A Goliath of vaccine manufacturing in India is behind a push to inoculate swathes of the global population amid an escalating crisis on home turf.
The Serum Institute of India, the world's largest vaccine maker, has been hedging its bets on different vaccines, pumping in money and ramping up production accordingly.
Despite this, a row is brewing as a catastrophe plays out across the nation. India has clocked more than 20 million cases. 222,000 people have already died as a result of the virus. Official figures hide the fact that the true numbers are probably much higher.
The strain the health service is under has meant that oxygen and equipment shortages have past crisis point.
The delivery of contracts is being closely watched worldwide.
So, what is the Serum Institute?
The Serum Institute of India, based in Pune in the west of the country, is the world's largest vaccine manufacturer by number of doses produced and sold globally. Annually it pumps out more than 1.5 billion doses of life-saving shots.
Since it was founded in 1966 it has played an outsized role in getting the world inoculated against deadly diseases, as well as, more recently, in the fight against COVID-19.
The company went into last year with a workforce of 6,000 and revenues of $735m (£529m). This year those numbers are expected to balloon.
Founded by Dr Cyrus Poonawalla, it makes life-saving immuno-biologicals, which were originally in shortage in India and had been imported at high prices. It is now run by Adar Poonawalla who has inherited the family business.
Vaccines it manufactures include ones that protect against Polio, Diphtheria, Tetanus, Pertussis, Hib, BCG, r-Hepatitis B, Measles, Mumps and Rubella.
The institute enabled India to be self-sufficient in the production of Tetanus anti-toxin and anti-snake venom serum, followed by vaccines against DTP (Diphtheria, Tetanus and Pertussis) and then later MMR (Measles, Mumps and Rubella).
According to its website, it is estimated that about 65% of the children in the world receive at least one vaccine manufactured by Serum Institute, which are distributed in about 170 different countries.
How many COVID vaccines does it make and who does it supply?
In March, the Economist reported that the institute was set to ramp up production of COVID-19 vaccines, adding 1.5 billion coronavirus shots to the other vaccines it already manufactures per year.
It has already agreed to produce a variety of different shots for different nations.
The end of February saw its first mass dispatch of the Oxford-AstraZeneca (AZN.L) shot to India and 24 other poor countries as part of the Covax vaccine-sharing programme. Canada has already earmarked 500,000 doses from the plant for its own vaccine effort.
As per The Economist, the company's CEO, Poonawalla, had also planned to raise the monthly production of the AstraZeneca shot from between 60 and 70 million to 100 million by April.
In fact, it was one of the first manufacturers to begin producing the vaccine even before it had gone to clinical trial — a wild bet that has since seemingly paid off only in part.
It has put resources into producing between 40 and 50 million doses of the Novavax vaccine, which is currently under accelerated review. Other vaccines it plans to produce include one by SpyBiotech and Codagenix.
Safe to say, India is now at the heart of the COVID-19 vaccine global supply chain, a fact that has worried politicians around the world due to the explosion in case numbers and unchecked variants.
India's vaccine export ban and what might happen next?
Despite the manufacturing drive, only 2% of India's population are fully vaccinated, and just days ago the Institute warned that the failure to prepare for India's latest COVID wave has meant that shortages of vaccines could persist for months.
Up until a few months ago it looked as though the country had weathered the fallout from the virus fairly well. Prime minister Narendra Modi had even boasted that India had defeated COVID and his political party, the BJP, even passed a resolution hailing him as a visionary leader in February.
Both Modi and his party's boast has proved to be a bluster as just a month later in March cases started to climb and it was evident India was reeling from a deadly second wave, with the government's complete lack of anticipation of a second wave and disaster preparedness brutally exposed. By April daily death figures climbed into thousands and crematoriums in several parts of the country ran out of space and wood to burn the dead.
Already behind in vaccinations, and late in placing its own vaccine order with suppliers, the Indian government's attention turned to the country's apex vaccine maker, the Serum Institute.
As COVID cases spiked the Serum Institute had been operating at full pelt — 20 hours a day, but had been held back by various factors including fires at a new production facility and the fact India paused its AstraZeneca trials for a month while rare blood clots were investigated.
Modi has been accused of acting too slowly in the latest barrage of cases and for prioritising politics over the crisis.
New Delhi had ordered more than 100 million doses of the jab by March, when caseloads were climbing steeply. India also froze vaccine exports in March in order to focus on its own supply.
Poonawalla has been caught in the crossfire of supply politics, later pointing out that the government, not the company, was responsible for policy and that the government had not made the orders it needed.
This is despite the advance of a loan from the Indian government to bolster vaccine production lines.
India instead is pushing to buy more jabs from overseas including Russia's Sputnik V — but that could also take months to arrive.
On top of its Covax commitments, the Institute has supply agreements with several countries, including the UK. Health secretary Matt Hancock said in March that 5 million doses of the Oxford-AstraZeneca jab would be delayed due to the Institute's backlog.
Poonawalla told the Financial Times the shortage would last through July, when production is set to increase.
Adar Poonawalla's flight
Poonawalla has been communicating with the British press from London where he joined his family shortly before flight bans from "red list" countries were imposed in April.
He told The Times that politicians and business figures looking for access to vaccines had sent him "threats," while the FT reported he is in London for a business trip and planned to return to India soon.
In an FT interview, he said: "I've been victimised very unfairly and wrongly." He said the Serum Institute did not make more vaccines because there were no orders.
“The level of expectation and aggression is really unprecedented. It’s overwhelming. Everyone feels they should get the vaccine. They can’t understand why anyone else should get it before them,” Poonawalla told The Times at the start of May.
There has been speculation about whether he will stay put in London while the crisis rages on, although he has since tweeted hinting at a return.
Watch: India coronavirus cases top 20 million as US, Europe ease curbs