Sridhar V Profile picture
22 Jun, 18 tweets, 4 min read
THREAD on the spectacular single-day spike on June 21 - a whopping 8.87 million doses administered in India.
1. The questions to ask are: How may this have happened? Is this sustainable over a longer time frame?
2. First, the context. Vaccine doses delivered yesterday was 42 % higher than the previous highest single-day number registered on March 16 (6.25 m doses). Indeed, apart from the March instance, dose delivery crossed 5 m/day only once - on April 7. So, this is indeed a big deal.
3. In the first 20 days of June an average of 3.16 m doses were delivered. Monday’s spike was 181 % higher than this avg. Let us look at the numbers a little more closely. In the last month or so Covshield had been accounting for about 88% of all deliveries. Y’day it was 92.35 %!
4. Covaxin remains a laggard. 0.67 m doses of Covaxin were delivered y’day, but was only 0.17 m higher than the avg daily doses delivered in the first 20 days of June. In contrast 8.19m Covishield doses were delivered - surge of >3 times the avg in first 20 days of June.
5. Spectacular as y’day’s surge is, the data reveals some some worrying patterns. 1st, there seems to be an extreme skew in terms of regional distribution of vaccines, with possibly a political emphasis.Two BJP-ruled states - MP and Karnataka account for almost 1/3 of the spike.
6. Add two other states ruled by BJP and/or its so-called allies — Gujarat, Bihar and Haryana — and half of all the vaccines delivered y’day India went to these “special category” states! Add UP and the share of just these 6 states soars to >58 %.
7. Is the spike sustainable? How might it have happened? Whether it is sustainable is primarily a function of how many vaccines are produced by the two producers - SII and BBIL. The GoI has told the SC stated that SII’s capacity could reach 70-100 m doses/month in July.
8. Even assuming the upper bound of production capacities at SII, it can produce a maximum of 3.33 m doses/day. This means that SII has to produce at the rate of 8.163 m doses per day EVERY DAY to maintain the overall strike rate at 8.873 m doses per day over a longer time frame.
9. Clearly that asking rate is too much for even the biggest vaccine maker in the world. This is because SII has to produce consistently at a rate that is about two an a half times the upper bound of its stated capacity that has always been shrouded in mystery.
10. The Covaxin story is too well known to need retelling.Its production numbers are suspect. Now,for my take on the question of how the spike may have happened.Since a dramatic scaling up of capacity is very unlikely, a buildup of stocks, particularly Covishield, may explain it.
11. In the 1st 20 days of June avg Covishield shots delivered were only 2.66 m doses/day. The spike resulted in a one-day increase of about 5.5 m doses of Covishield y’day.Over a 20-day period an average of about 0.27 m doses/day could have been accumulated as inventory.
12. This is perfectly feasible for two reasons: 1) the utter non-transparency of output and distribution data and 2) There is simply no other way this kind of an increase could have resulted from a spike in output, for reasons cited earlier.
13. One +ve result of y’day’s spike is the demonstration of Indian state-led capability and capacity too significantly expand vaccination. This arises from the achievements in vaccination a large population over many years. It also reaffirms the need for NaMo to do a U-turn.
14. Now for a thought experiment: How long will it take India to vaccinate everybody in the 18+ age group, even if the strike rate is maintained at the rate achieved y’day? We have delivered about 284 m doses for a target population that requires 1878 m doses.
15. Even at this rate it’d take exactly 180 days.Assuming an average daily capacity of about 3.5 m doses per day, vaccinating all those above 18 would take 511 days.Running at the June avg (2.92 m doses/day) would take us 643 days (more than 20 months) to reach the target.
16. Two conclusions: 1) The arbitrary and norm-less regional concentration of the spike in vaccine deliveries is an affront to epidemiology and what science demands as a response to the pandemic, in the midst of fear about an impending Third Wave.
17. 2) The poor visibility of vaccine supplies, driven by an unwillingness by the NaMo govt to clearly articulate constraints, coupled with the truant ways of the two leading vaccine suppliers, continues to dominate the Indian response to the pandemic. (END)
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More from @sritara

23 Jun
Thread on vaccination in states on June 22
1. Now for how the champion states of June 21 fared y’day. The six champions of MP, Karnataka, UP, Bihar, Gujarat and Haryana - in that order - accounted for 58% of vaccinations on July 21. How did the fare the day after?
2. Strikingly, all of them slid sharply as shown in the attached chart. The two prime champions of 21st slid by 96 % (MP) and 64 % (K'taka), respectively. UP was the only one among these states that increased vaccination-by 14 %. Who dares to say vaccines are not about politics? Image
3. Among the large states Maharashtra and UP were the only ones who managed to evade this collapse y’day. The collapse indicates three things: a) The rates of June 21 are unsustainable
Read 5 tweets
23 Jun
A short thread on vaccination on June 22, 2021. An inevitable fall from the peak?
6.07 m vaccines were delivered y’day, a fall of 32 % from a day earlier, clearly demonstrating that the spike is unsustainable.
2. Covaxin dose deliveries, the weak link in the chain, fell by 23 %. Covishield, the mainstay, which accounted for >95% of vaccinations y’day, fell by >32 % and Sputnik, of which only 4125 doses were delivered y’day increased marginally.
3. The avg for June (3.55m doses/day) has improved significantly thanks to the spectacular, but evidently weakening, spike. Like all averages, this can be misleading. Remove the two extraordinary days and the avg is down to 3.16 m doses/day.
Read 8 tweets
16 Jun
Thread on BBIL’s justification of higher Covaxin’s prices and the media’s gullible coverage of BBIL’s claims about costs, pricing and output.
1. Most stories in the business media are solely based on the BBIL’s press release of June 15, 2021, without any contestation.
2. To innocent journos who know little about manufacturing and costs, BBIL explains vaccine making has many steps and risks associated with production and marketing of a pharma product. It doesn’t tell us that these risks were known to it BEFORE it undertook to develop Covaxin.
3. It refers to the “complex” manufacturing process associated with the inactivated virus vaccine platform. Again, it does not bother to tell us that nobody forced the company to adopt this platform. It was a choice BBIL made, with its eyes open.
Read 20 tweets
9 Jun
Thread on the yawning gap between vaccine procurement and production

1. This is in the light of the Govt announcement on June 8 (VK Paul, head, Group on Vaccination) that the Govt is set to procure 770 million doses b/w Aug and Dec 2021.
2. To place the numbers in context: India has so far delivered about 235 m doses, of which about 90 % are Covishield. In April, the avg daily vaccination rate was 2.935 m, which dipped to 1.928 m/day in May - fall of 34% . Things improved in June, but not convincingly enough.
3. In the first 4 days of June the daily strike rate was almost 4 m doses but yesterday it was just 2.740, a drop of almost one-third. IOW, things look up but not convincingly enough.
Read 15 tweets
7 Jun
A thread on the PM’s speech today

1. Most important takeaway: This is not a course correction. It is a mere amendment to the disastrous vaccine policy. Why do I say this?
2. The decision to provide “free” vaccines to states for 18-44 is welcome, but it comes with no intent to streamline vaccine distribution by making it dependent on objective, normative and verifiable standards. The arbitrary allocations to states will continue.
3. The only difference is that instead of a three-tiered pricing regime, there will be a two-tier pricing regime as 25 % of vaccine allocations will be to private sector. Already, how this is happening, and what prices are being charged is shrouded in opacity. This won’t change.
Read 8 tweets
28 May
THREAD on BBIL’s saga of an incredibly spun yarn, based on its most recent release, today.
1. Starts with a treatise on vaccine making for the intellectually-challenged journalists - “complex and multifactorial process” with 100s of steps, it says.
2. Explains how the regulatory pathway is complex and takes time, effort, coordination with supply chains, etc. Generally, more fluff
3. Now comes to the real deal - that scaling production is a "step-by-step process". (BTW, what manufacturing process isn’t?). But here’s the innocently-couched punch: “There is a four-month lag time for COVAXIN to translate into actual vaccination.”
Read 11 tweets

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