Even as we battle the massive wave of Covid-19 infections, it is important to take steps to avert the next such wave. For unless we take these steps, another wave is all but certain. As on April 23, the United States had fully vaccinated 36% of above-18 population and given the first jab to another 17%. Yet, it had been averaging 60,000 cases per day. Adjusting for population size, this is equivalent to 2,50,000 cases in India.
The first and foremost step towards averting another Covid-19 wave is much larger and faster investment in vaccine manufacturing than currently planned. Scaling up Covaxin production to 100 million units per month by July would be too little too late. Assuming necessary raw materials are available, the objective should be to boost production capacity to at least 500 million units per month. Bharat Biotech need not be the only manufacturer of the vaccine. Production licence may be given to other credible and qualified manufacturers.
If necessary, the government must use public funds to buy full ownership of the patent on Covaxin at a reasonable price from Bharat Biotech. It should then mobilise multiple manufacturers to go full speed. It should also invest in rapid expansion of other vaccines such as Covishield and Sputnik V.
A key reason why the United States has been able to move ahead rapidly with vaccination is that its government invested heavily in de-risking vaccine research, trials and manufacturing early on. According to a paper by Chad Bown and Thomas Bollyky, the government began assisting vaccine manufacturers financially as early as February 2020. By March 12, 2021, it had committed more than $20 billion on clinical trials, manufacturing and future purchases of vaccine doses. Of this, more than $15 billion had been invested even before President Joseph Biden took office.
In an article published on January 7, 2021, I had recommended that India invest $8-10 billion in public money in vaccines. My argument then was that with the economy losing several billion dollars each week to Covid-19, we would more than recoup this investment through a speedier full restoration of economic activity. To this, we may add the benefit of saving tens of thousands of lives should there be another wave of infections.
Turning to the strategy for the administration of vaccines, we need to recognise that the recent decentralisation of purchase and allocation of vaccines has been a mistake. Given that the pandemic constitutes a national public health emergency, optimal response to it requires planning, coordination and prioritisation of vaccine delivery at the national level. This is also the approach taken by the United States, a country that otherwise champions decentralisation and markets. The federal government has negotiated prices with all vaccine manufacturers and allocates vaccine supplies directly to not just state governments but also major private entities such as hospitals and pharmacies that administer vaccines.
The issue becomes especially relevant if vaccine availability lags and we are able to achieve a pace of no more than 150 million jabs per month on a sustained basis. With two jabs per person needed, it would then take us one full year to vaccinate above-18 population, which is approximately 65% of the total population. Minimisation of damage from Covid-19 waves during that one year would require prioritising regions that fall victim to those waves.
A rough and ready analysis of district-level data shows that our current vaccination strategy has done a poor job of prioritisation. As on April 21, 2021, top 40 districts by the number of active cases accounted for 52% of the cases but received only 21% of all jabs. Arvalli district in Gujarat with 397 active cases administered 2,70,000 vaccine shots while Latur district in Maharashtra with 16,732 active cases administered 2,10,000 shots.
An unintended consequence of recent decentralisation has been that the decision-making power for the allocation of 50% vaccine supply has been passed on to manufacturers. Until July, this means principally one manufacturer who has gone on to announce that he would give the bulk of this supply to Maharashtra, his home state. Even if Maharashtra happens to be the state with most infections at the moment, such allocation is scarcely in the best public interest nationwide.
It is likely that the government announced the decentralisation policy as a response to a barrage of ill-informed criticisms. But it is something that requires a rethink once the current crisis abates. As a rule, policy reversals should be avoided to minimise uncertainty but when too much of public interest is at stake, course correction must be done. To blunt potential allegations of politicisation of allocations, the government may delegate the authority to an independent group of professionals.
Last but not the least, nothing that the government does can compensate for dereliction of duty by citizens. Given how aggressive and unpredictable this virus is, the only surefire protection from it is keeping out of its path. And that means minimising outside movement and wearing masks when stepping out. Even as we assert our rights and blame the government for every single ill we suffer, we must introspect on whether we have been discharging our own civic duty.
Views expressed above are the author’s own.
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