Its politics & economics

OF VACCINES AND VACCINATION

Udayan Hazarika

(The writer can be reached at udayanhazarika@hotmail.com)

Now that the unlocking process is almost on the verge of completion, two important conclusions that are circulating at the government level taking into account of the status of COVID-19 are i) that the infection curve is flattening and ii) that the pandemic can be controlled by early next year with COVID-19 vaccine is being ready by March next. There are some, grounds in favour of the first conclusion as the extent of infection is coming down which can be numerically established although the fact remains that the daily trend is not always downward, rather fluctuating. But the second conclusion regarding vaccines in March next is perhaps a misconception and a non-realisable proposition. There are indeed reasons for such hasty conclusion. General election to some Assemblies is round the corner and the political parties, especially the ruling BJP, wants to make it an election plank. The BJP has already incorporated it in the election manifesto for Bihar Assembly elections and on the day of opening Finance Minister Nirmala Sitharaman declared, "We want to assure the people of Bihar that as soon as the scientists clear a vaccine for mass production, we will give free vaccination for the people of Bihar. This is our first promise in the Sankalp Patra." Such free of cost vaccination has been promised in many other States, including Delhi, where election is being held in February next and also in Assam where the Health Minister H.B. Sarma has already announced about free vaccination although Cabinet decision to this extent is yet to be made.

Although there is grim chance of getting the most talked COVID-19 vaccine by March next year, yet the Government should start formulating a comprehensive COVID-19 vaccination policy urgently. This policy inter alia should incorporate the criteria for selection of beneficiaries at various levels and stages – as vaccine will not be available to all at one go and there will be a considerable time leg between the first and last group of beneficiaries who will be vaccinated, cost of the vaccine- its subsidised components, and most importantly a Standard Operating Procedure (SOP).

Almost all the important COVID-19 vaccines are covered under the project COVAX which oversees the development and manufacture of COVID-19 vaccines. COVAX is a joint collaboration of WHO, Coalition for Epidemic Preparedness Innovations (CEPI), and vaccine alliance GAVI. COVAX is also responsible for "diagnostics and treatments, and guarantee rapid, fair and equitable access of the vaccines etc for people in all countries". In this global collaboration and already more than two-thirds countries of the world are engaged.

Under the COVAX multilateral initiative, vaccines are supposed to be procured and distributed though the GAVI vaccine alliance to various countries. GAVI Board has already identified and classified the countries in three categories according to i) low income, ii) lower income and iii) additional IDA eligible countries. India is included in the group of lower middle income earning countries along with Bhutan, Pakistan Sri Lanka, Myanmar, etc., and will get the facilities of Advance Market Commitment (AMC) while procuring the vaccine. As per WHO report, a total of nine vaccines have entered the phase-III or the final stage which is the human clinical trials. Once these are passed through this critical trial, they will be eligible for marketing after completion of the administrative formalities. This non-technical stage consumes highest time, especially in India. Moreover, all the above quoted nine vaccines are foreign origin and therefore its clearance will need more time. India has ample infrastructure facilities along with comparative advantages for producing the vaccines locally once a license is allowed for production. In an interview with the Mark Suzam, CEO Bill and Melinda Gates Foundation told the PTI that "… next year as some of these vaccines should come out...and our expectation is that a very large portion of these are likely to be manufactured in India through the strong and robust Indian private sector partners and then that will be the key area to focus on in the next phase of the COVID pandemic."

India's Serum Institute has already made an agreement with the US Company Novavex and another jointly developed by University of Oxford and Astra Zeneca PLC for production of its vaccines in India. Both these vaccines are part of COVAX facility. In India, presently eight vaccines are undergoing trials of which two have reached the clinical trials of Phase-II namely Covaxin of Bharat Biotech and ZyCov-D of Zydus-Cadila. So the Indian vaccines have two more rounds to go before it is being qualified to come to market.

On the financial side, circle concerned believes that the national government should bear the burden of vaccine cost and that the vaccine should be made available free of cost to at least middle income earning population. As the average cost of vaccinating a person has not yet been worked out- and that it will vary from vaccine to vaccine – working out the actual amount required for the purpose is not an easy task. Along with the cost of production and other related costs, total cost will also include the factors like number of doses required per person, degree of its effectiveness etc. Some vaccines may also require a booster and in that case cost will increase further. So far, budget provision for the COVID-19 vaccine has not yet been made. Lump-sum provision for the purpose could have been incorporated in the budget by way of supplementary demand. The present estimated population of India is 138.43 crore. At this rate assuming per effective dose of vaccine costing about Rs 5000, total amount required will be around Rs 7.0 lakh crore which is a big amount. This again will involve a minimum of 10 per cent as administrative cost in the form of capacity building training programmes, transportation, raising of temporary infrastructure and other logistics costing about Rs 7000 crore. In view of gradually falling economic growth and financial crunch, the Central Government will not easily take up such huge burden of vaccine. It will attempt to make screening in terms of income level to reduce the burden and advice the companies to take some burden under Corporate Social responsibility fund. As per Melinga Gates Foundation, if the vaccines contracted by the Serum Institute of India come out successful, then the low and middle income countries will get 100 million doses at as low as $3 per dose i.e. between Rs 210 and Rs.240/dose.

As per media report, the State Health Minister Sri H.B. Sarma has already declared that the vaccine will be available freely. The present estimated population of the State of Assam is 3.12 crore and at market rate the vaccine will cost the State at around Rs 15,600 crore. The State has not made any budget provision for the vaccine even through supplementary demand. A total of Rs 870.75 crore has been budgeted during the last Assembly session for COVID-19, but except Rs 100 crore which is kept for 'COVID affected people' the remaining amount is for spending on various items related to COVID-19. It is time that the both Central and State governments who have in the past spent huge amounts in the name of COVID-19 should regularise the same issuing a White Paper. Already various complaints have been lodged taking into account of the way the money has been spent-items have been procured and the silence of the Government about the quality of items procured and the status of the rejected items.