States won’t have to pay for vaccines: PM

Prime Minister Narendra Modi on Monday announced that the Union government was taking back the responsibility for procuring vaccines and distributing them to states, in response to a growing chorus of demands from the states, sharp criticism by the Supreme Court, and amid increasing concerns that supply shortages and the insistence of foreign vaccine makers that they would only deal with the Union government could derail India’s vaccine drive.

The Union government will continue to allow private hospitals to buy up to 25% of vaccines made in India, although it has capped the service charge they can levy on these at ₹150 a dose. The details of India’s new vaccine policy will be worked out in consultation with the states in the next two weeks, and it will be launched on June 21, Modi added.

The Union government will bear the cost of vaccinating everyone over the age of 18 years (the population currently eligible for vaccines), he said.

Some chief ministers wel

comed the move. “The decision of free vaccination will decrease the financial burden of the state governments,” Madhya Pradesh chief minister Shivraj Singh Chouhan said. Uttar Pradesh chief minister Yogi Adityanath, too, praised the move.

The Delhi government said that if the Centre wanted, it could have taken this decision a long time ago. “We express our gratitude to the Supreme Court. After its intervention, free vaccines will be available to all age groups across the country. If the central government wanted, it could have done this long ago. But due to the policies of the Centre, neither the states were able to buy the vaccines, nor the central government was giving it,” Delhi deputy CM Manish Sisodia said in a tweet.

In his address to the nation, the Prime Minister also defended his government’s vaccine policy, pointing out that it was “decentralised” only in response to demands from many states that they be allowed to manage the vaccine drive, and buy directly from both Indian and foreign manufacturers. The Union government, therefore, allowed this from May 1, he said, pointing out that health was a state subject.

In phases till then, the Union government had managed the vaccine drive for health care workers, frontline workers, people over the age of 60 years, and those over the age of 45 years but with co-morbid conditions that made them more vulnerable to Covid-19. But in response to the demand from the states, it decided to allow states to offer vaccinations to all starting May 1.

The Prime Minister’s speech comes ahead of a hearing in the Supreme Court on the Covid-19 situation and the state of vaccination in the country. In its previous hearing, the apex court said the Union government’s coronavirus vaccination policy that put the onus of giving doses to adults in the below-45 years age group entirely on states and private hospitals was “prima facie arbitrary and irrational”. It ordered the Union government last week to submit within two weeks “all relevant documents and file notings” on the thinking and process behind the strategy.

India bore the brunt of the second wave in May – it added 9 million cases, or 31.2% of its total cases to date, and saw 120,071 deaths, 34.4% of the total, in the month – and this, combined with the supply situation, made the vaccine drive chaotic. States also found it impossible to deal with foreign manufacturers, many of whom wanted the Union government to provide them protection from lawsuits for adverse events (discussions on this are on). In just a few weeks, the PM claimed, states realised the old system was better.

India has already administered in excess of 230 million doses, Modi said, and its vaccine drive is among the fastest in the world, but the new policy will make it faster. Till Monday, a total of 46.6 million people in the country have been vaccinated fully, and another 142.8 million vaccinated with one dose.

K Sujatha Rao, former Union secretary, ministry of health and family welfare, said: “It was time that they changed the vaccination policy, which had already been badly delayed. A lot of precious time was already wasted in states trying to float global tenders.” Dr Sudarshan Ballal, chairman, Manipal Hospitals, said: “Central procurement of the vaccine would certainly strengthen our vaccination drive as the Centre would have a lot more clout in dealing with the multinationals and also the procurement of vaccines from the other manufacturers rather than individual states or smaller players directly negotiating with these companies. Also, free vaccination for 18 and above is a welcome move. As far as the private sector is concerned, not much would change at present.”

To be sure, apart from the unwillingness of foreign companies such as Pfizer and Moderna to deal with the states, and their inability to get anywhere with their global tenders – at least six states raised these, but most received little interest – the states were significantly hampered by the sheer lack of supply. With demand increasing manifold suddenly – there are 600 million Indians between the ages of 18 and 45 years who became eligible for vaccines on May 1 – and supplies not keeping pace, this was always going to be a problem.

The situation has improved in June, with the government anticipating supplies of at least 120 million doses, and the number is expected to increase even more in the coming months.

The Union government has said that 2.16 billion vaccines will be available in India between August and December, but this number includes aggressive estimates for the production of some existing vaccines, and some vaccines that are still in different stages of development and testing.

At least 710 million of the 2.16 billion expected doses are of vaccines yet to be approved. Reuters said in a report that Serum Institute of India will likely miss its target of 750 million doses in these five months by 27% (or 200 million), and Bharat Biotech’s scale-up to 550 million doses is clouded in ambiguity, with the company saying last month that there is a lag between production and availability, which means doses made in April will only be available in July. The actual availability in that period may instead be around 1 billion, according to an analysis by The Ken.

India has approved three vaccines (one locally developed, a second made under licence, and a third imported as well as locally made by at least half a dozen companies under licence) and most experts are convinced that vaccine supply will improve in the coming months, especially with the local production of Sputnik V, which India is currently importing.

The PM referred to this in his speech and said there were seven vaccines in various stages of development and three in final trials, including a nasal vaccine (being developed by Bharat Biotech, again), which, if approved, would significantly speed up the pace of vaccinations. Among the vaccines in late stage trials is one developed by Biological E, for which India has already placed an advance order for 300 million doses. Two vaccines are also being tested on children, the PM said.

The government has told the Supreme Court that it plans to vaccinate all eligible Indians by the end of this year, something that will require it to deliver 238 million doses a month, according to an HT analysis.

Responding to criticism of India’s vaccine strategy, Modi said that the government set up a vaccine task force as far back as April 2020, supported vaccine makers through trials and through funding, and planned a phased delivery starting with health care workers, something that helped them work without fear during the second wave.

Describing the coronavirus pandemic as a “once in a 100year” epidemic, the PM said he understood that many Indians had lost people to Covid-19, and that his sympathies were with them. The disease was “unprecedented in the modern world” but India fought it together, he added, “building hospitals, increasing ICU capacity, making ventilators, creating new health infrastructure…”

And then, he said, when, during the second wave, the country saw the kind of demand for medical oxygen that it had never seen before, it sourced liquid oxygen and concentrators from all parts of the world, deploying its navy and air force, using trains to move oxygen tankers, and working on a manifold increase in oxygen manufacturing capacity.

At a time such as this, Modi added, “politicking” isn’t good. It is important that states focus on the task at hand, he said – vaccinating everyone, including the last person in line. Some people have been consistently spreading misinformation about vaccines, he added, leading to fears and hesitancy among people. Such people, he added, are “playing with the lives of innocents”.

The Union government has repeatedly targeted opposition politicians for their comments on vaccines and said this could lead to hesitancy.

The Congress said the announcement marked yet another instance when the Modi government has done a “somersault” on the vaccination policy. “The people opposed the government’s policies, the Congress party opposed it, and Supreme Court bitterly reprimanded them and asked them to file an affidavit. Now, they have taken a third summersault. The policy is also flawed even now. Why should citizens of India be made to pay in the private sector? Do we make you pay for DPT injection or a pulse polio injection in the private sector?” said Congress spokesperson Randeep Surjewala.

Rajasthan chief minister Ashok Gehlot said: “Prime Minister Narendra Modi should share details on which states made the demand of being able to buy vaccines for the 18-44 age group. To my knowledge, no state made such a demand... I am happy that the PM had to change his old decision keeping in view the public sentiments.”