Stop posturing; start vaccinating
A big powerful man had the best view of the lions at a crowded zoo. Another man kept nudging him for a better view. Exasperated, the big man picked him up and dropped him into the lion enclosure. There, he said, you now have the closest view. The policy to increase demand for vaccines by opening vaccination up to adults below 45 years, allowing states to compete, and firms to price, in a situation of vaccine supply shortage, seems born out of such pique.
States are irresponsible in demanding vaccination for all, when the total supply is not even three million doses a day. The Centre is reckless in agreeing to the demand and callous in designing a new “liberalised” scheme to replace a more reasonable previous policy.
Any vaccine policy must increase supply as quickly as possible; procure at the least expensive cost, while enabling medium-term planning; and distribute to most effectively save lives now and in the future. The current version does none of these.
First, we are buying vaccines like monthly groceries. The finance minister said that Serum Institute of India (SII) and Bharat Biotech will get an advance of ₹3,000 crore and ₹1,567 crore respectively. Instead, they are being paid about half that to supply 160 million doses at ₹157 a jab, a month’s supply if the target is five million a day, and for less than two months even at April’s lower usage. The implicit rationale is that the Centre will only help vaccinate the 45-plus population, with the rest of the supply presumably met from other firms.
Vaccinating the rest is the task of the states.
Will manufacturers invest in increasing supply, without clear future orders? Sputnik V has been approved and a few million initial doses will be imported, but, apparently, though six manufacturers reportedly stand ready to deliver, orders are awaited. Janssen and Novavax are not yet approved. Both have identified Indian manufacturing partners and one hopes they will not be deterred by the current need to negotiate with multiple states, rather than one national government. Covaxin supply too can be increased by outsourcing to other firms, especially since intellectual property rights are shared with the Indian Council of Medical Research.
We must stop shadowboxing. In no other federal country are sub-national governments competing to buy vaccines. The Centre should negotiate a single price for each vaccine, with a delivery schedule, contingent on regulatory approval. Large national orders will provide the reassurance needed for investment to the various manufacturers and reliability of supply for our vaccination demand of one-and-a-half billion doses.
This will allow firms to plan to meet our other international commitments, especially to COVAX, where our default in supply has left most developing nations hanging on to nothing, precipitating a Chinese turn.
Second, on pricing. The new policy appears designed to punish the states. In the relatively sensible “pre-liberalisation” policy, the vaccine cost was borne by the Centre, for which it has budgeted ₹35,000 crore, and the vaccination cost was largely borne by the state, with an important private supplement. Daily press releases of “free vaccines” to states, like a kind of dole, are offensive to this spirit of federal cost-sharing.
Under the new policy, the Centre procures only half the supply. A quarter is for states, shared as per central quota, and a quarter for the private sector, which is paying twice, or thrice (in Covaxin’s case) the price. If SII and Bharat Biotech behave like normal private firms, they will first meet the entire demand of the private sector at the higher price and then offer the remaining supply, if any, to the states. For the right to vaccinate younger people, states will now get less vaccine and pay more for it.
This is chillingly stated in the health minister’s blog. The “private… route will empower a large number of people to get themselves quickly vaccinated… those who can afford to get them at the private… rates shall go ahead.” Shared idealism indeed. Michael Sandel’s market society writ large. Or is it Deng Xiaoping — some people get rich first? All this so the states can vaccinate the 18-44 age group, which accounted for 12% of the vaccinations in the first week of May. Why is this tail wagging the dog?
Third, if the Centre negotiates price and quantities with vaccine-makers, supply can be transparently allocated using current metrics, ie a state’s population of 45-plus; possibly adding urbanisation, since the virus favours dense urban areas, though the second surge is not sparing villages; and current caseload — leveraging the first dose’s protection to save as many lives as possible.
There can be a little extra incentive supply for states that vaccinate more, while a small share can be flexible for state-specific demands. Similar flexibility already exists in the National Health Mission. If states can agree on tax-sharing, they can agree on vaccine-sharing too.
A predictable supply will allow states to plan better and take vaccines closer and faster to the people – rather than passively wait for them. Some version of such a substantially and radically modified policy — a more transparent and flexible version of what was being pursued “pre-liberalisation” — can even lead to a fully vaccinated population by year-end, and even exports if manufacturers invest in starting production early.
So, will the Centre and states continue to keep posturing or will they sit down to make a sensible policy? In the past, such bickering usually affected only livelihoods. This time, it affects lives – of Indians, and of people around the world.
Partha Mukhopadhyay is a senior fellow, Centre for Policy Research
The views expressed are personal