The Perils Of Liberalising Vaccination In India

India is burning. The sight of dead bodies piled up, waiting to be thrown into flames has become extremely common. The plight is such that, the workers in crematoriums are worried about not being able to cremate all the bodies due to the lack of wood and materials. That is where India stands; at a place where we cannot even pay proper respect to the dead. Such is the scale of mismanagement of the COVID-19 crisis by the Modi led BJP government in the centre.

The pace at which vaccines developed generated hope. Free universal vaccination then becomes the most important task of our country in this situation, alongside providing quality treatment to all contracted with the virus, to fight the virus. But what is the nature of the present vaccination drive taking place in India?

India’s vaccine production capacity and related problems:

It has been four complete months since the anti-COVID vaccination process began in India. It began by vaccination of frontline and health workers, and voluntary vaccination of people above 60 and below 60 years with co-morbidities. Later, it had expanded to the above-45 age group. So far, the coverage of vaccination has been poor, to say the least. Before the vaccination was opened to the 18-45 age group, only about 44 per cent of the eligible population were at least administered one dose. This coverage will steeply fall, to a mere 9.2 per cent if one considers the coverage amongst the whole population. Comparing these figures with that of other leading countries, we stand far away from our expected targets (Kanitkar, 2021).

By the 1^st of May, owing to the second and more dangerous wave of COVID-19 spike, vaccination was open to all 18-plus age group by the central government. This should mean that with the increase in the total eligible population, an adequate increase in the total doses administered per day has to take place. However, from mid-April, the average per-day doses administered has been falling. This is due to the shortage in the production capacity of COVID vaccines in India (Kanitkar, 2021).

Presently only two private firms are producing vaccines in India, Serum Institute of India (SII) and Bharat Biotech. Reports suggest that SII’s capacity to produce Covishield stands at 60 to 70 million doses per month in April 2021. This number may increase to 100 million doses per month by May 2021. Bharat Biotech’s production capacity is even lower than SII’s. In April it was estimated to be 6 to 15 million doses a month. The company’s CEO claimed that this will rise to 30 million doses per month in May 2021 and 60 million doses per month by end of August 2021 (Ramakumar, 2021). Accounting for the loss of vaccines due to trade agreements by firms and natural wastage, with the current production capacities, there will be a shortfall of 170 million doses per month to vaccinate 80 per cent of eligible by the end of 2021, and a shortfall of 220 million doses per month for universal vaccination of the eligible group by the end of 2021 (Kanitkar, 2021).

The above estimations are done without taking regional differences in the distribution of the vaccine so far. If the state-wise disparity of deploying vaccines is considered, at the current rate states like Andhra Pradesh, Madhya Pradesh, and Uttar Pradesh will go beyond 2022 to vaccinate their whole eligible population (Kanitkar, 2021). Therefore, to meet the targets set, an immediate increase in the production of vaccine supplies should take place. It is agreed in April, that 650 million doses of the Sputnik vaccine would arrive in India. The time by which they arrive is unclear. Assuming that by June 2021 India has access to Sputnik, it will still not be enough to meet the targets set. A further complication arises as a significant percentage of the population are supposed to receive their second doses in May and June. This means the majority of the doses that will be given in May and June of 2021 are second doses. This in effect means a slow down in the process of vaccination (Kanitkar, 2021).  

Many policy suggestions have flooded in from all nooks and corners regarding improving the production capacity of India. Known as the “pharmacy of the world”, India has about seven public sector pharmaceutical manufacturing units that can be used to produce the vaccine. This requires doing away with patents attached to the vaccine production. Immediately providing licenses and beginning production as soon as possible. Also strictly following up with the firms regarding delivery schedules and continuous recording of production activity by government officials will help in overcoming shortfalls of the production process. These necessary steps towards increasing production have not been taken. Additionally, it is quite perplexing as to why the central government was so slow in ordering vaccines from abroad when domestic production was not being increased (Ramakumar, 2021) (Patnaik, 2021).

Vaccine liberalization and recent developments:

Recent developments depict a questionable stance taken by the government. Instead of expanding the production of the vaccine, the Modi government has decided to liberalize the vaccine distribution. This policy moves away from the original plan – the central government buying vaccines at 150 rupees per dose and distributing them freely to the people. With the liberalized policy, half of the vaccines produced will be bought by the central government at the same price, and the rest will be bought by state governments and private players at prices determined by the companies. The prices set are exorbitant with only one aim – to generate super-profits. With many state governments clearly stating their intent to vaccinate their population freely, and considering their precarious financial position; the edge is with the private hospitals to purchase a large share of doses. This will mean that people who have enough financial capacity and access to private hospitals can get vaccinated sooner (Patnaik, 2021). This may even force individuals with relatively fewer money incomes to buy the vaccine from private hospitals. People who cannot afford will have to wait till their turn comes about, while the risk of exposing themselves to a much dangerous strain keeps increasing. This is a dangerous step any democratic government can take in a crisis situation. Even in mainstream economic theory, it is always pointed out that for commodities like vaccines, private ownership of its production and distribution will often lead to a market failure. It was never advisable to take such a policy measure in normal times, let alone in midst of a raging pandemic.

The Supreme Court of India has intervened in this process with a Suo Moto writ petition. In response, the central government submitted an affidavit on 9^th May 2021; stating that Covaxin’s development happened in a public-private partnership model. The government admitted that intellectual property rights were shared with Bharat Biotech. One official from Indian Council for Medical Research (ICMR) stated the agreement with Bharat Biotech was an open-ended one regarding the sharing of knowledge about the development and production of the vaccine. This is an astounding development.

The central government had the time to increase production by sharing the necessary know-how of Covaxin a long time back. Yet, there were no steps taken in this direction. With the current shortage, only three additional firms are given permission to produce Covaxin, and their delivery schedules not known accurately (Ramakumar, 2021). Why this information was kept behind doors is unknown. Today’s vaccine shortage is something that could have been avoided if the government was open and faithful to the public with regard to the vaccine development process. 

The government also clarified, in the same affidavit, that the non-GoI share of vaccines will be divided into an equal quota between state governments and private hospitals. A 50:25:25 system of division of vaccines among the centre, states, and private hospitals is established (Kanitkar, 2021).

This is a broad picture of the vaccination policy-cum-drive of India so far. A drive that began with the promise of vaccinating the whole country as soon as the end of the year. As it became clear that at the current rate India does not have the capacity to meet the targets; the central government’s step to liberalize vaccine procurement is a dangerous and irresponsible one.

The economic rationale behind this policy measure is quite evident: to strengthen the hold of private firms in the production and distribution process; leaving behind state governments and people with no clear guarantee of availing the vaccine due to shortages, while the central government can rid itself from responsibilities. By giving both state governments and private hospitals equal quota in the non-GoI vaccine share; the central government has implicitly said that both private hospitals and state governments stand on equal footing to them. It is a clear step that will benefit the private players – both firms and hospitals. The central government has shunned away from vaccinating everyone for free in a crisis, staying true to its history. Rather, once again, it has left the common people of our country at the mercy of the market. While the private firms earn super-profits; the combination of an avoidable shortage of vaccines, policy measures strengthening the private players, and the in-built economic inequality in our country will lead to a bigger crisis than necessary.

Digital divide and vaccination:

The central government made it compulsory to register and book a slot online for all the 18-45 category. Since then, run-in registrations have more-or-less stopped, as there is a huge influx of online registrations and bookings. The shortage of vaccines meant online slot-booking became quite tough in a very short period, especially in urban areas. Even the urban population who had access to fast internet connection are finding it extremely difficult to get a slot. The urban poor, marginalized, and informal workers who are completely alienated from this online process will be left out completely in the vaccination process. Even if these sections of the urban population have access to the internet, there is no guarantee that they have enough know-how to get registered and book a slot.

The situation in rural India is even concerning. The crisis in urban areas had received widespread attention amongst the masses due to social media activity. This is not the case with rural areas. The countryside’s health infrastructure is far depleted than the cities; with extremely poor internet coverage and knowledge, there is little help that can be done with SOS messages. With cases now rising rapidly in rural areas, without ground reporting the rural health crisis would have never seen the day of light. The reports clearly show the dismal state of health infrastructure in rural India (BBC News, 2021).

ICUs filled with COVID patients with no oxygen or doctors or nurses attending the patients. Two or more COVID patients being treated on the same bed. Bodies not being removed for over an hour after the death has occurred delaying other patients from getting beds. This is the dire situation in most of rural India. There are also far fewer vaccination centres in rural areas, and the ones which are available have stopped on-spot/walk-in registration for the vaccine. This is because people from urban areas book their slots online. Recent reports already suggest that urban population with access to the internet have travelled more than 100 kilometres to get their shots in vaccination centres in villages. With poor internet penetration, the rural digital divide has cut people’s access to avail the vaccine to an alarming extent. (Times of India, 2021) (Adhvani, 2021).

At the same time, local MLAs from BJP have claimed that every rural household in Uttar Pradesh, one of the worst affected state, has at least two phone connections (Choudry, 2021). When people are carrying patients from many kilometres on cycles, and are still not able to get beds or oxygen or medicine; the local MLA has implicitly claimed that people should make better use of their resources to get vaccinated. This is exactly the opposite of what is required from the government’s side. There is a dire need for a responsible government, which will go to the people rather than expecting the people to come to them. The vaccination drive should be a proactive one from the government’s side, where efforts will be made on the ground to get people registered by going door-to-door, providing them with necessary information regarding the vaccination process, and quickly installing more vaccination centres in rural areas. The government has to ensure that every citizen has access to the vaccine, not just the ones with the resources. This is how we can keep our people safe and earn their trust. However, as it seems, the present government is far away from being a proactive one. Neither is it a government that seems to care for its people.   

Liberalization of the vaccine and right to life:

The most fundamental point when it comes to a mass vaccination is the recognition from the state that vaccination is linked to the fundamental right to life of an individual. A universal right that can have one universal price – zero. There cannot be another price, even if it is the same for everyone; as that would mean the effects of this price would vary according to one’s money incomes. Which would mean there is indirect inequality in accessing the vaccines (Patnaik, 2021). The burden of paying a higher relative price will fall on the poor if there is any positive price that is set. Therefore, the only way of upholding the fundamental right to life is by carrying out a free universal vaccination programme. The Modi government has done the opposite. With the three-tier pricing system and liberalization of the vaccine market, the central government has clarified its stand on where its priorities lie.  It has more concern for the capitalists than the people and the constitution. This, in essence, can sum up the BJP governments rule since 2014.

The vaccination process like this should always be an equalizing process. A process that protects every citizen equally irrespective of the economic, social, cultural, and other differences. Assuming there is no institution called the state, and the market is free to define the terms at which vaccine will be delivered; this would mean the marginalized, poor, and rural population will not be able to access the vaccine, at least as fast as the ones with resources; resulting in the exclusion of the former set of citizens, when they have an equal right to get protection from the virus. This will lead to great human loss and tragedy. Therefore, when left alone, to the market; processes that seek to protect citizens from a calamity of this sort will further in-equalize the society rather than equalize.

The state, on the other hand, exists to keep a check on such in-equalization; to protect all the citizens. The state should act as the equalizing institution – one that will uphold the fundamental rights of its citizens and protect them from the naked barbarity of the market. This is why free universal vaccination should be the only solution. At the most fundamental level, this liberalization step is anti-constitutional. By doing so, the central government has decided to act as the in-equalizer.

To understand why free universal vaccination is the only way requires a different political and economic understanding vis-à-vis the one which the Modi government carries. The vaccination drive carried out so far can be characterised by three features at least:

Habravysh Natta, is a first year master’s student at the Centre for Economic Studies and Planning, JNU, New Delhi

References

• Adhvani, R. R. (2021, May 7). Coronavirus: Digital divide curbs vaccine access in rural Telangana. Retrieved from The Hindu: https://www.thehindu.com/news/national/telangana/digital-divide-curbs-vaccine-access-in-rural-telangana/article34508753.ece

• Choudry, P. (2021, May 14). Without internet and smartphones, vaccination inaccessible in rural UP as Covid cases go north | Ground Report. Retrieved from India Today: https://www.indiatoday.in/coronavirus-outbreak/story/internet-smartphone-vaccination-inaccessible-rural-up-covid-1802744-2021-05-14

• India’s rural hospitals unable to cope as coronavirus spreads – BBC News. (2021, May 10). Retrieved from Youtube: https://www.youtube.com/watch?v=4gXQQSXHjUI

• Kanitkar, R. R. (2021, May 6). The harsh truth behind India’s grand Covid vaccination claim. Retrieved from The Indian Express: https://indianexpress.com/article/opinion/columns/covid-19-second-wave-india-vaccination-drive-7303483/?fbclid=IwAR3jaEPej5a46r7qzpeUfsrcRx-YnqVoHYgNsp_Avl_635i8Q7AbdubfBBQ

• Kanitkar, T. (2021, April 25). COVID-19 vaccine data analysis: At cuurent rate of 2.2 mn doses per day, India can only cover 30% of population by end-2021. Retrieved from Firstpost: https://www.firstpost.com/india/covid-19-vaccine-data-analysis-at-current-rate-of-2-2mn-doses-per-day-india-can-only-cover-30-population-by-end-2021-9562811.html?fbclid=IwAR0TAvHCkk3UHYmpBlUtD0Sza5i3RRQQ5Ny6a_UNn0L7u7UGSw1Z9xwel0A

• Kanitkar, T. (2021, May 16). Vaccine Supplies: The Elusive Second Dose. Retrieved from People’s Democracy : https://peoplesdemocracy.in/2021/0516_pd/vaccine-supplies-elusive-second-dose

• Moradabad: ‘No smartphones, no registration, no COIVD vaccine’: Rural UP faces trouble. (2021, May 15). Retrieved from The Times of India: https://timesofindia.indiatimes.com/videos/city/lucknow/moradabad-no-smartphones-no-registration-no-covid-vaccine-rural-up-faces-trouble/videoshow/82656359.cms

• Patnaik, P. (2021, May 9). For Free Universal Vaccination Against Covid-19 . Retrieved from Peoples Democracy : https://peoplesdemocracy.in/2021/0509_pd/free-universal-vaccination-against-covid-19

• Ramakumar, R. (2021, May 12). As Indian government offers some answers on Covaxin patent rights, more questions emerge. Retrieved from Scroll.in: https://scroll.in/article/994763/as-indian-government-offers-some-answers-on-covaxin-patent-rights-more-questions-emerge

• Ramakumar, R. (2021, April 19). India’s failure on the vaccine front, and what needs to be done now. Retrieved from The Federal: https://thefederal.com/opinion/indias-failure-on-the-vaccine-front-and-what-needs-to-be-done-now/

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