'Those Who Need It May Not Have The Ability To Pay For It': Supreme Court Slams Centre's Liberalized Policy Of Vaccination By Private Hospitals

The Supreme Court, in its order passed recently, criticized Liberalized Vaccination Policy of vaccination by private hospitals.

"The present system of allowing only digital registration and booking of appointment on CoWIN, coupled with the current scarcity of vaccines, will ultimately ensure that initially all vaccines, whether free or paid, are first availed by the economically privileged sections of the society.", the bench headed by Justice DY Chandrachud said in the order.

The Court, however, clarified that it is not opposed to the involvement of private hospitals in the vaccination drive.

The bench, also comprising Justices L. Nageswara Rao and S. Ravindra Bhat, noted that, being for-profit entities, the private hospitals may sell the vaccine doses procured at a higher price, for lucrative deals directly to private corporations. The court, therefore, directed the Government to respond to the following issues:

1. The manner in which Central Government will monitor the disbursal of vaccines to private hospitals, specifically those who have hospital chains pan India. Further, whether (i) private hospitals are liable to disburse vaccines pro rata the population of States/UTs; an (ii) the mechanism to determine if private players are genuinely administering the lifted quota in that State/UT alone. The UoI shall place on record any written policy in relation to this.
2. Whether the Central Government conducted a "means-test" of the demographic of a State/UT to assert that 50% of the population in the 18-44 age group would be able to afford the vaccine. If not, the rationale for private hospitals being provided an equal quota for procurement as the State/UT Governments.
3. The manner in which the Centre and States/UTs shall ensure an equitable distribution of vaccines across sections of the society, and how this factors into the rationale of equal apportionment between State/UT Governments and private hospitals.
4. The nature of the intervention with respect to the final, end-user price that is being charged by private hospitals, especially when a cap on procurement by the private hospitals has been set.

The Government had informed the Court that, under the liberalized policy, (i) Out of the 50% quota allocated for the "other than GoI channel‟, 50% will go to the State/UT Governments, calculated on a pro rata basis as per the population. The balance 50% would be open for private hospitals‟ procurement, based on contracts with the manufacturers. As such, the State/UT Governments and private hospitals would each end up with 25% of the total CDL doses; (ii) Vaccination through the private sector of 25% of the total CDL quantity would reduce the operational stress on government facilities and help with issues of crowding at vaccination centres; and (iii) Paid vaccination through private hospitals has been introduced for persons who can afford to pay, thereby reducing the operational stress on the Government.  

Regarding this, the bench made the following observations in the judgment:

Those who need vaccines may not have the ability to pay for it

26. As a consequence of this Liberalized Vaccination Policy, 50% of the population of any State/UT in the 18-44 age group is expected to pay for its vaccination. From the UoI‟s affidavit, we understand that this has been done while taking into account the ability of a certain section of the population to pay for their vaccination. However, the present system of allowing only digital registration and booking of appointment on CoWIN, coupled with the current scarcity of vaccines, will ultimately ensure that initially all vaccines, whether free or paid, are first availed by the economically privileged sections of the society. As such, even those who may have been able to afford a vaccine, may opt for a free vaccine simply because of issues of availability, even if it would entail travelling to far-flung rural areas. Hence, any calculations of the economic ability of a given individual may not directly correspond to the vaccination route (paid/unpaid) they opt for. Consequently, it is plausible that private hospitals may have vaccine doses left over with them because everyone who could afford them has either already bought it or availed of a free vaccine, while those who need it may not have the ability to pay for it.

While they provide a public health service, they still remain private, for-profit entities

27. Further consequences of the vaccination by private hospitals under the Liberalized Vaccination Policy relate to a simple issue at the core of their existence: at while they provide a public health service, they still remain private, for-profit entities. Consequently, they may sell the vaccine doses procured at a higher price, unless regulated stringently. Private hospitals also may not sell all their vaccine doses publicly through appointments on CoWIN, but rather sell them for lucrative deals directly to private corporations who wish to vaccinate their employees. Finally, private hospitals are not equally spread out across a State/UT and are often limited to bigger cities with large populations. As such, a larger quantity will be available in such cities, as opposed to the rural areas.

 Private health care institutions have an important role as well. 

28. It is pertinent to clarify here that we are not opposed to the involvement of private hospitals in the vaccination drive. Private health care institutions have an important role as well. The UoI has correctly noted in its affidavit that these hospitals will reduce the burden on government facilities. This was also happening earlier for the vaccination of those above 45 years of age, where the Central Government was providing these hospitals with vaccines and they were allowed to charge patients a nominal fee (Rs 250). However, the issue is about the effect of privatizing 50% of all vaccines available for the 18-44 age group.

Also Read other reports about the order :

'Digital Divide Will Have Serious Implications On Right To Equality & Health': Supreme Court On CoWIN Portal

How Rs 35000 Crores Budget Allocation Spent For Vaccines?Why Can't It Be Used To Vaccinate 18-44 Years Group? SC Asks Centre