Shifting responsibility? How world’s vaccine capital ‘failed’ its citizens so blatantly

Prof Ujjwal K Chowdhury* 
Covid infection has reached an inflection point in India which is now the Corona capital of the world, and the citizens need a warlike initiative to vaccinate the entire nation, of which just 14 crore out of 140 crores population has been vaccinated till now.
The Centre on May 10 told the Supreme Court that “all citizens of all age groups will get free vaccination throughout the country”. One would wonder how does the Centre tell this when vaccine manufacturers in India have not multiplied their capacities, and are charging different rates to the Centre, the state governments and private hospitals.
Then came the catch in the Centre’s affidavit: the reason for the magnanimity is “all the state governments have announced free vaccination for the population group of 18-44 years”. Regardless of the claim about free vaccine for “all citizens”, the affidavit said in a different paragraph that many would be paying for the jab at private hospitals. That lays bare the schism between promise and reality further.
The official declaration came at a time several leaders, including Mamata Banerjee and Rahul Gandhi, have repeatedly appealed to the Prime Minister to make the vaccination free across the country. Mamata, Uddhav Thackeray, Hemant Soren, Pinarayi Vijayan and many other chief ministers have already declared that free and universal vaccination shall be done for all citizens above 18 years of age.
If the court allows the Centre to stick to the stand articulated in the affidavit, the cash-strapped states will have to bear the cost of vaccinating most Indians. The Centre further tells in its affidavit, “Those who choose to be vaccinated and can pay the price can go to private hospitals.” Basically, the Centre now passes the ball to the states and the private individuals for vaccination and yet claim free universal vaccination to the Court and the world!

Differential pricing

Till April 30, the Centre was buying the entire vaccine stocks from the manufacturers and providing the doses free to the states, which administered free jabs to priority groups such as healthcare and frontline workers and those aged 45 or above. However, to ease the burden on their hospitals, the states were free to supply a part of the consignments to private hospitals, which charged people Rs 250 per dose and paid the Centre Rs 150 per dose. Therefore, millions of people aged 45 and above have already paid for their jab.
Since May 1, the Centre has opened up vaccination for all adults. Under its new policy, it buys half the vaccine produced and provides it free to the states to inoculate those aged 45 or above. The remaining half has to be bought by the states and private hospitals from the manufacturers.
Controversially, the manufacturers have been allowed set a differential pricing. The Serum Institute of India has set the Centre a price of Rs 150 per dose of Covishield while the states are being charged Rs 300 and private hospitals Rs 600, and Covaxin-maker Bharat Biotech has set prices of Rs 150, Rs 400 and Rs 1,200, respectively.
With the private hospitals expected to add a further charge, people will be shelling out a far larger sum than the Rs 250 they were paying before May 1. In the affidavit, the Centre has justified the higher price for the states and claimed credit for getting each company to charge the states a uniform price.
The affidavit further tells us, “It is pertinent to note that the central government by nature of its large vaccination programme, places large purchase orders for vaccines as opposed to the state governments and/ or private hospitals and therefore, this reality has some reflection in the prices negotiated.” It added: “Thus, while it is ensured that the two vaccine manufacturers are not unduly enriched out of public money, the citizens are not supposed to make any payment for getting both dose of the vaccine.” The affidavit does not explain how the companies will not be “enriched”, nor, after everything that went before, how the citizens “are not supposed to make any payment”.
It is to be noted that earlier three free universal vaccination programmes had been taken up in India, against polio, tetanus and small pox. And at a time when Indian health infrastructure and logistics were of a much inferior standard and India a much poorer nation. There were no state versus centre conflict too. This must be the premise of the largest vaccination drive in the world this time too, as has also been demanded by the twelve opposition parties in their joint letter to the Prime Minister.

Initial vaccine follies

Modi’s insistence on Atmanirbhar Bharat, the principle of self-reliance, made India slow to approve and purchase foreign vaccines, including Pfizer-BioNTech’s, in favor of its own Covaxin. In the meantime, the government was keen to wield its heft as the “pharmacy of the world,” exporting doses even as it vaccinated only 0.2% of its population per day. Today while the Modi government has gone on back foot and opened up for foreign vaccines, they have no capacity to take immediate orders to supply to India. Only Russian vaccine Sputnik is being taken up by Reddy’s Labs to produce in India. First despatches of Sputnik have already been delivered.
While most nations have given advances to pharma companies to research on and produce vaccines, India did not support Serum Institute and Bharat Biotech initially with any funds. Serum (SII) invested Rs.2000 crores by itself and got Rs.2200 crores from Bill & Melinda Gates Foundation. While US had invested Rs.44,700 crores in vaccines by Moderna, Pfizer, Johnson & Johnson, etc., as early as August 2020, India only on April 19, 2021, as reported by "Scroll", gave an advance of Rs.4500 crores to vaccine makers in India. 

While Modi government has gone on backfoot and opened up for foreign vaccines, they have no capacity to take immediate orders to supply to India

Our current monthly vaccine doses need is around 180 million, while production capacity is at best 80 million! Less than half. India placed its first order of vaccines in January 2021 and only for 16 million doses!
In the longer term, vaccinations are desperately needed to prevent a third wave. Less than 10% of Indians have had at least one vaccine dose till now, and the current pace of inoculation is too slow. With limited vaccine supply, the most effective way to reduce transmission may be to target hot-spot areas and higher-risk people—which means India needs better data, and fast, and not the rampant data-fudging as is done today.

High Court notice

The Kerala High Court issued a notice to the Central Government on two pleas challenging its "discriminatory COVID-19 vaccination policy". The Liberalised Pricing and Accelerated National COVID-19 Vaccination Strategy issued by the Centre recently is violative of Article 14, 19 and 21 of the Constitution.
By virtue of the new policy, dual pricing of vaccines has been allowed and states are forced to contend with private players to purchase the vaccines in the open market, whilst the Central Government procures them at a discounted/ subsidised rate. Also, the Centre should adhere to the National Vaccination Policy when it comes to procurement of vaccines. Polio and Small Pox vaccination drives earlier were free and universal, without any discrimination.

Preposterous vaccine diplomacy

Earlier, as part of vaccine diplomacy, India has supplied around 65 million doses of vaccines to around 70 countries. The two vaccines which have been supplied to other countries are the Covaxin and the Covishield, with claimed respective efficacies at 81% & 70%. The Covaxin developed by Bharat Biotech is a two-dose whole virion inactivated vaccine, which needs to be given in two doses separated by a duration of 28 days.

Covishield, manufactured by SII is a recombinant vaccine against Covid-19. It is perplexing that India was carrying out vaccine diplomacy till March 2021 at such a large scale when it is facing shortage of supplies in many of its own states. For what purpose such a large-scale of vaccine diplomacy was being implemented in such a time of national public health crisis in the middle of a second wave?
Is the vaccine diplomacy being carried out to skirt away the questions over the efficacies of the two indigenously manufactured vaccines? And are the vaccines are being distributed just for the purpose of image building of Modi whose government is on a back foot in multiple issues which have come under international attention; farmers’ protests and suppression of dissent being some examples?

Continuing Centre-State conflict

Also, the states are asked by the Centre to float global tenders and procure vaccines from the world, which is another preposterous suggestion. India, as a nation, through the central government, should be sourcing vaccines globally through a global tender in the fitness of things and avoid inter-state undesirable competition and price negotiations with pharma majors of the world. The 12 parties have also demanded global tender by central government, though at least 15 states of India are preparing for floating global tender if Centre does not comply.
The Delhi Chief Minister Arvind Kejriwal has rightly raised another issue. Why cannot the Centre expand the scope of licensing of vaccine production and share the formulae of the two vaccines made in India with other pharma companies of the nation to expand the production by leaps and bounds for nearly 140 crore people?
West Bengal Chief Minister Mamata Banerjee has also asked for expanding licensing to produce vaccines and allow the foreign vaccines to be produced on Indian soil if the foreign pharma companies are interested to. Many have asked Indian government to allow the much effective Chinese vaccine Sinovac to be also sold in India. The Centre has a stoic silence on these so far.
While the country is tackling with the issue of shortage and building capacities, the politics between the centre and the states has spilled into the distribution of vaccines. Various states pushed the Union Health Ministry to supply more vaccine doses for vaccination of everyone above the age of 18 yrs.
In response, the centre has asserted its view that the states having the second-wave of the spread of Covid19 are politicizing the public health issue and concurrently spreading lies. The centre also accused the states of not carrying out enough tests, contact tracing and ramping up the health infrastructure. The truth is on both the sides, and loser is the common citizen.

Cowin blues

Meanwhile, online Cowin booking of slots for vaccination is proving to be anti-poor and anti-rural, because a large part of India, more than 50% of the area and population, are beyond internet reach and do not have device to book. Digital divide has not been considered in this vaccination policy.
Cowin being in English is also institutionalizing injustice towards non-English population of India, which again is the overwhelming majority. They are also expected to be tech savvy to use it.
Also, even after booking a slot, the slots are not being actually honoured at the vaccination centres due to huge rush of people and non-availability of vaccines in most places. And the process boils down to registering name in person, stand in close proximity for long hours and wait for availability.
All of these are leading to high incidence of Covid among those who are struggling to get the vaccines, increasing the probability of infection by leaps and bounds among the senior citizens. Many states have asked for their own process of slotting vaccines in their local languages and end central monopoly on the process.
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*Educationist, columnist, television panelist, working currently as Pro Vice Chancellor of a Kolkata based university