Centre must own up to failures in handling second wave

Our ineptness to strategise the vaccination drive borders on criminal negligence. The two pillars of immunising a large population quickly and efficiently are procurement and delivery. In India, we have struggled on both fronts. While other countries placed advance commitments towards procuring vaccine supplies by mid-2020, India placed its first such order only a few days before the launch of its vaccination drive in January 2021. On April 28, the government announced a second order for 160 million doses to be delivered between May and July. Even this was too late. While infections peaked at over 4,00,000 daily new cases by the first week of May, the policy was abruptly changed — from prioritisation of high-risk groups to opening up of the vaccination drive to everyone over 18. This at a time when there is a global shortage of ancillary material critical to the development of vaccines.

India is currently administering two vaccines — Covishield by Serum Institute of India (SII) with a current manufacturing capacity of 65 million doses per month, of which a portion goes towards global commitments. Bharat Biotech’s (Covaxin) current manufacturing capacity is 20 million doses per month. The current total vaccine production in India is only 70-80 million doses a month to serve 940 million eligible candidates. Since January, India has exported approximately 66 million doses. While some of these exports were unavoidable, we did not do the math on the shortages that our country could have faced.

In April, while the second wave was in full swing, the government granted additional funding to SII and Bharat Biotech to increase their production capacity starting August 2021 along with a new order for vaccines. This is too little too late. Positive cases continue to surge. The shortage of vaccines has led to a sharp decrease in the vaccination rate: From a daily average of 3.65 million administered from April 1 to April 10, to an average of 1.8 million in May.

Having failed to procure vaccines in time, the Union has cleverly shifted the burden of procurement to state governments. The decentralised model for vaccination and the new liberalised pricing model is flawed. It allows manufacturers to sell only 50 per cent of doses produced directly to state governments, private hospitals and industry whereas the other 50 per cent goes to the Centre. States are now competing with one another and the private sector to procure doses. Many states have had to halt vaccinations due to a shortage in supply.

With domestic production reaching capacity, the only solution at the moment seems to be supplementing supply with imported vaccines. In response to a public outcry, the government has recently fast-tracked approvals for vaccines that have been granted emergency approval by select foreign regulatory authorities. Russia’s Sputnik V is the first such example. India is also in talks with Pfizer, Moderna, and Johnson & Johnson as well as with the US to secure a waiver for the procurement of raw materials essential for scaling up indigenous manufacturing. These discussions need to be expedited.

The new vaccination policy outlined by the Centre seeks to procure 2.1 billion doses between August and December 2021. However, five of the eight different vaccines outlined in the plan are currently undergoing trials and a multi-fold increase in current production capacity in a matter of months seems unlikely. When and if available, the delivery mechanism needs to be centralised, modelled on our successful Universal Immunisation Programme. Similarly, we need to supplement technological interventions like CoWin with tried-and-tested methods such as door-to-door vaccination.

Having fallen miserably short in our procurement strategies, our vaccination policy and treatment approaches should be thought through. There has been a huge gap in quickly and effectively communicating Covid-19 guidelines in tandem with emerging evidence. Such ineptness must not be repeated. The second wave saw a surge in over-prescription of medicines and treatments such as remdesivir and plasma therapy with little regulatory control. We should start looking ahead to newer interventions. Pharmaceutical manufacturers across the globe are testing promising interventions such as antivirals in pill form, monoclonal antibodies and immune modulators. We need to ease regulatory processes and make advance commitments to secure validated treatments as soon as they are available.

We must be alive to the fact that the course Covid-19 takes in our country, directly or indirectly, affects the world. Tackling the pandemic — based on science and hard, peer-reviewed evidence — is critical. It is time for the government to do a “mea culpa”, acknowledge the policy and planning mess-ups and course-correct as quickly as possible. If not, the consequences will be even more tragic.

This column first appeared in the print edition on May 27, 2021 under the title ‘Silence of the loquacious’. The writer, a senior Congress leader, is a former Union minister