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Insights into Editorial: Centre must address the Covid-19 vaccine shortage

 

Introduction: In News:

With India experiencing a devastating second wave of the coronavirus pandemic, questions are being asked about how the country which is home to the world’s largest vaccine manufacturer got to this tragic point.

India continues to report massive numbers of new infections. It passed the grim milestone of having reported over 20 million Covid cases and at least 226,188 people have died from the virus, although the reported death toll is believed to be lower than the actual death toll.

In the meantime, India’s vaccination program is struggling to make an impact and supplies are problematic, despite the country having halted vaccine exports in March in order to focus on domestic inoculations.

 

Pace of the vaccinations has fallen sharply:

  1. Even as the vaccine drive for those above 18 years kicked off, amid complaints by several states they were short of vaccines, a spreadsheet detailing the quantities that would be available over the next six months is still missing.
  2. It was a slow start with the Union health ministry saying only some states would be initiating the third phase of the rollout.
  3. Maharashtra chief minister announced the state would start inoculating those in the 18-44 years age bracket, adding it would be a phased process due to the shortage of vaccines.
  4. To be sure, the process will be streamlined over the coming weeks, but clarity on the supply pipeline would be helpful given the pace of the vaccinations has fallen sharply when it should be accelerating to fight the ferocity of the infection in the second wave.
  5. Going by the current availability scenario, based on the capacity guidance issued by the manufacturers, experts believe that at best about 50% of the population can be inoculated by the end of 2021, in the best-case scenario.
  6. This is worrying and probably inadequate to contain the spread of the infection and future ‘surges’.
  7. While India has negotiated supplies with Russia’s RDIF for Sputnik V the first batch of 1.5 lakh doses arrived on Saturday it must explore all other options.
  8. The government had recently eased the rules on bridging trials for foreign vaccine-makers like Pfizer or a Johnson & Johnson, but there has been no update how talks with these companies are progressing.

This is a national crisis and a critical minimum number of people must be inoculated in the next three months by end July. If the budget allocation of Rs 35,000 crore falls short, it needs to be topped up.

 

Following list enumerates what we ought to do to ensure more Indians have access to more vaccines soon:

Vaccine procurement and supply:

  1. Change the vaccination policy: The Centre needs to take charge of all procurement and negotiations with all vaccine suppliers, domestic and foreign, without exception.

It needs to negotiate one price for all supplies from one manufacturer – irrespective of whether the people receive the shot at a government centre or at a private facility.

  1. Work with Serum Institute to increase supplies
  2. Help Bharat Biotech enhance capacities for Covaxin: The Indian government has staked a claim in the intellectual property rights of Covaxin, since it enabled the development.

It should then facilitate Covaxin manufacturing in the refurbished facilities of other vaccine manufacturers in India and which are currently lying idle.

If not, Bharat Biotech should at least produce the bulk and allow multiple manufacturers to perform the fill and finish activity. This will increase the quantity of Covaxin available.

  1. Sign a deal with Pfizer
  2. Study Sputnik V agreements with Indian manufacturers
  3. Get a plan for the Johnson & Johnson vaccine
  4. Explore the Moderna vaccine
  5. Monitor progress of domestic and foreign vaccines under development: A number of candidates, both in India and abroad, are in various stages of trials and development.

The government should keep a close watch over all of them and be prepared to act on inviting and/or approving them for use in India at the most opportune moment.

  1. Track adverse events: This is critical – especially since all vaccines currently in play have received only emergency-use authorisation.

Experts in India and the EU have already raised concerns about rare side-effects following vaccination by the AstraZeneca shot (Covishield), and experts in the US of the Johnson & Johnson shot.

Regulators should keep a track of adverse events reported in India and abroad, and regularly share reports about them, government scientists’ assessments and the basis of their assessments with the public.

  1. Consolidate, share and review performance: It’s hard to overstate the benefits of a clear and detailed plan supported by an effective review mechanism.

The government should help consolidate all the expected supplies, under various arrangements, from all indigenous and imported companies, in one place.

The supply plan should be split by time interval: daily for the first month, weekly for the next two months, and monthly for the next nine months, adding up to an annual plan.

The supply plan should also have the explicit agreement of the vaccine manufacturers.

 

Way Ahead:

Importantly, states should be financially supported at least bridge funding to begin with so that they have adequate resources to fund their purchases of vaccines.

Ideally, the Centre should have procured these vaccines and distributed them to the states; that way, the disputes on the differential pricing could have been avoided.

Also, the distribution of vaccines would perhaps have been more equitable with ‘stronger’ states not running away with the available supplies, thanks to their ability to negotiate with manufacturers.

 

Conclusion:

In fact, it may still not be too late to reverse the process. This is the time to stand by the states, not move away.

The Centre should determine the actual allocation of stocks to state governments on a daily/weekly basis.

This should be on the basis of a predetermined template that anticipates logistical challenges, in addition to the parameters used by the vaccination policy.

States should have confirmed supply schedules for at least one month at a time and visibility for at least the subsequent two months so that they can plan and communicate with the people effectively.

While private hospitals should get their stock at the uniform price for all parties, negotiated by the Central government, the state governments should have a say in the allocations between them.

Indeed, logistics within the state should be the responsibility of the state governments, in consultation with the manufacturers.

Finally, there should be a dashboard that shows the planned v. actual supplies and planned v. actual vaccinations.

COVID-19 has brought India down to its knees. The country needs vaccines and help from the Centre and state governments to stand up again.