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The Big Story: Round about

A month and a half ago, India’s Union Government introduced sudden changes to its vaccination policy that it said would liberalise and accelerate India’s campaign to inoculate all adults. At the time we called some of the moves baffling and talked about how they seemed like a panicked reaction to an unforeseen second wave.

Over the last two weeks, a few more opinions on the policy have emerged.

The Supreme Court of India concluded that the Centre’s decision to not provide free vaccination to Indians between the ages of 18 and 44 was “prima facie, arbitrary and irrational.”

A number of chief ministers of various states have called for the Union Government to return to the earlier approach of it procuring all vaccines, instead of the fragmented approach it chose in the new policy.

And the NITI Aayog, the Centre’s think tank, made it very clear that the Union Government knew how misguided some elements of the new strategy were, giving the impression – as I write here – that it chose those policies just to spite the states.

Does this combination of circumstances mean that Prime Minister Narendra Modi’s ‘liberalised and accelerated’ policy is about to be reversed, at least in part?

Let’s look at each of the elements separately.

Spiting states

The NITI Aayog’s statement is, in some ways, the most galling of the developments. In the original press release the Union Government put out on its new policy, it gave no hint that it had arrived at these decisions based on some sort of compromise with the states, or that it was begrudgingly accepting a policy recommendation.

Instead, characteristically, the release on April 19 was laudatory and made it seem as if the ‘liberalised and accelerated policy’ was the natural next step.

“Government of India has roped in the private sector in the vaccination drive right from the beginning. Now, as capabilities and processes have stabilized, the public as well as private sector has the experience and confidence to rapidly scale up. In its Phase-III, the National Vaccine Strategy aims at liberalised vaccine pricing and scaling up of vaccine coverage.”

Now read what the NITI Aayog said on May 27.

“The states very well knew the production capacity in the country and what the difficulties are in procuring vaccines directly from abroad. In fact, GoI ran the entire vaccine program from January to April & it was quite well-administrated compared to the situation in May.

But states, who had not even achieved good coverage of healthcare workers and frontline workers in 3 months wanted to open up the process of vaccination and wanted more decentralisation. Health is a state subject & the liberalised vaccine policy was a result of the incessant requests being made by the states to give states more power.” 

In other words, the Centre now says, via NITI Aayog, that it knew this was a bad policy. And yet, it claims – dishonestly, as we point out below – that it was pressured into instituting this bad policy.

States push back

The Centre now wants to portray its much-criticised policy as the outcome of flawed demands of Opposition states. Madhya Pradesh Chief Minister Shivraj Singh Chouhan implied that the Centre ditched a “perfect policy” because of state pressure, a claim that says more about his Bharatiya Janata Party than the Opposition.

But there is little indication here that Prime Minister Narendra Modi’s famously centralising government suddenly discovered its federalist principles in vaccine policy and started listening to the states.

Certainly, there was a clamour to open vaccines up for the 18-44 band, despite a tiny percentage of the more vulnerable 45+ population having been covered. There were much more sporadic calls for a bigger say for states in procurement of vaccines. Instead, chief ministers were mostly demanding freedom to distribute as they wished.

And no state leader was asking for a confusing system in which the states would compete with the private sector, the Centre would negotiate itself a cheaper rate than the states, and the private sector would be permitted to charge any price they wished while being made responsible for covering 50% of the 600 million Indians between 18-44.

Rather than a sudden injection of federalism, the Centre’s new policy seems quite evidently to be a panicked reaction to quieten the barrage of criticism following a brutal second wave that it completely failed to anticipate. The changes meant that the entitled rich of all ages could now get the vaccines, even if little else about the policy made sense.

Now states are fighting back. Chief ministers of Opposition states like Kerala and Jharkhand have asked the Centre to procure vaccines for all, as most central governments the world over have done.

Even the chief ministers of Odisha and Telangana, who have tended to vote with the Bharatiya Janata Party in Parliament, have spoken up against the fragmented procurement – though, typically, they have addressed their comments to fellow chief minsters, rather than Modi.

Will the Centre respond to these demands to reverse its ill-advised strategy, which it has otherwise sought to blame the states for?

Supreme scrutiny

Among other things, the Supreme Court’s most-recent judgment in its suo moto case – meaning one that it started hearing on its own, without any petition – on Covid-related matters includes several paragraphs spent telling the Centre that its website for vaccine registration needs drop-down menus and keyboard shortcuts to aid disabled users. Why the top court of the land has to use its time giving basic directions on website design to the Centre, which had a whole year to put together the site, is hard to answer.

The court also announces its bafflement at the Centre’s vaccine policy changes, in particular the confusing decision to negotiate a different price for itself and states and the choice to give private hospitals freedom to charge as much as they wished for doses, while expecting them to cover 50% of the 600 million Indians between 18-44.

For example, after the Centre’s previous affidavit claimed that even the ‘liberalised’ vaccine policy actually gave states no freedom in either volumes or pricing, yet forced them to pay more despite an admission that the Union Government could get a better rate with a bigger order, the court said:

“Prima facie, the only room for negotiation with the two vaccine manufacturers was on price and quantity, both of which have been pre-fixed by the Central Government. This casts serious doubts on UoI’s justification for enabling higher prices as a competitive measure. Furthermore, the Central Government justifying its lower prices on account of its ability to place large purchase orders for vaccines, raises the issue as to why this rationale is not being employed for acquiring 100% of the monthly CDL doses.”

The order continues the trend of the court asking straightforward questions to the Centre for information on vaccine policy that it ought to have provided to the public anyway, months ago. It asks:

  • How is the Centre monitoring vaccine distribution to private hospitals? How is the Centre monitoring whether private hospitals are distributing doses in proportion to state populations, as claimed by the government?
  • Did the Centre do a “means-test” of the demographic of states to conclude that 50% of the 18-44 population would be able to pay for two doses of a vaccine? If not, why did it give private hospitals the responsibility to cover 50% of the 18-44 population?
  • How will the Centre and states ensure equitable distribution of vaccines across sections of society?
  • Is the Centre regulating at all the end-price charged by private hospitals, especially since it regulates how many doses they can get?
  • How has the Rs 35,000 crore set aside for vaccines in the Budget been spent?

Finally, as mentioned above, it considers the Centre’s approach to the entire 18-44 age group “prima facie arbitrary and irrational”, suggesting strongly that it will either have to be changed or defended with a radically different legal argument.

The court is set to next hear the matter on June 30. Will it be examining a radically different vaccine policy by then?

On this subject

Can’t make this up

The wild world of digital court hearings:

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