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K. Srinath Reddy, president, Public Health Foundation of India
K. Srinath Reddy, president, Public Health Foundation of India

'The World Bank has to come in a big way to finance global covid vaccine delivery'

  • ''While there are over 200 vaccines in the race at different stages, nine are in a fairly advanced stage. We can expect some of them to be successful. But there is no assurance yet.''

NEW DELHI : The Indian government is taking the first steps towards preparing for a mass immunisation programme in 2021, provided the world gets a successful covid-19 vaccine. These preparations would have to be based on a few assumptions simply because there are many unknowns, K. Srinath Reddy, president of the Public Health Foundation of India tells Mint. Excerpts from an interview.

What are the assumptions India has to work with in preparing for the immunisation programme next year?

The assumptions are that we are going to have a safe and effective vaccine and that we will get it soon. While there are over 200 vaccines in the race at different stages, nine are in a fairly advanced stage. We can expect some of them to be successful. But there is no assurance yet. Unless we see the results, it wouldn’t be proper to conclude that we are definitely going to get a vaccine. Assuming we get a vaccine, the next question is whether that vaccine is going to be an India-developed vaccine or is it going to be internationally developed for which India has been contracted for manufacture? That question would determine how much of the vaccine we will have access to and on our terms. For an internationally-developed vaccine, it depends on how we negotiate the contracts.

If we do get the vaccine, what would be the pecking order for immunisation?

There are groups where there is no dispute — health workers and other essential workers, including police forces, armed forces, sanitary workers, pilots and airline crew, train drivers, and anyone involved in the transport of essential goods or people. You also have to include school teachers. Then comes the question of identifying people who are at high risk. If you are trying to protect the elderly first, those above 60 years and people with co-morbidities, it is going to be a little tricky because we know that people who have illnesses such as hypertension, diabetes, cardiovascular disease, respiratory disease are not always aware of it or are not declared to the health system. That does introduce an element of inequity because people who are more aware are likely to be urban and educated or relatively affluent.

Then what about the people who are not detected by the system yet? We may have to go by the age criteria — above 60, above 55, above 50 etc. There is another tricky question. Are you going to look at people who are at risk or who are spreading the virus the most? If you turn the question on its head, then the young would also have to be immunised on a priority because they are the virus disseminators.

What are some of the other challenges you foresee?

There is the challenge of distribution, keeping the supply chain going and making sure that there are no stock -outs. But who will administer? Asha workers are not permitted to do that. Supply-chain logistics will be less of the problem; human resources will be the larger problem.

India’s experience with polio vaccine administration might help…

Yes, it gives us an edge. But public acceptance of polio drops versus intramuscular injections could be different. We know there could be some minor side effects like fever and severe muscle pains. People’s acceptance will partly revolve around that.

How can India finance the vaccine?

The pricing of the vaccine has to come down, one way or the other. The manufacturer would want the cost to be remunerated with a little profit margin. But it cannot be high priced. Whatever is the difference, public financing will have to subsidise. Even international funds will have to come in. You have to recognise that it is not a cliche to say that no country is safe till every county is safe. In a globalised world, where there is trade, people, commodities and flights moving around, you could always get the virus re-enter from another country. We have to ensure that public financing — national, global, supplemented by philanthropic funding — comes in. The World Bank has to come in a big way.

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