States are also facing an additional challenge — most international vaccine manufacturers already have made supply commitments to domestic governments or other countries, which may have made advance bookings.

Officials also said the only possible way to deal with vaccine shortage is to remove the patents and allow government-run public sector undertakings (PSUs) to manufacture the vaccines in large numbers to meet the domestic demand for vaccination to all above 18 years of age. They, however, said even if the patents are removed now, PSUs would take at least a few months to produce first batch of vaccines.

“We have no option but to allow public sector companies to manufacture vaccines,” said Andhra Pradesh chief minister M Jagan Reddy in a letter to Prime Minister Narendra Modi on Tuesday, asking the PM to direct Bharat Biotech to transfer the vaccine technology to whichever company is capable of manufacturing vaccines.

Covaxin, India’s first indigenously developed Covid-19 vaccine, is a collaborative effort between Bharat Biotech and the Indian Council of Medical Research (ICMR). It was developed using the SARS-CoV-2 strain, isolated in the National Institute of Virology in Pune, which functions under ICMR. ICMR and Bharat Biotech jointly carried out the clinical and pre-clinical trials of the vaccine in India.

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On Wednesday, West Bengal chief minister Mamata Banerjee asked PM Modi to allow “liberal, pro-active and discerning” import of vaccine saying 100 million in the state need to be vaccinated and supply of doses was “extremely inadequate.”

“Kindly consider if we could encourage the world players to open up franchise operations in our country. Even the national players could be inspired to go for the franchisee mode for bulk production of vaccines. We, in West Bengal, are ready to provide land and support for any manufacturing/franchisee operation for authentic vaccine manufacturing,” Banerjee wrote.

Giving reasons for her letter, a senior West Bengal government official, who did not wish to be named, said that it was made clear at the meeting with the CM that getting vaccines from international manufacturers to vaccinate all will not be easy.

Another state government official said Serum Institute has informed the state that it would not be able to provide vaccines to private players before July and supply for 18-44 age group will also be limited. “That is the reason for us to stop walk-ins for 18-44 age group,” the second official said.

Rupak Barua, group CEO, AMRI Hospitals and president of the Association of Hospitals of Eastern India, said that April 30 was the last day when private hospitals received supply of vaccines through the state health department.

“Those who received their first dose at private hospitals will be able to get their second dose from government health care facilities,” he said. During the last census in 2011, Bengal’s population stood at 91.3 million and it is projected to have increased to 101.9 million in 2021.

The Tamil Nadu cabinet on Wednesday decided to float global tenders to vaccinate people in 18 to 44 age group even as the state has received 7.7 million vaccine doses for those above 45 years of age. It has utilised 6.5 million doses. “We are planning a road map but a lot will depend on vaccines we can import,” said Vinay Kumar, joint director for immunisation, directorate of public health.

The state has more than 3,000 vaccination sites and is experiencing a shortage. “With such a shortage at hand, how can we distribute and vaccinate people on a sustained basis?” a senior health official said, not wishing to be identified. He added that the current strategy was to vaccine vulnerable groups with the vaccines the state was receiving.

Officials in Uttar Pradesh said they did not expect to get the first delivery of vaccines from international manufacturers before July. The state has decided to import 40 million vaccine doses.

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“The state is going to have a pre-bid qualification meeting with any prospective suppliers. After that, bids are scheduled for May 21. The companies (those who are interested) would mention the delivery schedule then,” said state health minister Jai Pratap Singh. The vaccination for 18-44 age group is underway only in 18 of the state’s 75 districts as the state has received only 8% of the vaccines it has booked with Serum Institute and Bharat Biotech, officials said.

Punjab, which needs to vaccinated around 20 million people in the 18-plus age group, has placed order for three million doses with Serum Institute and has received only 100,000 doses from the Pune-based company. The next consignment of 230,000 doses is expected to arrive from SII between May 15-May 25, when Punjab plans to start vaccinating the 18-plus.

The state set up around 3,000 vaccination centres when the vaccination opened up for 45-plus category from April 1 and 80,000 to 90,000 jabs a day were administered. As the Centre’s supply was cut short, state average day coverage has come down to 40,000-50,000 jabs.

Punjab’s health minister Balbir Sidhu has blamed the inadequate supply from the Centre as the reason behind slow vaccination in the state. “At the start of the drive, we faced a lot of hesitancy for the vaccine. However, now when we have set up our centres across the state and motivated the people by running massive awareness drive, low stocks has discouraged us,” said Sidhu.

Officials in several states such as Himachal Pradesh, Punjab and Uttarakhand said that in absence of adequate vaccines for 18-44 age group, the governments have decided to continue vaccination for 45 plus age groups only. Most of these state governments are waiting for additional vaccines to resume vaccination in full swing.

On Wednesday, Uttarakhand chief secretary Om Prakash said the government has decided to import over 2 million Covid vaccines in the next two months. “Vaccines will take time to come,” he said, adding the Centre was allocating vaccines to state based on its population.

A Rajasthan government official said that the international manufacturers have not even replied to queries regarding how much vaccines they can supply. “We presume many have prior commitments and may not be in a position to supply vaccines to Indian states immediately. We have decided to float global tenders to get vaccines in the next three to four months,” the official requesting anonymity said.

Experts said the states need to change its strategy and look for vulnerable community vaccination. “We are working on procurement, which is good, but we need to change our strategy from hospital facility to community based involving civil society organisations, religious leaders who will in turn mobilise communities,” says Prabhdeep Kaur, deputy director, National Institute of Epidemiology. “We need to target elderly and those vulnerable and people in the rural areas, who may not come forward to hospitals,” she added.

“Vaccination for Covid needs to go the routine immunisation way now. Covid vaccine should be made available in every locality just as other vaccines are available. In a nutshell, vaccination coverage has to be expanded manifold now, and if there is shortage of vaccine, it should be procured so that private clinics can also participate in Covid vaccination to expand coverage,” said PK Gupta, former president of Indian Medical Association, Lucknow chapter.

(With state bureaus)