How We Got Into The Vaccine Mess, And How To Get Out Of It Before The Third Wave Hits Us

That we have got our vaccine strategy all wrong needs no elaboration. But to course-correct, we need to go back and trace the origins of our vaccine policies in order to avoid repeating those mistakes.

If we fail to do so, not only will we face a third and more virulent wave, but the mad rush for vaccines will become super-spreader events on a par with election rallies and religious congregations.

In Mumbai yesterday (5 May), even jumbo vaccine centres like the Bandra-Kurla Complex (BKC) witnessed massive crowds, complete with pulling and pushing and abandonment of social distancing, thanks to the rush for the limited doses of vaccines available.

Other urban centres too face similar problems because our netas have put politics above common sense. They have created panic and shortages, as they have in every other sphere.

A brief history of the politics behind what got us into this mess is vital.

When India began its vaccine drive around mid-January – which was not much behind the rest of the world – we thought that we had ample time to slowly and efficiently roll out our vaccines. But by mid-February, three opposition-ruled states and a BJP-ruled one, were seeing huge spikes in infections.

By March, this was becoming more pronounced, and Maharashtra and Chhattisgarh were accelerating at a fast clip even as the election-bound states were seeing steady increases on a low testing base.

At this juncture, these states needed someone to blame, and started talking of a vaccine shortage and being constrained by the Centre’s policy of limiting vaccines only to the 60+ (and later 45+) age groups.

The Centre, as is the bureaucratic norm, denied any shortage, when it should have been obvious to anyone that any increase in vaccine eligibility would have made the shortages worse.

So, instead of delivering straight talk about the actual vaccine situation, which meant calling for at least two months of delay before expanding the eligibility to the 18+ groups, the Centre announced that all adults can get vaccinated from 1 May without expanding the supply situation.

Even though the two main vaccine makers, Serum Institute of India (SII) and Bharat Biotech, were belatedly given orders and advance payments to ramp up supplies, nobody bothered to explain that this expansion will not happen till the June-August period.

Meanwhile, everyone and the dog at the lamp-post was talking of the vaccine as a silver bullet solution to India’s Covid woes. From vaccine hesitancy to universal acceptance of the jab as panacea, we did a complete U-turn in less than two months.

To make an existing supply crunch worse, states like Maharashtra – again responding to central accusations of vaccine wastage – started entertaining walk-in registrations outside the Co-Win app.

With Covaxin supplies constricted, and Covishield production simply not enough to take care of demand from the newly-added 18+ group, those entitled to second doses found that they had two options: rush from centre to centre and stand in overcrowded lines to get themselves vaccinated within the period indicated by expert groups (ie, 28-42 days in the case of Covaxin, and 28-56 days for Covishield); or wait for some private sector hospitals to offer vaccines for a high price.

The choice is essentially between participating in super-spreader queues, where no social distancing norms are usually followed, or let the official deadlines for the second dose remain a dead letter, and take the vaccine when available.

The truth is by the time our vaccine supplies are expanded, and the new ones (Sputnik-V etc) are made widely available, the current Covid wave will begin subsiding.

This means these supplies will become available just when people become less afraid of contracting the infection and states start reopening for business.

Vaccines supplies will expand just when the queues contract. (Of course, this may turn out to be a wrong forecast if the second wave continues longer than June-July).

If this is how we got into this mess, the way out is to do the exact opposite.

One, we should accept that vaccinating two-thirds of the population is impossible by June-July, when the current Covid wave will peak, and focus instead of achieving this target before the third wave strikes (possibly around September-October or later).

Two, targeting the third wave means placing bulk orders on our producers now, and these orders need to be upwards of two billion doses in the aggregate. This way, the vaccine producers will not hesitate to ramp up quickly.

If they assume that orders will thin out once the current wave dies down, we are again going to be in the same mess come August-October, when another wave may begin to surface, according to some forecasts (read here, here).

We don’t know if the third wave will be as bad as the second, or it will be worse. This means building vaccine supply redundancy, and the possibility of losses if demand suddenly peters out.

This is the price we have to pay for safety – a price we didn’t want to pay when we bid goodbye to the first wave and expected the second to be no worse than the first.

Three, centralised procurement of vaccines is a must, for it makes no sense for Centre, states and private parties to bid separately for supplies. The Centre can ask states to indicate their needs, and then negotiate the best prices for supplies, which can then be given free for public vaccine drives.

Even for corporations and private hospitals, it could negotiate a higher price and get them supplied. It should not make the mistake of trying to decide how much private parties should charge for vaccines. In any event, 85-90 per cent of vaccinations will happen for free.

Four, all appointments should be scheduled and there should be no walk-ins, as far as possible. Even if there are walk-ins, these should be regulated by the issue of electronic tokens – and not by queuing outside vaccination centres.

These tokens should be limited to a rough estimate of daily available doses after accounting for the appointments scheduled. A little higher wastage should be acceptable as the price to pay for avoiding over-crowding at vaccine centres.

Five, if second doses for the 45+ are prioritised, these too should be done by appointments. When I got my first shot, I was told there is no need to seek an appointment, and I should come on my own after 28 days and latest by the 42nd day (for Covaxin).

But with vaccines being opened up to all adults, this bid to come without appointment means I have to stand in a long queue, and, worse, subject myself to the risk of participating in a super-spreader event.

I now have no option but to allow the outer deadline to pass without my second dose. And this is not only about me. It is the story in many places, with many individuals.

Six, just as we plan for abundance in vaccine supplies before the third wave, we should do the same with other vital requirements, from oxygen supplies to ventilators to hospital beds.

The big mistake most states made after the first wave ebbed was to not just lower their guard, but also ramp down their healthcare preparedness.

If we had used the time to continue ramping up supplies, we would not have seen the terrible scenes in Delhi and elsewhere, where patients are running helter-skelter to find beds, oxygen and drugs like remdisivir.

We have to plan for abundance in a country that tends to panic at the first sign of shortage in anything and then overstocks everything. Shortage is a self-fulfilling prophecy in India, and abundance and oversupply are the only remedies for it.

Vaccine development must now think of tackling the newer mutants strains with better vaccines, and the ultimate aim should be a single-dose vaccine. As long as we need two doses, our problems will be amplified by shortages in any one vaccine, since people have to wait for the same vaccine for the final dose.

Experiments with mixed doses – first with Covishield and next with Covaxin or Sputnik – should be conducted to see if this mixing of doses works as well, or causes more side-effects and problems.

Seven, expanding healthcare and medical insurance must be the theme songs for India in the rest of the Modi term. Infrastructure that we did not build over 70 years must now be built as if there is no other objective for government.

Eight, we have to think like Singapore in terms of safety. After being repeatedly hit by swine flu, SARS, and other such infectious diseases, Singaporeans have gotten used to wearing masks even when threat levels are lower or non-existent.

While manual labour-oriented work cannot be done easily while wearing masks, in most other walks of life, a minimal masking should be the norm in offices, public transport and government offices in the foreseeable future.

Other elements of hygiene, hand-washing, etc, are important for us in a society where social distancing is so difficult to maintain in crowded places.

Nine, we need expanded investments in new drug and vaccine discoveries, including public-private partnerships like the one that delivered Covaxin, not only to deal with Covid, but all diseases, including TB, diabetes, heart disease, cancer, etc.

In the next phase, protecting children and non-adults (18-) must be a priority. There is no way we can restart schooling and education without these protections.

Ten, lockdowns will halt the transmission of infections in the short run, but they also damage testing and tracing. So, the drop we see after lockdowns could well be illusory.

Protecting lives cannot be at the permanent cost of livelihoods. According to a study by Azim Premji University, Covid has pushed 230 million Indians back into poverty. Even as we fret about vaccines, oxygen and beds, we cannot presume that other problems loom larger, and social stability will be at stake.

Covid should prompt us to think fail-safe, to make health the topmost concern of our lives. And yes, healthcare is one sector where jobs can grow in line with investments. Healthcare should be the infotech of the 2020s.