The Government of India unveiled a completely revamped vaccine strategy.
The resultant vaccine inequity could make containment measures more difficult.
What is the recent decision?
Two key elements are the hallmark of this new strategy, which will be implemented from May 1, 2021.
1) The phased roll-out of the vaccination drive (initiated on January 16, 2021), under which the vaccine-eligible sections of the population were gradually increased, has now been extended to the entire adult population.
All above 18 years will now get vaccinated.
2) A significant deregulation of the vaccine market has been effected.
Vaccine manufacturers now have the freedom to sell 50% of their vaccine production to State governments and private hospitals.
This can be sold at prices that can be substantially higher than that hitherto fixed by the government.
A third element of the vaccine strategy, which was not announced formally, is a grant of ₹45 billion to the two vaccine manufacturers to boost their capacities.
Serum Institute of India (SII) and Bharat Biotech.
What are the concerns?
In the midst of the second wave of the pandemic, the Central government has abdicated its responsibility to ensure vaccine equity through free vaccination for the poor across all age groups.
State governments were never consulted or given prior notice about the change in vaccination policy.
And the two vaccine manufacturers are given a free hand to decide the price at which vaccines will be sold to State governments.
This has made universal COVID-19 vaccination a difficult task to achieve.
A large percentage of those aged 18-44 years does not have the resources to pay for vaccines.
Most of them will hence go without being vaccinated.
So, the States will have to take a leading role in the free immunisation programme.
Nearly two dozen States have already committed to vaccinate for free the target population.
It remains to be seen if they use any criteria to identify the beneficiaries.
What are the implications?
The Union government restricts itself to vaccinating for free just 300 million.
Never before has universal immunisation of nearly 600 million people been left to State governments and the private sector.
With this precedent, States will probably be required to vaccinate children too, when vaccines become available.
This will burden them even further and thereby actively promote vaccine inequity.
Making States pay for vaccines is an ill-conceived idea.
And forcing them to shell out more than what the Union government pays for the same vaccines will for sure exacerbate vaccine inequity.
Notably, vaccination is now the only safe way to end the pandemic.
So, undertaking any exercise that leaves a large population unprotected will cost the country enormously in terms of lives and livelihoods.
Is financial resource a constraint?
The Union government has already allocated ₹35,000 crore for COVID-19 vaccination in the current Budget.
It has also committed to provide further funds if required.
With this, it will have to spend less than ₹10,000 crore to vaccinate for free all above 45 years.
The sudden change in policy is therefore not due to lack of financial resources.
But, the State governments, which have not factored in funds for vaccination, will now be required to garner funds for the same.
There is hence a great compulsion to make pricing more transparent and allow States to collectively bargain for a lower price and assured timelines to receive supplies.
How does the future look?
The new policy takes the States and the companies to a completely uncharted territory leading to competition among States, and between State governments and private hospitals.
Vaccine shortage from both manufacturers is likely to last a few months.
There is less likely to be a smooth roll-out of vaccines for the target group given the combination of -
policy pandemonium
profiteering by vaccine manufacturers in the thick of the pandemic
vaccine shortage
This could lead to a dangerous situation where containment and mitigation measures become even more difficult.
In all, the new vaccine strategy could undermine “vaccination for all” (in a country that has long championed the cause of access to affordable medicines in international forums.)
