Since March 1, when the new rules came into effect, senior citizens and those in the age bracket of 45-59 years with specific comorbidity have started taking the jab priced at Rs 250 per dose in over 10,600 private facilities across the country. The central government has later said that a state can rope in any number of private hospitals as vaccination sites, which means the list of such entities will be longer. Can this, then, be called a watershed moment for India’s Covid-19 vaccination programme? Not really.
Sample this: India has so far administered 1.9 crore Covid-19 vaccine doses, covering about 1.4% of its population, as against 34% in the UK and 26% in the US. Even China, the world’s most populous country, has vaccinated 3.8% of its population as on March 6, according to Bloomberg’s Covid-19 tracker.
What’s more, India, considered the world’s factory for vaccines, dispatched only 5.3 crore doses of Covid vaccine to 54 nations, as on March 6, according to data available with the Ministry of External Affairs, way below the nation’s capabilities.
Both sets of data point to one fact — India needs to innovate and play a larger role in vaccine distribution. First, it must try harder to inoculate more of its citizens as quickly as possible and simultaneously demonstrate its soft power by supplying more and more vaccines to the rest of the world.
New Delhi has to max the vaccine game: for that it has to roll out Covid-19 vaccines in the open market while ensuring equitable distribution and ramp up its commercial export. It will be a shot in the arm for both health and economy.
“The government has already allowed private entities to charge for Covid vaccination. It’s a step forward. In a couple of months, the vaccine should be available on demand,” says a senior central government official in the know, requesting anonymity. An official from Telangana, who attended a couple of critical meetings on vaccine rollout, echoes a similar view.
There are, though, enough reasons why the government has not gone ahead with it at this juncture. One, it’s a political call. The government would not want to be seen as a facilitator for the rich to pocket available vaccines ahead of ordinary citizens, particularly when elections in four states — Assam, Kerala, Tamil Nadu and West Bengal — and one Union territory — Puducherry — are just a month away.
In the current pricing strategy, the Centre will procure the vaccine from manufacturers at about Rs 220 per dose and supply the same to a private hospital for 150, allowing the hospital to charge Rs 100 extra as service fee. In the entire process, states are relegated to the background as they are only playing a supporting role in offering logistics and infrastructure. This means, whatever be the vaccination site — a government hospital or a private facility — Covid vaccination is primarily a GoI venture.
Meanwhile, the Election Commission has asked the health ministry to remove the prime minister’s photo from Covid-19 vaccination certificates in poll bound states after the Trinamool Congress lodged a complaint about it.
Two, as argued by cardiologist and CMD of Medanta Dr Naresh Trehan, the supply of Covid vaccine in the open market at this stage will lead to black marketing. “Just because you have the money, you have no right to jump the queue in a matter as sensitive as Covid vaccination,” he told ET Magazine, adding that private hospitals have untapped capacity to vaccinate a greater number of people, provided the government ensures better supplies.
Three, the government is reluctant to permit vaccine manufacturers to sell part of their stock in the open market as such a move will likely create a monopoly. The reality is India still lacks enough vaccines that have completed Stage 3 trials.
India has embarked on its Covid-19 vaccination programme with Covishield, the vaccine manufactured by the Serum Institute, and the indigenously developed Covaxin by Bharat Biotech and ICMR, the Phase III trials of which are still under way. Dr Giridhar R Babu, epidemiologist and professor, Public Health Foundation of India, suggests that one way to increase availability would be to use more vaccines that have efficacy data from other countries.
“Right now, Covishield is given with emergency use authorisation, using efficacy data from other countries. The government has already decided to make vaccines available in the private sector at a price, so why not increase the options of vaccine and how much to pay?” he asks. In mid-January, the Union health ministry said at a press briefing that four more vaccines, including Sputnik V, are in the pipeline though none has so far been approved.
As far as export of Covid vaccine is concerned, the government is handholding the process. Till 10 am on March 6, as many as 3.4 crore doses were exported on commercial terms, with another 73 lakh supplied to 26 nations as gratis. The top recipients of the free vaccines were Bangladesh (20 lakh), Myanmar (17 lakh) and Nepal (10 lakh) — clearly an attempt by New Delhi to foster neighbourhood diplomacy. In addition, 1.2 crore doses have been supplied under COVAX, a WHO-anchored global programme for pooled procurement and equitable distribution of vaccine.
Restraining free exports has a logic. The government fears that supplying more vaccines to the world will draw criticism if it lags behind in the pace of vaccination of its own people. However, Dr Shahid Jameel, virologist and director of Trivedi School of Biosciences, Ashoka University, says India should speed up exports.
“Export of Covid vaccine is not really hurting local supplies. Exports are a good thing as it is helping India improve its soft power,” he says, adding that just as India has supplied food grains to the world during Covid crisis, it should also step up its vaccine export to earn goodwill.
“We should not just be sending food grains to the world. In times like these, vaccines are the new food,” he says. India has the opportunity to become a global leader in Covid vaccine supply.
According to data released by the Directorate General of Commercial Intelligence and Statistics, a GoI entity, India’s export of vaccine, including for Covid, amounted to $126 million in the “other single vaccine” category and another $227 million in “mixed vaccine” category for the period between April 2020 and January 2021. As exports of Covid vaccines began only on January 20, the data for “mixed vaccine” category mostly captures figures other than Covid. In “other single vaccine” category, however, the January numbers jumped to $57 million from $6.2 million in December — a reflection of Covid jab export.
As Infosys cofounder Kris Gopalakrishnan argues, India must capitalise on its edge in domestic manufacturing capacity and enlarge its Covid vaccination programme. “We should look at whether we can arrange camps for larger groups of people. Otherwise, everyone will be crowding a few hospitals, which have other services to deliver,” he says, emphasising the point that India is not dependent on other nations for supply of vaccine.
India should adopt a bottom-up approach in vaccine rollout, as it has successfully done for its other immunisation programmes, rather than depend on a topdown approach using a central list, with people expected to come to the vaccination centre, says epidemiologist Babu. “In all other vaccination programmes, we rely on a strong micro plan. For instance, for every 1,000 people, there is an ASHA (accredited social health activist) and for every 5,000 there is an ANM (auxiliary nurse midwife), who already know the list of adults in a particular age group. It’s not new to them. In urban areas, you will need to get volunteers for this.”
Having restrictive provisions like getting a doctor to issue a medical certificate which then has to be uploaded will invariably slow down the process. “Any public health programme needs to be simple. Only when it is simple is it scalable.”
In areas that are harder to access, with no hospitals or health centres, innovative approaches such as mobile health clinics could be deployed. The measles rubella immunisation, which involves an intramuscular vaccine for adolescents, is complex but one crore children were covered in a state in a month, he says.
“There are a lot of innovations we have already tested. I’m really surprised why all the skilled manpower, competence and tested strategies are not being put to use,” Babu adds.
In Israel, lauded for its swift rollout of the Covid-19 vaccine, the country had 335 drive-through vaccination centres operating for extended hours as early as mid-January. In an interview, Israel’s health minister, Yuli Edelstein, told Sky News, “Get out there. Don’t put a huge station in the middle of your capital and wait for people to come. Try to get it out to their areas.”
Zahabiya Khorakiwala, MD of Wockhardt Hospitals, says decentralisation will be a good way to increase the penetration of vaccination, particularly in small towns and villages. The number of vaccination centres also needs to be increased. Khorakiwala says a lot of companies have been reaching out to Wockhardt for immunising their employees who are eligible for it. “As people are coming in for vaccination, they are happy with the experience and want it to be extended to their companies.” An ITC spokesperson says: “We intend to support our employees with vaccination under the company’s medical assistance policy.”
SBI and companies like Accenture and Infosys have also announced that they will bear the cost of employee vaccination. “As we continue to navigate the pandemic, nothing is more important than the health and well-being of our people. For employees who are eligible and choose to receive the Covid-19 vaccination, Accenture will cover the cost for the employee and their dependents who are part of our medical benefits programme,” says Rekha M Menon, chairperson and senior managing director, Accenture in India, in an emailed statement.
India Inc is, in fact, waiting for the government’s nod to go ahead with vaccinating its employees. That will boost the morale of the workforce, bring back normality to workplaces and factory floors and keep the wheels of the economy turning. After a year of being battered by Covid-19, this would be the healing touch on multiple fronts.
We need to look at multiple ways to vaccinate: Kris Gopalakrishnan, Cofounder of Infosys, Chairman of Axilor Ventures
My experience of getting vaccinated was very straightforward. I had agreed to take it publicly to tell people it is safe. So my registration was done at Narayana Health City on the morning of March 1. The vaccination itself was simple, painless and took less than 30 seconds.
I’m feeling fine now, with only slight tiredness and fever. My personal request is that as many people should get vaccinated as quickly as possible through many channels as possible. The reason is, every time the virus infects a person, it can theoretically mutate. The number of mutations increases as more people get infected. Some of the mutations could negate the immune response that is already there. The only way to get ahead is to vaccinate as many people as fast as possible, bring down the infections and reduce the opportunity for the virus to mutate.
Beyond allowing vaccination in all private hospitals, we need to think about using mobile clinics. We could look at models like Aravind’s eye camps, where the clinic goes to the village. It’s easy for someone in Bengaluru city to get vaccinated but if you go beyond that, access to vaccination centres will be limited and I don’t know what the situation is in villages. If someone has to travel two-three hours to reach a centre and another two hours to return, that’s a whole day gone. We need to think about how to mobilise other means to vaccinate a larger percentage of the population.
We should also look at whether we can arrange camps for larger groups of people. Otherwise, everyone will be crowding a few hospitals, which have other services to deliver. Finally, India is one of the few countries with domestic manufacturing capabilities so we have enough doses. We are not dependent on others for supply. We should use that capability.
In the US, they are converting car parks to vaccine facilities — where all you need is a nurse, technicians and a doctor to supervise a group of nurses. I’m sure we, too, can easily do it in innovative ways.
(As told to Indulekha Aravind)
Vaccine exports will help India boost its soft power: Dr Shahid Jameel
Dr Shahid Jameel, virologist and director of Trivedi School of Biosciences in Ashoka University, tells Prerna Katiyar that time is not ripe for Covid vaccines to be sold in the open market but advocates the ramping up of exports. Edited excerpts:
Now that private hospitals have been roped in for vaccination, do you feel some of the restrictions should go?
These are early days of vaccination in private hospitals and we have seen both ends of the spectrum: crowds jostling with each other in Mumbai versus capacity not fully utilised in other places. So, we haven’t had enough time to make a judgement. Roping in private hospitals was a good idea as the government alone does not have the capacity to vaccinate 30 crore in priority groups. Easing the time from 9 am to 5 pm, to 24/7 was another good move as it gives flexibility to working people.
Do you feel restrictions on supply should go?
The supply has to be equitable as most of it can’t go to Delhi-Mumbai-Bengaluru. Also, supply has to match registrations on sites. It will take time for demand and supply to stabilise and I feel the way it is being done is fine. We must understand that there is no shortage of vaccines and some interim data on Covaxin efficacy has just come out, which will give more confidence.
Do you think vaccine should be made available in the open market?
Not yet. Vaccine is being given at Rs 250 (Rs 150 for the dose and Rs 100 as service charge). In reality, the government is subsidising the vaccine as it is buying it for around Rs 220 and supplying it for Rs 150. If you put it out in the open market, then how will you control vaccination drive for priority groups of older people and those with comorbidity? The goal will not be achieved. If you put it out for, say, Rs 1,000 then even an 18-year-old will get it somehow and supply will not be able to meet demand. There is bound to be shortage and our target will not be met. So, what we are doing is just right.
What else should be done to enable India to emerge as a global leader of vaccine supply?
India is already a global leader in vaccines as we supply 65% of global childhood vaccine. According to an article in The Economist, Serum Institute of India will by this summer supply 50% of Covid vaccine to the world.
Do you think we have the capacity to export more vaccines?
Exports of vaccines are not really hurting local supplies. Exports are a good thing as it is helping India improve its soft image and power. It’s a good thing to do. We should not just be sending food grains to the world. In times like these, vaccines are the new food.