There are no two opinions that the way out of the pandemic still remains the same – express vaccination till we achieve herd immunity. Israel has already done it and the US, UK and Russia are well on the way to achieving the same.
India’s Vaccination Plan
The first phase of the world’s largest vaccination drive kicked off on January 16, 2021. It aimed to inoculate 30 crores of people by July 2021 with a target of 70 lakh doses administered daily. In line with WHO’s recommendations, the beneficiaries of the first phase were healthcare and frontline workers. Subsequently, the second phase of the inoculation drive saw the net being widened. People over the age of 60, or people over the age of 45 with co-morbidities, were eligible beneficiaries. On April 1, 2021, the second phase was extended to people of 45 years and above. The third phase of the vaccination would be set in motion from May 1, 2021. It will provide access to vaccines for people in the age group of 18-45 years of age.
The National Expert Group on Vaccine Administration opted for the distribution of the vaccines as per age groups. This made sense as the fatalities recorded in people over the age of 60 and people with co-morbidities were significantly higher. However, the slow rate of vaccination at 8.7 % of the total population in 90 days compared to 36.3 % in the US and 32.3 % in the UK is proving to be counter-intuitive of this theory. The sluggishness is partly due to the initial vaccine hesitancy followed soon after by huge vaccine shortage. May be this was one reason for PM Modi to exhort the nation into celebration of ‘Tika Utsav’ vaccination festival from April 11 to April 14. However, the doses administered during the Tika Utsav fell due to supply constraints.
Between April 1 and April 2021, on an average 36 lakh doses were administered across the country. But, during the Tika Utsav, on an average only 32 lakh doses were administered. As many as 900 inoculation centres (65 %) were closed all over Odisha because of unavailability of vaccines. Odisha was only provided one-tenth of its demand for 25 lakh vaccines for 10 days for the Tika Utsav, despite the state achieving negative vaccine wastage. Average vaccinations have shrunk from 32 lakhs during the Tika Utsav to just about 25 lakhs between April 15 and April 26. Whereas a record low of 9 lakh vaccinations took place on April 25, the day the country recorded its highest ever daily cases of fresh infections.
This problem is likely to get accentuated in phase 3 of the vaccination process due to acute shortage in manufacture and supply of vaccines. Odisha, for example, does not expect its vaccination to start before May 15 for Covaxin and end of May for Covishield.
Unlike other countries which boldly stockpiled corona virus vaccines even when they were undergoing clinical trials, India probably played inexplicably safe. We continued to put ad hoc orders and did not strengthen the production line of Bharat Biotech (BB) (producer of Covaxin) and Serum Institute of India (SII) (producer of Covishield) until recently. Maybe we assumed that there would not be a second wave.
Burden on the States
Added to the above, the higher price of both the vaccines for states has put them under enormous fiscal burden. In the third phase, beginning May 1, cumulatively about 60 crores of population (aged between 18-45 years) would be eligible for vaccination in various states whereas the national age-wise distribution of population over the age of 45 accounts for only about 34 crores. This implies that there is a disproportionate fiscal pressure on the states most of whom have understandably already declared universal free vaccinations. This is further aggravated manifold by a higher pricing (Rs.400-Rs.600) of both the vaccine types for the states compared to the Centre (Rs.150 per dose) even while all earlier universal immunization efforts in India have been Central schemes with a pre-determined sharing pattern between Centre and states to keep the implementation simple.
The states could have harnessed this money towards strengthening the already noticeable inadequate infrastructure in the district and sub-district hospitals, preparing for a possible third wave. Additionally, the higher price of Covaxin and Covishield for private hospitals would crowd out the private sector and their infrastructure and manpower from this national effort as people would throng government centres for free shots, thus putting enormous pressure on the existing fragile government–run vaccination centres.
Vaccinate and vaccinate fast. This is the best-fit solution. Along with Covid appropriate behaviour, an expedited vaccination drive is the need of the hour to break the chain of transmission. Currently, we have only vaccinated about 10 persons per capita while Brazil and China have vaccinated 18 and 16 persons per capita. At present, the centre should enforce immediate compulsory licensing under Patent Act for both the manufacturers while simultaneously approving a greater number of manufactures and vaccine types to preclude possibilities of cartelisation and profiteering. This would allow other manufacturers without infringing on intellectual property. Additionally, India should continue to advocate for relaxation of the Trade-Related Intellectual Property Rights (TRIPS) given the global health emergency to quickly ramp up production of vaccines.
(The author is Member of Rajya Sabha of Biju Janata Dal (BJD) from Odisha. He is also the Member of Parliamentary Standing Committee on Finance and Joint Committee on the Personal Data Protection Bill, 2019)