The government has moved back one step from its insistence that it wouldn’t allow booster Covid-19 shots by declaring it will let scientists take a final call on whether they are needed or not. And now a key question is whether the government will be able to strike a deal with Pfizer, which has emerged as the world’s biggest producer of the most sought-after vaccine because of its effectiveness.

The emergence of the Omicron variant when there were hopes that the worst of the pandemic might be over has added to the urgency of offering booster shots, particularly to older Indians.

The debate about booster shots comes as two more cases of people suffering from the Omicron variant emerged in Gujarat and Mumbai. A 72-year-old person in Jamnagar had just returned from Africa and had received one dose of the Chinese Sinovac vaccine. The 33-year-old person in Mumbai was unvaccinated. Earlier, two cases had emerged in Bangalore. So far, the symptoms of all four people with the Omicron variant are reported to be mild.

The call for the booster doses got an additional fillip after it was backed by INSACOG (Indian SarsCov-2 Genomic Sequencing Consortium), the chain of laboratories that is doing genomic sequencing of Covid-19 test results. The consortium suggested everyone 40 and above should get booster shots first along with high-risk individuals in what it said was a discussion paper. Also, now India has passed the halfway mark in double-vaccinating the adult population with more than one million doses administered Saturday, official data showed, and the Serum Institute of India, the main supplier of vaccines in the country, has said there’s no problem now with supplies -- in fact that India is sitting on 22 crores of unused doses. India’s active caseload is the lowest it’s been since March 2020.

Pfizer vaccine in demand

But faced with the worries that the Omicron variant might lead to another devastating Covid-19 wave, the government may wish to press forward with a deal with Pfizer whose vaccine is in huge demand across the globe, as well as Moderna. Prime Minister Narendra Modi is now entering the second half of his five-year term and will want to make sure he manages the pandemic successfully as he readies for the next election in 2024. There is also a string of state polls next year that will mean that Modi, who prematurely announced victory over the coronavirus before the second wave, will want to avoid any dramatic upsurge in cases. Modi has already done a U-turn on the controversial farm laws, although the repeal doesn’t seem to have completely pacified the farmers who are pushing the government for guaranteed crop prices.

Bourla, the most sought-after

The Financial Times reported that world leaders are beating a path to Pfizer CEO Albert Bourla’s door. “By email, text or phone, global leaders have pleaded with Bourla for orders, in some cases hoping that it might rescue political careers.” the FT said: “He was welcomed to the Olympics by then-prime minister Yoshihide Suga, the first time officials could recall the Akasaka Palace state guesthouse hosting a corporate leader.”

Bourla is working on reformulating its vaccine to deal with the Omicron variant and expects that to be ready in about three months. Pfizer has predicted that the Covid-19 vaccine will bring in revenues of $36 billion which is twice its 2021 profits and double what its closest rival Moderna is expecting to make. However, the pharmaceutical giant is facing an avalanche of hostile criticism because it has hardly supplied anything to major African countries. Strive Masiyiwa, who’s a Zambian billionaire coordinating the African Union’s vaccine efforts, said bluntly they were: “treading water…until we were drowning,” according to the FT.

Under the circumstances, India’s usual emphasis on its huge population and the fact that it’s a gigantic market has cut no ice with Pfizer’s top brass. In April when the pandemic second wave was sweeping through the country and having a catastrophic impact, the government had appealed to both Pfizer and Moderna to deliver vaccines to India or start production here.

Tough terms

However, both companies which are making their heavily-in-demand vaccines laid down extremely tough terms including sovereign indemnities. “Their price will be high. Why should we take on their conditions,” a senior government official reportedly said in September by which time the pandemic numbers had dropped steeply.

“Sovereign indemnity is clearly something we can’t give,” a second bureaucrat said. In South Africa, the FT reported, Pfizer had demanded the government should put up sovereign assets to cover potential liabilities. Later, Pfizer reduced that demand to indemnity against civil claims and asked that the government should put up money for an indemnity fund and the health ministry agreed. According to The Hindu, a senior Indian health ministry official recently said “we are in dialogue” with Pfizer, Moderna and Johnson & Johnson about allowing the import of the companies’ vaccines. “Talks are on and, yes, an indemnity clause is also being discussed. India has put across its stand,” the official said.

An indemnity clause means the government will ensure that the manufacturer will be covered against civil suits or other potential losses. The fact is the government may have to grant the companies some form of indemnity because the huge global demand means India needs them more than they need us.

3 billion doses by end-2021

Pfizer expects to ramp up production of its vaccine to 4 billion in 2022. About 80 per cent of people in the EU have received Pfizer vaccines. Moderna and Astra Zeneca have provided the remaining. Pfizer has moved into pole position in the global vaccine business because it has extremely efficient production facilities and has earned a reputation globally of being with Moderna the most effective vaccine in the market.

The vaccine, which uses the new mRNA technology, was originally developed by a German company BioNTech which is now in partnership with Pfizer. Moderna has been hampered by its limited production capacity. Its shares plummeted in early November after it announced it would be only able to supply 700 million to 800 million vaccine doses this year, down from its previous forecast of 800 million to 1 billion doses.

Barbara Dickerman, a Harvard epidemiologist, of the first “head-to-head” study of Pfizer and Moderna endorsed both vaccines, published in highly reputed New England Journal of Medicine, said: “Given the high effectiveness of both vaccines, either one is highly recommended to any individual offered the choice between the two.”

The study concluded there were 4.52 Alpha variant infections per 1,000 people who received the Moderna vaccine. By comparison, it said there were 5.75 infections for 1,000 people who received the Pfizer jab. But the differences between the two vaccines’ efficacy against developing severe illness were consistently small. The study conducted using 440,000 US veterans was carried out by Harvard Medical School, the Harvard T. H. Chan School of Public Health, Brigham and Women’s Hospital and the US Veterans Administration.

Covishield effectiveness

A study in The Lancet said that the effectiveness of Covishield made by Serum Institute of India was 63 per cent against developing Covid-19 and 81 per cent against developing moderate-to-severe symptoms during the peak of the second wave in April-May. The study was conducted by a team led by the Translational Health Science and Technology Institute.

Researchers still don’t know how well vaccines will hold up against the highly mutated Omicron variant. South African researchers believe that preliminary findings indicate that the variant has “substantial ability to evade immunity from prior infection.” But many scientists are confident that those individuals who are double-jabbed will still be well-protected against severe illness caused by Omicron.