A new vaccine regime

Govt conducts welcome course correction

The Union government has announced a major change to its vaccine distribution plan, new guidelines that it is calling the “liberalised and accelerated phase 3 strategy”. The biggest move is that, from May 1, all Indians above the age of 18 will be permitted to get the vaccine. The Union government itself will continue to restrict access to free vaccines to those above 45, alongside health care workers and front line workers as before, and will have the right to half the production of vaccines domestically. In addition, state governments have been “empowered” to buy vaccines directly from manufacturers and to make decisions about access to vaccines in their territory. The guidelines have been designed, according to the government, to provide flexibility to individuals, companies, and state governments in terms of “pricing, procurement, eligibility and administration” of the vaccines.

This flexibility should have been part of the government’s approach to the vaccination roll-out from the beginning — if not January this year, then at least April, when access was opened up to those over the age of 45. It is likely that the surge in Covid-19 cases and deaths, alongside the stress on the health care system and pressure from the political opposition, played a role in the government’s decision. Even so, it is welcome that the government has recognised good sense and not stuck with a mechanism that was clearly not working. This decision has the chance of reinvigorating the vaccination roll-out, and shows that the government is capable of reacting swiftly to emerging crises. Given the liberalisation of the demand side for vaccines, the question that now will be asked is what is being done to prop up supply.

Last week, the government had also announced that vaccines approved by a set of reliable foreign regulators would be granted emergency use authorisation in India as well without the need to conduct bridging trials on Indian patients first. It has been reported that the two Indian manufacturers which are crucial to the existing vaccination programme — namely Serum Institute of India (SII) and Bharat Biotech — will be provided a government advance of Rs 3,000 crore and Rs 1,500 crore, respectively. SII specifically asked for this sum recently in order to scale up its production capacity. The government must also directly engage the United States administration to relax its export controls on crucial raw materials for vaccine production, which SII has named as another major bottleneck in its capacity expansion.

One concern that is looming is that the shift of responsibility to state governments may lead to conflicts of various kinds. Encouraging state governments to independently procure vaccines might lead to attempts to intimidate or strong-arm vaccine producers in their states. To head off such conflict, the government should — as recommended recently by Manmohan Singh — make transparent the formula for inter-state division of its half of the vaccines, and strictly follow it. State governments, too, should see this new policy as a clear suggestion that they ease bottlenecks for private supplies on their territory. Indians have shown in the past that they are willing to pay for private health care, and state governments should take advantage of that and not choke off the private route.