The failure of the private sector in vaccine administration shows why the Union government should procure 100% of the COVID-19 vaccines and adopt a policy of uniform pricing.
A healthcare worker holding a rose receives an AstraZeneca's COVISHIELD vaccine, during the coronavirus disease (COVID-19) vaccination campaign, at a medical centre in Mumbai, India, January 16, 2021. Photo: Reuters/Francis Mascarenhas/File Photo
India’s economy can possibly recover on a sustained basis if 70%-80% of the population is fully vaccinated with two jabs as early as possible. Based on an RTI answer from the department of health and family welfare, the Hindu reported recently that private hospitals picked up only 9.4% of the COVID-19 vaccines — Covishield and Covaxin — between May 1 and August 17, though 25% of the doses were allotted. Out of the 9.4%, private hospitals had administered 65% of vaccines by August 13. In 12 states and union territories, doses supplied to private facilities was less than 2%.
On the poor offtake from private players, Murali Neelakantan, principal lawyer at Amicus, Mumbai, said: “In the latest phase, private hospitals were asked to pay upfront for the doses, which was not the practice in the previous phases. Also, there is no fixed date at which the doses will arrive. Thus, they were not able to plan the administration process efficiently. This explains why the private offtake dropped.”
Union health secretary Rajesh Bhushan in a high-level meeting on July 14 highlighted that private vaccination centres and states had not physically lifted the vaccines they paid for in some regions. Also, wherever they are lifted, the administration has been poor, he observed.
Lagging behind
On July 24, commerce and industry minister Piyush Goyal had lamented that the private sector has not picked up the 25% quota allocated to them. Moreover, an official press release dated July 14, admitted to four problems with Private Covid Vaccination Centres (PCVCs), which includes private hospitals.
First, many PCVCs were not placing orders for the full quantity of vaccine doses earmarked for them. Secondly, even when orders were made, the required payments were not made by PCVCs. Thirdly, even when payments were made, the dispatched vaccine doses were not lifted by PCVCs. Finally, even when the vaccine doses were lifted, actual administration of doses by PCVCs fell short.
State governments are complaining to the Centre, but in vain. In a letter to Prime Minister Narendra Modi, chief minister Y.S. Jagan Mohan Reddy wrote: “The past experience and the demand for vaccines at private hospitals in Andhra Pradesh clearly indicate that such huge quantities of vaccines cannot be utilised by the private hospitals.” Similarly, another report noted that in Tamil Nadu, “of the 1.85 crore doses administered so far, just 5% was at private hospitals”.
Tamil Nadu chief minister M.K. Stalin wrote to the prime minister asking him to reduce the allocation for private hospitals from 25% to 10%. Odisha chief minister Naveen Patnaik also demanded that the proportion be reduced from 25% to 5%.
This evidence confirms again that the Union government must immediately adopt a policy of uniform pricing of COVID-19 vaccines with 100% procurement by the Government of India (GOI). Neither the GOI policy of April 21 (50% central, 25% by states, 25% by private hospitals) was appropriate, nor the June 7 modification of it (75% by Centre, 25% by private).
Lacunae in the COVID-19 vaccination policy
In addition to the failure of the private sector in vaccine administration, the reasons why 100% procurement should be done by the GOI are the following:
First, vaccines against infectious diseases have positive externalities, i.e. with positive effects on the entire citizenry. Nowhere in the world is a public good priced for the public. It is free, available to all, because it is good for everyone. Leaving it to market forces is both inequitable and inefficient.
Second, the National Vaccination Policy 2011 states that all vaccines (100%) will be procured centrally, and supplied to the states, which will then be used by states to vaccinate the population. All vaccines have been procured centrally for over four decades in consonance with the National Vaccine Policy.
Third, it has been held by the Supreme Court that right to health is part of Article 21 of the Indian Constitution (the fundamental right to protection of life) and restriction of capacity through the aforesaid notification directly impinges upon the right to health of a substantial number of citizens who would not be vaccinated.
Fourth, the rationale behind leaving 25% of the vaccines produced for private hospitals appears to be to incentivise production by vaccine manufacturers and encourage new vaccines, is irrational and arbitrary as a policy at a time of a once-in-a-century pandemic.
As of September 28, the cumulative number of vaccinations is 875.9 million of the 1,980 million that have to be administered (taking both doses into account). At least 68% of the estimated adult population has received their first dose and 24.61% are fully vaccinated. At this rate, there is little likelihood that the entire target population will be covered before the middle of 2021, a far cry from the GOI claims of immunising the country by end-2021.
Fifth, the cost of two vaccines per person in a household of five members is very high. Therefore, there is no way more than 5-6% of India’s population will be able to afford the 25% vaccines allocated to the private sector. That is the main reason why vaccine offtake at private hospitals has fallen off.
Finally, major developed countries which moved faster than India in ordering COVID-19 vaccines have adopted a central procurement model, with varying distribution mechanisms. Britain, Canada, the United States and the European Union have all followed similar strategies, pre-ordering doses — more than enough to inoculate everyone — from multiple makers. No country in the world has adopted the procurement strategy GOI has adopted.
The African Union (AU) created an African Vaccine Acquisition Trust to make available up to 220 million doses of the vaccine produced by Johnson and Johnson to the AU’s 55 member states starting July 2021.
Since India’s rapid second wave surge in new cases is the result of a combination of the spread of COVID-19 variants, including Delta, it is critical that the unvaccinated population is protected against further spread of the disease. (The Alpha variant, first identified in the United Kingdom, was dominant in New Delhi and Punjab, during the second wave of COVID-19 in India.)
The delta variant contributed to a rapid rise in COVID-19 cases in much of Asia, as well as much of Europe and the US. The spread of the Delta variant is now ravaging the rest of the world – a far cry from the situation when Prime Minister Modi had claimed that India was going to save the world with its vaccine exports. India has failed to meet even its COVAX commitments to WHO, which poorer countries desperately needed. They are hence relying on the Chinese and Russian vaccines.
There’s only so long unvaccinated people (or countries) will be able to hold the line against SARS-CoV-2. If the vaccines arrive too late, COVID-19 will already have reached the vulnerable as a severe disease, as in the second wave. It may also mutate again, as it did in India. If the vaccines arrive soon enough, COVID-19 might still spread, but people will be protected against severe disease. Our lives are in the Union government’s hands.
Santosh Mehrotra is visiting professor, University of Bath, UK.
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(With input from news agency language)
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