Paid Covid-19 booster shots: Experts divided on govt intervention

Centre may have to step in to ensure universal coverage, some say; also call for shift in focus to strengthen surveillance, testing and gathering data

With the roll-out of paid Covid-19 boosters off to a slow start, experts believe that in order to ensure universal coverage the government may need to step in and offer free doses of the precautionary shots at some point.

Some experts are also of the opinion that it is a time to strengthen surveillance, testing and collating epidemiological data rather than achieving marginal improvements in vaccination coverage or boosting immunity.

K Srinath Reddy, president, Public Health Foundation of India, feels that the government might intervene if it senses a need for universal booster shots.

“The government does not feel that everyone needs booster shots at the moment. That is why it has gone with the policy of allowing whoever wants it to pay and take it. This will ensure that people who are vulnerable or at high risk will have priority for free administration of the third dose,” he says.

Reddy adds, “Eventually, if a time comes when there is a need to cover the entire population, then we can expect the government to step in and offer it for free.”
 

According to experts like Dileep Mavlankar, director, In­dian Institute of Public Health, and former professor of Indian Institute of Management Ahmedabad, people may be in a better position to gauge their vulnerability than the government.

“The government is deciding based on some criteria such as age and co-morbidities. But it does not have access to data related to our lifestyles — how many people we meet daily, for example,” Mavlankar adds. He explains that the risk profiles of a 60-year-old diabetic in a Northeastern village and a 50-year-old diabetic shopkeeper in Mumbai are not the same. He feels that paid shots would en­sure cov­erage across major cities as people who need to travel, who can afford, or who feel they are vulnerable, will definitely take the shots.

T Jacob John, senior virologist and former head of the departments of clinical virology and microbiology at Chris­tian Medical College (CMC), Vellore, however, is of the opinion that if the government does not give booster shots, it is essentially misleading people who have taken two doses in the universal vaccination programme. “No vaccination regimen is complete without booster doses, and thus the Covid vaccination, too, needs the third shots,” John says.

He also points out that the Centre needs to come out with a clear policy on Covid-19 — what is the strategy to face this disease in the endemic stage? “We do not have a policy on influenza, for example. It’s for everyone to decide how best to protect themselves. But we do have a policy on TB (tuberculosis). Similarly, the government needs to clear its stand on Covid-19,” he added.

Gagandeep Kang, microbiologist and professor at CMC Vellore, however, disagrees. She feels that opening boosters for all has no relation with universal coverage, instead it’s about facilitating people who need a third dose (for example, ones who need to travel or are immune-compromised, or do not fall into the senior citizen category) to get access to a dose.

“I am not sure if we need a booster shot for all at this point of time. Also, not all vaccine regimens need boosters within six months. At best, that is done for the flu shot. So, we now need to gather epidemiological evidence on Covid-19 vaccination,” Kang says, adding that once we know where the vaccines are failing and people are getting breakthrough or severe infections, we can intervene at the right places and with the right kind of vaccines.

Also, the Centre needs to we­igh its options for how best to use its public health tool, she felt. “Is this money best spent in trying to achieve marginal improvements in vaccine coverage, or can these funds be spent on other disease like TB or diabetes,” Kang said.

The Centre allocated Rs 5,000 crore for Covid-19 vaccinations for FY22-23.