Thread by @surajbrf

This week’s update will only briefly cover performance - weekly total likely to be ~42 million, same as late Aug/early Sep rate after 1.5 weeks of festival driven slowdown.

The main topic this week is a numerical dive into the 1 billion doses administered performance.

1/

https://twitter.com/surajbrf/status/1449453807755169794

This is of course just the doses administered within India. Total production is approximately 1.25 billion, including supplies sitting with states, exports and wastage.

Covishield exceeds 1 billion doses produced.
Covaxin exceeds European Moderna output, close to US.

2/

Approx 6 billion doses of COVID-19 vaccines have been produced worldwide. 6 entities account for almost all of it: China, India, EU, US, UK and Russia.

India’s peers are lower middle income countries. But it ranks #2 in vaccine output.

3/

Of the 23 vaccine formulations currently approved (covid19.trackvaccines.org/vaccines/appro…), 3 are Indian.

Vaccine design and production incredibly complex. Only 5 entites have designed, trialed and produced at least 100m doses of at least one vaccine:
China
India
EU
US
Russia

4/

Now let’s look at costs. India has administered 1 billion vaccines. Produced 1.25B, total order book 2.375B. Here’s the details:

So, just over Rs.42000 cr ($5.7 billion) in vaccine order spend for 2.375 billion doses, consisting of Rs.35,000 in Budget 2021 + PM CARES.

5/

There was a lot of criticism that orders were late, we were not ambitious like US ‘Op Warp Speed’, or EU ordering 4 billion doses total. As we saw earlier, EU has received <800M doses to date.

Here are US costs: time.com/5921360/operat…

That’s $12 billion initial spend.

6/

Moderna is yet to complete its original order from 16 months ago.
The entire US J&J and AZ production was contaminated, and US J&J consumption was imported from Netherlands.

Emergent, the producer, received $630M in Op Warp Speed.

nytimes.com/2021/05/19/us/…

7/

US: $18B OWS + $8B for 300M more Pfizer = $26 billion for ~500M doses

EU’s >4 billion dose orders are cumulatively worth over $75 billion, with about 1/6th delivered, cost ~$30 billion.

India: 2.3 billion doses for $5.7 billion and received ~1.15B.

Who did better here ?

8/

A note of appreciation for @SerumInstIndia . India administered 1B doses two days ago. They reached 1B doses produced weeks ago, quietly.

This company bet their existence on this pandemic. This is a stirring story worth reading in full:
npr.org/sections/goats…

9/

It reads like a James Bond casino scene. Going all in. But why ? SII is already the greatest contributor to world vaccination efforts this century, accounting for $140B in healthcare cost saving in developing countries:

ncbi.nlm.nih.gov/pmc/articles/P…
(Table 4)

10/

They didn’t need to bet. They were guaranteed windfall business anyway. So why make a bet ? The answer comes from @adarpoonawalla himself in April 2020 - because they had the backing and complete support of the government who sought urgency:

https://twitter.com/adarpoonawalla/status/1255385852273983488?s=21

11/

This is one of many such stories during the period when vaccines were being developed. I cannot do justice to them all.

Fundamentally, one billion doses done is a story of India demonstrating the effective exercise of state power, or Comprehensive National Power.

12/

We have a per capita income of $2500 / $8000 PPP. We’ve until recently failed in any measure of universal coverage or access of any basic goods/services.

Pulse Polio is hailed as a success. We were the 4th from last to eradicate polio. China succeed 20 years prior.

13/

https://twitter.com/prasannavishy/status/1451078536115068934

Not with COVID-19. We matched the developed world in speed and number of choices. We beat all but the world’s factory in production volume.

Since end-August we outproduce every other country. Doses done since Sept 1:
World: 1450 million
India: 360 million (25% of world)

14/

If 1 billion doses show us anything, it is that throwing ridiculous sums of money at companies just feeds their profit motive. Producing 3B+ low efficacy vaccines means China keeps shutting down entire cities every week.

washingtonpost.com/world/2021/10/…

15/

The west here has been the poster boy of big pharma kleptocracy, spending an order of magnitude more than India for less.

China is learning that volume doesn’t replace efficacy because they’ll just have to solve the same problem repeatedly.

16/

Nations do not achieve great power because of ideals . Great ideals are inspiring, but great power is literally that - the demonstration of hard capability to marshall and direct national resources towards a cause, making judicious choices that generate effective results.

17/

Think of one thing where India offers near universal adult access to it at the same time as the developed world. Almost nothing. Maybe the air to breathe. We know the quality of that air.

Bijli, sadak, pani… all fixed or being fixed 50-100yrs after the west.

17/

This is a moment where from @PMOIndia down is a demonstration of hard state power to achieve.

Mean-spirited criticism from the west is normal. It just means our rise bothers them.

What matter is that we demonstrate effective state power to accomplish great things.

18/18