The Projections And Realities Of Vaccine Equity

The pandemic is neutral whether there is confrontation or co-operation among institutions. The debate about free play in executive domain and limits of judicial review is irrelevant. A citizen would like to assume that GoI is for transparency in policy on procurement, pricing and distribution of vaccines for its equitable administration. One good way to ensure this transparency is by sharing the details of conceptualizing, dynamic fine tuning and implementation through court. A court which can ask tough questions, seek accountability and harness wisdom as reflected in the laudable order of 30^th May 2021. The disclosures pursuant to queries of the court would address the confusion and lead to collaboration instead of conflict.

There is no doubt in science now that countries, big or small, can bounce back to normalcy only after they have successfully vaccinated the majority. Even for new variants, the vaccines are safe, beneficial and needed to restore normalcy. We must now have a closest possible target date in India for vaccination. An open or longer target date can throw us in endless waves of pandemic. A staggered vaccination would compromise the efficacy both for vaccinated and non-vaccinated. This target date can move closer but not farther for economy to come back in full swing. On liberal estimates, out of the current population of about 140 crores, the population above 18+ to be vaccinated on priority is around 82 crores. This adult population would need 164 crores of doses on the basis of two doses per person. As per CoWin about 22 crores of doses are already administered. For requirement of about 142 crores of doses, even if we have 20+ crores of doses every month as against 30+ crores projected, the 31^st December 2021 does not appear so farfetched. A judicial oversight with continuous mandamus can aid to concretize the target dates for vaccination in India.

As per the projections, the current production capacity of SII is to make 10 crores doses per month which can be further ramped up. Bharat Biotech is stated to be in position to ramp up production capacity to 10 Crores+ doses per month. Dr.Reddy's Sputnik is due for roll out of 1.2 crores doses per month. After the last order, the GoI has signed deal with Biological E for 30 crores of single dose vaccine in collaboration with J&J. It is stated that new manufacturers like Haffkine Biopharmaceuticals, Indian Immunological, Bharat Immunological can ramp up another 6 crores doses a month. There is Russian Development and Investment Fund (RDIF) with plan for another 5 crores doses a month of double dose Sputnik and unknown number of its new single dose vaccine. Pfizer and Moderna can export vaccines to us. If correct, we can expand the reach to 15+ or even younger population. Or even advance the target date to 31^st October 2021. One can be audacious to welcome a mask free Deepawali even if 60% are vaccinated. The Court can seek, GoI would give and people shall have more clarity on capacities, targets and adherence. The whole process can also fix accountability in vastly scattered High Powered Covid-19 Committees in GoI.

The procurement and delivery of vaccines to vaccination centre require a lot of recalibration. The vaccination has to be universal and fast to be effective. The cost of stalled economy is very high as compared to estimated price of free vaccination. This is the reason all countries in the world have gone for centralized procurement and zero charge for vaccination. We can definitely afford free vaccination through the States/UTs which can administer them as per pre-determined priorities. The vaccine has to be available at uniform price which can be negotiated with manufacturers to assure them cost plus reasonable return. The Oxford University received huge grants from EU, UK Government and Charities to develop the vaccine with AsrtaZeneca which sells it in US, UK and Europe at lesser price than India. Apart from help from ICMR in trials, SII has received Rs. 3000 crores as advance from GoI. After grants and charities, the private investment of SII for rollout of Covishield is relatively very low also its international price. Likewise, Bharat Biotech got major support in R&D, trials and roll out of Covaxin apart from Rs. 1500 crores as advance. On the scale in crores for vaccine roll out, the turnover assures enormous windfall for innovation and enterprise. All these financial factors need to be duly accounted in price determination. The SII, Bharat Biotech and others can be asked to share price structure in public through court. The disclosures on oath and scrutiny by court itself can lead to acceptable resolution of this issue.

We have seen temples, mosques, gurdwaras, churches, schools, NGO apart from public and private hospitals coming forward to vaccinate with their space and manpower. This assures that to administer the jab to all those willing on mass scale would not be an issue. However, an assumption that people would flock to vaccinate is not very sound. The vaccine hesitancy is already there and is likely to increase as we progress in rural areas. The awareness campaign, mobile vans and mass mobilization should begin now. There is need to incentivize vaccination with direct cash to BPL recipient of vaccines. At the same time, there should be penalty and disqualifications for non-vaccination. The vaccinated population is not safe till critical mass is vaccinated for herd immunity. The Court can harmonize energy, ground work and wisdom of NGOs, domain experts and private efforts. The ongoing judicial oversight would certainly not be off limit.

Views are personal.

The Author is a Senior Advocate at the Supreme Court of India