THE PIXELATED VISION OF INDIA’S COVID-19 IMMUNISATION STRATEGY

Introduction

Jan 2020 India reported its first case of COVID-19, since then it has impacted nearly every sector of the country. The vaccination roll-out came out as a promising end to this global crisis but poor anticipation of the upcoming second wave by the Indian Government made the matters worse. Practically, it was probable that successful completion of vaccination in India would be a tiresome and difficult process owing to the huge population and low investment in healthcare infrastructure by the government. Of all the efforts put in India’s vaccination policy, it was inefficient in doing further damage control. Although, Centre is trying to fill the gaps and expedite the process by waiving of 10% customs duty on vaccine imports and relaxing tendering and procurement norms, the delay in such decisions has already cost many lives.

Cowin Vaccination Drive: Digital Access and Delivery Issues

The Central government has launched the fourth phase of the vaccination for those persons aged 18-25. It’s been a month and a half since the government announced the vaccination, despite this, many registered candidates have been unable to get the vaccine. It is because of the fact that the slots would open up at random and without any prior notification to the general public. Therefore, the only way to get an appointment for vaccination is to constantly check the portal for hours. ​Booking a slot via the Cowin application invites too much effort and the majority of results for these efforts are in the form of “non availability of slots”. The most serious flaw in India's vaccination program is its high dependency on technology.

One of the major challenges regarding the Covid 19 vaccine is to ensure adequate supply of it. Instead of making the vaccine available to a larger audience, the government puts another hurdle in front of the eligible candidates with online registration on the Cowin app, where the public health worker has been overtaken by the technocrats. In this country where a significant number of the digitally illiterate population exist, the government has solely relied on policy regarding online registration for booking a slot. Furthermore, this app requires an identity proof of the concerned candidate who wants to register but again the problem is the same where not everyone has aadhar card or other identity proof which ultimately prevent those candidates from taking a jab.

Dual Pricing, Procurement, and Allocation Policy

Bharat Biotech and Serum Institute of India, the largest manufacturer of the vaccine dominate the market by charging different prices for the central government and the state governments, which leads to an improper distribution/allocation in supply of the vaccine. Dual pricing policy means these market players can prioritize the private sector over the state governments in order to generate more revenue, which could lead to black marketing of this essential commodity. The central government passed a budget of Rs. 35,000 crore for vaccination purposes. The centre procured Bharat Biotech’s Covaxin at the rate of Rs. 150 per dose, which means the central government is capable of vaccinating over 100 crore people in this vaccination drive. As compared to this, the state government is charged Rs. 400 and private sectors Rs. 600. These exorbitant prices may act as a hindrance for the people, who may not get vaccinated because of the same.

Ironically, while India has embraced the right allocation policy on vaccines on the worldwide stage, it fails to apply that policy domestically. Instead of invoking compulsory licensing mentioned u/s 92 of the Patents Act of 1970 and requiring Bharat Biotech or SII to share its method/formula/technology with other domestic companies, the Central government permitted these vaccine producers to keep their monopoly on vaccine manufacturing. Till today, the central government is not clear on the allocation and distribution policy of vaccines.

Shortcomings During the Second Wave: Poor Anticipation of Crisis and Vaccine Maitri Programme

The deadly second wave, with an approx. four lakhs Covid 19 cases a day, invited a lot of criticism on diplomacy and policies of the central government. Poor anticipation of Covid crises and the vaccine Maitri program are the major reasons. No doubt that last year the Maitri program won the hearts of many nations, but this year the government failed to anticipate the requirements of the nation and solely focused on diplomatic relations. For instance, overall 6.6 crore vaccine doses were exported to 95 countries worldwide, whereas India's overall vaccination program has provided 13 crore doses over the course of three months, from mid-January to mid-April. This means that India had exported enough vaccines that could satisfy a monthly demand for vaccinations domestically.

The reason behind the sudden increase in Covid 19 deaths is that the government did not utilize its strengths to increase hospital beds, oxygen production, and pharmaceutical supplies through imports. Apart from this, the government did not halt exports of essential commodities (such as oxygen and pharmaceuticals) that were most required during the second wave.

Current Plans: Inefficiency, Hesitancy, and Human Rights Violations

To begin with, mandatory Aadhar for registration prima facie discriminated against the undocumented population, denying them the basic fundamental right to life. It was not until May, that the government recognized this lapse and allowed beggars, prisoners, etc. to get ‘walk-in vaccination’ without identity proofs. However, , refugees and immigrants are still not included in this list, thereby depicting that they are being denied the basic human rights.

Secondly, price discrimination across centre, states, and private hospitals are visible to the casual eye minimizing equity, accessibility, and affordability of vaccines. Lastly, no clarification on the spending of 35,000 crore Budget allocation, no transparency regarding usage of PM Cares Fund, no effective plan for migrant laborers, unnecessary political rallies in between humanitarian crisis, and no plan for after vaccination health check follow-ups demonstrate, that citizens’ rights are taken for granted and policy formulated to tackle COVID-19 was hurried into and is flawed.

Current Data states that the centre exported 663.698 lakhs doses in 2021 on the contention that the government wants the entire humanity to benefit from it. The irony of this argument is that India exported more vaccines than it used for its citizens. With developed countries prioritizing their citizens during the COVID crisis, on its part, the Indian Government should have anticipated the requirement and regulated the doses exported in a much efficient way. Moreover, the Government’s rushed approval of using indigenously developed COVAXIN, with incomplete Phase-3 results and no published efficacy data, lead not only to considerable vaccine hesitancy but could also have led to gross human rights violation and another health crisis.

Recommendations

The Supreme Court of India couldn't stand as a mute observer looking at how the rights of citizens are jeopardized, Thus it took suo- moto cognizance on 22 April 2021 to direct centre and state government policies whilst questioning the irrational aspects, laid out to manage the public health crisis. The bench comprising of Justices DY Chandrachud, L Nageshwar Rao, and S Ravindra Bhatt issued the following guidelines and directives in order, to rectify the policy:-

  • Clarification over the spending plan of 35000 crore budget allocation and its utilization for the 18-44 population

  • To place on record the projected plan of vaccine availability till December 31st, 2021

  • Government should cease to threaten the general public for sharing information about essential items available on digital platforms.

  • Vaccination drives for people who are not considered frontline workers but are giving on-ground assistance such as crematorium workers.

  • Review pricing policy to remove state pricing discrimination for universal immunization.

  • Vaccine procurement to be centralized in order to negotiate with manufacturers properly and distribution to be decentralized, to increase accessibility

Adding on to Supreme Court’s effort, A supplementary report by the Lancet COVID-19 commission task group, titled ” Managing India's Second COVID-19 Wave: Urgent Steps”, also suggested that there is a need to address vaccination hesitancy through advocacy campaigns and clear disclosure of safety and hazards.

Apart from these short-term solutions, Other recommendations that are vital for universal immunization are:-

  • the inclusion of refugee and immigrant populations in vaccination drives exempting them from mandatory registration.

  • Setting up of vaccine follow-up camps, to assist people having unusual after-effects.

  • Transparency in data about funding and spending related to COVID-19 policies, to generate public trust

  • Free/affordable vaccines for marginalized and outcast communities

  • Lastly, acknowledgment of foreseeable issues and formulation of a practical timeline for upcoming months.

Image source: The Financial Express


This article has been authored by Pragati Mot and Vividh Jain. They are students at Institute of Law, Nirma University.