India’s Vaccine Drive Will be a ‘Work in Progress’

There are many inherent difficulties and future uncertainties that will come up in the implementation of the drive. GYAN PATHAK argues that the government still must speed up the process since there can never be a 'final plan' in a 'fluid situation'.

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Since both the Indian vaccines – Covaxin and Covishield – have now been officially approved for emergency use, the focus is on its distribution and prioritization. These aspects are still being worked out as a 'work in progress' due to many inherent difficulties in India's vaccine drive against COVID-19, including the monitoring the recipients of the vaccines, and also the future uncertainties relating to the pandemic itself. The known and unknown administrative issues may also crop up during the implementation of the drive, which requires great alertness and a quick response. 

The Serum Institute of India's (SII) Covishiled and Bharat Biotech's Covaxin formally cleared by the Drugs Controller General of India (DCGI) has enabled the country to launch the vaccination drive simultaneously in most states that were part of 'Dry Run' of January 2. The idea is to test the preparedness of our system to effectively furnish the task in hand as well as to train the medical and non-medical personnel for best implementation of the inoculation. We must not forget that the DCGI has given only "emergency use approval" which means the companies that have developed the vaccines will have to fulfil certain additional "conditionalities".

There are therefore apprehensions among the people regarding safety of the vaccines. 

Union Minister of Health, Dr Harsh Vardhan has said that both the vaccines ensure safety, efficacy and immunogenicity. Drug Controller General of India (DCGI) Mr V G Somani has declared, "We'll never approve anything if there is slightest of safety concern. The vaccines are 100 per cent safe. Some side-effects like mild fever, pain, and allergy are common for every vaccine." These very statements and the conditionalities suggest that the monitoring of recipients of the vaccine doses are going to be an important task for which the government should have special arrangement in place before the drive is launched. 

The best part of these approvals is that these vaccines are 'Made in India' and will be available to the country at a cheaper price than the imported vaccines. 

Prime Minister Narendra Modi while congratulating India for approval of these 'homemade' vaccines has also referred to his 'Aatmanirbhar Bharat', though the government hasn't yet worked on its affordability to the common people. As per the reports already published, the common people may need to spend five times more than the government's purchase price. The cost for one dose of vaccine for private entities will be above 1000 rupees, who in turn will charge individuals much more. 

We must note that the per capita expenditure of the total health expenditure in our country, in Financial Year 2020, was as low as 1,944 rupees. The centre and states spent only 1.29 per cent of the GDP which was 2.6 trillion rupees in absolute terms. Of this, the centre's share was only 25 per cent. 

Our states' finances are in a very bad shape due to the pandemic and cannot be expected to manage the required finances. State's shares in the central revenue dwindle to a new low due to fall in the GST revenue. It is also a fact that the centre spends less on public health and sanitation as they are on the state list. 

Government of India has no plan except that the state governments are required to take institutional and market loan. In this scenario, if we are to vaccinate all the people in the country including the poorest of the poor, the Union Government needs to do much more than merely expressing pride on 'Aatmanirbhar Bharat'. 

SII has offered a price of Rs 225-250, and Bharat Biotech is offering Rs 350 for one dose of vaccine, to be supplied to government. They will be sold in the market at about five times higher prices. When they reach the end users, the prices would be much higher and would be at around Rs 1500 – 2000 per dose due to additional supply, storage, and handling costs. A family having five members will thus need to spend around Rs 8,000 – Rs 11,000 to get one dose of vaccine to all its members. It will be too costly to bear for majority of the families in the country.

According to an assessment around 800 million people are struggling for survival in India, and therefore they will need free vaccination as soon as possible. Crores of people rely on private medical facilities in the country because of lack of sufficient government medical facilities, mismanagement and chaos due to heavy load of patients. The government therefore must do something to make the market price of the vaccines affordable for people. 

Government of India has made a plan of vaccination drive in likeness to the "election process" and will vaccinate only a handful at each site initially. Sessions and sites in particular districts in almost all states will be identified for vaccination on particular dates. Given the huge population in the country and limited availability of the vaccine doses, we are constrained to vaccinate people in phased manner. Obviously, there will be politics and opposition political parties have already started raising their fingers.  

Government has started registering people for vaccination by launching CoWIN, the IT platform. The platform has been developed to implement the mega vaccination drive. This platform was used during the nationwide vaccination dry runs conducted at 286 session sites across 125 districts. 

We have 718 districts in the country and a population of around 1.38 billion. Only 75 lakh priority receivers were registered by the day of 'Dry Run'. Such low number of registrations indicates the hesitation among the people regarding the acceptability of the vaccines. To make the vaccines acceptable among the people is thus a priority, as well as implementing the drive in all the districts of the country at convenient locations where people can reach especially when there are several transport restrictions at place. 

India plans to vaccinate 30 crore "priority population" by July. 

First three crore intended recipients would be the healthcare and frontline workers who are to be vaccinated over the next two months. Then over-50 and younger population with other serious ailments would be vaccinated. 

Obviously, we need to speed up the process on priority basis.

Mobilisation of vaccines to cold chain hubs, storage, and then to the vaccination centres are also going to be tough tasks. Union and state governments are yet to create such facilities in required numbers. Governments are yet to place 'supply orders' for vaccines, implying that our system is not yet ready to receive supply of the same. 

Needless to say, we need to speed up the vaccine administration as a 'work in progress', since there will be no 'final plan' in a highly 'fluid situation' with even new threats. (IPA Service)

(Gyan Pathak is a senior journalist. The views are personal.)