Fears are growing that the central government’s new policy allowing states to procure covid-19 vaccines in the open market from 1 May could exacerbate existing health inequalities.
“This is bad policy. One agency should be purchasing and supplying vaccines. With this policy, one state may get it because the manufacturing unit is in that state but others could get left out. This is a decision with which I don’t agree,” Chhattisgarh health minister T.S. Singh Deo told Mint.
According to the policy for phase 3 of the vaccination programme, all adults can be vaccinated starting 1 May. Those who do not qualify for the government’s subsidized doses can buy them from the market.
Half of all the vaccines produced will go directly to the Centre for its existing vaccination programme. Vaccine makers will have to supply the other half to states and to the private market at a “pre-determined price”.
“These steps will allow the speed and extend of immunization to ramp up and for people to get vaccinated at the earliest,” K. Vijayraghavan, principal scientific advisor to the government, said.
However, talk of a “pre-determined price” puzzled states and experts, who want clarity on whether this means separate prices for different states and the private market or a uniform price. “First, the government will address supply issues. As other vaccines come in the market, the pricing issue will also be addressed. The government is working on these areas and it will take a week’s time to finalize,” said Samiran Panda, a member of the government’s National Expert Group on Vaccine Administration for Covid-19.
However, with states asked to finance the vaccines from their own pockets while competing with each other and the private market—all within the 50% quota—there is concern about financial capability at a time when the pandemic has already stretched them fiscally.
Kerala chief minister Pinarayi Vijayan wrote to Prime Minister Narendra Modi on Tuesday asking him to reconsider aspects of the policy. “State governments are already facing additional financial commitments from the consequences of the pandemic. Given the present scenario, we have to provide vaccine to public free of cost. As the economic downturn is still persisting, the additional burden of purchasing covid vaccine will place considerable strain on state finances,” Vijayan said.
Currently, the Centre procures Serum Institute of India’s Covishield and Bharat Biotech International’s Covaxin at ₹150 per dose. People in priority groups can get the doses at private hospitals for a maximum of ₹250 per dose. On the other hand, Serum Institute chief executive officer Adar Poonawalla has said he is expecting the price of Covishield in the open market to be ₹1,000 per dose.
“There should be a cap on pricing and then there should not be any hidden charges in name of administration charges or any other. It should be available in hospitals and may be paediatricians should be roped in as they are already running immunization services. It should not be available at pharmacies,” said Naveen Thacker, former civil society organization (CSO) representative to Gavi board, the Vaccine Alliance.
There is also a concern about availability, with only two vaccine makers producing 70-80 million doses per month together. Capacity expansion is still about two months away before more doses come in while supply of the Russian Sputnik V is likely to start only next month. “The situation is alarming, with only one day of stock of vaccine left, while central government has also announced the vaccination of all 18+ population to be commenced from 1 May,” Punjab chief minister Amarinder Singh said, adding that while the state can vaccinate 300,000 people per day, it manages only two-thirds of this because of lower supplies from the Centre.
Another aspect that could be a concern when the vaccination eligibility is expanded is of monitoring side effects. Already, there’s a backlog of hundreds of severe adverse effects following immunizations (AEFIs) that have yet to be reviewed by the government panel responsible for it. They have given final review reports for just 13.
Nearly 127 million vaccine doses have been administered so far, and this number is expected to increase sharply from 1 May if production can keep up with demand, and with it, cases of adverse effects could see a proportionally sharp increase.
“Centre seems to have washed its hands off the primary responsibility of vaccination. The policy is not putting any checks on prices of vaccines for private sale which could put them out of reaches of the masses. Given the short supplies, there is the real risk of the kind of blackmarketing and overcharging that we are currently witnessing for remdesivir and other COVID drugs. There are also issues of equity” Malini Aisola, co-convenor of All India Drug Action Network, said.