There isn’t much information available on India’s Covid-19 vaccine game plan. We do know — HT’s Saubhadra Chatterji broke that story — that there is a vaccine committee. We also know that this committee is speaking to several vaccine developers. And we know that states have been asked to prepare a list of people who should be prioritised for a vaccine shot. There are several unanswered questions, though.
Infosys chairman and former Unique Identification Authority of India (UIDAI) head Nandan M Nilekani wrote a two-part article detailing how he thinks India should go about it, but, again, it isn’t known whether the government is thinking along those lines, or whether the people in charge have even read Nilekani’s article. I am not sure (and this is based on my own interactions) that these people are as informed of the pandemic as they should be. A long career in India’s sprawling and bureaucratic health system, or a medical degree of some vintage, don’t matter as much as an open mind, the ability to read and understand current literature on Covid, and then synthesise what that means in the Indian context. The US has Dr Anthony Fauci; we have a man who thinks the influenza and Covid viruses are from the same family. It’s the reason I recommended — Dispatch 108, titled A Million and a Manifesto, on July 18, shortly after India crossed the million-case mark — that the country appoint a Covid Commissioner. But I digress.
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There are four aspects involved in vaccinating a population.
The first involves identifying and procuring a vaccine. Sure, if you are a country such as the US, you can launch a program like Warp Speed, funneling billions of dollars into companies developing vaccines; but even otherwise, it makes sense to secure supplies by striking deals, private bilateral business agreements, with companies developing the vaccines. The UK and the EU have such agreements. As have many other countries. India doesn’t, and is largely dependent for vaccines on a WHO initiative, Covax, but not all vaccine developers are part of this equitable access platform; Pfizer, for instance, isn’t (and its vaccine will likely be the first one available). India should aggressively pursue bilateral agreements, and use as a hedge, like many other countries plan to, the vaccine doses it will be eligible for under Covax. The next few years are going to be about vaccine stockpiles — most of the initial vaccines may be two-shot ones; people may need annual vaccination — and India should get serious about building its own.
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The second involves funding. India needs to figure out who is eligible for a free vaccine, and who pays. The easier, but more expensive option, is to underwrite the costs of vaccination for the entire population — something that could cost tens of billions of dollars. And at least for the first few years (I’m not sure anyone has thought about this), till a one-shot-lifetime-protection vaccine is developed, this staggering amount of money may have to be spent annually. The government could also consider providing the vaccine free only to people who need it (say, those covered by the Public Distribution System), and make others pay for it.
The third involves distribution. Here the government should do the smart thing and tap the expertise of those who do this best — companies in the consumer products business such as ITC, Hindustan Unilever Ltd, Parle, the Gujarat Co-operative Milk Marketing Federation, and others. These companies are in the business of ensuring their products are available in remote corners of the country. Some even deal in perishables, and some others in products that require refrigeration.
The last involves administration. This is perhaps the most complex part of the exercise, but also the one where India has a very good template — the general elections, down to the neighborhood election booths. Just like government employees, usually school teachers, are drafted to man the polling booths, health care workers from government and private hospitals should be asked to staff the vaccination booths. The national elections, conducted in phases, in just the span of a month-and-a-half, provide the perfect template for a national vaccination drive. People know which their booths are; go there, present some ID (even a phone number will do, or a name and thumbprint in the extreme case of someone who has no ID at all), be vaccinated, get a receipt to that effect, and perhaps one of those indelible-ink marks on a finger.