Edit & Opinion

Free Vaccination: Easier Said Than Done

The Centre will start rolling out free vaccines to all States for those above 18 years from next Monday. However, the big question is whether this time round it would have done its homework thoroughly. More so, as to achieve its target of fully vaccinating its adult population of around 94 crores,by year end, it will have to step up the average daily vaccination levels close to five times from what has been achieved from January 16 to June 7. This possibly appears an impossible task and experts are unanimous on this point.

States such as Uttar Pradesh may need a nine-fold jump in daily vaccinations, Bihar over eight-fold and Tamil Nadu, Jharkhand and Assam over seven-fold. Five of the country’s most populous States in terms of 18 plus population face the task of raising the daily vaccination levels five-fold or more.

According to census projections, it would need to administer further 170 crore doses in the remaining 231 doses of the year. That would require an average of around 75-80 lakh doses a day (weekends included), a nearly five-fold increase over the average so far. Vaccinating such huge population is not merely a challenge of supplies. It would mean adding many more vaccination centres than have been used at any point in the vaccination drive and finding the extra personnel needed to man them and to administer the doses.

Therefore, it’s necessary that there is close coordination between Centre and the States and that there is a task force set-up or the existing Raisina Hill-centric one revamped, which enables proper monitoring of the vaccines’ supply and distribution. It needs to be noted that Prime Minister Modi made the announcement of Centre’s decision to buy 75% of jabs from vaccine makers, including 25 per cent of the State quota, and give it for free, following strictures of Supreme Court on the differential pricing in purchase of domestically manufactured vaccines.

The apex court had raised serious doubts about the Modi government’s liberalised vaccine policy of “fixing higher prices as a competitive measure” and stated that it’s the responsibility of the Centre and not the States to provide free vaccination. The bench headed by Justice Chandrachud said the Centre’s policy of allowing vaccine manufacturers to charge the States’ higher rates violated the fundamental right to equality, as did its policy of providing free vaccination only to those aged 45 and above. The court underlined that this year’s annual budget had set aside Rs 35,000 crore exclusively for vaccine procurement and wanted to know how it has been spent.

The present cost of free vaccination would come to around Rs 45,500 crore and to make a modest recovery of expenses, only those who can afford to pay can get the jab from private nursing homes. Unfortunately, though the Centre chose to ignore experts’ advise on pandemic control and vaccination of maximum population through development of health infrastructure. Diverting maximum resources towards this end, specially by shelving the Central Vista project by at least a year or two, would have been the right decision.

This was a demand among others raised in a joint letter by 12 Opposition leaders to Modi as also a group of 187 eminent persons, who pointed out that “it is shocking that the GoI has neither welcomed the suggestions (of Opposition leaders) nor created a truly national task force comprising all parties, State governments, experts and civil society to tackle the unprecedented situation India is facing”. It too had regretted the Government outsourced procurement of vaccines to States, resulting in “differential and exorbitant rates”.

While the sticky issue of free vaccines for all stands resolved and the Centre giving in, it would also need to consider seriously the large number of children in the country who could be affected by the pandemic. Our current vaccination policy extends to cover all those above 18 years. There is need for herd immunity level of 80% to contain the epidemic. It is impossible to achieve this level by vaccinating only those above age 18. Thus, India must urgently draw up plans to vaccinate children under 18. The question that arises is how long will fear of Covid keep children away from schools, given that parents, children, teachers, educationists, nutritionists and paediatricians are all alarmed by the adverse effects on children’s well-being.

With vaccinations still moving in a rather slow pace in the past two months and unlikely to pick up steam from July, there are fears that the incidence of the pandemic may not be curbed in rural and semi-urban areas. However, even here an internal government projection for August and September shared by a source put the monthly number of Covishield doses at 100 million out of 200 million for all the three approved shots combined, as claimed by the government.

The official figure of those who contracted the disease had reached 30 million (widely believed by experts to be a gross under estimate) and deaths exceeding 300,000. Meanwhile the The New York Times had suggested last month that actual Covid infections in India could be 20 to 26 times the government figure and the death count could be 5 to 13 times the official toll.

A section of experts are talking of a third wave as official warnings have surfaced of this possibility. Though the magnitude of its impact is yet to be ascertained, its incidence is likely to impact children. The fear is perpetuated by the shocking slippage in vaccination coverage and the shortages of vaccines for adequate and fast protection of the virus. Moreover, the fear factor may restrict mobility and social and economic engagement and sentiments of consumers may not be back to normal in the coming months.

The problem in the country is that the Modi administration being seen as heavily centralised, there is little scope for professionals to air their independent views, even in internal meetings. It is said Modi does not entertain other’s views and professionals and experts have just to carry out orders. In such a situation, what is needed is a decentralised system where views of experts are given due cognisance and there is no diktat from the top.Note that in the United States, it is a renowned expert Dr Anthonu Fauci, who is taking decisions relating to the pandemic and related issues.

Advice of experts needs to be given topmost priority and a communication drive launched that could clear misconceptions and effectively tackle such pandemics or other types of disasters. While vaccination has to be enhanced with not even 15% of the population vaccinated as on date, it is also necessary to ascertain whether a booster dose would be necessary within 12 months of full vaccination, as predicted by Pfizer CEO.In all, pragmatism is the need of the hour, which sadly has been lacking in governance so far. There is need to go beyond ad-hoc decisions and take a holistic view of building the country’s health infrastructure. The government would do well to remember, a stitch in time saves nine.

 

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By Dhurjati Mukherjee

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