It is surprising that political parties were surprised that one of them — the Bharatiya Janata Party, as it happens — announced in its manifesto for the Bihar assembly election that it would provide free Covid-19 vaccines to everyone in the state if elected to power. By now they must know that the BJP under Narendra Modi and Amit Shah is an exponent of totalpolitik that stops at nothing to win the next election, big or small. Indeed, the promise of a free vaccine is perhaps among the milder instruments in its political armoury. Moreover, in a country where political parties have promised colour televisions, cable TV connections, bicycles, electric scooters, durable slippers, lunch boxes, sarees, kitchen utensils, cooking oil, rice, electricity, fertilisers, wedding cash gifts, laptops, WiFi and smartphones with six months of free internet to voters, a free vaccine for everyone against a raging pandemic seems even reasonable.
No, this is not whataboutery. As I argued in an earlier column, there are sound economic reasons for the Narendra Modi government to provide a free vaccine for everyone as part of a nationwide vaccination campaign. So it is good news that the Modi government has signalled that the vaccine will be available to the people of the country free of cost. As the reactions of the Tamil Nadu and Madhya Pradesh governments show, political incentives will cause all state governments — whether in power or facing an election — to announce free vaccines for people.
With the Union government likely to centralise vaccine procurement, logistics and distribution, state governments will have to mobilise their administrations to actually deliver the vaccines. The Union and states will also have to work out the cost-sharing arrangements. These negotiations will no doubt be challenging, given the tight fiscal circumstance they both face. But one thing is now more or less politically settled — people will not have to pay for the vaccine. Like the BJP, state governments, political parties and local politicians will seek the political dividends of giving free vaccines. Given that in India politics is a far stronger driver of policy than economics, the BJP’s Bihar manifesto promise should result in fast, universal vaccination across India.
It was always about politics
The argument that vaccination should not be “politicised” ignores the reality that pandemics are inherently political. Covid-19 was political from the outset. Recall how China’s leaders stifled early reports of the outbreak. They then arm-twisted the World Health Organization (WHO) to name the Wuhan coronavirus as Covid-19. To this day, the commonsensical precaution of wearing a mask is a political act in the United States. Vladimir Putin’s curiously timed announcement of the ‘first’ vaccine, Xi Jinping’s promise to share the vaccine with the world and the Indian Council of Medical Research’s ill-considered injunction to fast-track a vaccine by August were driven by political considerations, rather than scientific or even economic ones. The Donald Trump administration is spending billions of dollars to get a vaccine ready by the presidential elections in November, with the man himself declaring last month that “We’re gonna have a vaccine very soon. Maybe even before a special date. You know what date I’m talking about.”
The other reason why any vaccine policy will be politicised is because public health is a political matter. The political dimension cannot be wished away. There is, in this day and age, an anti-vaccination movement in the United States and Britain. There are people and groups in other parts of the world who refuse to be vaccinated due to their religious or ideological beliefs. Happily for us in India, the case for vaccination does not have to be politically made (although public awareness and education will become necessary as part of the vaccination campaign). What we have instead is a debate on whether it is proper for a political party to promise free vaccines in its election manifesto. It is a good debate to have.
Bigger questions to ask
What the parties opposed to the BJP ought to do is pin the government down on how, when and at what cost will the national vaccination programme be implemented? How will the implementation be done in a federal setup where there is a great variation in state capacity? Given that health is a state subject, when will the Modi government start engaging the states to chalk out the rollout strategy? How do the Union and state governments harmonise their prioritised recipients?
After the promise of free vaccines in the Bihar manifesto, the policy debate should shift into the details of the “free”. For one thing, “free” should not mean low quality — as is the case with schools, hospitals and other facilities that governments currently provide. It will certainly mean prioritisation and queuing, which creates its own politics, and needs to be managed with sagacity. Politically motivated prioritisation might not effectively achieve public health outcomes.
Another big policy question is in what form will private establishments be permitted to vaccinate people who are willing to pay for it. It is in the public interest to ensure that all those who can afford to pay for the vaccine do so, and reduce the burden on the state. This is less of a challenge if supplies are abundant, but harder to do otherwise.
Economics can help answer these policy questions, but it is politics that makes the decisions. As long as it does not trump the science, politicisation of vaccination is not a bad thing at all.
Nitin Pai is the director of the Takshashila Institution, an independent centre for research and education in public policy. Views are personal.