The Time I Stole Someone’s Vaccine
Posted on October 27, 2021How systems stop us from becoming better versions of ourselves
By Manavi Datta
Eighteen months of the pandemic in India forced me to confront my individual position in society. I was constantly situated in a devastating macro climate yet I was distanced from the problems around me. Many call it the survivor’s guilt. Getting fully vaccinated in India was one of those times I had the seeping realization of the stark societal inequities that I reap the benefit off of. I however want to place my experience of becoming fully vaccinated within the larger systemic context of India’s vaccine distribution in order to make sense of why I feel like I stole someone else’ s vaccine.
Understanding the Basic Elements of the System
If vaccine distribution was visualized as Donella Meadows’ simple system diagram, the inventory of manufactured vaccines (the stock) would involve two balancing feedback loops, the supply of vaccines in vaccination centers and the demand of vaccines across centers. Both of these loops are goal seeking, feedback loops that regulate the system. Their purpose is to fill the gaps in the demand and the related supply of vaccines so that the most number of people can be vaccinated in the fastest period of time. Alas, this is called a simple system for a reason, it isn’t remotely close to reality.
Understanding Systemic Delays
Behind the Indian Government’s propaganda of celebrating the “world’s largest immunization effort” is a system driven by power abuse and cursed with bureaucratic red tape that left millions without access to vaccines during the most crucial periods of the pandemic. This implies that the system developed delays of different kinds that reduced access to vaccines.
Delays Because of Divergent Political Agendas
In the early days of the vaccination program the government was keen to place India as a mass vaccine exporter, it re-directed 64 million vaccine doses to various governments abroad between January and March 2021. This comes as a persistent effort to build a narrative of Indian exceptionalism, what now seems like a desperate effort to restore global competitiveness. There was thus a lower supply of the home-made Covaxin in health centers across the country in the build up to the torment second wave that peaked with 403,000 daily cases in the first week of May 2021. Even in June 2021, India remained the largest vaccine exporter in the world and only four percent of the country’s population was fully vaccinated.
There was a need for a change so India got onto the path of becoming a major vaccine importer thus two sub-systems emerged as the gap between the demand and supply widened domestically. A system for vaccine exports with the purpose of bringing revenue into a tanking economy and an import system with the purpose of vaccinating the Indian population.
Delays Because of Global Interdependence
India became very dependent on the import system as a desperate effort to increase the rate of vaccination especially with the threat of the third wave looming. This added pressure on Serum Institute of India (SII) which is the largest manufacturer of the Oxford AstraZeneca vaccine. The vaccine maker committed 2 billion doses to low and middle income countries by the end of 2021 and AstraZeneca’s global problems consequently required SII to fill the gaps even in Canada, Britain and Saudi Arabia. It could thus not match the growing demand for vaccines in India as the eligibility criteria for the population to access vaccines simultaneously widened. By June 2021 the government expedited approvals for Pfizer and Sputnik vaccines to enter the Indian market.
Delays Driven by Underdeveloped Infrastructure
Each of these imports needed new manufacturing units and logistics infrastructure which remained underdeveloped. The Sputnik vaccine for example relied on a cold storage system in order to administer the vaccine in working condition to individuals. This needed to be set up across the country but it cut off the rural population in India because of the lack of storage units, the vaccine has thus been made available in 80 cities so far. Unlike other vaccines Sputnik uses a different component in its second dose which also needs to be imported thus the production of the second dose within India was pushed to September 2021.
Constant changes in the supply of manufactured vaccines became a behavior of the system that was often expressed. This behavior pattern of the system also made me an exception when it came to being fully vaccinated.
Getting Comfortable with Exceptions
Amidst multiple delays and the creation of new convoluted sub-systems it was announced in June 2021 that the time between two AstraZeneca doses in India was increased from six weeks to twelve weeks. SII- AstraZeneca being the only WHO approved vaccine widely available in India forced the government to create exceptions for people needing to travel outside India. India has been a hub for students and migrant workers going abroad. Close to 770,000 Indian students studied abroad and 334,000 migrant workers moved to the Middle East in 2019 alone. In a country with 1.3 billion people exceptions within systems are large enough to affect supply of vaccinations for other groups of people.
As an exception, my early vaccine dose was a result of stocks being diverted from someone else in the system. I stood in a special line at a government hospital with other individuals going abroad and saw hospital personnels turning away agitated citizens who no-longer could avail their first vaccine dose that day. These individuals were often from low-income communities making many failed attempts at getting a free vaccine dose at the hospital. Soon fights broke out as different sets of individuals lost patience and rumors of vaccine doses getting over moved across the hospital corridors, many stared at the foreign goers with annoyance and envy. Who could blame them? We were standing there as a barrier to them accessing health and security.
I got the second last vaccine that day, it was unclear when the next batch would come. I do think if I gave up my dose that day, it would go to another person in a position of power. It would not have gone to the person most vulnerable to the health and economic effects of covid. I say this having realized that the system is highly non-linear and my decision would not have a predictable, causal outcome.
Moreover the hospital I was in would make a decision based on bounded rationality, a rational shortsighted decision based on the information one has. The hospital in this case knows only about the doses it has for that day, it has a mandate to vaccinate at least X number of foreign going individuals on a particular day thus it will make a decision based on these known variables. Again, this would stop vulnerable segments of the population from getting their vaccine that day.
I got fully vaccinated on July 12, 2021 when only 5.4% of the country was fully vaccinated. So it is not wrong if I say I stole someone’s first dose because getting fully vaccinated in India became a game of power. Knowing the realities of the system, standing in line for seven hours on that day and the stakes of moving abroad and starting a graduate program made me less likely to do the ‘right thing’.
I thus end with a lingering question: how might we continue to express human empathy when we are placed in systems that make us less humane?
Citations:
Aljazeera, March 31 2021, “COVID forces India’s former Gulf workers to forge new futures” https://www.aljazeera.com/news/2021/3/31/covid-forces-indias-former-gulf-workers-to-forge-new-futures
Vinay Umarji. Business Standard. September 25 2021. “Indian students’ overseas spending to hit $80 bn a year by 2024”. https://www.business-standard.com/article/education/indian-students-overseas-spending-to-hit-80-bn-a-year-by-2024-redseer-121092400679_1.html
John Calabrese. Middle East Institute. April 14 2020. “India-Gulf Migration: A Testing Time”. https://www.mei.edu/publications/india-gulf-migration-testing-time
Lauren Frayer. npr .org. June 29 2021. “India Is The World’s Biggest Vaccine Maker. Yet Only 4% Of Indians Are Vaccinated”. https://www.npr.org/sections/goatsandsoda/2021/06/29/1011022472/india-is-the-worlds-biggest-vaccine-maker-yet-only-4-of-indians-are-vaccinated
New York Times. October 18 2021. “Tracking Coronavirus in india: Latest Map and Case Count”. https://www.nytimes.com/interactive/2021/world/india-covid-cases.html
Neha Arora and Krishna N. Das. Reuters.com. April 15 2021. “Analysis: India Shifts from Mass Vaccine Exporter to Importer Worrying the World”. https://www.reuters.com/world/india/india-shifts-mass-vaccine-exporter-importer-worrying-world-2021-04-16/