On Friday, Gavi, The Vaccine Alliance, which was founded by the Bill & Melinda Gates Foundation (BMGF), Serum Institute of India, and BGMF struck a $150 million deal to produce 100 million doses of Covid-19 vaccines from AstraZeneca and Novavax for 57 and 92 countries that are part of Gavi Covax AMC, which aims to provide up to two billion doses of vaccines to eligible countries, including India, by the end of 2021 (see page 6).

Also on Friday, the Indian government finally set in motion the process of identifying the vaccine or vaccines it wants to buy, and planning other aspects including financing and procurement by setting up a panel to oversee all these aspects. (see page 1).

Covax is led by Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI), and the World Health Organization (WHO), and it hopes to ensure “fair and equitable” access to Covid-19 vaccines to “every country in the world”.

India, as a lower middle income country (its GDP per capita is about $2,100), is eligible for vaccines under Covax (one criteria is that the country should have a per capita GDP less than $4,000), and until it formed the committee on Friday, it seemed that it was pinning its hopes on this mechanism to access a vaccine or vaccines that provide immunity against the coronavirus disease (Covid-19). Covax stands for Covid-19 Vaccine Global Access.

Some countries have struck direct deals with companies for vaccines in anticipation of their development, investing upfront in them and bearing some of the risks. The US, under Operation Warp Speed, a Covid-19 vaccine development programme, has pumped billions of dollars into vaccine makers (almost every major one). More than any country, the US appears to have a clear plan on how to build a vaccine stockpile – impressive for a country that has pretty much got every other part of its response to Covid-19 wrong. The UK has signed deals with AstraZeneca, the BioNTech-Pfizer combine, and Valneva, for a (total) of around 200 million doses of the three vaccines. The European Union has signed a deal with Sanofi for 300 million doses of a potential Covid-19 vaccine.

WHO’s director general Tedros Adhanom Ghebreyesus referred to the rush, among nations that can afford it, to throw money at vaccine makers and sign advance deals. “Vaccine nationalism is not good; it will not help us,” he said at an event on Thursday. “No country will be safe until we are all safe,” he added.

Covax intends to ensure that the vaccines that work are distributed fairly around the world. It aims to make available two billion doses of Covid-19 vaccines by the end of 2021, for which it is raising $18 billion, but some of the money is coming from around 75 countries that have signed up as donors in return for a share of the vaccines. Like the 92 low and middle income countries, they too will get, through Covax, enough doses to vaccinate 20% of the population. Some health activists have criticised this part of the programme (giving donors vaccines), but in the absence of this sweetener, it is unlikely that Gavi will be able to raise as much money as it needs. The UK, Singapore, Switzerland, Japan and New Zealand are among the donor countries.

In the first phase, Covax will make available vaccine doses to cover 3% of the population of countries that are part of the programme (this proportion is expected to cover essential workers).

India has not signed deals with any of the vaccine makers yet. The Department of Biotechnology and the Biotechnology Industry Research Assistance Council, DBT-BIRAC, have funded some Indian vaccine candidates (including those of Cadila Healthcare and Bharat Biotech), but this doesn’t come with any strings attached. To be sure, as a country with enough vaccine-making capacity (and huge expertise in this area), it can always play catch-up with countries that have already planned their Covid-19 vaccine stockpiles, but it wouldn’t hurt to do this now. The creation of a panel suggests that New Delhi has realised this.

Serum Institute is the world’s largest vaccine maker and its CEO Adar Poonawalla has previously said to the New York Times that he would split his company’s production 50:50 between India and the rest of the world .

With two-thirds of the year gone, there are six vaccine candidates in Phase-3 or Phase 2/3 trials, according to WHO. Three of these are Chinese – from Sinovac, Sinopharm and the Wuhan Institute of Biological Products, and Sinopharm and the Beijing Institute of Biological Products. The other three are from Oxford-AstraZeneca, Moderna, and BioNTech/Pfizer.

There are other companies developing vaccines too – 20 candidates are in human trials (other than the six). At this stage, the probability of not having a vaccine (leaving aside details such as whether it will be single-shot, and how well it will work) for Covid-19 in 2021 is very low.

That’s all the more reason why India has to start focusing on its vaccine acquisition plan now.