Addressing Different Needs: The Challenges Faced by India as the Largest Vaccine Manufacturer While Conducting the World's Biggest COVID-19 Vaccination Campaign.

The COVID-19 pandemic has highlighted some of the challenges that countries face when balancing domestic and global necessities, for example with regard to vaccine needs, production and distribution. As India hosts one of the world's largest vaccine manufacturing industries and has one of the most extensive vaccination strategies, the country is particularly exposed to these challenges. This has become all the more obvious as the country experienced a second pandemic wave in the first half of 2021, which has led to a total ban on exports of COVID-19 vaccines. An analysis of the national vaccination strategy and the domestic vaccine industry through review of peer-reviewed literature, grey literature, and news reports showed the fragile balance between domestic and international needs. A numerical comparison of India's domestic COVID-19 vaccine needs, export agreements, and production capacities was conducted. It was found that at current production rates as of April 2021, meeting all of the needs and complying with all of the agreements would be impossible. Scale-ups in production, as promised by the industry, however, will enable the achievement of all targets in the long term.