The crucial third phase of India's COVID-19 vaccination strategy, under which everyone above 18 years of age will be eligible for inoculation, will begin from 1 May. While the liberalised vaccination strategy is an ambitious one, its implementation could pose several logistical challenges, health experts told Firstpost.
There are two broad strands of the policy in terms of the supply of vaccines. Firstly, the Centre will procure 50 percent of the doses from vaccine manufacturers. A part of these doses will be used to inoculate the categories of people who are eligible as on the present day"healthcare workers, other frontline workers and people above 45 years of age. These jabs will be administered free of cost. The remaining doses will be allocated to states and Union territories based on their requirement.
Coming to the second strand, state and UT governments and the private sector will be able to procure the remaining 50 percent of vaccine doses. Manufacturers are expected to 'transparently' make an advance declaration of the price at which they will supply these vaccine doses.
The new policy seeks to clear several bottlenecks that have slowed down vaccination efforts at the ground level. Firstly, the finance ministry has cleared a proposal to give advance funds to Serum Institute and Bharat Biotech without bank guarantees. This is expected to augment the availability of vaccines ahead of the anticipated increase in demand. Secondly, the Centre has allowed imported, fully ready-to-use vaccines to be entirely utilised by state governments and the private sector. Thus, if and when companies like Pfizer bring their vaccines to India, they can directly sell the doses in the open market at competitive prices.
At present, vaccines are being administered at government hospitals as well as private clinics. Jabs are provided free at state-run facilities and priced at Rs 250 a dose at private facilities. From 11 April, government and private offices have also begun vaccinating their employees at the workplace. As no additional norms on this aspect have been mentioned till now, the same process is expected to continue after 1 May.
Speaking to Firstpost on what more needs to be done, T Jacob John, virologist and former professor at the Christian Medical College, Vellore, said, "One cannot find fault with the desire to open up vaccination for everyone above 18 years of age. However, there is no precedent when it comes to arranging the logistics of such an exercise. The government will have to come up with a model for this purpose. It may involve district collectors and panchayat officials, etc. People above 18 years of age may be asked to come to public health centres or schools with their Aadhaar cards for getting their shots."
John added, "The government must also define its expected outcome and the yardstick it will use to measure its performance. Stating the number of people who are expected to be given vaccine is an indicator of the process. The authorities, however, should also state the expected outcomes " whether in terms of reducing transmission rates or deaths, or the suchlike."
Concerns over supplies
Even as the number of people eligible to get the COVID-19 vaccine will rise manifold after 1 May, concerns over adequate supplies are being expressed from multiple quarters. In the past few weeks, states like Maharashtra, Odisha and Rajasthan have raised alarm bells over shortages of vaccines.
While there have been announcements on plans to augment manufacturing capacity, it isn't clear if these will be enough. Bharat Biotech has announced in a press release on Tuesday that it has 'implemented capacity expansion' across multiple facilities to reach over 700 million doses per year. On 27 March, Adar Poonawalla announced on Twitter that Serum Institute and Novavax hope to launch the vaccine Covovax by September 2021.
Commenting on India's position with respect to vaccine supplies, public health expert and epidemiologist Chandrakant Lahariya said, "India is currently producing an estimated 70-75 million vaccine doses per month. At the current daily vaccination rate of 3 to 4 million doses per day, monthly supply needs to go to 90 -120 million doses a month for a significant period of time if a sufficiently large percentage of the population is to be vaccinated. This needs to be further scaled up manifold if we want to sustain high coverage in the newly-opened age group of 18 years and above. For context, the total number of people above 18 years of age in India is estimated to be about 900 to 940 million."
The Centre, in its official statement, has claimed that its new strategy gives all stakeholders flexibility to customise the process to local needs. However, in practice, this can lead to an unfair burden on states, believes Lahariya. He said, "For all other vaccination efforts"such as polio, BCG, etc"the funds traditionally come from the Centre. For COVID-19 vaccination too, the Centre should have provided the funds. Now, the strategy announced by the government on Monday will effectively lead to states competing with one another and private sector, to procure vaccines. It is quite possible that richer states will gain at the expense of less affluent ones. Also, as of now, state governments do not have experience in dealing and negotiating with vaccine manufacturers. This lack of experience can also create hurdles for them."
He further remarked, "When India is in the middle of a pandemic and the Central government has already allocated Rs 35,000 crore for COVID-19 vaccines, it would be incorrect to push states in the uncharted territory of procurement of vaccines."
As the government has made the pricing of vaccines more flexible and allowed private players to use imported vaccines, the issue of vaccine prices has gained more importance.
The Centre, in a document laying out the policy on liberalised pricing from 1 May, has stated, "...The present dispensation where private COVID vaccination centres receive doses from the government and can charge up to Rs 250 per dose will cease to exist."
As of now, Covishield is being sold to the Union government at Rs 150 per dose while Covaxin is being sold at Rs 206 per dose, excluding taxes. However, Poonawalla of the Serum Institute has said in an interview to ANI that the firm proposes to sell the vaccine in the private market at Rs 1,000 a dose.
In January, Union health secretary Rajesh Bhushan had announced tentative prices of other COVID-19 vaccines that are in the pipeline. According to these figures, the vaccines of Pfizer-BioNTech, Moderna and Novavax will cost Rs 1,431, Rs 2,348 to Rs 2,715 and Rs 1,114 per dose respectively. Thus, unless governments intervene to bring costs down, there is a possibility that the Centre's new vaccination strategy can lead to higher prices of vaccines.
According to an article in The Times of India, most companies are expected to price vaccines at Rs 700-Rs 1,000 per dose in the private market. However, the article quoted companies as saying that the pricing will depend on the quantity that they can sell in the private market, export considerations and supply chain issues.
Speaking to Firstpost, Lahariya said that on the whole, it seemed that not enough planning has gone into formulating the strategy. "The situation that we will see in the coming days will be a reflection of what happens when the government does not take up its requisite share of responsibility towards vaccination," he said.
In a similar vein, John also said that the government did not appear to have adequately taken supplies into account while deciding the new vaccine policy. "The announcement that everyone above 18 years will be made eligible for the shots seems to be more of a political statement than a public health decision. The way in which the strategy will actually materialise is not clear."