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Tuesday, June 22, 2021

We need a vaccine policy based on fairness and justice, not the current Centre vs state vs private sector mess

The convoluted policy is not ‘muddled’ but well thought through to deflect attention from Centre’s own mismanagement onto the states

Written by K. Sujatha Rao |
Updated: June 4, 2021 8:47:15 am
A youngster is administered a vaccine dose against Covid-19 in Chandigarh (Express Photo: Kamleshwar Singh)

A good public policy must be based on a principle. It has been challenging to find one in India’s liberalised vaccine policy, even for the Supreme Court, which observed in its order Wednesday that it has simply fragmented demand, expanded eligibility when supply is severely restricted, allowed suppliers to fix prices and fixed quotas to control sales. The Court summed up the policy as “arbitrary and irrational” and, like most of us, found it to be neither fitting into any known economic theory nor substantiating a principle, be it equity, competition or choice. It seems fair to conclude that the vaccine policy is simply whimsical. There is no evidence to show that the states demanded the right to procure. Instead, several CMs have written to the PM asking him to follow the settled policy governing immunisation, under which the central government procures the vaccines for obvious reasons of market advantage.

A deeper reflection, however, shows that the convoluted policy is not “muddled” but well thought through to serve three objectives for the party in power: One, deflect attention from own mismanagement onto the states, as evidenced by the frontal attacks on them for their “inability” to procure vaccines for those between 18-45 years. What we now see is the embarrassing charade of states running around suppliers, competing against each other and the private sector, as if we are many countries and not one. We see governments’ vaccination centres shutting down while the private hospitals sell vaccines for prices between Rs 850 to Rs 2,000 per dose. This situation does not seem to worry the powers that be, even as the external affairs minister has just returned after lecturing the western world about the virtues of equity when they have provided free vaccination to their citizens.

Two, politically, the central government has arrogated to itself the power to allocate quantities to be supplied to competing entities. But there appears to be no legal basis for imposing sales quotas on the manufacturers and cornering half the stocks at Rs 150/dose for itself. Besides, as this power is being leveraged “informally”, the companies are not obliged to inform states on delivery of stocks to ensure better coordination. This is likely to create confusion and disharmony between the state governments and private sector entities.

Three, this is an assertion of the politico-economic model being pursued by the current government in sectors like telecom or civil aviation, now applied to health, as can be seen in the reluctance to use its sovereign power of compulsory licensing, and instead preference to favour a few conglomerates and the private hospital industry. In the US, peoples’ aspiration for universal, equitable health for all has been consistently thwarted by the sectional lobbying of the hospital, pharma and insurance industry. In India, such a model would destroy millions of lives. In destroying a well laid down public health universal immunisation programme that is the envy of the world, the government is endangering peoples’ right to health security.

Notwithstanding the political advantages that the ruling party is deriving from the above policy mix, the social price being paid may not be worthwhile. The Covid caseload is falling but a third wave is expected to hit us around September, giving us four months to prepare. Currently, an estimated 12 per cent population has received one dose of the vaccine and about 4 per cent the second dose.

The recent Public Health England study regarding the efficacy of AstraZeneca (Covishield) vaccine against the strain B.1.617.2, the dominant strain in India, shows that one dose is 33 per cent efficacious and that increases to 59.5 per cent when the second dose is taken after eight weeks. Since 90 per cent of our vaccination is Covishield, we need to use our data to study its impact on different age groups/duration of vaccination to arrive at the right policy. Likewise, we need to get Bharat Biotech to complete its phase three trials and publish the findings and the SII to publish the results of their bridging trials. It’s unacceptable that they should be allowed to profiteer without even completing the minimum protocol required for technical evaluation.

Globally, also, the supply market is restricted. While Moderna has indicated its inability to supply any vaccine till the middle of ‘22, for Pfizer, the asks are ambitious — no technology transfer, regulatory oversight, bridging studies or indemnity. As it is, the Indian regulator has lost a lot of its reputation in the various emergency approvals it has given without due circumspection.

India has a well-grounded vaccination policy with well-defined boundaries between the Centre and the states regarding what has to be done by whom and based on the principle that infectious disease control is a shared responsibility. In creating a Centre vs state vs private sector situation, the central government has created a messy rigmarole.

I have six suggestions for the way forward: One, centralise procurement to speed up placing of orders and accessing vaccines. Price determination could be based on a short tender or alternatively, notify vaccines under the Drug Price Control Order and have the NPPA declare the base price. Keeping prices within a reasonable range is sound policy in today’s economic situation, as there is still no data to show for how long the vaccines provide immunity and whether a booster dose would be required soon. Affordability must definitely be a concern for government.

Two, make the vaccine available free to all so as to ensure no blackmarketing, siphoning, price gouging etc. Three, undertake data analysis to base policy on evidence. Vaccinating people on a random or a first-come-first-serve basis may not be the most efficient way. Instead, prioritisation must be based on epidemiological data. State level sero-surveillance studies, as done in Kerala, could be immensely useful.

Four, invest to ramp up production and place full orders to incentivise it, without compromising on quality. Five, launch campaigns particularly in rural areas to remove vaccine hesitancy; and, six, let CoWIN be an option, not a mandatory requirement, as more than half the population has no access to smart phones or technology.

There is no time to lose and none to waste on blame games. The GoI must heed the sound advice of the Supreme Court and review its policy so as to make it sustainable, based on the principle of fairness and justice.

This article first appeared in the print edition on June 4, 2021 under the title ‘Injecting confusion’.
The writer is a former Union Health Secretary.

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