February 23, 2021The PrinthealthCovid-19

Without the private sector, India’s vaccination rate will be sub-optimal

The current pace of India’s vaccination programme is, paradoxically, both impressive and inadequate. To be effective, it must be ramped up 10-20 times, so that 80 per cent of the population can be protected by the end of the year.

The Print This is an unedited cut of my weekly column in The Print (2018-2021)

Despite being the second-fastest country to vaccinate over 10 million people and currently having the third-highest number of people vaccinated against Covid-19, it is fair to say that India’s vaccination programme has gotten off to a slow start. At around 300,000 per day, the current vaccination rate is only a quarter of the 1.3 million per day that was estimated by the government in January. As Naushad Forbes, co-chairman of Forbes Marshall, pointed out in Business Standard a few days ago, at this rate it could take up to 17 years to administer two doses to 800 million adults.

In other words, the current pace of India’s vaccination programme is, paradoxically, both impressive and inadequate. To be effective, it must be ramped up 10-20 times, so that 80 per cent of the population can be protected by the end of the year. Speed is important for many reasons: the faster the population is immunised, the quicker the economic recovery, the smaller the risk of new strains, and lower the human cost.

Need for high targets

Not only is a rapid vaccination programme necessary, India can also do it if we run it in mission-mode, sharply focusing state machinery and national resources onto achieving a single task. A country that can routinely carry off the gargantuan tasks of organising national elections or events like the Kumbh Mela can pull off a rapid, universal vaccination programme. Prime Minister Narendra Modi has said as much.

The Union Health Secretary, Rajesh Bhushan, has written to state governments recommending that Covid-19 vaccination be conducted at least four days a week, and at more sites. A key member of the Indian Council of Medical Research (ICMR) vaccination task force expects to bring online 50,000 to 100,000 immunisation centres over time, and achieve 5 to 7 million vaccinations per day. It is unclear if these are official targets, but to the extent that they are an indication of the government’s ambition, this is good news.

The important point is that targets of this magnitude are achievable. But it can’t be pulled off by the government alone. Other than elections, no public service in India — education, healthcare, transport, water, power, banking, telecommunications — has ever been delivered by the government alone. The rapid rollout of Aadhaar to over a billion people in a few short years, for instance, was made possible by leveraging private sector capabilities. It was only after India permitted private laboratories to carry out Covid-19 tests that our testing rates improved to levels that were meaningful in managing the pandemic. It is no different with the vaccination programme. As the Confederation of Indian Industry (CII) and several industry leaders have argued in recent days, India’s vaccination programme needs a shot in the arm from the private sector.

In his Cut the Clutter video, Shekhar Gupta was overly harsh on the administrators when he blamed bureaucratic conservatism for the slow rate of vaccination. There are a few good reasons to be cautious, for many things are new, untested, and risky. The safety and efficacy of the vaccines have not yet been completely established in the Indian context. The adequacy and reliability of the supply schedule cannot be taken for granted. The digital infrastructure is new and bound to have teething problems. There has not been a lot of time to test and train the logistics and administrative processes. Too little is known about the various issues at the point of delivery. So a cautious Phase 1 deployment targeting the relatively more educated, aware, and traceable healthcare worker segment is prudent, before expanding it to millions of people a day, across as diverse a country as India.

Road ahead for India

What is fairer and more important is to ask how much the Union and state governments have learnt so far, and how well they will use this knowledge to quickly scale up the pace. First, there is clearly a case for the government’s facilities to work all days of the week and vaccinate thousands every day. Second, there is also an urgent case to enable India’s vast private healthcare industry to plug into the national digital infrastructure. Third, the drug regulatory authorities must create a fair, transparent and credible route for the world’s vaccine makers to bring their products to India.

The tendency to impose price caps as a condition to allow private sector entry’ is representative of the old sarkari mindset that sees the private sector as an unscrupulous adversary, instead of a useful ally. As long as the government’s own vaccine delivery system is readily available and accessible to all Indians, it need not be overly concerned about the prices of private vaccines. If those who can afford it get their vaccines from private providers, that much of the money can be used by the government to pay for those who can’t. Price caps will be counterproductive.

An early survey of vaccine recipients by Rajeev Jayadevan, Ramesh Shenoy and Anithadevi T.S. suggests that vaccines are safe even among the elderly. Such knowledge, along with concerns of a resurgence of infections in some states, should be used to allay the vaccine hesitancy that has unexpectedly crept in. Whether by design or otherwise, the slow start has put India in a better position to achieve the historic feat of vaccinating everyone in a few short months.

The rest of my The Print columns are here.

Tailpiece: As I wrote in an earlier column, India is unlikely to see a second wave, but places and people who protected themselves well thus far risk getting infected as restrictions are relaxed. Masks, social distancing and other precautions remain necessary until vaccination is complete.



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