June 13, 2021

Modi Government’s Covid Vaccine Policy

J S Majumdar

THE central government’s Covid vaccine policy has to be seen in the background of its healthcare policy, which mainly is the privatisation of entire healthcare system-including national health policy and the drug policy.

Establishment of public sector pharma companies, Patent Act 1970 and Drug Prices (Control) Order 1979 were the three instruments with which India could become self-reliant in almost all medical products, including vaccines, at economically affordable prices; and major supplier of generic (non-patented) medicines to different countries of the world.
With neoliberal policy the drug policy was systematically diluted in all three areas and finally, all public sector drug companies are being sold out by Modi government.

Modi government made a big push in privatising the entire healthcare system making business of ‘health for profit’ through (a) giving up health planning along with five year plans; (b) adopting National Health Policy in 2017 which includes side by side private healthcare system with that of the government healthcare system; (c) Ayushman Bharat – National Health Protection Mission (AB-NHPM) renamed as Pradhan Mantri Jan Arogya Yojna (PM-JAY), announced in the budget speech on February 1, 2018, which is an insurance-driven policy with private healthcare network participation; and (d) In 2020 introducing National Digital Healthcare Mission (NDHM), a government platform for promoting Tele-medicines and E-pharmacy with private sector participation.

Modi government’s Covid vaccine policy was tuned to the above-mentioned health and drug policies as against the need for free public universal vaccination in the situation of the pandemic.

Modi government failed in the overall handlingofthe pandemic — in organisingandbuilding public healthcare capacity, medical equipment, oxygen, equipping medical andparamedicalpersonnel etc. Their folly on the vaccine front ismonumental.

After the first wave of Covid, Modi government came to the conclusion that Covid-19 attack ended and there was no need to take defensive measures against its further attack.
Since January 2020, during the very first wave of Covid-19 pandemic, there should have been a roadmap of Covid vaccine’s development, production, procurement, distribution and vaccination.

The government did not take any initiative for indigenous capacity of vaccine production by (a) Placing advance orders; (b) Extending bank credit for the expansion of production capacity; (c) Take initiative for public sector production; and (d) Share with other vaccine manufacturers Covid vaccine technology of Covaxin.

Covaxin technology is available with the central government, as it was the only vaccine technology available and developed in India by ICMR (Indian Council of Medical Research) and NIV (National Institute of Virology) from inactivated virus and produced by BBIL (Bharat Biotech India Ltd) at Hyderabad.

Again, only recently, the government said that it will be using three public sector enterprises for manufacturing Covaxin to augment the manufacturing capacity under mission COVID Suraksha. These PSEs are (1) Haffkine Biopharmaceutical Corporation Limited, a state PSE under Maharashtra government; (2) Indian Immunologicals Limited at Hyderabad of National Dairy Development Board; and (3) Bharat Immunologicals and Biologicals Corporation Limited, Bulandshahr, a CPSE under the department of biotechnology.

The government did not diversifytheproductionofCovaxingeographically and involving morepublicsectorcompaniesas wellas smallerbiological manufacturers. Thiswouldhavegiventhe governmentgreaterleverageinitsdealings with the MNCs like AstraZeneca, the owner of Covishield and produced at SII.
In contrast, the production model of RDIF (RussiaDirectInvestment Fund), theownerofthe SputnikVvaccine isspreadovernearly10differentcompaniesinIndia, mostly smallandmedium-sized biological manufacturers with easytransferoftechnology. Dr. Reddy’s Laboratory (DRL) isplayinga“facilitator role”bycoordinating productionamongthesecompanies.

In China, they are utilising all technologies and wide bases of production. There is a cooperationbetweenChinaandCuba, while Cubabrings its biotechnology capabilities,Chinaoffersitsmanufacturingexpertise.

A vaccine for mass inoculation is produced on getting orders. For a vaccine, it takes time for production, distribution, inoculation, time gap between two doses and time for the body to develop antibody. Therefore, early mapping for vaccination is important to complete the process.

To face the Covid pandemic while several other countries placed their first order for vaccines in 2020 - UK in May, Japan and USA in July, EU and Brazil in August and Australia in September; Modi government waited till January 2021.

Modi government placed delayed order for the vaccine in measly quantity – in January 2021 for 16.5 million doses to last for 10 days; the next order was in February of 14.5 million doses. Inall,the governmentplacedordersforthe supplyofjust 311 milliondoses as against nearly one billion peopleinthe 18+agegroup with two doses each.
First Phase of Vaccination: In the first phase, healthcare workers, frontline workers and those above the age of 45 selectively were vaccinated. The centre procured the entire quantity of vaccines from the manufacturers and distributed it to the states to administer the vaccine free of cost and to private hospitals that charged recipients Rs 250 per dose. 

Next Phase: In the disastrous next policy statement effective from May 1, 2021, the supply was divided into two baskets: 50 per cent for the centre and 50 per cent for the open market.

GOI’s 50 per cent would be available at all vaccination centres to vaccinate healthcare workers, frontline workers, and those above 45 years of age.

The second 50 per cent include state governments, private hospitals and industries to procure doses directly from manufacturers. This is to vaccinate people above 18 years of age.

Short Supply: BetweenApril 3-9, 2021,anaverageof3.54milliondosesa day were delivered. Inthefirstweekof May, it dropped to 1.80 million doses aday and by end of May grim reality ofshortages was exposed.

Already short supply to states put them under tremendous pressure to inoculate health workers, front line workers and 45+age group. Central government’s sudden direction to include 18+ populationwithoutensuring adequatesupplies of doses has collapsed the whole inoculation drive.

Withinthe45+agegroup,many are facing the danger of overshootingthe medically prescribedtime intervalbetweenthe two shots.

Manufacturers’ Refusal: The situation has further aggravated when the manufacturers refused to deal with the state governments against the state government’s tenders and said to deal with the central government only.

Therewere several deficiencies inModi government’s vaccine policy announcement effective on May 1, 2021, just at the onset of Covid’s secondwave of attack. These are (a) Three-tierprocurementand distribution by the centre, statesand privatehealthcare; (b) Of the Centre’s procurement, the centre would keep half and split the remaininghalfbetweenthe statesandtheprivatechannels; (c) Itadded‘free-market’ adage byprescribingthatthe statesand thetwo manufacturing companies are “free”to “direct” negotiation for rate and supplies; (d) It introduced layeredpricingregime,which inthenameof“free”marketwaspromoted for notional entrepreneurialzeal for abundant vaccines supply; (e) Thedecisiontoextendthevaccination drivetothe18-44 agegroupfrom May1, despite short supply situation; (f) It was aggravated by naming as “Liberalised and Accelerated Phase-3 Strategy”of Covid-19 in the vaccination policy announcement inApril by the Modi government.

As a result, the vaccine “market” is havinga fieldday.The three-way splitbetweenthecentre,thestatesandtheprivatechannels is facilitatingrampant profit and thriving of the black market across India. Itis evidentthatprivatechannelsareaddingtheirownmark-up to the pricesset bythe twomainsuppliers,SIIand BBIL.

Covid vaccinationin theprivatesector,in largecorporate hospitals,smaller nursing homesandevenpathologylabs shot up to Rs 1,800adose. It is reported in the print media that nine top corporate hospitals cornered 50 per cent of the doses, meant for the private sector in May 2021, procured at higher prices from the manufacturers. These hospitals include Apollo, Max, H N Hospital Trust of Reliance Foundation, Medica, Fortis, Godrej Memorial, Manipal Health, Narayana and Techno India Dama.

Such a vaccination policy, the only medically defensive mechanism against the predicted third wave of Covid attack, led to widespread countrywide protest and agitation. All opposition parties, the chief ministers of opposition-ruled states, several mass organisations of workers, farmers, agri-workers, women, youth and students, other social and cultural activists raised their voices of protest. CITU launched a countrywide movement from June 1-10, inter alia raising the issues related to the central government’s vaccine policy.

The Supreme Court  criticised Modi government’s April 2021 vaccine policy as irrational, arbitrary and lack of mapping and directed for free vaccination with central government’s responsibility.

Ultimately, the BJP government retreated and completely reversed its vaccine policy of May 1, 2021. The new vaccine policy, announced by the prime minister on June 6, will come into effect from June 21, 2021.

By this policy the central government would procure the entire doses of vaccine and supply to the states without charging anything, for free vaccination of entire adult population of the country; and restricting Rs 150 per injection cost plus vaccine cost by private sector for those who would like to avoid public mass inoculation centres.

This is a big victory of the people demanding free universal public vaccination.