As the Narendra Modi government’s National Expert Committee on Vaccine Administration deliberates on a vaccination strategy against Covid-19, the single biggest thing it should be wary of is status quo-ism packaged as pragmatism. One thing India is not short of are people who can tell you why something cannot be done. We are now being told that a fast, universal national vaccination campaign is not possible because India does not have the infrastructure, administrative capacity and funds to do so.
A couple of weeks ago, a research report by Sanford Bernstein, a financial brokerage firm estimated that it will take as long as three years to vaccinate 60 per cent of the population at a total cost of $6 billion. The government’s share of this will be $2 billion, which will cover 30 per cent of the population. The remaining 30 per cent will purchase the vaccine privately at a cost of $4 billion (because the government will procure the vaccine at $3 per dose, as opposed to $6 in the private market). The analysis might have calculated timelines based on the public health system’s rate of delivering 60-100 million vaccinations per year. I do not have access to the report, but if the media summary is correct, it would seem that the Indian government will pursue Covid-19 vaccination as if it were any other vaccination project. It takes a lot of cynicism to set such low expectations of the government. Worse, if such low expectations get anchored in public discourse, they might creep into public policy, becoming a self-fulfilling prophecy.
In election mode
The Modi government should reject the narrative of low expectations. Covid-19 is not measles. It is the source of the most acute national crisis in two generations. Acquiring immunity from Covid-19 is crucial to putting India on the path to economic recovery. It is perhaps the most important thing that India’s Union and state governments will do in 2021. It follows that India must make an extraordinary effort to ensure enough people are vaccinated in a matter of weeks and months so that the country quickly gets back onto its development path. We should not be talking about how many years this will take. We should be talking days.
And it is possible to vaccinate over 60 per cent of India’s population in months. As I argued last month in Mint, the vaccination challenge seems daunting only until you realise that the Indian government routinely mobilises at this scale, when it conducts elections. Over 600 million people across the country voted in the 2019 Lok Sabha election in a process that took just short of three months from the date of announcement to the declaration of results. The process involved over 900 million eligible voters who were identified on electoral rolls. Yet, every polling booth was located reasonably close to the voter, queues were manageable, logistics arrangements were competent and the process was safe, secure and reliable. A nation and a government that can regularly conduct elections on such a scale can also conduct a national vaccination campaign at the same scale and timeline. Yes, we can vaccinate everyone in India in three months.
A cold chain
While many administrative and logistics processes are similar, there are key differences between elections and a vaccination plan. EVMs, on the one hand, need to be secure but do not need a cold chain. Vaccines, on the other hand, need less security but a more reliable cold chain in the form of temperature-controlled transportation and storage. The more stringent the cold storage requirement, the more difficult and more costly it will be. For instance, some vaccines require -70°C, whereas others like the Oxford/Serum Institute vaccine can be stored at -20°C, the temperature at which most commercial freezers operate. Solving the cold chain problem is perhaps the toughest challenge, because it is infrastructural. Which is why it is important to start setting up cold chains now, even while we await a vaccine. In any case, investing in cold chains for vaccines is a good thing, because they will enable the public health system distribute other vaccines too. There is already an electronic Electronic Vaccine Intelligence Network (eVIN) in place in many states. The time between now and the availability of the vaccine should be used to strengthen it.
Another important way in which a vaccination campaign differs from an election is in the need for multiple doses and post-vaccination surveillance. This too can be tackled in both low-tech and high-tech ways. Using indelible ink on your left forefinger for the first dose and right forefinger for your second dose is a good enough solution. Using an informed, consent-based, privacy preserving, tokenised-Aadhaar-linked, temporary database is the high tech way. India has the capability to use either of these options. In fact, elections have more stringent requirements for positive identification of the voter than a vaccination programme would have for dose recipients.
Largest and fastest vaccination
Will we have enough doses? The Serum Institute alone can produce 60-70 million doses per month at full capacity. It can be higher if licensing and production arrangements are spread across India’s manufacturing base. There is every indication that supply will not be a bottleneck — even if it is, the vaccination schedule will be extended by a few months, not years.
Does the government have enough money? Rs 50,000 crore (or $6 billion) is around 0.3 per cent of GDP. Even in these straitened times, the Union government can afford to finance it through its regular budget. Given the tremendous positive externalities of vaccination (and the tremendous negative externalities of non-vaccination) there is a strong case for the vaccine to be paid for by the government.
The upshot is that India already has the administrative capacity, experience and finances for a large-scale vaccination programme. It should be implemented in an election-like ‘mission-mode’ with expertise from both the Election Commission and the public health departments of the government. It is quite possible for India to have the world’s largest and fastest national vaccination programme, administering the vaccine to 80 per cent of the population in a matter of months. Ambitious targets and high expectations are the first steps in their achievement.
The author is the director of the Takshashila Institution, an independent centre for research and education in public policy. Views are personal.