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India's decentralized vaccine procurement policy 'ignores' informal sector workers

By Bappaditya Mukhopadhyay* 

Preventing the third wave requires a judicious mix of vaccination and lockdown. Our current strategy regarding vaccination is far from what it should be. Let us begin with some numbers. As on May 25, 2021, we have administered close to 19.5 crore vaccines. However, this means only 3% of the population receiving the complete dose and around 11% receiving a single dose.
Compared to the other G20 countries, while India is not the least vaccinated country compared to the rest, given the percentage of people at mortality risk owing to Covid (cardio vascular diseases and diabetes) and the health infrastructure (number of beds per thousand), our vaccination numbers are far less than what we should have aimed. 
It is now clear from various studies that vaccination against Covid primarily reduces the hospitalization rate. Most studies estimate that the hospitalization rate will reduce by at least 80% on an average between those who have received the complete dosage versus those who have not received any vaccination at all.
Given that India has the highest number of high population density clusters as well as the least number of hospital beds per 1000 among the peers (0.53 against 2.4 from the nearest country, South Africa), prevention for us may soon have to be realistically replaced by no hospitalization. This simply means for us we have to place far more importance to vaccination than anyone else.
The current shortages in vaccination numbers are evident from the fact that as against the daily average of 29 lakh doses administered in April, the number fell to 19 lakh a day a month later in spite as people queued up all across the country for the jabs. The distribution of the new arrivals across first and second dose also presents a gloomy future. In the month of April, close to 80 million received the first dose.
In the best-case scenario where India produces 75-80 million vaccines per month July onwards, it will not be sufficient to even give the second doses “on time” forget any one getting their first doses. It does leave us with one uncomfortable choice -- either a significant population who all are equally vulnerable with a single vaccine or few in the population who are least vulnerable (having both doses) while a large portion of the population are left without a single dosage.
However, there are ways to avoid the dilemma and that doesn’t stop with procuring more vaccines alone. We need to look at our strategy to vaccinate. Unless vaccination starts from the lowest economic strata, we would struggle to keep hospitalization rates down. 
In best-case scenario if India produces 80 million vaccines per month July onwards, it won't be sufficient to give second doses on time
Therefore, the single most important mantra must be that vaccines are available for all at the same price-free! The current combination of judiciously mixing vaccination strategy to prevent hospitalization and lockdown to prevent the spread, will be largely ineffective unless those in the informal sector are not vaccinated.
While the government is trying to procure more vaccines and hopes higher availability by early July, will there be enough demand with the current proposed pricing and distribution? As it stands, often the cost for a single dose will be higher than the poverty line itself! Expecting economically stressed household to pay that is beyond any rational belief.
As a result, two things will happen: The rich, who can afford, will get vaccinated first, and the poor will be left far behind. One could argue that the vaccine would be free in government hospitals. One shouldn’t be surprised if the profit-making manufacturers would be more inclined to serve the ones who can pay more. Thus, many will be left behind.
Therefore, with large population unvaccinated and the crisis looming large, the only strategy left for the government will then be to impose lockdowns. However, given the labour force composition in India, those who can afford to “work from home” are those who would have already got their vaccines at the “market price”, while those who couldn’t afford will also not be able to stay home especially given the stressed economy. This is particularly true of households who do not have a steady income flow and/or are daily wage labourers.
Thus, neither can an effective lockdown be imposed, nor can there be large scale adherence nor is it desirable. As a result, the current vaccination strategy will neither have significant dent on the severity or spread. If anything, the government must get the informal sector employees vaccinated at a war footing. It can use innovative data collation techniques to identify such beneficiaries if needed. 
If the government wants to continue with its multi-party Centre, state and private entities procuring separately, it must clearly have a plan as to who should procure for which target group although there seems to be little merit in such decentralized procurement. The price barrier to get vaccinated must be the last bottleneck the government needs.
---
*Professor at Great Lakes Institute of Management, Gurgaon; research interests include data analytics and public policy

Comments

Partha P Mandal said…
Very good unbiased analysis. Thanks

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