What you should know about India's perplexing new vaccine strategy?
The update in eligibility of people to administer the vaccines from May 1, provided some solace. Vaccines will now be available to citizens of India of working age, the vast majority of the Indian population. But it also appeared a little perplexing. The government added 600 million people to the list of vaccination, just as the country appeared to be facing vaccine shortages and an inability to scale up its vaccination campaign. Eligibility for vaccines would be revised shortly, but experts say that no new vaccine stocks would be available by then.
These were two of the many questions that arose as reports of the brutal second wave of Covid-19 started to surface from around the country last week: “Has Prime Minister Narendra Modi and his government failed in their Covid-19 strategy?”, and “What were the equations behind his government's massive vaccination program, which seemed to be losing momentum rather than gaining traction?” Both questions received responses this week, albeit unsatisfactory ones. The government of India announced a range of changes to its Covid-19 vaccination policy on Monday, including making every adult eligible for a shot beginning May 1.
What Changes will Citizens Notice?
- Vaccines will be available to all adults over the age of 18 beginning May 1, 2021.
- Adults over 45, health care professionals, and frontline workers who were previously registered will continue to receive free vaccines from government vaccination centers.
- Some states, including Kerala, Assam, Uttar Pradesh, and Madhya Pradesh, have declared that vaccines will be given to all adults at state vaccination centers for free. Many states will most likely be pressured to follow suit, but not everyone will choose or be able to.
- Adults aged 18 to 45 would be able to get the vaccines at a cost from private clinics.
- For citizens who are in the 18-45 age group, they must not expect to be vaccinated in the first week of May. Even before the new policy was revealed, India was experiencing shortages in the 45+ age group, and new supplies aren't anticipated until June or later.
What Adjustments Are Occurring on the Supply Side?
- Previously, the Centre procured 100% of vaccines and distributed them to the states based on demand and an ad hoc formula.
- Only 50% of vaccines manufactured by manufacturers will be automatically sent to the Centre under the new regulations. It will distribute these to the states based on a new set of parameters, which will include the number of active Covid-19 patients, speed of administration, and wastage (which will be penalized). These vaccines are intended for people over the age of 45, frontline workers, and health-care professionals.
- The remaining 50% may be purchased at a cost by the states, industrial facilities, or private hospitals. Any adult over the age of 18 is eligible for these.
- Significantly, this suggests that vaccines for the entire 18-45 age group – 600 million individuals – would have to be compensated for by either states or by the residents themselves. The Centre is not going to compensate.
- Manufacturers will be required to set a price for this batch of vaccines, and private hospitals that provide vaccines will be required to do so as well.
- States and private clinics may also use ready-to-use – imported vaccines.
- To cover vaccine supplies until July, the Centre has advanced Rs 3,000 crore to Serum Institute of India, which makes Covishield, and Rs 1,567 crore to Bharat Biotech, which makes Covaxin.
Is This to Say that Enough Vaccines Are Available for Everyone?
Is it possible to start immediately? The response is an unequivocal no. Before the new announcement, India scarcely had enough vaccines to administer 3 million or so vaccines per day to the needy, 45+ age group who were qualified. Despite the fact that the Centre unexpectedly opened the country to new vaccines last week, just days after senior ministers mocked the Opposition for requesting it, no large-scale supplies are anticipated in the next two weeks, or even the next two months.
Sputnik V, a Russian vaccine developed in collaboration with five Indian manufacturers, could potentially provide up to 850 million doses. However, the majority of this, as well as supplies from a range of other suppliers, are expected to arrive in the second half of the year.
According to the Times of India, “assuming ramped-up potential by June, three vaccine companies – Serum Institute (100 million Covishield doses per month), Bharat Biotech (10 million Covaxin doses per month), and Dr Reddy's (around 4 million Sputnik V doses per month) – will be able to produce just 115 million doses per month, or just over 10% of total demand.” This will not even cover the 400 million vulnerable citizens the government wanted to reach by August, let alone the much wider target population now qualifying.
The question that this policy must now answer is whether an opaque, disorganized public-private vaccination strategy with price discrimination can vaccinate as many Indians as possible in the quickest way possible.
One response comes from Ashok Malik, a policy analyst at the Ministry of External Affairs, who tweeted just few days before the decision: The notion that the economy should import Moderna and Pfizer and charge the privileged hundreds of dollars while the poor receive free Covishield and Covaxin from the government is a baffling non-starter. It demonstrates a lack of knowledge of existing global Covid-19 supply and export constraints. Furthermore, a mass vaccination campaign in the middle of a pandemic would be jeopardized if a two-order vaccine rollout occurs, raising questions about whether "more costly" is "better." It has the potential to undermine the reputation of a major public health initiative.
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