New Delhi: It is in the nature of things, and in accordance with the trend set by the Bharatiya Janata Party (BJP) ahead of last year’s assembly elections in Bihar, that the chief ministers of poll-bound Tamil Nadu and West Bengal have announced free Covid-19 vaccines for the people of their respective states.
Even in Delhi, Health Minister Satyendar Jain has announced that Delhiites will get the vaccine free. This is notwithstanding the fact that the Centre has told states not to move on their own on the purchase of vaccines. There is no clarity yet on what eventually will be the funding pattern for vaccine procurement, either.
Even as India has now set 16 January as the date for start of the national programme for Covid vaccination, there continues to be a lack of clarity on several crucial issues of logistics including vaccine availability, funding, options of independent procurement by states, comorbidities that would make people eligible for the vaccine and most crucially, the size of the critical mass that the government intends to vaccinate.
These questions linger even if the graver ones such as lack of efficacy data of Covaxin and approved dosage schedule for Covisheld are kept aside for the time being.
ThePrint takes you through the unanswered questions that will need to be resolved before the vaccination programme expands beyond the first “priority” group of 3 crore healthcare and frontline workers.
Who is the vaccine free for?
Right now, going by Prime Minister Narendra Modi’s statement following the meeting with chief ministers Monday, it is free for 3 crore health and frontline workers.
But is it free only for the first 3 crore beneficiaries and not for others? There is no clarity yet on this, even though multiple BJP manifestos in multiple states have made the free-vaccine-for-all promise and now state CMs are following suit.
However, it is actually not clear whether all citizens of India will get the vaccine at all, free or otherwise. For now, of course, because of lack of trial data, children are not going to be vaccinated. But even for adults, the Government of India has so far spoken in multiple voices.
In an interview to The Economic Times in October, Prime Minister Narendra Modi had said, “First and foremost, I would like to assure the nation that, as and when a vaccine becomes available, everyone will be vaccinated. None will be left behind. Of course, initially we may focus on protecting the most vulnerable and the frontline workers. A National Expert Group on Vaccine Administration for Covid-19 Vaccine has been constituted to chart the way forward.”
But on 1 December, Health Secretary Rajesh Bhushan while replying to a question on whether the Covid vaccine will be available free of cost, said: “The government never spoke about vaccinating the entire country. It is very important to get the factual information on these things.”
There are also talks about the vaccination being covered under the Pradhan Mantri Jan Arogya Abhiyan (PMJAY), but a final decision on that too is still pending.
Can states procure vaccines on their own?
So far, there is no such provision. During an earlier interaction with states, the Centre had specifically asked states not to move on their own on vaccine procurement. Last week, during an interaction with the health minister, several state health ministers also raised the issue of clarity on vaccine availability schedule and pricing.
States will not need to pay anything for the first 3 crore vaccinations — a little over 6 crore doses including 10 per cent wastage — but it is not known how much will be the states’ share in vaccine cost.
Vaccines for the Universal Immunisation Programme are procured in 60:40 ratio by Centre and states. “We do not yet know if such a formula will be applied on this,” a senior health ministry official told ThePrint.
Among the states that have promised free vaccines is West Bengal. Trinamool Congress leaders, without getting into the tricky territory of vaccine procurement, maintain that the state would not disrupt the vaccine flow but procure vaccines from the Centre as required but for all its people rather than just specific groups.
“We will get the vaccine from the Centre since they are the only ones who have it. But we will pay for the additional doses,” said a party MP who didn’t wish to be named. He did not get into the question of availability of sufficient doses of vaccines.
Which comorbidities will make people ‘eligible’?
This is a big grey area currently as a committee formed by the Ministry of Health is deliberating on who the most vulnerable are during the pandemic. Through the pandemic, people with hypertension, diabetes, or immunocompromised status saw the worst outcomes.
Niti Aayog member (health) Dr V.K. Paul said during the weekly briefing on 29 December: “A committee comprising about 12 experts from various specialties including cancer, kidney, lungs, heart, etc has been constituted for this purpose and it is actively working and we are expecting their report very soon — may be in a few days.”
The panel will also need to take a call on how to prioritise recipients based on the seriousness of the disease. Whether there will be various categories based on the stage of the disease is not clear yet, but it may be a difficult proposition given the high burden in India of non-communicable diseases (NCDs) to include all of them as a monolith in the vaccine beneficiary list.
“We will need to take a call on what for example on how to prioritise a person who is on insulin over one who is just on a first line anti-diabetes drug,” a health ministry official said on condition of anonymity.
When will vaccine be available over the counter in pharmacies?
The answer to this question has many unknowns, including the manufacturing capacity of the approved vaccines and the speed at which the others in trial manage to clear regulatory hurdles.
On Monday, during his interaction with states, Prime Minister Narendra Modi expressed hope that by the time the first 3 crore vaccinations take place, India’s Covid vaccine basket may have more options.
Adar Poonawalla, chief executive officer of Serum Institute of India that is making the Covishield vaccine, has said in multiple interviews that he hopes to be able to sell the vaccine in the market by March. However, this is subject to the rate at which he and Bharat Biotech can supply the 66 crore vaccine doses that the Government of India will need to inoculate the 30 crore priority vaccine beneficiaries.
If vaccines become available in pharmacies across the country, some of these 30 crore could fall off the government’s list by procuring it on their own. It is also possible that vaccines that are not part of the government programme are sold in the open market, officials say, as and when more approvals come through.