, encompassing approximately ninety-five crore people who would require 190 crore doses.
At the onset, Serum Institute and Bharat Biotech were producing only eight crore doses combined. The central government launched the vaccination drive without a clear understanding of the basic logistical requirements necessary to effectively control the spread of COVID-19.
According to the initial vaccine policy, the central government mandated that 50% of the required doses be purchased directly from vaccine manufacturers and distributed to states free of charge. The remaining 50% was to be procured by state governments and private entities. This decision drew widespread criticism from state governments already grappling with financial crises exacerbated by COVID-19. Concerns were raised that purchasing vaccines from private manufacturers would inflate costs, whereas centralized procurement could potentially negotiate more favourable rates due to India’s substantial vaccine needs.
Additionally, vaccine manufacturers, having already supplied vaccines to wealthier nations, began to show interest in India’s vast market. The central government’s decision to only procure 50% of the required vaccines effectively opened India’s vaccine market to private companies, leading to fears of price gouging and inequitable distribution.
Considering mounting public outcry and criticism, the central government partially revised its policy but still mandated that 25% of vaccines be purchased by private entities for distribution through hospitals. Many argued that viewing vaccination as a public good, the government should have implemented a universal and free COVID-19 vaccine distribution policy from the outset. Despite some revisions, public opinion remained critical of the central government’s handling of the vaccine distribution, accusing it of imposing a policy that jeopardized the lives of millions across the country.
As India faced the challenges of a second wave of COVID-19, the central government has a significant opportunity to ramp up vaccine production by leveraging existing public sector pharmaceutical companies. Despite the intellectual property rights ownership of Covax, jointly developed by ICMR and Bharat Biotech, not being clarified, the central government holds the manufacturing technology rights for Covax, currently produced by Bharat Biotech in partnership with ICMR. This technological ownership provides a clear path to overcoming technical barriers and resolving vaccine shortages through increased mass production by Indian public sector entities, given adequate financial support.
However, the central government has missed these opportunities. Instead of maximizing production capacity within the public sector, it allocated substantial financial aid—3500 crores to Serum Institute and 1500 crores to Bharat Biotech. Meanwhile, smaller public sector vaccine companies such as Haffkine Biopharmaceutical Corporation in Maharashtra (65 crores), Indian Immunological Limited under the National Dairy Development Board in Hyderabad (60 crores), and Bharat Immunologic and Biologicals Limited in Bulandshahr (30 crores) received significantly lesser financial support. Furthermore, an additional sixty-five crores were earmarked for Bharat Biotech’s new facility in Bengaluru. This disproportionate allocation has led to the neglect of major public-sector pharmaceutical companies, which have historically been sources of national pride.
This decision raises concerns about the government’s commitment to fostering and supporting India’s indigenous vaccine manufacturing capabilities. By prioritizing financial assistance to private entities over strengthening public sector institutions, the government risks perpetuating dependence on external suppliers and diminishing the role of established public sector champions in India’s healthcare landscape.
Patent System and the Exorbitant Prices of COVID Medicines
In the early days of the COVID-19 pandemic, many countries, including India, faced the problem of multinational pharmaceutical companies raising the prices of medicine used for COVID management. Although specific antiviral drugs for COVID had not yet been discovered, several drugs being administered experimentally to reduce symptoms and disease severity were found to be beneficial. Remdesivir, an antiviral drug, was a key medicine among these. Gilead Sciences, an American company, holds the patent and is the manufacturer of Remdesivir. The Kerala government, disregarding the financial burden, purchased Remdesivir at a high price and provided it free of charge to all eligible COVID patients.
In this context, the demand arose to invoke Section 92 of the Indian Patent Act, which deals with Compulsory Licensing, and grant the right to companies willing to produce Remdesivir at a lower cost. However, the central government ignored this demand. India, along with South Africa, and with the support of countries like Kenya, Mozambique, Pakistan, and Bolivia, had requested the World Trade Organisation to exempt COVID products, including vaccines, from patent laws until COVID control was achieved. However, India withdrew from this move, presumably due to American pressure.
To champion India’s international contributions while downplaying the domestic failures is to offer a skewed and incomplete narrative. While India’s vaccine diplomacy may have earned it some international plaudits, it cannot serve as a convenient smokescreen to obscure the very real and consequential shortcomings of the Modi government’s handling of the pandemic within its own borders.
Dr. B Ekbal, Health Activist and Neurosurgeon, former Professor of Neurosurgery and Vice Chancellor University of Kerala
