The Indian government this week announced major changes to its national Covid-19 vaccination strategy, including opening eligibility to all adults over 18 from May 1 and shifting the responsibility of procuring doses and inoculating those in the 18-45 band to the states and the private sector.
Many aspects of this new strategy are confounding, yet there have been few explanations forthcoming. The Centre has so far issued a press release announcing the new approach that barely explains the thinking behind the dramatic shifts in strategy. It held a press briefing with senior bureaucrats, who read out the press release without going much further.
As has been the case from the beginning, we have little understanding of the government’s rationale or its calculations or even an inkling of whether this had been part of the plan all along, or was a pivot in view of the country’s massive second wave.
But there was one source of further details, one individual willing to talk to the press and respond to questions: Serum Institute of India Chief Executive Officer Adar Poonawalla.
The Serum Institute plays an extremely important role in India’s vaccination strategy. Covishield, the version of the AstraZeneca-Oxford University vaccine that it manufactures, has accounted for 90% of the 12.76 crore or 127.6 million vaccine doses India has administered so far. While there is one other manufacturer and more are on the way, the Serum Institute and Covishield will continue to provide the vast majority of Indian vaccine stocks most likely until the second half of the year.
On Wednesday, Poonawalla spoke at length to CNBC-TV18 to clarify aspects of the new vaccination strategy. A number of his comments were important, considering the limited information from the government.
Maybe, the most significant – and egregious – was his response to the decision to charge state governments a higher price for vaccines than had been offered to the Centre earlier, especially since vaccinating the entire 18-45 band would be falling on them.
“The private hospitals in these states have the ability to vaccinate a large percentage of the population. So, in effect, the states don’t really need to buy anything if they don’t want to. It’s just an option. They wanted clarity at what price would they have this option, and that is why it’s Rs 400.
There are enough private hospitals to take care of each state.
In fact there are far more private hospitals who can vaccinate so many more people in every state, which they are happy to do. No state really needs to spend any of their money. Let me make that very clear. This is nothing against any of these states that are making noise that they have to pay more or whatever. It’s entirely their option. If they have excess funds, they want to do it, it’s their choice.”
This raises a number of questions.
Starting May 1, the Serum Institute will be free to provide 50% of the vaccines it produces to state governments and private hospitals, according to the Centre’s new rules. Has the Centre given Poonawalla the impression that the bulk of this will go to private hospitals and not state governments?
If so, does the Centre really expect that the 18-45 age band – 600 million people in India – is most effectively served by vaccines that cost a minimum of Rs 1,200 for two shots, though most likely more since hospitals are expected to tack on their own logistics costs as well?
If Poonawalla did not get this impression from the government, will the attitude reflected here – that private hospitals, which will be paying more for the vaccines after all, can do the job by themselves – have any impact on how the Serum Institute decides whom to allocate its limited supplies over the next few months?
None of this is to question why Poonawalla is speaking about this. It is not only his prerogative, it is useful for citizens to be able to hear from all the players in this complex process. Indeed, the more information we get about the vaccination strategy, the better.
The problem is Indians having to divine the country’s vaccination strategy from the comments of a private manufacturer, no matter how influential. Why isn’t the government being transparent about its calculations and thinking?
Vaccines in India have only been authorised for emergency use at the moment, while the pandemic is still on. Yet, the Serum Institute in its press release announcing pricing also said that the vaccines will be available in “retail and free trade”, meaning in chemist shops, “post 4-5 months”. How does the company get to say so, before the government has given any indication?
Take another aspect of Poonawalla’s interview. Talking about the prices again, he said:
“By opening it up to the private market and the states to procure separately above Rs 150 was also a move to encourage the foreign manufacturers to come here. How are we going to get foreign vaccines in India, if they have to sell at Rs 150?
So even for the states, they would always have [had] to buy at a higher price than the historic price of Rs 150, if they want new vaccines... This was their demand. They asked, can we can get new vaccines, can we waive trials, can we open up the market on pricing to encourage this. Modji’s government did this. I’m not defending anyone or arguing on anyone’s behalf. But I’m just saying, this was the need of the hour.”
Officially, according to the government, pricing was not the reason that other foreign manufacturers were not in India. The government had, instead, insisted that foreign manufacturers carry out a ‘bridging trial’ to get clinical data on the success of the vaccine on the Indian population.
Is Poonawalla effectively revealing that the government was unwilling to pay higher prices to other manufacturers – despite availability – and that this was the reason only SII and Bharat Biotech were authorised in India, the latter without even phase 3 trial data? And if so, is it the Centre’s intention to pass on those higher prices entirely to the states to cover the entire 18-45 age group, even though it did not warn them to create a budget for this?
Again, none of this is to say that Poonawalla should not be revealing these details or that the underlying policies he is talking about are necessarily wrong. The problem is, the government has simply not articulated its thinking behind India’s vaccine approach, and now has made a dramatic shift – without spelling out whether that was part of the plan all along or a reaction to circumstances.
Now that India is indeed going to be unique in relying heavily on the private sector to vaccinate its population, something even famously pro-free market nations like the US are not doing, should we also expect the most transparent articulations of government policy to come from private manufacturers?