Joining forces

COVID-19 is not the first or deadliest health condition to afflict this nation but it is the only disease where the private sector has been deliberately excluded from key aspects of the vaccination programme. This will leave much of the population unvaccinated for at least two reasons: first, not everyone is willing to get vaccinated, and those who are will likely be unable to get it; and second, public healthcare without private support is weaker and overstretched here than in any other area.

In Pakistan, while the centre is taking the lead on vaccine acquisition, it does not have a monopoly over the import of Covid-19 vaccines. The federal planning minister has stated that the provinces and private sector are not only free but are also encouraged to import vaccines themselves, subject to regulator Drap's approval. But it is unclear how this process will work: if both the public (federal and provincial) and private sectors are expected to import vaccines, who's allowed to administer them?

The government's attempts thus far indicate that the public sector has limited funds to procure and store large numbers of vaccine doses. Partnering with the private sector in the vaccine roll-out process can address several issues. Firstly, the private sector has the funds to procure vaccines in bulk. However, if one or a few private firms corner the market, they will undersupply and overprice the doses, as competition theory predicts. The government will need to ensure competition or price and quantity regulation to maximise coverage. Both the centre and provinces should identify nodal points for the vaccine's storage, logistics and distribution.

The private sector can also provide storage facilities, transportation, and inventory management services. As procurement accelerates, the federal and provincial governments must establish vaccination centres in each major population centre. The private sector can assist through the designation of private healthcare facilities as vaccination centres, and partnerships with medical associations and social welfare organisations to raise vaccine awareness.

Public-private cooperation on the vaccine can address many issues.

Capacity-building and training of the inoculator force is also a key concern. Strict criteria must be developed to determine the eligibility of different classes of healthcare workers for priority inoculation. The private sector can lend its support by developing and implementing training workshops. Tracking and monitoring technologies are also needed for efficient vaccine roll-out. The government must share these technologies and dashboards with private-sector storage facilities and vaccine transportation vehicles. Lastly, the private sector can supplement government data by identifying, registering and allocating vaccines to beneficiaries. Private hospitals carry precise data on at-risk/vulnerable populations with underlying health issues; this can be leveraged to target the dispersal of vaccines to population groups most at risk.

Although, the provinces receive support from the federal EPI (Expanded Programme on Immunisation) cell for the procurement of vaccines, safety boxes and other medical equipment, the provinces remain responsible for bearing the operational costs of the immunisation programmes at the provincial and district levels. While these provincial vaccination drives have the supposed advantage of managing the administering of vaccines in the provinces, historically, vaccination campaigns have not been very effective. Provinces have heavily relied on assistance from the federal government.

The federal government has several advantages in the provision of healthcare services nationwide: with its greater purchasing power it can enjoy the economies of scale, and thus save on costs, when procuring bulk quantities for the country. It also benefits from the expertise of the federal EPI cell. The latter has sophisticated logistical processes in place, such as a large number of cold rooms, which can store bulk quantities of vaccines and injection equipment, making it much more suitable for vaccine acquisition compared to the provinces.

A combination of both public/private and federal/provincial interventions thus seems to be the best way forward with the Covid-19 vaccination drive. The involvement of the federal and provincial governments ensures the institutional and structural integrity of the vaccine administering process. It also eases manoeuvrability through federal and provincial regulatory hurdles. However, the support of the private sector will provide the government with the means to store larger numbers of vaccine doses, obtain better data, target populations more intelligently, and accelerate the vaccination rate.