Vaccine for all adults: Maharashtra to use development funds

In a special cabinet meeting held on Tuesday, it was decided that the government will use the state’s development funds to procure vaccines, including those which may need to be imported, Maharashtra health minister Rajesh Tope said

In a special cabinet meeting held on Tuesday, it was decided that the government will use the state’s development funds to procure vaccines, including those which may need to be imported, Maharashtra health minister Rajesh Tope said.

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This decision comes a day after the Centre allowed all adults to seek a vaccine against Covid-19 starting May 1, although people under the age of 45 will only be able to receive doses once private sales begin or if state governments procure stocks for distribution to these age groups.

“We currently have two vaccines, Covishield and Covaxin, but if the need arises, we have also decided to import stock of other vaccines such as Pfizer-BioNTech, Moderna, and Sputnik from other countries. There will be no dearth of the money for the vaccine, as we have decided to use the development funds to procure vaccine stock,” Tope said after the meeting.

Sputnik V made by Russia’s Gamaleya Institute, was approved formally on April 13 and its initial doses are expected to be imported. On Monday, pharma giant Johnson & Johnson applied to India’s drug regulator seeking permission to conduct Phase-3 clinical trial of its single-dose Covid-19 vaccine in India as well as for an import license.

Last week India said that it would fast-track emergency approvals for vaccines authorised by Western countries and Japan, paving the way for possible imports of Pfizer, Johnson & Johnson, and Moderna shots. None of the companies have announced plans to enter the Indian market under the fast-track routes as yet.

In Maharashtra, with 73% of the state population in the age group of above 18 years, more than 90 million people are now eligible for the vaccine.

“A lot of the population from the age group of 18-44 years is from the working class and is highly mobile. Thus, they could transmit the virus to others. By vaccinating this age group we could contain the transmission rate at great extent,” Tope said.

Maharashtra has around 4200 vaccination centres with a daily inoculation rate of over 350,000 people. The state has so far administered 12.76 million doses on 11.32 million citizens. This means, in a month, 4 million people are being inoculated. At this rate, it would take well over a year to vaccinate the remaining 80 million. The pace needs to be augmented rapidly, a senior official of the public health department said.

“We are planning to increase the number of vaccination centres to more than 6000. Our manpower in the government machinery is all set to roll out the drive. There will be large-scale participation of the private sector which will help us in effective implementation of the drive. We expect adequate supply of the vaccine as three more manufacturers are set to enter the market,” Dr TP Lahane, Director of Medical Education and Research, said.

Health department officials said that they were expecting guidelines to be issued by the central government soon which would clarify specific questions on cost (how much the Centre will pay, and how much will the state have to spend); supply frequency; and pricing of vaccinations (whether the Centre would put a cap on the price, which Monday’s order said would be decided by the vaccine manufacturers).

Apart from this, the state will also have to take a call on which section of the 18-44 age group it would bear the vaccination cost for, as well whether it would need to exercise control over how many vaccine doses can private hospitals buy. This will prove vital to ensure equitable vaccination for all, as well as help the state earmark the outlay for the inoculation.

“We have robust infrastructure in Maharashtra with the past experience of implementation of such huge vaccination drive. We are only concerned about the supply of the doses,” said state immunisation officer Dr DN Patil.

The state government had been demanding the stock of about 5 million doses per week as it had aimed to double its daily inoculation to 700,000 doses.

The official said that though the state has the infrastructure with the capacity of vaccinating 1 million people a day, the health care workers in the government and private sector are fatigued. “We will have to increase the number of vaccination centres to a large number for which additional personnel will be required.”

“We are also expecting the price of the vaccine to drop further amid the increase in the demand and one more player (Sputnik) likely to be added in the next few weeks. At the same time, we are also planning to rope in the private sector by allowing the corporate houses to inoculate their employees and social organisations to hold the camps,” said the official.

According to the details in the PIB statement issued on Monday, vaccine makers will be able to sell half of what they produce at a price of their choosing to the open market and to state governments.

If the vaccines have been imported as ready-to-use, the government will allow all of the stocks to be sold on the open market or to the states. The pricing for any doses sold in the open market will need to be “transparent”, although the government’s release did not indicate a cap.

Vaccine manufacturers will still need to supply half the vaccines to the Centre for the state-sponsored component of the vaccination programme, which remains limited to the 45-and-over age group, and health care and front-line workers even after May 1.

However, people under the age of 45 will only be able to receive doses once private sales begin or if state governments procure stocks for distribution to these age groups.

The Centre said that the allocation of doses to states and Union territories will be on the basis of their active case load and their performance in vaccinating people, while wastage will be taken into effect as criteria that can affect a state negatively when doses are being distributed by Centre.

“We never have stock for more than 3-4 days. We have been planning to ramp up the daily inoculation to 6-7 lakh people, but the short supply of the doses is causing a hindrance. Now the Centre has announced to allow the state to procure the stock directly from the manufacturers, but it remains to be seen if the manufacturers have the capacity of the production,” said another official from the health department.

Both, Covishield and Covaxin are manufactured in India, by Serum Institute of India and Bharat Biotech respectively. An executive of SII said that the company would be able to ramp up production from the current 60 million doses a month to 110 million doses by June. The Centre on Monday agreed to pay SII ₹3000 crore advance payment of two months for vaccines.

J&J and Novavax already have licensed Indian companies (J&J has authorised Biological E and Novavax has authorised Serum Institute of India) to produce millions of doses.

Tope said that the United Kingdom vaccinated 60% of its population within three months of the lockdown and it has helped it in bringing down the positivity and mortality rate drastically. He said that the Central government should continue to bear the financial burden for the people above 45 years.

“The vaccine companies overwhelmed with the orders from other countries and the waiting period for the delivery is long. The Maharashtra government wants to register its orders for Pfizer, Moderna vaccines in advance,” a health department official said.