New Vaccine policy: Need and Concerns – Explained, Pointwise

Introduction

Vaccines are a proven shield against the SARS-CoV-2 virus. They have prevented serious illness and death, especially in patients who have been administered both doses. India’s new vaccine policy came into effect on 21st June. The policy aims to reduce the stress of procurement on states who were not able to effectively procure under the previous policy.

It would also boost the per day vaccine administration in the country and ensure equitable access to vaccines by small hospitals as well.

However, it also gives a disproportionate allocation of 25% to the private sector and doesn’t provide concrete steps to tackle hesitancy, which may impair the vaccination drive. Therefore, allocation of government should be enhanced, and confidence-building measures are taken for achieving universal immunization.

Progress of Vaccination in the country

• India’s cumulative COVID-19 vaccination coverage has reached 28.33 crores since 16th January 2021.
• A spike in vaccination delivery was observed post the initiation of the new vaccine policy from 21st June 2021. 
  • More than 82 lakh doses were administered on the first day, which was the highest-ever single day inoculation since the drive began in India.
• Currently, 17.1% of the country’s population has received at least one dose, while 3.7% are fully vaccinated.

About the New Vaccination Policy

• The stated objective is universal access to free vaccinations in all government and accredited facilities.
• It creates a dual market, under which the Centre will buy 75% of doses from vaccine makers and give it to the State governments for free to inoculate all adults. While the rest will be left for the private sector procurement.
• The funding will be a mix of public finance and out-of-pocket expenditure. 
• The outcome is to ensure that all 95 crore adults are fully vaccinated by the end of this year.
• Pricing:
  • Covishield and Covaxin would be supplied to the Central government at Rs. 150 per dose, while procurement price would be higher for private players.
  • Consumers will get a free dose at government centers while a capping price is placed on private players. It is Rs. 780 for Covishield, Rs. 1,145 for Sputnik V and Rs. 1,410 for Covaxin.

• Quota allocation:
  • 75% of Vaccines would be procured by the Centre and 25% would be available for private players.
  • The Central government will specify hospital-wise and State-wise quotas for private sales.
• The policy was announced on 7th June and came into effect from 21st June.

Need of New Vaccine Policy

• First, the revision in the vaccination policy came after the number of doses administered daily started to decline in May. 
  • Between May 11 and 20, only 15.7 lakh doses were administered on an average daily. However, the need was to administer around 82.1 lakh doses for attaining universal immunization in 2021.
  • The daily rate reduced due to a shortage of vaccines, as most major States used 90% of all doses supplied to them.
• Second, the states were obligated to purchase vaccines on their own under the previous policy. The Centre gave free doses only to vaccinate the elderly and the frontline workers. 
  • This induced severe financial stress on them as their cost of procurement was much higher than Centre. 
• Third, the second wave of Covid-19 brutally impacted the population. Its reach and magnitude were much higher than the first wave. Thus, a new vaccination policy was desired to speed up the vaccination drive in a short time.
• Fourth, the previous policy was unable to make substantial progress towards universal immunisation. The shortage of vaccines in government centers and the high cost of vaccines in private centers discouraged vaccine administration to millions.
• Fifth, under the previous policy, the States were competing with each other for the limited vaccines. This was adversely impacting the spirit of cooperative federalism in India.

Issues associated with New Vaccine Policy

• First, the private sector possesses less vaccination centres than its approved procurement quota. This may create a demand-supply mismatch and result in inequitable distribution.
• Second, the quota is based on a mistaken assumption of an inflated ‘middle class’.  
  • The data of Pew Research Centre shows a fall in the number of people in the higher, middle, and lower-middle-class segment due to the pandemic. For instance, the middle class numbers fell from 9.9 crores to 6.6 crores.
• Third, the top 25% of the population has better access to government vaccination centres. They may choose to get free vaccination which may have a ‘crowding out’ effect for the poorer sections.
• Fourth, the price of vaccination in small hospitals would be much higher than in big healthcare hospitals, as they do not have deep pockets to buy such costly vaccines.
  • The piecemeal orders and delivery in remote locations would enhance the price and discourage private vaccination in these regions.
• Fifth, differential pricing and dual markets provide wrong incentives and result in unhealthy competition. 
  • There could be diversion and leakage of the free vaccines to the private markets as many government doctors are also owners of private hospitals.
• Sixth, the policy doesn’t propose concrete steps to tackle vaccine hesitancy which has grown tremendously post the occurrence of the new delta variant. Further, constant shifts in vaccine dosage and periodicity also shakens the trust of masses.

Read more: Challenges in Vaccine Procurement in India – Explained, Pointwise

Suggestions

• There is a need to simplify the policy with the government as the sole procurer. The model of the Universal Immunisation Program (UIP) can be adopted in this regard.
  • Under UIP, the Central government indicates the quantity required, the delivery schedules, and the rates as per global tender. It supplies quality, ready-to-use vaccines to the States. 
  • The manufacturer is left to dispose of excess quantity, if any, in accordance with market forces and without interference from the government. 
  • The private sector’s participation catering to the better-off sections has averaged 5%-15% depending on the vaccine.
• The implementation of the policy must be in accordance with district-level micro plans incorporating the public and private sector. This would help cover target groups in accordance with epidemiological data.
• The government should encourage walk-in vaccination in hinterland regions due to poor digital literacy levels, which impairs online registration on Cowin portal. Further a framework of ‘Vaccination at Home’ should be made for severely ill patients. 
• It should now prepare a robust strategy for children as well. The advent of the delta variant made it clear that the previous plan to vaccinate a smaller part of the population was inadequate. The need is to vaccinate around 85% of the population for achieving herd immunity.
• India can establish an independent team of experts under the aegis of the WHO. They will ensure adherence to recruitment standards, consent conditions, and adverse event record management. This would improve public confidence and provide enough data for the future policies of the government.

Read More: Universal vaccination in India : Challenges and way forward – Explained, Pointwise

Conclusion

India witnessed a large number of deaths in the second wave and to date, only 3.7% of the population has been fully vaccinated. Further many experts are predicting an onset of the third wave around October-November. This makes it imperative to achieve universal immunisation in a short time with an effective vaccine policy. Under this, the vaccines should be freely available and accessible to all, not only to the privileged few.

Sources:

The Hindu: Article 1, Article 2, and Article 3