India, the world’s second-most populous country with nearly 1.4 billion people, has authorized two COVID-19 vaccines and will start a gargantuan inoculation program this week. The country has the second-largest virus outbreak after the U.S with more than 10.3 million confirmed coronavirus cases and over 149,000 deaths — which makes mass vaccination very necessary, but also very difficult.

The country granted emergency approval to two vaccines: the one developed by AstraZeneca and Oxford University and the one developed by the state-run institute Bharat Biotech. Both will be administered in two dosages and were “carefully examined,” India’s Drugs Controller General Venugopal G. Somani told AP.

The news was welcomed by Indian Prime Minister Narendra Modi, who called the vaccine approval a “decisive turning point to strengthen a spirited fight” and said every Indian should be proud of the development. Still, a massive vaccination like the one planned by the government can never be easy.

A decisive turning point to strengthen a spirited fight!

DCGI granting approval to vaccines of @SerumInstIndia and @BharatBiotech accelerates the road to a healthier and COVID-free nation.

Congratulations India.

Congratulations to our hardworking scientists and innovators.

— Narendra Modi (@narendramodi) January 3, 2021

Starting this month, health care and front-line workers such as police officers will be vaccinated in the first phase of the campaign, as well as those above 50 years of age and those with pre-existing conditions. India aims to vaccinate up to 300 million people by summer. Getting the shot will be voluntary, officials say.

The massive campaign will build on the country’s election platform. Demographic information from the electoral rolls will be used to identify elderly people who need the vaccine. The vaccination sites will be set up like polling booths, with officers responsible for verifying identification documents and managing crowds.

India already carried out mock vaccinations last Saturday at more than 250 sites across the country. The test included all the steps involved in a vaccination campaign, from transporting the vaccine to checking how the doses will be administered. The government is also working on a website to monitor vaccine delivery.

Producing vaccines

India’s Serum Institute, the world’s largest vaccine manufacturer, was contracted by AstraZeneca to produce one billion doses for its vaccine for developing nations, including India. But exports from India won’t be allowed for several months says Adar Poonawalla, Serum Institute’s CEO, told AP, which might delay vaccination in other countries.

Although the manufacturer doesn’t have a written agreement with the Indian government, India will undoubtedly be its main priority, having already given the country most of its stockpile of around 50 million doses. The decision was taken to ensure protection to vulnerable populations in India and to prevent hoarding, Poonawalla said.

India is the second country to approve the AstraZeneca-Oxford vaccine after the UK approved it last week. It’s a cheap vaccine, costing between $3 to $4 per dose to produce. AstraZeneca has vowed not to make a profit during the pandemic. It’s also easier to transport and store than others like Pfizer’s.

But this isn’t India’s only choice amid the pandemic. The country is also betting on COVAXIN, the second vaccine so far approved by the government. It was developed by Bharat Biotech in collaboration with government agencies but it’s still in stage 3 clinical trials, with the results yet to be released by the manufacturer.

The trials started in mid-November with over 25,000 volunteers. The Drugs Controller General of India said in a statement that the vaccine has been found “to be safe as per the data available” but India Drug Action Network, a public health watchdog, asked for more transparency and said there’s not sufficient data. It’s a somewhat similar situation to Russia, where the vaccine has also been approved before completing Phase III trials.

As well as India, other countries are also working to secure vaccines and start vaccination as soon as possible. At least 7.7 billion vaccine doses have already been purchased, with another 3.9 billion reserved should countries or blocs elect to expand their orders, according to Duke University’s tracker.

The U.S. has reserved nearly one-quarter of the global supply with 2.6 billion doses, combining both categories. On the other hand, not a single country in sub-Saharan Africa has announced a deal to purchase vaccine doses. Nevertheless, Johnson & Johnson is aiming to produce 300 million doses in South Africa next year, and other vaccines are also right around the corner.