There are grand gestures that do no greater harm than the minor knocks and bruises that come with being swept off your feet. Think the promise of Achche Din or getting back the black money that has been spirited away from the country to remit ₹15 lakh into everyone’s bank account. Then there are grand gestures that do significant damage, but the damage is obscured by images of gain. Think demonetisation. And there is the grand gesture that kills. Throwing all norms of prioritisation into the bin of hospital waste and announcing vaccination for all those above 18 years of age falls in this category.
Our vaccine production capacity is 70 million doses per month. That is 2.33 million per day. The population aged above 18 was 911 million in 2019 (that many were eligible to vote in the last parliamentary election). It is probably around 930 million now. Less than 160 million people have been vaccinated so far. When vaccination eligibility is thrown open to all adults, for every 2.33 million shots available each new day, 770 million potential claimants are in queue. What is achieved by asking 330 people to queue up for every jab on offer?
Mere frustration and disappointment for those who have to wait for another day, you think? Think again. Opening up vaccination for all adults without any thought as to their vulnerability, given their age, co-morbidities, line of work or geographical location in a context of differential degrees of COVID-19 intensity among the states, sets up a mad scramble in which many who are most vulnerable would lose out to those who need the jab the least. The result would be avoidable deaths.
But we have opened up imports of vaccines. Our global allies and well-wishers are gifting us vaccines and other medical supplies. Can’t we stop worrying and finding fault?
The world at large faces a vaccine shortage. The US is sending across 20 million of the 60 million Astra-Zeneca vaccines that it has bought but does not plan to distribute domestically. This will make a marginal difference, that is all. Vaccine production has to be stepped up for the world at large, and India is the most viable place for increasing such output.
A bench of the Supreme Court last week asked the government to explain the logic behind differential pricing of the vaccine for procurement by the Centre, by the states and by private hospitals. I am not a fan, in general, of the judiciary stepping into the domain of the executive. However, the present intervention by the court is altogether tenable, as the chaotic scramble for vaccines implicit in the differential pricing regime minus any guidelines for inter-se allocation among the states thought up by the Centre endangers the right to life of vulnerable citizens, protecting which falls within the legitimate domain of the courts.
Are private companies to decide which state should get priority over which other state in vaccine allocation? This question was also raised by the Supreme Court. It is a most pertinent question.
The only purpose served by multi-tier pricing of the vaccine is to allow the Centre to procure vaccines at rock bottom prices, while the states and the private sector pick up the cross-subsidy tab. Health is a state subject, so it is not entirely unreasonable on the Centre’s part to expect the states to pick up at least part of the tab for vaccines. And there is no harm if those who want to get vaccinated in the comfort of a private hospital are asked to pay a higher price for their vaccines.
But pricing is not the main issue. Whatever the pricing, whatever the sharing of the cost of vaccination among the Centre, the states and the individuals getting vaccinated and whatever the mechanism of such sharing, the priority of allocation should flow from just one consideration: saving the maximum number of lives from the pandemic.
That means vaccine doses, as and when they become available, should be allocated among the states as a weighted average of their overall population, current vulnerability given the incidence of the pandemic, priority groups by age, occupation and co-morbidities, with a negative weight for vaccine wastage, while the states deliver the vaccines as per the desired priority.
This should not be left to the market, but determined by the Centre. Whether the Centre pays for the vaccines or the states is immaterial to the people. Those who are covered by health insurance should expect their insurance providers to pay the government for the vaccines delivered to those insured. After all, insurance companies are better off pre-empting the hospitalisation and treatment they have to pay for, if the insured were to fall prey to COVID.
However, whether the cost of vaccination is borne by private insurance companies, Ayushman Bharat or the Employees’ State Insurance Corporation or by governments is a matter of detail, incidental to the main task of vaccinating people according to the logic that minimises the toll of the pandemic.