Former Secretary, Government of India
India finds itself caught in the web of premature and pompous vaccine nationalism, disproportionate vaccine diplomacy efforts and unwarranted vaccine complacency. The national need and equity in vaccines was, it seems, lukewarm somewhere.
India could have granted a compulsory license to Covaxin to 18 domestic manufacturers to gain moral upper hand.
Based on their manufacturing capacity, the two named companies manufactured 28 crore of doses in four months. But the government administered 15 crore in doses. Six crore doses have gone to various countries under India’s Vaccine Maitri program and the gap must have been covered by the Serum Institute of India’s (SII) own licensing requirement.
At this rate of vaccine availability, the country would surely miss the third wave, the impact of which is difficult to predict for the moment. True, there is a plan for SII to increase its monthly manufacturing to 100 million and Bharat Biotech to 70 million doses per month, starting in August.
The Indian government will recover 50 percent of the proceeds, or 54 crore in doses by December. Since only the over 45 age group is considered the responsibility of the Center, it represents 45 crore of doses. This means that the remaining nine crore is for vaccine diplomacy.
It is wise for nation states to look after their own economy rather than overwork. India, a budding power at best, is emerging as a one-ride pony; imitating China, regardless of the huge gap in their forces.
The country missed the opportunity to pre-order vaccines on time from the seller’s market and expand its capacity. He is now trapped in unavailability. Even the use of a CDL-type test lab in Hyderabad and that of Kasauli, which would have saved time and improved logistics, has not yet been considered.
Now comes the issue of transferring responsibility for immunization of 18 years and over to states. The Centre’s budget provision of Rs 35,000 crore would also have supported this category. If it were insufficient, the putting on hold of the Central Vista project of Rs 20,000 crore could have released funds to meet the additional need for a booster dose if necessary.
For the first time, the central government has washed its hands of vaccination, even though it is its constitutional obligation under the concurrent list (entry 29).
But there are deeper issues here. The 50 percent inventory left to manufacturers after the Center took its share does not clearly divide the claims of state governments and the private sector.
In this unequal struggle, states will be the losers. The pricing of vaccines has been left to the manufacturers, and outright profit is evident in the prices they set for states and the private sector.
If the SII made a profit when the price was 150 rupees per dose, setting the rate at 300 rupees would give it at least a 300 percent increase in profit. The rate of Rs 1,200 per Bharat Biotech for private hospitals increases profits by 400 to 1,200 percent. It also becomes a benchmark price for new entrants, even though these tariffs are much higher than the tariffs at which they are sold to other countries.
Already, vaccination campaigns in various states are sizzling for lack of vaccine availability. Manufacturers will be more inclined to sell it to the private sector than to states with either a half or a third of the first rate. States, with their limited resources, will have to pay double or triple the price paid by the central government.
The right to life apparently comes with different price tags for different age groups. The Center’s statement in its affidavit to the Supreme Court that the market should determine the price of the vaccine shows a convoluted understanding that would have even put Milton Friedman to shame.
State governments will not only compete with the private sector, but will eventually compete with each other as well. Are we waiting for a resumption of the chaotic situation the United States has known?
The central government eventually succeeded in shifting the crisis to the states and created chaos. The country has missed the coordinated procurement of vaccines with the benefit of economies of scale like the national immunization program.
The Indian government’s proposal, along with that of South Africa, for a TRIPS exemption for the vaccine has received support from the US government. But it still faces resistance from the EU, Japan and Australia. If ultimately the exemption is accompanied by a few warnings on the transfer of technology, confidential information and trade secrets, the objective will not be achieved.
Given the enormity of the crisis, India could have mandatorily allowed Covaxin to the 18 domestic manufacturers of the vaccine. It would have helped India to take the high moral position to seek compulsory licensing of international vaccines. We seek vaccine equity internationally without guaranteeing it within the country.
India’s immunization program is already faltering. In any condition, you will experience dose unavailability, driving limited to second dose cases, and a noticeably slow pace.
Finally, there is an ambivalent attitude towards vaccine producers and we could end up paying a heavy price. There is a Tamil proverb: “I will pretend to beat you, you will pretend to cry and we will continue as before.” It looks like we won’t be ready for the third wave as it comes.
The problem with late vaccination is that the virus will move around, mutate and become more virulent and it is likely to strike young people, precisely those caught up in our messy vaccination policy.