Coronavirus | Opeds and editorials

A recipe for vaccine inequity

With the stroke of a pen, the Central government on April 19 abdicated its responsibility to ensure equity in vaccine availability by clearly stating that free vaccination would be limited to healthcare and frontline workers and people above 45 years of age. Worse, the government has set the stage for State governments, private hospitals and the private market vying to have access to vaccines from the Serum Institute of India (SII) and Bharat Biotech.

The April 19 announcement of the roll-out of vaccines in the third phase, wherein anyone above 18 years is eligible for vaccination, comes at a time when many States have already been reporting shortages in supply, which is reflected in the dropping number of vaccine doses administered daily, the four-day Tika Utsav (vaccination festival) notwithstanding.

Also read | Covishield to be sold to States at ₹400 a dose and at ₹600 to private hospitals from May 1

While allowing all adults above 18 years is indeed a welcome move, the Centre’s announcement comes with several caveats.

The two vaccine manufacturers will supply 50% of their vaccine doses to the Union government, while the remaining doses will be made available to State governments and private hospitals. A press release from the SII says Covishield will be available in retail and free trade after four to five months.

Unlike the rest of the world, the Indian government took the first step of charging for vaccines by fixing the cost of jabs at private hospitals at up to ₹250 per dose. But with the April 19 announcement, the government has gone the whole hog by allowing the two companies to decide the price of vaccines.

Also read | Covishield comprises over 90% of 12.76 crore COVID vaccines administered so far

A contradictory approach

Many developed countries have sealed vaccine supplies many times their total population; most countries, including the U.S., where healthcare is highly privatised, are vaccinating adults for free. Against this, India has taken a dangerous gamble in allowing companies to sell vaccines at huge profits amid a pandemic, and particularly so when the second wave is ravaging the country and daily deaths are spiralling.

The government’s projected population for the year 2021 for the 18-44 years age group is 595 million. With two doses per person, this translates to 1,190 million doses. This huge population has not been included in priority groups to have access to vaccines, and it would be covered solely by State governments and the private sector. While the private sector may be able to cater to a small percentage of the population that can afford to pay a higher price per dose, the States must buy vaccines and administer them for free for a huge number of people, lest the poor are left out. Whatever policy each State government formulates to identify those eligible for free vaccines, it would need to allocate huge resources to buy the doses. A significant number of people are likely to be left out in this process.

 

As per the Centre’s demand, on Wednesday, the SII announced the price at which vaccines will be sold to States and private hospitals. Adar Poonawalla, CEO of the Serum Institute of India, told CNBC-TV18 that Covishield will cost ₹400 for both Central and State governments and ₹600 for private hospitals.

On April 6, Mr. Poonawalla went on record saying that even at the subsidised price of ₹150-₹160 per dose, the company was not selling at the cost price but was making a profit. “I would not say we are not making any profits, but we have sacrificed what we call ‘super profits’,” he told NDTV. “Super profits are needed to further build capacity, innovate and compete with the western companies. But we don’t care for these at the moment as we want to address the needs of the nation first… and we can make profits after a few months.”

However, since the Centre has already agreed to advance ₹3,000 crore to the SII and ₹1,500 crore to Bharat Biotech to ramp up manufacturing facilities, would the two vaccine manufacturers still feel the need to make a killing?

 

Rising costs

On several occasions, the latest being December 30 2020, both Oxford University and AstraZeneca promised to manufacture and distribute the vaccine “on a not-for-profit basis for the duration of the coronavirus pandemic”. When AstraZeneca walked back on its word with Brazil, the company said it had the right under the contract “to declare the pandemic over by July 2021” and that it could extend the agreement beyond July 2021 but only in “good faith” and if it considered that the COVID-19 pandemic was not over.

In India, the SII, despite not selling the vaccine at the cost price, is making a small profit while supplying it at ₹150 per dose. With the price tags of ₹400 and ₹600 per dose, the company will be earning more than 2.5 to three times the profit as early as May 1, when the pandemic is nowhere close to ending and the second wave is raging in India.

How much vaccine inequity will be seen in each State will depend on the policies that governments design to identify beneficiaries. Since no one is safe till at least a vast majority is protected to achieve herd immunity against COVID-19, it is imperative that the Indian government ensure that companies do not become greedy while selling to State governments. Any “super profit” that a company plans to make can come from retail and free trade about four to five months later.

Editorial | A moral test: On the vaccine divide

Further, India may soon have three more vaccines, in addition to the three already approved for restricted use. The rich can then avail of the best vaccines in the open market, in line with the government’s announcement that all imported vaccines will be available only in the private market.

The second wave has amply demonstrated that unlike last year, more people in the age group of 18-40 years have been symptomatically infected, with many requiring hospitalisation. Hence, a policy that promotes vaccine inequity based on age bands is a dangerous proposition.

A bigger issue is that with States required to procure 50% of vaccines directly from manufacturers, the governments will end up competing with each other and with private players. A similar situation was seen in the United States last year, when former President Donald Trump made individual States procure ventilators and Personal Protective Equipment (PPEs) on their own, leading to a chaotic situation where States outbid each other and diversion of supplies from one State to another became rampant.

 

With around 2.4 million doses being produced a day, the SII is currently manufacturing 60-65 million doses a month. According to Mr. Poonawalla, the company will be able to ramp up production only after June; capacity addition at Bharat Biotech, too, will take a few months. Hence, the current shortage is likely to continue for a few more months.

Amid the sharp criticism for the shortfall, the Central government, by allowing States to procure vaccines directly from manufacturers, has deftly shifted any future blame to State governments.

prasad.ravindranath@thehindu.co.in

Related Topics
This article is closed for comments.
Please Email the Editor

Printable version | May 8, 2021 2:32:56 PM | https://www.thehindu.com/opinion/op-ed/a-recipe-for-vaccine-inequity/article34379474.ece

In This Package
Social murder and the missing state
A CT scan for COVID merits a word of caution
To stop a third wave, India has to mask up
Is the government committed to vaccine equity?
Salutary steps: On Election Commission norms to curb COVID-19 spread
Shortage and wastage: On cutting vaccine wastage
Gasping for air, gasping for answers
Misinformed and misleading
Right priorities: On U.S. COVID-19 aid to India
A patently wrong regime
Tips for managing COVID-19 at home: the dos & don’ts
Undermining ‘vaccination for all’
Another wave spells more nutrition loss
Unfair and dangerous: On vaccine inequity
Viral load: On lockdowns, lives and livelihoods
The road ahead in India’s augmented vaccination drive
Infernal infernos: On hospital fires amid the pandemic
Too little: On the Election Commission’s COVID-19 curbs
India’s COVID crisis — when difficult became worse
A descent into disillusionment and chaos
Open and safe: On Modi government’s vaccination policy
You are reading
A recipe for vaccine inequity
Vaccine diplomacy that needs specific clarifications
On the trail of the second wave’s dynamics
How can India contain the second wave?
Lessons from the first wave
Examination priorities: On annual exams amid the pandemic
The secrecy around deaths after vaccination
Indian universities need immediate vaccination
Lessons from COVID-19
The second wave: On why new COVID-19 vaccines should be cleared
Weighing in on the saga of a vaccine
Rising poverty: On pandemic-induced disparities
A booster shot for India’s vaccination plan
Allaying concerns: On public trust and vaccination programmes
A moral test: On the vaccine divide
Efficacious too: On Covaxin
Sustaining the drive: On COVID-19 vaccination phase 2
Vaccine inequities: On need to vaccinate all above 45
Addressing vaccine reluctance and policy hesitancy
Redefining the exit plan for COVID-19
Boosting confidence: On need for efficient use of COVID-19 vaccine stocks
Opening up the vaccine market
Origin and spread: On the source of SARS-CoV-2
New questions: On COVID-19 infecting one-fifth of Indian population
A year on, mind the gaps in the pandemic response
Should Board exams be conducted in one go this year?
No to vaccine nationalism, yes to global cooperation
Tempered optimism: On India’s sliding COVID-19 graph
The best shot against COVID-19
More vaccines than takers
Managing the rollout: On addressing vaccine hesitancy
Injecting confidence: On India’s COVID-19 vaccination drive
Vaccine optimism and the scientific uncertainty link
Building trust in vaccines
The debilitating side-effect of a flawed vaccine trial
Gearing up: On vaccines and public trust
A hurried gamble: On vaccines and transparency
The second dose: On COVID-19 vaccine
A constant vigil: On the new coronavirus strain in India
Unmasked, reflections on the pandemic and life
Caution pays: On Centre’s COVID-19 surveillance guidelines
Towards an effective vaccination distribution policy
Essential dry run: On COVID-19 vaccination drive
COVID-19 and limits of political accountability
The purpose of a vaccine
Clear the fog, draw up a clear vaccination policy
Rein in the vaccine nationalism, the profiteering
In vaccine race last lap, the key steps for India
The storage tale of two vaccines
T-cell immunity and COVID-19
COVID-19, climate and carbon neutrality
Signs of easing: On India’s COVID-19 fight
Has India passed the COVID-19 peak?
Sooner, better: On indigenously developed COVID-19 test kits
The battered Puja economy
Outline of a pandemic fight, by and for citizens
Pandemics and the collective consciousness
Vaccines with a global common good guarantee
Saving lives under the long shadow of the pandemic
Until vaccine: On Unlock 5
The challenge of changing health behaviour
Weighing the costs: On COVID-19 vaccine
The slow and frustrating journey of recovering from COVID-19
Health worker safety deserves a second look
Unlocking campuses: On UGC’s revised academic calendar
Recovery from COVID-19 can be a struggle
Uniting to combat COVID-19
Coronavirus fears and preconception advice
An agriculture-led revival as flawed claim
A necessary pause: On the COVID-19 vaccine race
The uncertainties over COVID-19 numbers
The challenges in counting the dead
COVID-19 deaths may be higher than reported
The many challenges in estimating deaths
Alone at the top: On India’s COVID-19 numbers
The participants we need in Phase 3 trials
Differential impact of COVID-19 and the lockdown
More than a vaccine, it is about vaccination
COVID-19 and a country club India must leave
A quest for order amid cyber insecurity
Adopting a public systems approach to COVID-19
Milestone of a million: On India’s COVID-19 numbers
Testing times: On university exams
Predictions, pandemics and public health
It’s time to flatten the pandemic stereotyping
Viral outrage only spikes the data
Sending the right message
Needed: Clear testing data
The social contract needs to be rewritten
The pandemic is about eyes shut
Joblessness and opportunity in Tamil Nadu
Green-lighting ecological decimation amidst a pandemic
COVID-19 has no religion
A case for extension: On rural jobs scheme
Surely, even if slowly: On a COVID-19 vaccine
Bend it like Italy: On flattening the COVID-19 curve
Promise and delivery: On India’s first COVID-19 vaccine
States hold the key: On Unlock 2.0
PCR testing is a double-edged sword
Science vs nonsense: On Patanjali’s COVID-19 claim
Shut and open: On tennis during the pandemic
The perils of follow the leader syndrome
The many questions about Favipiravir
In new lockdown, a second chance for Tamil Nadu
United front in Delhi: On Kejriwal government-Centre camaraderie
A prescription of equitable and effective care
Multilateralism post COVID-19
Making public transport safe during COVID-19
A better rate: On COVID-19 recovery
Look back in relief: On the migrant labour crisis
Needed, a transfusion for public health care
Wrong priorities: On keeping religious places open during a pandemic
Crossing the line: On Delhi’s decision to limit health services
Profit, not profiteering: On regulation of COVID-19 testing charges
In Persian Gulf littoral, cooperative security is key
Paging the private sector in the COVID fight
Curves and recoveries: On India’s coronavirus numbers
India’s Parliament is missing in action
Axing the economy’s trunk
Scripting a new narrative for COVID control
Open with caution: On Unlock 1
It’s time for a universal basic income programme in India
The waning of subaltern solidarity for Hindutva
Export blocks: On India’s trade amid the pandemic
A moment to trust the teacher
The echo of migrant footfalls and the silence on policy
Enjoying the fruits of their labour
Helping supply chains recover
The heavy burden of social suffering
An effective lockdown
The lockdown has highlighted stark inequalities
Will sport be the same in empty stadia?
Cinema after COVID-19
The eternal longing for the distant home
Working safely: On workplaces during the pandemic
A hole in the whole: On health sector woes
China, better prepared for the post-COVID world
How public health boosts an economy
Keep it retrospective
Backing the ‘angels in white coats’
Standstill: On opening of stadia for training
Flawed stimulus is justice denied
We need social physicians
A callous response
Peaking: On India’s coronavirus tally
Farm gate in focus: On amending Essential Commodities Act
A question of quarantine: On migrant workers and other travellers
TASMAC tribulations: On Tamil Nadu liquor sale
The pandemic and the challenge of behaviour change
One for the poor: On Centre’s corona package
Lockdown syndrome: On virus-induced economic crisis
Are India’s labour laws too restrictive?
Stop the return to laissez-faire
States cannot be left to the Centre’s mercy
Local motif: On Modi’s call for self-reliance
Liquidity lifeline: On Nirmala’s MSME package
A plan to revive a broken economy
Provide income support, restore jobs
Perilous state: On State finances
COVID-19 and the path ahead
Reaffirm cooperative federalism
Riding roughshod over State governments
Tragedy on the tracks: On the killing of 16 migrant workers
Coming to terms: On India refusing to admit community transmission
The trends shaping the post-COVID-19 world
The epidemic and ensuring safety in courts
Responding to COVID-19 at the grassroots
The face of exploitation
Contempt for labour: On dilution of labour laws
Slower growth and a tighter fiscal
Back home: On return of Indian expatriates
Blame game: On Donald Trump’s anti-China rhetoric over COVID-19
Resuscitating multilateralism with India’s help
A war-like state and a bond to the rescue
Fear and loathing in the land of the free
Everyone wants a good stimulus
Rent control amidst pandemic
Slow release: On lockdown 3.0
No comfort in numbers: On Bengal’s coronavirus cases
Pandemics without borders, South Asia’s evolution
India’s disease surveillance system needs a reboot
No relief for the nowhere people
BRICS against COVID-19
Recovering early: On India’s COVID-19 patients
It’s about food, nutrition and livelihood security
Taiwan’s coronavirus protocol shows how it is done
Needed: a pandemic patent pool
Getty Images/iStockphoto
Plasma therapy is no silver bullet
Take care of yourself too, fellow journalists
Strategic shift: On home isolation of mild coronavirus cases
Coping with today, planning for tomorrow
No end in sight: On India’s coronavirus strategy
Vividly imagining the life of migrant workers
A task for South Asia
Privacy concerns during a pandemic
Unlocking justice in the lockdown
Safe return: On migrant worker distress
The outline of another pandemic combat strategy
Pandemic and panic: On Tamil Nadu’s five-city lockdown
Protecting the poor from becoming poorer
Did SARS-CoV-2 begin from a lab?
Protection for protectors: On safety of healthcare workers
Rapid failures: On antibody testing kits
The COVID-19 paradox in South Asia
Fishing in troubled waters during a pandemic
How will India emerge out of the lockdown?
Making doctors wash hands
Locked out of cities, homes and livelihoods
Script of unity: On coronavirus and social prejudices
Exploiting a pandemic: On Trump’s immigration policy
The village is still relevant
A time for planetary solidarity
There may be no going back
No transparency in West Bengal
Focus on the curve: On India’s COVID-19 numbers
Economy in lockdown: On India’s worst case scenario
A shot of hope with a game changing vaccine
Caught in the heightened arc of communal polemics
Singing the corona tune
Helping a lending hand: On RBI’s second lockdown stimulus
A season of change: On IMD forecast system
A virus, social democracy, and dividends for Kerala
Across the gulf: On stranded Indian workers
Virtual reality: On telemedicine
A blueprint to revive the economy
A case to use JEE-Main instead of JEE-Advanced this year
Will the aviation industry recover from the pandemic?
Data-driven reporting during COVID-19
Stress test: On revised lockdown guidelines
Disastrous decision: On Trump halting funds to WHO
Cease the distractions, seize the moment
Getting the containment strategy in India right
In India’s response, a communications failure
Harmonising with nature
End the harassment of farmers now
A narrowing window: On extension of lockdown
Corona bond: On Eurozone COVID-19 rescue package
Halting the march of rumours
Polls during a pandemic
The pandemic and the contours of a health response
Economic liberalisation and its faults
Invasive, alien, most fearsome
Trade in tatters: On the global slump
Wanted, a collective national endeavour
Disingenuous and no antidote
COVID-19 and the crumbling world order
Women’s safety during lockdown
Lives and livelihoods: On economy after lockdown
Stage fright: On denying community transmission
Team India and winning the pandemic battle
In time of need: On hydroxychloroquine export
Will COVID-19 affect the course of globalisation?
Finding a scapegoat in WHO
Curating news for children during pandemic
A time for extraordinary action
For better use: On MPLADS funds
Needed, greater decentralisation of power
A key arsenal in rural India’s pandemic fight
Preparing for exit: On lifting the lockdown
Sanctions and pandemic: On America’s Iran policy
‘A script of action, responsibility and compassion’: Chief Minister Ashok Gehlot writes on Rajasthan’s fight against COVID-19
Taking a long view of the pandemic fight
Ten questions posed by the virus
A different economic approach
Why healthcare workers above 60 should be ‘benched’
Enemy at the gates: On Kerala-Karnataka border row
Reducing farm distress during a pandemic
Why everyone should wear masks
The criticality of community engagement
A niggardliness that is economically unwarranted
The spectre of a post-COVID-19 world
Light and sound: On Narendra Modi’s 9-minute light ceremony
A million and counting: On global coronavirus spread
Safe forests, safe people: On diseases of animal origin
Quarantine and the law
Making the private sector care for public health
Looking east to contain COVID-19
Limits to rugged individualism
Uncritical endorsement: On exodus of migrant workers and the Supreme Court
Beyond the blame game: On the Tablighi Jamaat episode
A long road: On India’s 21-day coronavirus lockdown
The missing notes: On politics and the fight against COVID-19
China’s zero: On China’s lead in containing coronavirus
Unprecedented step: On Wuhan lockdown
The return of the expert
Lessons from Hubei
A pandemic in an unequal India
Faith can’t override public health
Devising a people-centric response to COVID-19
Karnataka CM writes on how the State is fighting the pandemic
Tamil Nadu CM writes on how the State is stopping the pandemic in its tracks
The hunt for a cure begins with telling the truth
COVID-19 and a city’s anatomy
Long live the nation-state
The COVID cycle
Coronavirus | The worst of times, the best of times
It’s also a fight against punitive measures
The age of the neoliberal virus
The deep void in global leadership
Thinking national, acting local
Every man is a part of the main
Beyond social distancing to fight COVID-19
Next Story