Vaccinations: Take Responsibility, Advice, Plan

Immunization related to vaccination has made its place in history. Prime Minister Modi corrected two mistakes in his televised address on June 7.

I understand that this is their way of admitting mistakes. The state governments and the opposition should proceed at their own level. We must remove this mess and achieve the targets set by the pandemic and health experts.

However, for the sake of the record, the mistakes committed during the last 15 months need to be noted:

Vaccinations: Omissions and Responsibilities

• 1. The central government was assuming that the first wave of the virus would be the only wave and that vaccination could be done at a leisurely pace, step by step with domestic supplies. He ignored warnings of a second wave. At the same time, he did not understand the importance of the absolute need for rapid vaccination.

• 2. The government was passionate about protecting the interests of the two domestic manufacturers and their interests; It has moved away from emergency use approval (EUV) of other vaccines and may have discouraged their manufacturers from applying for approval in India (for example to Pfizer).

• 3. The government placed its first order on the Serum Institute (SII) on January 11, 2021, while the US, UK, Europe and Japan placed their orders to the manufacturers in May-June, 2020 itself. Not only this, the order was also for only 11 million doses! Bharat Biotech (BB) was subsequently ordered and the number is not known.

• 4. Despite the demand for a capital grant or subsidy by Serum Institute, advance payments against supplies to both domestic manufacturers were also not made. Advance payment (Rs 3,000 crore to SII and Rs 1,500 crore to BB) was sanctioned only on April 19, 2021.

• 5. The Government had also not correctly estimated the month-wise expected production by both the domestic manufacturers for the years 2020 and 2021; Nor did he pressurize them to speed up production. Even today the actual production and supply being made month-wise by both the manufacturers have not been made public.

Vaccinations : No consultation policy

• 6. The Government unilaterally formulated and implemented the vaccination policy without consulting the State Governments. The Supreme Court termed the vaccination policy as ‘arbitrary and irrational.

• 7. The central government decentralized the procurement of vaccines and passed the burden of vaccination to the state governments in the age group of 18 to 44 years. Whoever encouraged decentralization or for whatever reason, it was a big mistake. As a result, no one came forward to bid on the tender of the State Governments. The purchase was thrown into terrible confusion.

• 8. The government made a big mistake by fixing different rates for the supplies to be made to the central government, state governments and private hospitals. Due to the price differential, large quantities of vaccines were sold to private hospitals at the cost of government hospitals, leading to vaccine shortages in some states and postponing vaccination. The controversy continues, as the government has allowed private hospitals to charge Rs 780, 1,145 and 1,410 per dose for Covishield, Sputnik V and Covaxin, respectively.

• 9. The insistence of the government to register on the Kovin app for vaccination was biased. The Supreme Court held that insisting on Covin widened the digital divide and was discriminatory.

• Let’s put these mistakes aside. The production and distribution of vaccines seem to have improved. Imports of the Russian vaccine Sputnik V have helped. In the week starting June 6, the average vaccination rate increased from 30 to 34 lakh daily. But even at this pace, by the end of 2021, only 600 million people will be able to get the vaccine. This is grossly inadequate given the target of two doses of the vaccine to 90 to 100 million adults. (At present less than five crore people have received both doses of the vaccine)

This is not rocket science

The next steps that should be completed by the central government before June 2021 are clear. Here I am listing them:

• 1. Prepare a reliable timetable of month-wise production of each domestic manufacturer (two or three or more) between July to December 2021. Add to this the import of Sputnik V. Add the month-wise production of any licensees or licensees that can be approached for vaccine production.

• 2. Immediately place orders for World Health Organization-approved vaccines for Pfizer-Biotech, Moderna, Johnson & Johnson and Sinopharm. Advance payment to be made and schedule of supply agreed upon. Add this figure to the total supply.

• 3. The government should take full responsibility for the procurement of vaccines (on June 7 the Prime Minister has agreed to 75 per cent procurement) and distribute them keeping in view the need of the states and the pace of vaccination in each state. States should be allowed to distribute vaccines in government and private hospitals.

• 4. Since it looks like there will be a shortage in the availability of vaccines as needed, the government should publicly state how it intends to close the gap. If this gap cannot be bridged by December 2021, the central government should decide on vaccination priorities in consultation with state governments.

• 5. The central and state governments should maintain and enhance the health infrastructure including the number of hospital beds.

• The five stages mentioned above are no rocket science. There is a need to plan for this, this is something that has been missing in the Modi government since the abolition of the Planning Commission, but it is happening continuously in other countries. The government will have to shed its apathy towards planning and appoint a dedicated group that can anticipate any contingencies and plan accordingly.

Let us see how the central government deals with the challenging task before it.