Home >Opinion >Columns >The big vaccine paradox that Indian statism has given us

The health ministry’s press conference in New Delhi on Monday was of such importance that it should have had higher TV ratings than the India-England Test match. With scarcely 9 million having received the first vaccine dose in the month since vaccinations began in India (population: 1.35 billion) speed is a necessity. Ignoring social-distancing rules, reporters crowded around health minister Harsh Vardhan. Vaccines, Vardhan declared, “cannot be brought into the open market yet… if some wrong product comes to the market, then who would be responsible for it?" How would the vaccination of people over 50 work? How would it be priced? “There is no clear-cut decision on this matter yet. The strategy for the next 270 million group is being deliberated by the expert group," said the health minister. According to a Business Standard report, “The committee of experts is yet to finalise the details of vaccinating those with co-morbidities, such as the diseases that will be covered."

As the witty economist Jagdish Bhagwati once wrote of India’s socialist government, “It really makes all the difference how you see the control system, whether from the lens of the one who runs it or of the one whom it runs over." The government’s statist approach thus far to the vaccination drive is emblematic: Reportedly, hospitals have often been informed by the government of their allocation of vaccine doses on the very day of their administration, leaving them to rush around making arrangements. The CoWin portal, meanwhile, has had more than its fair share of problems.

Thankfully, the appointment of R.S. Sharma, the founding chief of India’s epic Aadhaar effort between 2009 and 2013, suggests that technological glitches will likely be adequately addressed by the end of next month, when a quarter of a billion people seek appointments. Harder to resolve may be the Centre’s failure to overcome its shortage mindset of rationing vaccines, whereas the reality is already of surplus production because India is the world’s vaccine factory. As Nandan Nilekani wrote in the Hindustan Times in August, “We are not distributing a precious resource, we are trying to deliver fast and far." Nilekani suggested using Aadhaar or mobile phone identification to allow “anytime-anywhere vaccination" where a person can go to any approved provider of the vaccine. He told me that the net should be widened beyond private hospitals to dentists and vets.

In the US, for instance, the national networks of pharmacy chains such as Walgreens and CVS, and even those in WalMart stores, will be used to administer vaccines to the wider population. In the UK, which has the advantage of its National Health Service, decisions on who gets the vaccine have been delegated to primary care general practitioners. Each had to commit to giving people jabs for 12 hours a day, seven days a week. On vaccinations per 100 of its population, the UK is now behind only Israel and the United Arab Emirates. According to the Financial Times, since November, Brigadier Phil Prosser, along with 50 military logistics personnel, has been working at the NHS headquarters to set up vaccination centres and secure vaccine shipments. The UK, which began its vaccinations on 8 December, crossed a tally of 15 million this week.

This may sound like sci-fi in India, which spends a very low proportion of GDP on public healthcare, compared with East Asian countries, let alone the UK, but if the government can draft private hospitals and companies in areas such as logistics management, India can ramp up quickly. With the more infectious South African variant in India now, we are in an even more urgent race against time. Gautam Menon, a professor of physics and biology at Ashoka University, told me that if we accept the government will be able to increase vaccination sites by five times in the next phase, at the current pace, “we might expect 27 to 30 million to be vaccinated (per month), starting from March, which would mean about 180 million by the end of August." That optimistic estimate is well below what we need.

The good news is that private-sector manufacturers, ranging from Serum Institute, which will have produced 2 billion doses by June, to Bharat Biotech (500 million in 2021), Zydus Cadila (150 million this year) and Dr Reddy’s tie-up with Sputnik (250 million doses), are moving at pandemic speed. But, this predictable paradox of private-sector ingenuity and public sector plodding is shaping up to position India as the world’s largest manufacturer of vaccines with a huge domestic stockpile of unused vaccines because New Delhi doesn’t trust the private sector enough to administer them. There may well be attempts at price gouging by private hospitals, but both public opinion and regulation can keep that in check. Besides, as a recent Indian Express exposé of fraud in Bihar’s state-run covid testing regime shows, governance is hardly squeaky clean.

I entered this pandemic with no co-morbidities, but reports of millions of migrants walking home last year and imagining the waste of vaccines as they pile up in warehouses (possibly being managed the way the government manages wheat and rice surpluses) have pushed up my hypertension. If any reader has the number of an eminent doctor in a government hospital in New Delhi, please let me know. Failing that, any suggestions for vaccination tourism this summer would be welcome.

Rahul Jacob is a Mint columnist and a former Financial Times foreign correspondent.

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