Where is the vaccine?

Policy in a mess

By Poonam I Kaushish

The proof of the pudding is in eating. In medical analogy proof of India’s vaccine failure is in its falling rates of vaccination. Till dte only 2% of the population has been inoculated thanks to poor planning, politics, too much bravado, excessive control and vaccine nationalism which has led us to a scarce situation with all asking one question: Where is the vaccine?
Shockingly, the number of doses delivered had fallen from 51.82 million in April beginning to 29.46 million last week with about half as many people being inoculated per day from a month back. At the peak of the second wave if 43 lakhs were getting the jab, this month it is less than 20 lakhs with various States Delhi, Maharashtra, Karnataka etc chorusing they had supply for just two-three days. Yet, when the Supreme Court pulled up the Central Government asking it to revisit its vaccine policy, the Center averred it had enough.
Compounding this, it opened up vaccination for its 594.6 million 18-44 population when it had placed a total order of 280 million doses from the country’s two suppliers Serum International and Bharat Biotech, barely enough to cover 140 million people. Totalling, just over 2% of the population with merely 11% having received one dose.
Now add to this mix, the Centre’s dual pricing and procurement policy from the two suppliers whereby the Center will procure 50% of vaccines at Rs 150 and the rest divided between States at Rs 300-400 and private hospitals and corporate at Rs 800-1200 has resulted in chaos. Alongside the Government has ended up creating supply bottlenecks and leaving the prioritising of doses to the manufacturers.
Further it grandiosely announced States were free to buy and negotiate pricing from international manufacturers as well. Only to fall flat on its face as both Pfizer and Moderna have snubbed Punjab and Delhi by stating it would sell only to the Indian Government. “Allocation of doses and implementation plan within a country is a decision for local Governments based on relevant health authority guidance,” they added.
Alas, instead of relying on its talent pool of public health experts and scientists to guide its response and vaccine policy the Government put over-zealous bureaucrats in charge of coordinating the vaccine drive via a website and app. In a country where majority of the poor do not have not access to mobile phones and internet they would need to find someone who would be willing to register them using their phone which has aggravated the uncertainty resulting in a wrong-headed policy.
Besides, it conveniently turned the other cheek to the National Vaccine Policy adopted in 2011 which underscored the need and mechanism for creating a stockpile of vaccines in case of emergencies. Even after Serum and Bharat Biotech announced their vaccine in June last, policymakers showed no alacrity to order and did so only in January by which time both had made commercial commitments to other countries.
Moreover, the Modi Sarkar could have easily borne the cost of vaccinating the entire country above 18 years given that it had earmarked Rs 35,000 crores in the Budget, a little over 0.34 % of our GDP to vaccinate nearly 100 crores Indians. Instead, of giving vaccine makers realistic orders with advance payments it chose drip-drip placement of doses.
This despite knowing the size of the target population and production capacities of the two domestic vaccine manufacturers, the first responders to the crisis in advance. Consequently, this resulted in a lack of liquidity and incentives, if not disincentives, for manufacturers to rapidly scale up.
Indeed, India has come a long way from being Atmanirbhar to Vishvanirbhar thanks to the Government’s premature declaration of victory over Covid 19 in January without checking if we had enough vaccines, oxygen, Remdesivir whereby we are pleading with Western countries for vaccine and health paraphernalia as the country stares at a full-blown crisis. It has backtracked on its policy and fast-tracked vaccines approved by international regulators.
In January when Western countries had booked vaccines 2-3 times their populations, we placed an order for just 15 million, for a population of 1.4 billion. The Government’s explanation for vaccine, oxygen and ventilators shortage? Nobody could have anticipated this. Really? Yet the rest of the world did.
Currently, we are facing three major challenges. One, ensuring adequate supplies in a short time. Two, sorting out our pricing policy for the vaccine and three, the administration of the vaccine. The Government needs to realize its current policy cannot be fixed in bits and pieces. It needs to start from scratch.
The Centre needs to fund a part of the vaccine capacity expansion to ramp up production and delivery, procure 70% of the vaccine output directly at speed to vaccinate people before the virus or its mutation gets to them and allocate it among States based on their share of the vulnerable population. It needs to lay out the hierarchy, make it public and leave it to States to administer the jab as it our main tool to fight this pandemic.
If this is bad we now have to grapple with an epidemic in the ongoing pandemic a fungal ailment mucormycosis or black fungus which if not caught early can lead to death with the average fatality rate being 54%. Already, it has infected over 7500 people across 18 States. Mostly those who suffer from diabetes and have been given strong doses of steroids or immuno-suppressants to calm the immune system kicked into overdrive by Covid 19.
Sadly, instead of taking cognizance of this when the first case was detected the Government sat on the data hoping the fungus would disappear. Compounded by doctors disregarding experts advice urging them not to prescribe steroids too early and many people self-medicating steroids s they are cheap and seen as life savers. Two other fungus, white and yellow fungus have also been detected.
Predictably, like Covid 19 the Government has repeated the same mistake: there is a severe shortage of the main anti-fungal drug to treat the infection leaving patients begging for life-saving medicines at the mercy of the Centre which has centralized quota allocation in its hands. Take Delhi. It needs 2000 injections daily for 500 patients but is provided only 400.
Worse, even as it grapples with the virus our healthcare sector continues to get no attention. Picturise a Primary Health Centre in Bihar. It only exists on paper and doctors, nurses & sanitation workers are appointed but they come only once a month specially on 26 January and 15 August for flag-hoisting resulting in pigs having a field day scavenging in garbage on its premises. Multiply this pan India. Any wonder why we are in mess.
Sadly, we not only have missed the boat but what is worrisome is policy paralysis continues to this day. Time for the Government to get its head of the sand and read the writing on the wall before it is too late.
If we fail to do so, not only will we face a third and more virulent wave, but the mad rush for vaccines will become super-spreader events on par with election rallies and religious congregations. We need to maximise vaccination fast and safely. This is our only hope to try and beat the virus. —— INFA