Nine corporate hospital groups in big metropolitan cities bought 50% of the coronavirus vaccine stock in May, since the Narendra Modi government made abrupt changes to its inoculation drive and opened it to the market in mid-April, The Indian Express reported on Saturday.

Experts have repeatedly warned that vaccine inequality could hamper India’s already difficult fight against the pandemic. The Centre’s new vaccine distribution policy has allowed private hospitals to set their own prices for the shots.

The nine private entities – Apollo Hospitals, Max Healthcare, Reliance Foundation-run HN Hospital Trust, Medica Hospitals, Fortis Healthcare, Godrej, Manipal Health, Narayana Hrudalaya, Techno India Dama – have cumulatively bought 60.57 lakh doses of the total 1.20 crore stock of vaccines.

As the fourth phase of inoculation began on May 1, the Central government announced a differential pricing for states, allowing them to buy vaccine doses on their own. Private players were allowed to buy 50% of total output directly from manufacturers. Before that, the Centre was procuring and allocating vaccines to states.

In the latest roll out, however, the Centre took responsibility for sourcing 50% of the doses for what has been categorised as the vulnerable population – those above 45 years, healthcare and frontline workers. This essentially means that vaccinations for all those below 45 years will have to be paid for by the states or by the citizens themselves.

The new “liberalised and accelerated” strategy has been severely criticised. Vaccination rates have fallen steadily nearly every week since early April as many states complained of shortage of doses.

Nine hospitals of the Apollo Group procured 16.1 lakh doses, six hospitals of Max Healthcare got 12.97 lakh doses, and Reliance Foundation-run HN Hospital Trust bought 9.89 lakh doses. Eight hospitals of Fortis Healthcare purchased 4.48 lakh doses, Medica Hospitals got 6.26 lakh doses, Godrej procured 3.35 lakh doses, while Manipal Health received 3.24 lakh doses. Narayana Hrudalaya and Techno India Dama also bought 2.02 lakh and 2 lakh doses, respectively.

Most of these hospitals are concentrated in metros, state capitals and tier-I cities, revealing the stark disparity in vaccine distribution. The purchase price set for private hospitals for Serum Institute’s Covishield vaccine is Rs 600 per dose and Bharat Biotech’s Covaxin is Rs 1,200 a dose. But hospitals charge beneficiaries in the range of Rs 850 to 1,000 for Covishield and Rs 1,250 and above for Covaxin.

Significantly, hospitals in Tier-III cities could manage to get only a few thousand doses of vaccine, The Indian Express reported. A private hospital, Sarji, in Karnataka’s Shimoga city managed to get only 6,000 Covishield doses. Shimoga has a population of 3.22 lakh.

Smaller hospitals in India’s financial capital Mumbai have also flagged concerns. “We ordered 30,000 doses, we got only 3,000,” said Dr Vaibhav Deorgirkar, medical director in Hindu Sabha Hospital. “Big hospitals with stronger networks and resources have managed to make better deals with manufacturers.”

Tejal Kantikar, associate professor in Bangalore’s National Institute of Advanced Studies said, vaccine manufactures want to sell their stocks to private players and hospitals with more bargaining power.

Earlier this week, the Supreme Court had said that the Centre’s policy to provide free vaccination for priority groups and replacing it with a paid process for those in the 18-45 age group was “prima facie arbitrary and irrational”.

The court has asked the Centre to furnish complete data on the government’s purchase history of all Covid-19 vaccines till date. The order asked the government to submit an affidavit within two weeks from June, detailing the dates of orders for vaccine placed by the government, quantity of the vaccines ordered on each date, and the projected date of supply.

The judges have also asked the government to explain why it was mandatory to register on the Cowin app to get a shot, noting that this would hamper vaccinations across rural India where it is difficult to access internet.