The city of Ambala in the state of Haryana is quite small compared to the large centres of Delhi or Mumbai. Nevertheless, the first phase III trial of the Indian vaccine COVAXIN was conducted here. Anil Vij, Health Minister of Haryana himself, had volunteered as a candidate. “This is an important signal to the public,” says Sukhpreet Singh, who as Chief Medical Officer is responsible for Ambala’s COVID strategy and had organised this event. “We are showing that everyone can participate in testing. Especially since the numbers in our state have risen sharply recently, it’s important to see that a vaccine is on the way.” Sukhpreet Singh knows what he’s talking about: a few weeks ago he had been infected by COVID himself – he is still feeling the after-effects of the virus, but that doesn’t stop him from working.

Whoever discovers the vaccine first, it is certain that the largest share of doses will be produced in India. Almost everyone on earth has already received a vaccination from one of the many production facilities in India. The Doctors Without Borders network calls the country the “pharmacy of the world”, 70 percent of all vaccines worldwide are produced here. The share of generic medicines, i.e. medicines that can be produced without a patent, is as high as 90 percent. The most promising candidates so far are called COVAXIN, COVIDSHIELD – vigorous names of a country that wants to show itself as a strong player in the power game of pandemic control. The Serum Institute of India (SII) is the world’s leading producer of vaccines with 1.5 billion doses. Phase III clinical trials for the COVIDSHIELD vaccine have also been underway here since 11 November. BharatBiotech’s COVAXIN is a candidate developed by domestic Indian research – the SII has an agreement with the British company AstraZeneca, which is jointly conducting research with experts from Oxford University. India’s strong position in drug production has enabled the country to sign several deals that provide easier access to potential candidates against COVID – the Russian vaccine Sputnik V has also been undergoing clinical trials in India since early November.

But this does not mean that everyone in India can get the vaccine so easily. According to the journal Nature, COVIDSHIELD will cost 225 rupees, which is the equivalent of about 2.50 euros. COVAXIN even costs 1000 rupees (about 11.40 euros). No vaccination distributed in the country has ever been so expensive. These costs are already higher than what many people can afford. There has been a national vaccination strategy since 20 November, presented by Prime Minister Narendra Modi. Medical personnel and those with previous illnesses first – then the doses will be made available to all other private individuals. Although, not exactly: There are still election promises to be kept. In the key state of Bihar, such elections were held a few weeks ago. The ruling party BJP promised free vaccinations for every vote cast for them. In West Bengal and Kashmir, similar deals are already being promised in the upcoming elections. 

All of this is part of a larger economic campaign poetically named Atmanirbhar Bharat. Translated, it means “economic independence”, but encompasses more than that: it includes the Hindu nationalist vision of superiority of Prime Minister Narendra Modi, who read from the holy scriptures of the Vedas instead of naming concrete economic measures when introducing the concept. Modern pharmaceutical technology as part of a marketing campaign, nationalism in doses.

Just because India gets the vaccine, that does not mean a fair distribution or even an end of “vaccine apartheid”, as the economist Jayati Ghosh put it. For other countries in the Global South, it will be much more difficult to gain access to the limited amount of capacities. The World Health Organisation (WHO), along with its member countries and private donors, has therefore established a common vaccine pool, COVAX. This agreement is considered a success, as poorer countries can get their supplies on a subsidised rate. – German President Frank-Walter Steinmeier promoted the initiative at the WHO Global Health Summit in October. However, the distribution of COVAX drugs is based on charity – recipient countries have to prove their need. This means they have to specify exactly how much healthcare personnel and how many high-risk patients are acutely affected.

The Executive Vice President of the New Delhi-based think tank Global Health Strategies Anjali Nayyar has a positive perspective on the current developments of vaccines. For decades, she has been addressing the challenges of the global pharmaceutical market in her work. Nayyar’s previous engagement in the International Aids Vaccine Initiative (IAVI) has contributed to building up one of the pioneer networks advocating free access to lifesaving medicines and a rethinking of patent law. The current Covid-19 crisis would be a chance for a reimagination of health care systems. “We can benefit from global knowledge, solutions and experience if we are willing to share the products equally”, she states in a conversation with Jungle World. She is convinced that “the world will have to come together being committed to principles of equity” to combat the pandemic.

At the level of the World Trade Organisation, several developing countries, led by India and South Africa, have now petitioned to lift patent rights on COVID vaccines. But patents are just one hurdle in a market of scarce goods. In other words, it is in India’s interest to produce as many off-patent drugs as possible. At what conditions they are then sold on to other countries is another question. It even seems as if India is trying to expand its supremacy in South Asia through its quasi-monopoly position in the drug market. Bangladesh has already signed an agreement with its big neighbour; negotiations are underway with Myanmar, Bhutan but also Qatar, Switzerland, Austria and South Korea.

Sukhpreet Singh in Ambala contends that there is still a lot to do, that the days of routine overtime work is far from over. Vaccinations could only be a first step on a long road to fighting this disease. “The safest strategy is to isolate the virus from its host – that means wearing masks, using disinfectant regularly and maintaining social distance. The virus not going to go away that quickly. “

Various versions of this article were first published by Jungle World in German, and DinamoPress, as well as GlobalProject in Italian.