India’s ‘arbitrary and irrational’ vaccine policy spells trouble

Author: R Ramakumar, Tata Institute of Social Sciences

In May 2021, the Supreme Court of India remarked that the country’s policy of charging those aged between 18–45 for COVID-19 vaccines was ‘prima facie arbitrary and irrational’. The government has since revised its vaccine policy by covering a larger share of the population with free vaccines. Yet, India’s vaccine policy continues to be based more on politics than on reason or science.

Despite its boastful posture of being the ‘pharmacy of the world’ and a vishwaguru (world teacher), India’s vaccine supply has come under strain and cast doubt on its ability to fully vaccinate its population by early 2022. To fully vaccinate everyone above 18 years old, India must administer 1.9 billion doses. As of late July 2021, 434 million doses were administered. This means that only 26 per cent of India’s population has received at least one dose and 7 per cent has received both doses.

To fully vaccinate its population by January 2022, India would need to administer 7.4 million doses per day, almost double its June 2021 rate of 3.9 million per day.

India made three major errors in planning for its vaccine rollout. First, the government failed to diversify its vaccine sourcing, sticking to just two ‘Made in India’ vaccines. Prime Minister Narendra Modi stated in February 2021 that these two vaccines would not only be sufficient for domestic use, but also to supply the world. Such a hyper-nationalist posture was expected to bolster Modi’s political position.

Second, India failed to make ‘at-risk’ investments in research and development for vaccines yet to pass regulatory clearance. In the United States, United Kingdom and Germany, such at-risk investments were instrumental in the rapid development and mass production of COVID-19 vaccines.

Third, India failed to place advance purchase orders for vaccines. While many countries placed such orders in June 2020, India’s first purchase order was placed in January 2021. By then, producers were already committed beyond capacity to other purchase orders.

By April 2021, these failures hit home in the form of an acute vaccine shortage. Daily vaccination rates halved after 7 April 2021. Vaccination centres closed. An export ban on vaccines was imposed to ensure domestic supply.

In response, the government changed its vaccine policy. In a hasty retreat from its nationalist chest-beating on ‘Made in India’ vaccines, it indicated readiness to import foreign vaccines. The government also announced a ‘liberalised’ vaccine policy, effective from 1 May 2021, whereby half of all vaccines would be purchased at regulated prices by the government and administered free to all. The rest would be purchased at higher market prices by state governments (25 per cent) and private hospitals (25 per cent).

There were two reasons behind the ‘liberalised’ vaccine policy. The first was economic — private vaccine companies lobbied for freedom to earn ‘super-profits’. The government succumbed to these demands, resulting in vaccine prices tripling or quadrupling within a week.

The second reason was political. The government did not want the burden of blame over vaccine shortages. By shifting the responsibility of direct purchase, it could hide its own failures and accuse state governments of failing to procure vaccines.

Both these moves backfired. State governments failed to buy vaccines directly, with Chief Ministers accusing the government of failing to discharge the responsibilities of an enlightened welfare state. Meanwhile, half the vaccine allocations to private hospitals were cornered by a few large corporate hospitals in metropolitan cities.

By early June, Modi was losing his grip on the narrative. The Supreme Court of India examined whether charging for vaccines violated the fundamental right to life guaranteed under Article 21 of the Indian Constitution. Consequently, the government was forced to partially revise its 50:25:25 ratio. From 21 June, the allocation ratio would be 75:25 — that is, 75 per cent of vaccines would be directly procured and administered for free by the government, with the remaining 25 per cent reserved for private hospitals.

This revision only partly corrected the bias in the earlier policy. The 25 per cent allocation for private hospitals was essentially a reservation of vaccines for the rich, as the prices were entirely out of range for poorer households. For a household on the poverty line, the price for two vaccine doses would wipe out half its monthly income.

The crisis of production continues. India’s vaccine production capacity is likely to be limited to less than 3 to 4 million doses per day for at least the next two months.

The most serious crisis, and failure of policy, is in the production of Covaxin. Despite the Government of India sharing the intellectual property rights on it with the private biotechnology company Bharat Biotech, no steps were initiated to mass produce the vaccine. Bharat Biotech retained the exclusive license to produce it for many months. Finally, the government allowed three public sector companies to produce the vaccine, but their first batch of supply is not expected before the end of 2021.

India’s failure to quickly vaccinate its population is not just India’s problem. Given the international mobility of the Indian population and the rising threat of the Delta strain, a failure in India will have global ramifications. Policy failures and an inability to base decisions on science and reason have led to the present state of crisis. Unless India’ vaccine policy is overhauled on war-footing, it is unlikely the crisis will blow over anytime soon.

R Ramakumar is Professor in the School of Development Studies at the Tata Institute of Social Sciences, Mumbai.

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