Over the past few months, Southasia has steadily made headway in the race for vaccinating its population against COVID-19. The following report provides an overview of the procurement and rollout of COVID-19 vaccines in Southasia, based on the latest figures available. From the reports coming from across the region, it is clear that some countries are faring better than others, partly due to deals secured with manufacturers, early approval of COVID-19 vaccines, and coherent, systematic inoculation strategy and implementation. Others, meanwhile, are struggling due to poor planning and supply shortages.
With the pace of vaccinations accelerating in almost all countries, a noteworthy development has been India’s overwhelming presence in the region’s rollout programmes. The Serum Institute of India – the local manufacturer of the Oxford-AstraZeneca vaccine, known by the acronym Covishield – with its capacity to produce 50 to 70 million doses a month, has played a vital role in the manufacturing and distribution of the vaccine. In what is being dubbed as vaccine diplomacy, India has distributed free doses under its grant assistance programme ‘Vaccine Maitri’ to almost all the countries in the region. However, following a spike in new coronavirus cases in late March 2021, India has temporarily halted vaccine exports to focus on domestic demand. This move will impact nearly all the countries in Southasia, especially those who are relying exclusively on India’s Covishield and have already administered the first dose.
In a bid to boost the region’s vaccination drive, the COVAX initiative, led by the World Health Organization and supported by The Global Vaccine Alliance (GAVI) and Coalition for Epidemic Preparedness Innovations (Cepi), will cover vaccine costs for up to 20 percent of the population. Some countries in Southasia, starting with Afghanistan, have already received their first consignment under COVAX.
The vaccination programmes in most countries in the region began by prioritising frontline healthcare workers, high-risk groups, and elderly populations. Some countries have leveraged technology to make the inoculation process a seamless experience for their citizens, raising security and privacy concerns. Apart from procurement delays, another obstacle Southasian countries are facing is vaccine hesitancy that is heightened by fear, misinformation, and a lack of consistent messaging.
It should be noted that while this is a snapshot based on the latest reports from the region, as inoculation drives are underway in all the countries mentioned below, the figures will change with each passing day. In some countries, the strategic approach and rollout plans too may undergo amendments.
Amid a surge in violence in Kabul at a critical stage of intra-Afghan peace negotiations, hospitals and clinics in Afghanistan are navigating low COVID-19 testing, limited access to medical facilities and significant delays in rolling out its vaccination programme. The country began its vaccination drive on 23 February by inoculating security force members, healthcare workers, and journalists. So far, over 12,000 health workers have received the vaccine in all 34 provinces. However, officials have yet to confirm the vaccine distribution process for the remaining population.
On 7 February, Afghanistan received its first consignment of 500,000 doses of Covishield from India. China has also pledged 400,000 doses of Sinopharm vaccine to Afghanistan. Further, COVAX has pledged USD 112 million to reach 20 percent of Afghanistan’s population.
Along with the COVAX facility, the World Bank and the Asian Development Bank have committed to providing vaccines for an additional 40 percent of the population. On 8 March, Afghanistan received 468,000 doses of the Covishield vaccine.
Inoculation teams are also contending with setbacks to the polio vaccination programmes due to fighting between the Taliban and government forces. Many remain sceptical that the government will be able to distribute the limited supplies of the COVID-19 vaccine equitably and on time.
Bangladesh began its vaccination drive on 7 February with 31,160 people vaccinated throughout the country in around 1000 centres on the first day. As per the vaccination plan, more than 13 million people will be vaccinated in five stages. Health workers, freedom fighters, law enforcement agencies, military and other forces, government officials, journalists, elected representatives, employees of city corporations and municipalities, and religious leaders will be getting the shots initially. As another step of the vaccination plan, Bangladesh unveiled the ‘Surokkha’ app for its citizens to register for the vaccine. However, initial registrants reported having faced numerous logistical and technical issues with the app and the website.
On 21 January, Bangladesh received 2 million free doses of Covishield vaccines from India. A further 30 million doses were secured under a tripartite agreement among Beximco Pharmaceuticals Ltd, Serum Institute and the Bangladesh government. On 25 January, Bangladesh received the first consignment of 5 million doses under the tripartite agreement. Bangladesh is set to receive 10.9 million doses from the COVAX facility by May.
As of 22 March, over 6.2 million people have registered for the vaccine, and as of 24 March, over 4,9 people have been vaccinated.
The government is planning a mass vaccination drive to administer the vaccine to the whole population starting from 27 March. The head of the National Immunization Technical Advisory Group (NITAG) has stated that it has developed a vaccine deployment strategy that recommends mass vaccinations to be done within two weeks. All citizens above the age of 15 were requested to register for the vaccination drive through the Ministry of Health website. As of 23 March, 500,316 individuals have registered.
On 20 January, Bhutan became the first country (along with the Maldives) to receive 150,000 free doses of India’s Covishield vaccine under India’s ‘Vaccine Maitri’ initiative. A further 400,000 free doses arrived from India on 22 March. Further, Bhutan will receive 108,000 doses through the COVAX facility.
India’s immunisation drive began on 16 January with vaccination of frontline and healthcare workers, followed by that of individuals over 50 and high-risk populations. The two vaccines being used in the country, Oxford-AstraZeneca’s Covishield and Hyderabad-based Bharat Biotech’s Covaxin, have inoculated more than 10.5 million healthcare and frontline workers. Only 1.2 million of them have taken Covaxin. Overall, almost 42 million shots have been administered in the country, but a lack of transparency around the two vaccines has significantly set back the country’s vaccine drive. Many have declined the shots, especially Covaxin, as India’s top drug regulator issued emergency approval for restricted use without any data on its safety and efficacy from phase 3 clinical trials, amid allegations of ethical violations. People receiving Covaxin were asked to sign a consent form that noted its “clinical efficacy has yet to be established”. After almost all states failed to meet their targets in the first few days of the immunisation drive, the government urged frontline workers not to refuse the vaccines. Another setback has been the use of the vaccine management system app Co-WIN instead of using a door-to-door approach. This limits the number of people who can access this system due to potential technical difficulties and privacy concerns.
Bharat Biotech announced early in March that Covaxin showed a strong efficacy of 81 percent in those without prior infection after a second dose. Health experts warn that the country is far from herd immunity; these findings which support Bharat Biotech’s claims of the vaccine being safe may help overcome vaccine hesitancy across India.
On 27 February, the Maldives reached a milestone of over 100,000 people – around 19 percent of the population – administered with the first dose of the COVID-19 Vaccine. The Maldives was among the first countries in Southasia to receive an initial shipment of 100,000 free doses of Covishield vaccines from the Serum Institute under ‘Vaccine Maitri’. On 20 February, the country received an additional 100,000 free doses from India.
The Maldivian government has also signed a direct agreement with AstraZeneca Singapore to procure 700,000 doses of the vaccine as well as vaccines for 20 percent of the total population from the COVAX facility. The first installment of 12,000 doses of Covishield through COVAX arrived on 7 March, in addition to the 100,000 syringes and safety equipment donated by the facility. On 15 March, the Maldives Food and Drug Authority (MFDA) also approved the Pfizer-BioNTech and Sinopharm vaccines for emergency use, in addition to the 18,000 doses of Sinopharm vaccine ready for use in the country. The Maldivian Red Crescent is now registering migrant workers, with or without valid documentation, to receive the vaccine at no cost.
Myanmar launched its immunisation drive on 27 January, with healthcare workers and volunteer medical workers being the first to be inoculated. From 27 to 31 January, more than 100,000 healthcare workers and volunteers as well as members of the Parliament were administered the vaccine.
Following the military coup in early February, the vaccination programme has been severely disrupted. Myanmar’s frontline health workers (an estimate of almost 50,000 out of 110,000 so far) have joined the civil disobedience movement (CDM) and have refused the second dose of the vaccine. There has also been a wave of arrests and crackdowns on those who have mobilised healthcare workers. Dr Htar Htar Lin, the former director of Myanmar’s Expanded Programme on Immunisation, has gone into hiding after the military junta began threatening her with criminal charges for joining the CDM. Ara Darzi, director of the Institute of Global Health Innovation, Imperial College London, said, “There are reports from other cities across the country of doctors being dismissed from their posts, arrested, or going into hiding in fear for their lives. The arrest and detention of medical staff for joining a peaceful protest is an affront to doctors everywhere and a clear breach of humanitarian law. It demands an immediate robust response.”
Due to the political crisis, there is also a dearth of information from Myanmar regarding the current status of the vaccination rollout. The military government, however, has restarted the process with selected groups. On 8 Mar, 12,922 people – healthcare workers, elderly, monks, nuns – from Nay Pyi Taw, Kachin, Kayin, Mon, Sagaing, and Mandalay received their first doses.
On the procurement front, on 22 January, a total of 1.5 million free doses of the Covishield vaccine were given to Myanmar by India. The government further procured 30 million doses from India, which was to be delivered in batches. Yet, with the current state of affairs, it is unclear how the procurement and distribution processes will unfold.
Nepal began its first phase of vaccine rollout on 27 January, administering the vaccine to its frontline healthcare workers. As reported in Pakistan and other countries in the region, vaccine hesitancy resulted in a moderate turnout in Nepal due to safety concerns and inaccessibility. Therefore, the government expanded the first phase to include civil servants, diplomats, bankers and journalists. The second phase will consist of those above 55 years and those with comorbidities, followed by the 40-54 age group and finally those below 40 years of age. On 15 January, Nepal’s drug regulator granted emergency-use approval to Covishield, while Nepal’s Foreign Minister Pradeep Gyawali was in India for a three-day visit.
India provided one million doses of the Covishield vaccine to Nepal on 21 January. In addition to the first Covishield doses, Nepal procured two million additional doses from the Serum Institute of India at a subsidised rate. China has promised Nepal 800,000 doses of its vaccine in early March, though no definite delivery dates have been discussed. On 1 March, it was reported that the government was negotiating with the Serum Institute of India to obtain 5 million more doses of the vaccine, with the Health Minister expressing worries that commercial deals alone would not be able to meet the country’s needs. Russia too, has offered 25 million doses of its Sputnik vaccine, but the government has asked for additional documentation before reviewing its efficacy.
With Pakistan struggling with a new wave of infections in early March, the country has faced obstacles in the procurement of the vaccine for its citizens. This dilemma has arisen due to a delay by the government in placing final orders to import the vaccine from manufacturers. Nevertheless, Pakistan began its vaccination drive for those aged 60 and above on March 10. Citizens could register for vaccination using their mobile phones. Executive Director Major General Aamir Aamer Ikram of the National Institute of Health stated that Pakistan plans to vaccinate 70 million people this year.
Pakistan has approved China’s Sinopharm and CanSino, Oxford-AstraZeneca, and Russia’s Sputnik V vaccines for emergency use. On February 1, Pakistan received the first batch of 500,000 doses of Sinopharm from China as a donation. Pakistan is also due to receive the first shipment from the COVAX facility in March. The country’s planning and development minister stated that Pakistan would receive over one million doses of Chinese Sinopharm and Cansino COVID-19 vaccines by the end of March. Pakistan is also one of the first countries to allow private imports of COVID-19 vaccines for commercial sale.
Meanwhile, vaccine hesitancy has emerged as another obstacle for Pakistan. As per figures by the Ministry of National Health Services, only 180,000 of approximately 8 million senior citizens in Pakistan have registered for inoculation. Pakistan has vaccinated about 350,000 citizens as of 14 March.
Sri Lanka’s COVID-19 vaccination rollout began on 29 January with the inoculation of frontline healthcare workers, selected police and security forces, and members of the tri-forces. Sri Lanka’s State Ministry of Primary Health Care, Epidemics and Disease Control launched a website for COVID-19 vaccine registration on 10 February, but the site was taken down on 17 February due to logistical issues. The initial period of mass inoculation too was riddled with confusing and conflicting information. Vaccination programmes for the general public began by prioritising those between 30 and 60 years of age in mid-February. As of 19 March, Sri Lanka has vaccinated 824,523.
Sri Lanka received 500,000 free doses of the Covishield vaccine from India on 28 January. The country received a further 500,000 doses of Covishield on 25 February and has ordered 13.5 million doses from India. However, there are recent reports of a significant delay in future procurement of vaccines from India, especially following the Serum Institute of India’s temporary halting of Covishield exports. Therefore, Sri Lanka is currently looking at other options such as Sputnik V from Russia and the government has sought to expedite the approval process for the Sinopharm vaccine. Further, Sri Lanka received 264,000 doses through the COVAX facility on 7 March.
China has administered vaccines to 64 million residents as of 14 March.
The Tibet Autonomous Region is reportedly receiving the Chinese-owned Sinopharm vaccine, according to local government reports. Tibetan pharmaceutical company Tibet Rhodiola Pharmaceutical Holding Co. is also said to be bringing in the Russian vaccine Sputnik V for early to mid-stage trials in the country. Throughout China, workers in nine sectors including logistics, food delivery, customs, transportation, healthcare and public security are being prioritised for vaccination, as they are more likely to be exposed to the virus through their work. Pregnant women and people who have cancer, severe liver and kidney conditions, high blood pressure or diabetes, as well as those who have recently received the Human Papillomavirus (HPV) vaccine are prohibited from Sinopharm’s vaccination programme for now.
Meanwhile, the Central Tibetan Administration, the government in exile in India, had requested that the Dalai Lama and his staff be vaccinated, along with the Tibetan community in India. According to the deputy commissioner of Kangra, the vaccination schedule for the Dalai Lama and around 70 of his staff had been finalised on 4 March, following reports of 160 monks at Gyuto Tantric Monastery near Dharamshala being tested positive for COVID-19. The Dalai Lama received his first dose of the COVID-19 vaccine on 6 March, along with 10 others living in his residence. On 9 and 10 March, 64 Tibetans over the age of 60 received their first dose of the COVID-19 vaccine in Tso Pema and Tashiling.