India Needs A Public-Private Model For Covid-19 Immunisation

Popular interest in Covid-19 statistics — fresh infections, recoveries and fatalities — has considerably declined in recent times with India embarking upon a gradual and graded process of opening up after a prolonged pandemic-induced lockdown.

On the other hand, there is rising interest and curiosity in the promised vaccines to ward off what can be a potentially lethal disease. Three questions now dominate public discussions: Which are the vaccines that will be available? When will they be available? And, to whom will they be available?

Given the huge global demand for Covid-19 vaccines — every country wants it for its citizens — there are legitimate apprehensions as to how much of the total availability will fall into India’s share, at least in the early months.

Linked to this are two other apprehensions: Does India have the financial resources to acquire sufficient doses of the vaccine (or vaccines) and, perhaps more importantly, does it have the capacity to distribute, store and administer the vaccine across the length and breadth of the country which will require extensive cold chain facilities and trained human resource.

The first apprehension is addressed to a degree by COVAX, billed as a “ground-breaking global collaboration which aims to accelerate the development and manufacture of Covid-19 vaccines, and to guarantee fair and equitable access for every country in the world”.

We must ensure that this is not gamed by the rich and powerful as other institutions have been in the recent past. The second apprehension is yet to be conclusively addressed though Prime Minister Narendra Modi, in his latest address to the nation on the pandemic, has stressed that the “government is preparing to look for ways to deliver the vaccine to every Indian as soon as possible whenever the vaccine against Corona arrives. And the work on ensuring delivery of the vaccine to every citizen is being done at a fast pace.”

The speed and scale of a Covid-19 immunisation programme will determine how India copes with the pandemic — it is neither abating nor disappearing any time soon — in 2021.

The implications of success or failure are intimately linked to both lives and livelihoods. Hence, Covid-19 vaccination is now as much a political as a public health issue. The BJP has promised free vaccines to all in its Bihar Election Manifesto and in Madhya Pradesh too where crucial byelections are scheduled; the Government of Tamil Nadu has made a similar promise ahead of elections in the State.

And President-aspirant Joe Biden has made the same commitment to voters in the US. The race for the vaccine is global, deeply political and will witness competition and contests.

Union Health Minister Dr Harsh Vardhan has been combatively optimistic in putting down fears of India missing the bus even as other countries board it either by jumping the queue or paying a premium.

He has even gone to the extent of saying that since India will be one of the main manufacturing hubs of Covid-19 vaccines as and when they get approvals of certifying agencies, not only will the government be in a position to leverage this fact for adequate supplies, the country will be doing a service to the world.

But words are at best words and the reality often turns out to be at variance with expectations. There are unresolved issues on pricing — will India invoke a provision in the law that prohibits transfer of licence fees to foreign-based pharma companies using Indian manufacturing facilities?

Will there be price-capping? Will the immunisation programme be free for all or some? If free vaccination is restricted, how much will it cost for others?

Who will oversee acquisition, distribution and vaccination since the actual implementation has to be done by State governments with their poorly-funded and near-decrepit public health system already stretched to the limit by the pandemic?

During a conversation with ORF, Principal Scientific Adviser to the Government of India, Prof K Vijay Raghavan, had disclosed that a National Expert Group of Vaccine Administration had been set up to deal with all aspects of the Covid-19 vaccination programme.

Dr Harsh Vardhan says the Expert Group is “designing innovative approaches to distribute vaccines in rural and remote regions”.

This is easier said than done. It requires budgets and capabilities at an unprecedented speed and scale.

However, as the prime mover behind India’s successful and globally acknowledged polio vaccination campaign, Dr Harsh Vardhan should know what he is talking about and putting on the table: 40 to 50 crore doses to vaccinate 20-25 crore Indians by July 2021.

His confidence rests on India’s track record: It implements the world’s largest immunisation programme, vaccinating 27 million newborn infants every year.

India has an established infrastructure for supply, storage and delivery of vaccines ‘to the last mile’. The government plans to “leverage its integrated IT platform e-Vin (electronic Vaccine Intelligent Network) for managing vaccine distribution”.

India’s UID, or Aadhaar, database could play a critical role in this project and must be deployed for this national security imperative.

The ‘surge’ in demand and distribution infrastructure for a country of 1.3 billion people will be mind-numbing.

Irrespective of how the government decides on the purchase price of the vaccine, it will cost a humongous amount of money. Serum Institute’s CEO Adar Poonawalla estimates the total cost to be around Rs 80,000 crore.

That’s for the vaccine alone. Distribution, storage and administration of the vaccine would cost extra.

That figure may have been an exaggeration and the Union Health Secretary has contested Mr Poonawalla’s claim.

Nonetheless, it has prompted Expenditure Secretary TV Somanathan to allay fears of insufficient funds hampering the vaccination programme:

Budgetary resources would not be a constraint in “vaccinating the needy; that is our responsibility.”

So, briefly, this is where India stands today apropos the Covid-19 vaccination programme: 20-25 crore Indians will be vaccinated by July 2021, funds will not be a constraint, it will be free for the needy unless a national free Covid-19 immunisation policy is announced, a set of criteria will be adopted to decide who gets the vaccine first depending on risk factors, and government believes it has the wherewithal to conduct the vaccination programme.

Hence, the question arises: Why isn’t the government thinking in terms of scaling up the vaccination programme with both speed and efficiency by partnering with the private sector?

The pandemic has impacted the national economy, and consequently livelihoods, the most (India has done well in saving lives) and it is in the interest of major private sector stakeholders that they should contribute their mite in meeting the challenge of immunising Indians and, to that extent, mitigating the burden of the government so that it is able to focus better on the poor, the underprivileged and those facing maximum risk on account of comorbidity or age.

Major private sector companies can be encouraged to run sub-immunisation programmes, under the watch of the Health Ministry and its agencies, for their employees, their families and their associates.

They would be free to acquire the vaccines at prices they negotiate with producers, arrange for its storage and distribution through cold chain that can be designed in a manner so as to enable its use later for commercial purposes through an appropriate arrangement that catalyses such investments.

They can use the services of health workers in the private sector for the vaccination process.

Companies which have the capacity to purchase more than their requirement can contribute the excess to the national kitty.

Or, immunise the employees and their families of downstream companies and vendors.

Millions of Indians could be vaccinated in this manner with extraordinary speed. It would make industry more Covid-19 resilient.

It would lend a degree of predictability and certainty to their ramping up, a prerequisite for business operations. It would protect both lives and livelihoods.

Health delivery in times of pandemics or epidemics cannot, and must not, be the government’s responsibility alone. Government’s efforts should be supplemented with what is loosely referred to as ‘corporate social responsibility’ that goes beyond mandated contribution from annual profits.

The early stages of the pandemic saw the government struggling and getting pushed to the proverbial brink while dealing with something as basic as testing with both kits and public health personnel in short supply.

It is only when the private sector was roped in that India witnessed both speed and scale in the testing process, which in turn ensured better handling and containment of the pandemic as it unfolded.

Similarly, when the pandemic erupted, India faced a severe and crippling shortage of personal health equipment, including masks and body covers.

A point came where health workers were pitifully recycling and reusing personal health equipment, endangering their lives as also those of their patients.

Given the massive spurt in global demand for personal health equipment, money could not buy masks and body covers in the international market.

Even when they could be sourced, disrupted supply lines resulted in shipments getting delayed or, worse, diverted at a time when speed was of critical importance.

Then a miracle happened. The private sector was roped in to produce personal health equipment and this proved to be a game-changer.

From a desperately scrambling net importer, India is today a leading exporter of personal health equipment. This turnaround was made possible by the private sector through its robust participation in the national effort.

Similarly, if called upon and given a free hand, the private sector can play a game-changing role in the proposed Covid-19 immunisation programme.

For this to happen, the process of integrating the public sector and the private sector into a National Anti-Covid Mission platform has to begin now.

The National Expert Group of Vaccine Administration should not be an exclusive club of government officials and epidemiologists; its membership should be expanded to include private sector players and their views on forging a public-private partnership should be solicited to create and put into place a model based on speed, scale and efficiency.

Government’s primary responsibility is to save lives; let industry do its bit for saving livelihoods.

There are big corporates more than willing to pitch in with resources to create the necessary storage, supply and human infrastructure for a sub-immunisation programme after acquiring large quantities of any of the vaccines cleared by health authorities.

They have the capacity for speed and to scale up their efforts to include those not in their employment, directly or indirectly.

Add to this India’s thriving private sector healthcare facilities and a PPP model would serve as a force-multiplier.

The government has to now decide whether it should target 20-25 crore Indians for immunisation in the first phase and be satisfied or push that figure substantially to a higher number with the help of the private sector.

It is a decision that cannot be put off for another day.

(This piece was first published on orfonline.org and is reproduced here with permission.)