India’s Covid-19 vaccination programme just can’t seem to shrug off shortages—first of vaccines, now syringes.
The country has enough vaccine supplies for its year-end immunisation goal. This is a big change from April and May when several states had to shut down vaccination centres and manufacturers had to halt their exports.
It is Indian syringe makers who are now struggling to balance global and domestic commitments, despite the country being counted among the world’s major producers of the medical commodity.
For instance, Hindustan Syringes & Medical Devices (HMD), one of India’s largest syringe makers, churns out around 90 million units suitable for Covid-19 vaccines every month. But it also supplies the instrument for global vaccination programmes like those undertaken by Unicef.
Serum Institute of India’s (SII) likely delivery of 200 million doses of Covishield this month alone far outpaces syringe production in the country.
Faced with such a shortage, India, on Oct. 4, placed restrictions on syringe export. Only 40 million (pdf) units will be allowed to be exported in October and November, and then 90 million each in December and January.
HMD has even claimed that it has diverted 100 million units from a Unicef order for vaccination efforts within India. Its chairman and managing director, Rajiv Nath, told The Wire in an interview that the global body had “rapped” the company on the knuckles.
India’s avoidable syringe shortage
All this may have been avoided if India had placed orders in advance and had been transparent about the momentum of its vaccine rollout. “It could have been handled better. This crisis wasn’t necessary,” Nath told The Wire.
He said industry leaders had, in vain, been seeking a three-way meeting with vaccine manufacturers, syringe makers, and government officials to chalk out a delivery timeline and scale. Trade bodies have also sought clarity on the government’s syringe requirement, but to no avail.
Murmurs of a possible shortage have been around since September when India’s Covid-19 vaccination drive accelerated significantly, from a daily average of 5.5 million doses in August to 7.8 million in September. This included the largest single-day spike of 25 million doses on prime minister Narendra Modi’s birthday.
It now appears that the government had not considered the availability of syringes amid this spike.
As with Covid-19 vaccines, syringe shortage in India and the curb on their export can have huge ramifications for global immunisation programmes, both pandemic-related and others.
The impact of India’s syringe shortage on the world
Syringe supplies from India are key to the world, especially for inoculation of children in low- and middle-income countries. Its products vary in size from 0.1 millilitres to 3 millilitres.
For Covishield and Covaxin, the Covid-19 vaccines administered in India, the 0.5 ml auto-disposable (AD) syringes are used. These are single-use units and recommended in the World Health Organization’s (WHO) guidelines to prevent transmission of diseases like HIV and hepatitis.
They are also efficient and help healthcare workers extract the precise doses from a vial. For instance, Pfizer’s mRNA vaccine needs a 0.3 ml syringe to administer each dose.
Earlier this year, countries like the US, Japan, and those of the European Union faced shortages of these “low dead” syringes. At that time, India’s vaccination drive was limited in its reach, so manufacturers like HMD were able meet the demand.
Now, however, India’s export curb could cause a potential crunch, especially since it applies to all syringes and not only the 0.5 ml units. This will particularly affect programmes targeting diseases like measles, mumps, rubella, and hepatitis among children.
The WHO had, in 2018, estimated that the world administered 16 billion injections every year, which would likely have exponentially increased by now because of Covid-19.