News Analysis India

Tag: Covishield

  • Covishield gives 93% protection against COVID, 98% mortality reduction, finds AFMC study

    By PTI
    NEW DELHI: Covishield gives 93 per cent protection against COVID-19 and a 98 per cent mortality reduction, the government said on Tuesday referring to a study by the Armed Forces Medical College (AFMC) during the second COVID-19 wave that was driven by the Delta variant.

    Addressing a press conference, NITI Aayog Member (Health) Dr V K Paul presented findings of the study which was conducted on 15 lakh doctors and frontline workers.

    ALSO READ | Both Covishield and Covaxin cut severity of Delta variant: Study

    “Protection to the extent of 93 per cent was seen (in people who were administered the Covishield vaccine) and this was during the second wave which was driven by the Delta variant also 98 per cent mortality reduction was seen,” he said.

    Reiterating the usefulness of vaccines in battling COVID-19, Paul said inoculation reduces infection but it is not a total guarantee.

    “No vaccine guarantees that infection will not happen but serious disease gets prevented and nearly eliminated.

    I urge you to please be vigilant, be careful, have faith in our vaccines and continue to be careful in the weeks and months ahead,” he added.

  • No shortage of vaccines, only marginal difference in purchase prices: MoS Health

    By PTI
    NEW DELHI: The Centre is purchasing Covishield and Covaxin doses at the rate of Rs 205 and Rs 215 per dose, respectively, and there is only a marginal difference in the purchase price of the two vaccines for the government, the Lok Sabha was informed on Friday.

    In a written reply, Minister of State for Health Bharati Pravin Pawar also said that the government is not facing any difficulty in procuring and arranging vaccines for states and Union territories (UTs).

    In fact, the Government of India has been supplying vaccines free of cost to the states/UTs for administration to prioritised beneficiaries as recommended by the National Expert Group on Vaccine Administration for COVID-19 (NEGVAC).

    “Advance visibility of these allocations, that is, the total doses of vaccine that would be available to a state and UT, is provided to them 15 days in advance, so as to enable them to plan for acceleration of vaccination coverage while being cognizant of the available vaccines,” the minister said.

    The Government of India allocates vaccines to states/UTs based on criteria such as pro rata target population, progress of vaccination in the state and UT and vaccine wastage.

    “According to the latest supply order, the Government of India is purchasing Covishield (exclusive of taxes) at the rate of Rs 205 per dose and Covaxin at the rate of Rs 215 per dose.

    There is only a marginal difference in the purchase price of the two vaccines for the Government of India,” Pawar said in the written reply.

    As on July 20, 2021, a total of 42.52 crore doses of Covishield and Covaxin have been supplied for COVID-19 vaccination drive in India.

    Till July, around Rs 8,071.09 crore has been spent on purchase of COVID-19 vaccines.

    The price of vaccine for procurement by the Government of India is negotiated by NEGVAC and its subgroups involving detailed deliberations with the vaccine manufacturers, the minister told the House in response to a separate question.

    She further elaborated on the initiatives taken by the Union government to help Indian vaccine manufacturers who are in the process of developing COVID-19 vaccine which are in advance stage of trial.

    The Department of Biotechnology (DBT) under the Ministry of Science and Technology is implementing ‘COVID Suraksha- the Indian COVID-19 Vaccine Development Mission’.

    Under the mission, facility augmentation for production of Covaxin is being supported whereby Bharat Biotech and three public sector enterprises, including Haffkine Biopharmaceutical Corporation Ltd, Mumbai; Indian Immunologicals Limited (IIL), Hyderabad; and Bharat Immunologicals Biologicals Limited (BIBCOL), Bulandshahr, are being supported.

    Additionally, technology transfer of Covaxin production to a consortium of partners, including Hester Biosciences and OmniBRx Biotechnologies Pvt Ltd led by Gujarat Biotechnology Research Centre (GBRC), Department of Science and Technology, Government of Gujarat, is being facilitated by the Department of Biotechnology, the minister said.

    The Government of India has also provided financial assistance to domestic vaccine manufacturer ‘Biological E’ which is at present in advance phase III clinical trial for ‘At-risk manufacturing’ of COVID-19 vaccine, she added.

    As on date, no foreign COVID-19 vaccines have been purchased or received as donation by the government of India, Bharati said.

    On whether India in the first instance exported vaccine without assessing the impact of the second wave and need of vaccine in the country, Pawar, in a written reply, said the government of India has secured COVID-19 vaccines for the eligible beneficiaries as per the availability of vaccines in the country.

    In response to another question on whether the government has signed any agreement with foreign countries for supplying Covid vaccine to India, the minister said while the government of India is engaged in a dialogue with foreign manufacturers of Covid vaccine, no specific agreement has been signed as yet.

    The export quantity comprised vaccines committed under international agreements by the domestic manufacturer to COVAX and its individual commitments to other countries or organisations and vaccines supplied through the “Vaccine Maitri” initiative, Pawar said in the written reply.

    Elaborating on the reasons for not identifying journalists as frontline workers and giving them priority for vaccination, she said COVID-19 vaccination is guided by the National Expert Group on Vaccine Administration for COVID-19 (NEGVAC) on the basis of concurrent scientific evidence.

    The prioritisation for vaccination has been done with an aim to protect the pandemic response and health system and to have maximum impact on reduction of disease and deaths due to COVID-19, she said.

    This was later followed by age-based prioritisation, which is considered equitable and which has also been the practice globally, Pawar stated.

    On the total doses of foreign vaccines so far received on purchase or as donation so far and the timeline fixed by the government to vaccinate all the eligible people in the country, she said, “As on date, no foreign COVID-19 vaccine has been purchased or received as donation by the government of India”.

    In view of the dynamic and evolving nature of the COVID-19 pandemic, no fixed timelines at present can be indicated for the completion of the vaccination drive, however, it is expected that all beneficiaries aged 18 years and above will be vaccinated by December 2021, she stated.

    The National COVID-19 Vaccination Drive is progressing at a steady pace and Covid vaccination has improved significantly from 2.35 lakh doses per day in the month of January 2021 to an average of 39.89 lakh doses per day in the month of June 2021, Pawar said.

    However, in order to raise awareness about COVID-19 vaccines, address vaccine hesitancy and sustain vaccine confidence, a communication strategy is in , lace which is being implemented across all states and UTs, she said in another reply.

    Under the National Covid Vaccination Program, from January 16 to April 30 2021, 100 per cent of vaccine doses were procured by the government of India and provided free of cost to state governments.

    From May 1 to June 20, “The Liberalized Pricing and Accelerated National COVID-19 Vaccination Strategy” was brought in effect in order to incentivize production by vaccine manufacturers and encourage new COVID-19 vaccines.

    Under this strategy, states and UTs and private hospitals were allowed to procure COVID-19 vaccine directly from manufacturers.

    The government of India procured 50 per cent of monthly vaccine production by the domestic manufacturers, the state government and private hospitals procured remaining 50 per cent doses.

    The quantity of doses available for states and UTs and private hospitals was worked out on state-wise population of 18 to 44 years on pro-rata basis, Pawar said in her reply.

    The “Revised Guidelines for Implementation of National COVID Vaccination Program” were issued on June 8, to be effective from June 21 under which the government of India is procuring 75 per cent of COVID-19 vaccines produced in the country and providing it free of cost to states and UTs.

    The states and UTs, in turn, will administer the vaccines free of cost to all citizens as per priority.

    The domestic vaccine manufacturers have the option to provide 25 per cent of their monthly vaccine production directly to private hospitals.

    The guidelines were reviewed and revised keeping in view the experiences gained from May 1 this year and the repeated requests received from states, the reply stated.

    Advance visibility of vaccine allocation — total doses that would be available for states and UTs — are provided 15 days in advance to enable them to plan for acceleration of vaccination coverage while being cognizant of the available vaccines, she said in a written reply.

    Asked whether the government is aware that many inoculation sites got closed down due to non-availability of vaccines there, Pawar said, “There has been no shortage of vaccines and the Government of India has been providing free supply of vaccines to states and UTs for administration to prioritised beneficiaries as recommended by NEGVAC (National Empowered Group on Vaccine Administration against COVID-19).”

    On whether the government is aware that less than 10 per cent of Indians have got single dose of Covid vaccine despite India being the world’s leading vaccine manufacturer, the minister said as of July 20, around 34.5 per cent of the estimated population aged 18 years and above has received at least one dose of COVID-19 vaccine.

    As of July 20, 2021, a total of 32.64 crore first doses and 8.55 crore second doses have been administered across the country.

    A total of 2.15 lakh COVID-19 Vaccination Centres have been operational across the country, Pawar said.

    The Government of India has taken many steps to augment the domestic manufacturing capacity of COVID-19 vaccines.

    These include support to M/s Bharat Biotech and three Public Sector Enterprises under ‘Mission COVID Suraksha-the Indian COVID-19 Vaccine Development Mission’, technology transfer of Covaxin production, financial assistance to one of the domestic vaccine manufacturers for ‘at-risk manufacturing’, advance payment against the supply orders placed with M/s Serum Institute of India and M/s Bharat Biotech, and streamlining of regulatory norms for approval of vaccines, the minister said.

  • Current average monthly production capacity of Covishield 11 crore doses, Covaxin 2.5 crore doses: Government

    The procurement of COVID-19 vaccines by the Government of India, state governments and private hospitals is 36.01 crore doses of Covishield and 5.45 crore doses of Covaxin.

  • Private hospitals write to Centre, say they are struggling to procure Covid-19 vaccines

    Express News Service
    NEW DELHI: Private hospitals in most parts of the country, barring metropolitan cities, seem to be struggling to carry out Covid-19 vaccination due to low supply by the vaccine manufacturers and coordination issues at the state level under the new inoculation regime.  

    Days after criticism by the Centre for the slow pace of vaccination, their representatives have retorted in a letter to the government, which The New Indian Express has accessed, that the majority of the available vaccines this month has gone to the Central quota.

    The Association of Private Healthcare Providers of India, in a letter to the Union health ministry has said that since vaccine manufacturing ramp up is yet to materialise fully, most of the stock is picked up by the central government for distribution.

    After that not much was available for the private sector, they noted. It is only after July 15 there has been progress on procurement of vaccines by private hospitals.

    “It is therefore not correct to say that the private sector was not showing interest in vaccination,” said the letter.

    Of about 41 crore Covid-19 vaccine doses administered in India, it is not clear how many were given out in private hospitals. Sources said it could be in the range of 7-8 crore – the majority of which may be concentrated only in a handful of cities.

    ALSO READ | In a fresh report, national AEFI panel confirms 55 severe adverse events after COVID-19 shots

    From June 21, the Centre has taken over the responsibility of procuring 75 % of the total available Covid-19 vaccines in India while the rest is up for procurement by private hospitals.

    Last week, in a review meeting of the vaccination at private centres, Union health secretary Rajesh Bhushan had termed the slow pace of vaccination through such hospitals as a “cause of serious worry”.

    In the letter, the AHPI however pointed out that many hospitals were not able to get the vaccine for a variety of reasons, which could include the absence of coordination at state-government level and also inability on the part of manufacturers to supply the vaccine.

    It also cited a recent survey carried out during the first two weeks of July among 70 private hospitals to gauge the status of supply of vaccines to private hospitals. About 77% of the hospitals said that they were not getting the vaccine on time and 41% hospitals said that there were no nodal officers appointed by state governments in their localities.

    ALSO READ | Those who get jabbed become ‘Baahubali’, over 40 crore people vaccinated against COVID: PM

    “It shows that the new system which was to come in effect from 21st June, has still not been in full functionality and therefore it will not be correct to say that private hospitals were not showing interest in vaccination,” the association has said.

  • Over 40 crore vaccines administered in country, Centre to acquire 66 crore doses more

    By PTI
    NEW DELHI: The cumulative number of COVID-19 vaccine doses administered in the country has gone past 40 crore with over 46.38 lakh doses given on Saturday, according to the Union health ministry.

    A total of 21,18,682 beneficiaries in the age group of 18-44 years received the first dose, while 2,33,019 were administered the second dose of the vaccine on Saturday, the ministry said.

    “India’s cumulative COVID vaccination coverage has surpassed 40 crore (40,44,67,526),” according to a provisional report compiled at 7 pm.

    More than 46.38 lakh (46,38,106) vaccine doses were administered on Saturday, the report said.

    Cumulatively, 12,40,07,069 people in the 18-44 age group have received the first dose and 48,50,858 have been administered the second dose across the 37 states and Union territories since the start of the third phase of the nationwide vaccination drive.

    Eight states — Uttar Pradesh, Madhya Pradesh, Rajasthan, Tamil Nadu, Bihar, Gujarat, Karnataka and Maharashtra — have administered the first dose of the vaccine to more than 50 lakh beneficiaries in the 18-44 age group each.

    Andhra Pradesh, Assam, Chhattisgarh, Delhi, Haryana, Jharkhand, Kerala, Telangana, Himachal Pradesh, Odisha, Punjab, Uttarakhand and West Bengal have administered the first dose of the vaccine to more than 10 lakh beneficiaries in the 18-44 age group each.

    The Centre has placed an order to procure 66 crore more doses of Covishield and Covaxin to be supplied between August and December this year, at a revised price of Rs 205 and Rs 215 per dose, respectively, excluding taxes, official sources said.

    They said 37.5 crore of Covishield doses from the Serum Institute of India and 28.5 crore Covaxin doses from Bharat Biotech will be procured by December.

    “An order to procure 66 crore more doses of COVID-19 vaccines–Covishield and Covaxin–to be supplied between August and December, at a revised price of Rs 205 and Rs 215 per dose, respectively, excluding taxes, has been placed,” the source said.

    The price of each dose of Covishield amounts to Rs 215.25 and Covaxin Rs 225.75, including taxes, it said.

    The Union health ministry which was procuring both the vaccines at Rs 150 per dose, had indicated that the prices would be revised after the new COVID-19 vaccine procurement policy came into effect from June 21.

    Under the new policy, the ministry will procure 75 per cent of the vaccines being produced by the drug manufacturers in the country.

    While the Centre has asked both the vaccine manufacturing firms to scale up their production, the manufacturers had indicated that getting Rs 150 for each dose while making investments to ramp up the production was not viable for them, sources said.

    The Union government had earlier allowed states and private hospitals to procure 50 per cent of the vaccines following demands for decentralisation of the process.

    However, after several states complained of problems including of funding, Prime Minister Narendra Modi announced the revision of the vaccine guidelines on June 8.

    Domestic vaccine manufacturers are given the option to provide 25 per cent of their monthly production of vaccines to private hospitals.

    According to the revised guidelines which came into effect from June 21, vaccine doses provided free of cost by the Centre will be allocated to states/UTs based on criteria such as population, disease burden and the progress of vaccination, and all above the age of 18 will be eligible for the free jabs.

    Any wastage of vaccine will affect the allocation negatively.

    The states and UTs would aggregate the demand of private hospitals keeping in view equitable distribution between large and small private hospitals and regional balance.

    “Based on this aggregated demand, the Government of India will facilitate the supply of these vaccines to the private hospitals and their payment through the National Health Authority’s electronic platform. This would enable the smaller and remoter private hospitals to obtain a timely supply of vaccines, and further equitable access and regional balance,” the ministry had said.

    The price of vaccine doses for private hospitals would be declared by each vaccine manufacturer, and any subsequent changes would be notified in advance, it said.

    More than 41.69 crore vaccine doses have been provided to states and UTs so far, through all sources, the health ministry said on Saturday.

    In a statement, the ministry said 18,16,140 more doses are in the process of being supplied.

    It said that 41,69,24,550 vaccine doses have been provided to states and Union Territories (UTs) so far through all sources.

    Of this, the total consumption, including wastage, is 38,94,87,442 doses, according to data available at 8 am Saturday, the ministry said.

    It said that 2,74,37,108 Covid vaccine doses — balance and unutilised — are still available with states and UTs, and private hospitals.

    The new phase of universalisation of COVID-19 vaccination programme commenced from June 21.

    The new phase of the universalisation of COVID-19 vaccination programme started on June 21 and under it, the central government made inoculation free of cost for all adults.

    Vaccines were earlier free for people above 45 years of age.

    Under the nationwide vaccination drive, the government of India has been supporting states and UTs by providing them the vaccines, the ministry said.

    In the new phase of the drive, the Union government will procure and supply free of cost 75 per cent of the vaccines being produced by vaccine manufacturers in the country to states and UTs.it said.

  • Delhi HC refuses to entertain plea to reduce Covishield dosage interval

    By PTI
    NEW DELHI: The Delhi High Court on Thursday refused to entertain a plea seeking reduction of the 12-16 week interval for the second dose of Covishield vaccine to eight weeks for persons over 50 years of age and those having comorbidities.

    “We are not inclined to issue notice. We will dismiss with costs,” said a bench of Chief Justice DN Patel and Justice Jyoti Singh on a PIL by Dr Siddharth De. “Are you aware of any procedure? How are doses fixed? Who is fixing the doses? We will have to alter the procedure if at all we have the power to do so,” the court questioned the counsel for De, advocate Kuldeep Jauhari.

    Jauhari responded that there was a COVID working group and other expert groups which looked into the aspect. He added that based on studies conducted by scientists in the UK, there was a need to reduce the dosage interval in view of the new variants of COVID-19.

    The court opined that Jauhari was unable to convince it. “You are unable to convince us. Just for the sake of arguing you are arguing”, the court said.

    While Jauhari claimed that the petition was an honest PIL, the court responded that it had no doubt regarding the honesty of the plea and dismissal was not a certificate of dishonesty. Jauhari subsequently withdrew the plea unconditionally. The gap between two doses of Covishield vaccine is presently 12 to 16 weeks.

  • With Covishield ‘running out’ and Covaxin left for a day, Punjab wants enhanced supplies

    By PTI
    CHANDIGARH: With Punjab running out of coronavirus vaccine Covishield and left with only one day’s stock of Covaxin, Chief Minister Amarinder Singh Friday reiterated the need for enhanced supplies from the Centre, his office said Friday.

    The increase in supplies was critical also because the state on Friday lifted weekend and night curfews and allowed reopening of colleges, cinema halls, malls, restaurants, bars and gyms to those who have received at least one dose of COVID-19 vaccine.

    “With the state running out of Covishield & left with only one day’s stock of Covaxin, CM @Capt_Amarinder Singh again stressed the need for increase in vaccine supplies from Centre,” the Chief Minister’s Office tweeted.

    During a Covid review meet, the chief minister directed officials to continue pursuing aggressively with the Centre enhancing the state’s quota of vaccine.

    Pointing out that Punjab has already vaccinated nearly 83 lakh eligible people (approximately 27 per cent of population) — 70 lakh first doses, 13 lakh second — the Chief Minister said the stock was being utilised in the state without any wastage.

    Punjab was able to utilise more than six lakh doses in a single day when adequate supply was received, he noted at the Covid review meeting.

    Chief Secretary Vini Mahajan told the meeting that the administration was following up with the Centre for more doses.

    Meanwhile, the CM also asked the departments concerned to step up whole genome sequencing (WGS) to expeditiously identify cases of new Covid variant and to fast track execution of an MoU with the Indian Council Medical Research (ICMR) for a regional institute of virology at Mohali.

    Though no fresh cases of Delta Plus variant (apart from two reported earlier based on May sampling) have been identified in the state, the Chief Minister directed that the WGS Lab at GMCH Patiala must become functional this month.

    The CM noted with satisfaction that the state was also starting dry swab testing, with a pilot at government medical college Patiala next week.

  • Centre’s target of supplying 51.5 crore COVID vaccine doses by July end may fall short by over 10%

    Express News Service
    NEW DELHI: The Centre’s target of supplying India with 51.5 crore COVID-19 vaccine doses by July end may fall short by over 10%, shows an analysis of the vaccine supplies so far and the projections for this month.

    The figures shared by the Union ministry of health and family welfare show that while about 34 crore COVID-19 vaccine doses were supplied to states till June end, the projected availability of vaccines in July is 12 crore.

    Together this adds up to 46 crore, which is 5.5 crore or 11% less than the figure projected earlier by the government for supply till July.

    The shortfall in the projected supply does not paint a happy picture as only about 4.4% of the 94 crore adult population in India have been fully vaccinated so far.

    Of the projected supply of vaccines for July, there will be 10 crore doses of Covishield and 2 crore doses of Covaxin. A further break-up proposed by the government for this month shows that 7.5 crore Covishield doses will be supplied to government hospitals while 2.5 crore doses will go to private hospitals.

    ALSO READ: Covaxin phase three results decoded: Vaccine offers 93.4 per cent protection from severe Covid, 65.2 per cent immunity against Delta variant

    Similarly, 1.5 crore Covaxin doses will be available for government facilities, while private hospitals will get a share of only 50 lakh doses.

    This is in line with the Centre’s revised COVID-19 vaccination strategy under which it will directly procure and supply 75% of vaccine doses available in the country to government hospitals for free vaccination of all adults, while the rest will be procured by private hospitals for paid vaccinations.

    This new policy came into effect from June 21. A look at the daily COVID-19 vaccination graph however suggests that after reaching a peak of over 85 lakh daily vaccinations on this day, the figures have been dropping. In June, the average daily vaccination was less than 39 lakh doses and given that a maximum of 12 crore doses are available for July, the average daily vaccination for this month too will remain only about 40 lakh.

    Biostatisticians however have estimated that in order to fully inoculate the entire adult population in the country by the year-end, 90 lakh doses should be administered daily — a target that looks nearly impossible given the vaccine shortage.

    Despite the government’s efforts to ramp up the production of the vaccines in the country, it conceded in an affidavit in the Supreme Court recently that only about 135 crore vaccine doses may be available between August and December this year.

    This is a revision from its earlier far more ambitious target of 216 crore vaccine doses projected for the last five months of the year.

    Five states with the maximum vaccine supply this month

    1. Uttar Pradesh — 1,91,16,830 doses

    2. Maharashtra — 1,15,25,270 doses

    3. Bihar — 91,81,930 doses

    4. West Bengal — 90,12,680 doses

    5. Tamil Nadu — 71,01,320

  • Nine countries in Europe accepting Covishield for travel: Sources

    Austria, Germany, Slovenia, Greece, Iceland, Ireland and Spain are among the countries allowing travel by people who have taken Covishield vaccines, the sources said.

  • Consider Covishield, Covaxin vaccines under Green pass scheme to avoid mandatory quarantine: India tells EU nations

    By PTI
    NEW DELHI: As the European Union relaxes travel restrictions under its ‘Green Pass’ scheme, India has asked the members of the 27-nation grouping to individually consider allowing Indians who have taken Covishield and Covaxin vaccines and want to travel to Europe, sources said.

    India has also conveyed to the EU member states that it will adopt a policy of reciprocity and exempt European nationals holding the ‘Green Pass’ from mandatory quarantine in the country provided its request to recognise Covishield and Covaxin vaccines is heeded to, they said.

    The sources said India has requested the EU member nations to accept the vaccination certificate issued through the CoWIN portal.

    The European Union’s Digital COVID certificate or “Green Pass” will be rolled out on Thursday with an aim to facilitate free movement during the COVID-19 pandemic is to come into effect on Thursday.

    ALSO READ | Confident of getting EMA’s approval in a month for Covishield: Adar Poonawalla

    Under this framework, persons who have taken vaccines authorised by the European Medicines Agency (EMA) will be exempted from travel restrictions within the EU region.

    The individual member states have the flexibility to also accept vaccines that have been authorised at the national level or those recognised by the World Health Organisation (WHO).

    “We have requested EU member states to individually consider extending similar exemption to those persons who have taken COVID-19 vaccines in India, that is Covishield and Covaxin, and accept the vaccination certificate issued through the CoWIN portal,” said a source.

    The sources said the genuineness of such vaccination certification can be authenticated on the CoWIN portal.

    “We have also conveyed to EU member states that India will institute a reciprocal policy for recognition of the EU Digital Covid Certificate,” the source said.

    “Upon notification of Covishield and Covaxin for inclusion in the EU Digital Covid Certificate and recognition of Indian CoWIN vaccination certificates, Indian health authorities would reciprocally exempt the EU member state concerned for exemption from the mandatory quarantine of all those persons carrying EU digital COVID certificate,” the source said.

    There have been apprehensions in India that people who took Covishield and Covaxin jabs are unlikely to be eligible to travel to the European Union member states under its ‘Green Pass’ scheme.

    The EU Digital COVID certificate or ‘Green Pass’ will be mandatory to travel to European countries and the document will serve as proof that a person is vaccinated against COVID-19.

    An EU official on Tuesday said individual member states of the European Union will have the option to accept vaccines authorised by the World Health Organisation (WHO) like Covishield for obtaining the bloc’s digital COVID certificate.

    External Affairs Minister S Jaishankar on Tuesday took up the issue of inclusion of Covishield in the EU digital Covid certificate scheme during a meeting with Josep Borrell Fontelles, the High Representative of the European Union.

    The meeting took place on the sidelines of a G20 meeting in Italy.

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