India's new Covid vaccination policy - May 2021

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  India's new Covid vaccination policy - May 2021

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• The story: Spurred by a horrific degeneration in the pandemic situation in India, the union govt. decided it will dramatically expand its vaccination coverage from May 1, 2021, including everyone aged 18 and older. This "fourth phase" of the mass inoculation programme incorporates several changes in vaccine policy. India will now be the first nation in the world to allow such an open-market sale of vaccines, as no one else has.
• First impression: It seems certain that many recipients will pay more than in the first three phases of vaccination, but key questions about availability, distribution, prioritisation remain unanswered. 
• Details: India was self-assured ever since the daily no. of new cases started to drop, from October 2020. That led to a certain approach in vaccine policy, announced first in January 2021.

1. In the first three phases, when healthcare workers, frontline workers, and those above the age of 45 were vaccinated, the Centre procured the entire quantity of vaccines from the manufacturers, Serum Institute of India (Covishield) and Bharat Biotech (Covaxin), and distributed it to states. The states distributed the stock to government vaccination centres, which administered the vaccine free of cost, and to private hospitals that charged recipients Rs 250 per dose.
2. Now, from May 1, the supply will be divided into two baskets: (i) 50 per cent for the Centre, and (ii) 50 per cent for the open market. Through the second — non-Government of India — channel, state governments, private hospitals, and industries that have facilities to administer the vaccine, will be able to procure doses directly from manufacturers.
3. Distribution changes now. First, the 50 per cent basket of vaccine doses earmarked for states and private hospitals in the open market will be used to vaccinate those above the age of 18 years. Second, free vaccination would be available at all vaccination centres that receive doses from the Government of India — with those doses, healthcare workers, frontline workers, and those above 45 will be vaccinated.

• Private vaccination centres: They won't give it anymore at Rs.250, since no doses will be made available to the private sector, and private hospitals will have their own rates. 

1. In the first three phases, out of the Rs 250 charged for vaccination, private hospitals received Rs 100 for administering the jab. Since they will now be procuring the vaccine at a higher price, the cost of a jab will be much higher. (so there's a risk many poor may opt out of vaccinating their families)
2. Union govt. has said the prices charged by private hospitals would be monitored. A mechanism will be put in place, and vaccine stocks and prices will be captured on the Co-win platform. (the efficiency of such monitoring in the middle of a raging pandemic is hugely suspect)
3. States will receive doses from the Centre and also make additional procurement from the open market — so they will plan their own vaccination sessions.

• Planning vaccination sessions: The Centre said it will be able to allot vaccines for 15 days — which means that states will know in advance that for the next 15 days, they will receive a specific number of doses. They will, therefore, have both a big as well as a granular picture of availability on date and for the coming fortnight. 

1. The Centre will allocate its 50 per cent share to states based on the extent of infection (active cases) and performance (speed of administration). Currently, states receive vaccine doses according to demand (number of registrations and walk-in vaccinations). Now, low wastage will be incentivised.
2. The Centre will allow the imported, fully ready-to-use vaccines to be entirely utilised in the other-than-Government of India channel. Thus, if and when a foreign pharma giant brings its vaccine to India, it will be free to directly sell the entire stock in the open market at a competitive price.
3. Those who have received the first dose — and whose second dose is due — will be prioritised. The Centre said that the second dose of all existing priority groups, "wherever it has become due, would be given priority".

• Who will sell to whom, at what rates: The Centre has only said that private vaccination providers shall transparently declare self-set vaccination prices. States have not been given the liberty to negotiate prices.

1. The Serum Institute of India (SII) announced the prices for its vaccine — Rs 400 per dose to states, and Rs 600 per dose to hospitals. Bharat Biotech and Dr Reddy’s (which will distribute the Russian Sputnik V shot) have not made an announcement yet.
2. SII's CEO Adar Poonawalla was vocal about supplying to hospitals, rather than to states, as he believes hospitals are better placed to carry out the vaccination exercise; besides, states are expected to get some free supplies from the Centre anyway. Buying is an “option” for states and not mandatory.
3. There is little clarity on the mechanism that manufacturers will employ to decide among states that place orders. And in the absence of a formula or guidelines, passing control over to private vaccine producers will mean that there will be no social basis for allotting vaccines to states. Poor are bound to be simply left out of the mad race (at least in initial weeks).

• First-come, first-served: It may depend on how many states enter into deals with manufactures, and on the availability of doses. Richer states, which have the ability to procure large amounts, and states with large networks of private hospitals, are expected to receive a higher proportion of doses from the open market. 

1. No country has allowed this kind of a market approach so far. The reason is that the vaccines that are being used around the world have received only Emergency Use Authorisation (EUA) — none of them have presented enough evidence yet on their safety and effectiveness to receive full regulatory authorisation.
2. It might take 8-10 years to develop, test, and receive approval for a vaccine. But in this pandemic scenario, the development, clinical trials, and approvals have been fast-tracked to ensure that people have a chance at escaping severe disease or death.
3. Given the public health priority of vaccinating a large segment of their populations, several countries, including the US, UK, Japan, France, and China, are providing vaccines for free to citizens.

• Sixty crore Indians from May 1, 2021: Some 130 million (13 crore) shots have been administered in India so far, and over 111 million people (11.1 cr) are yet to receive their second dose. Depending on how many people in the priority groups are still left to receive their second shot by the time May 1 comes around, India will need over 1.2 billion doses (120 crore) of vaccines. Supply will certainly fall short of demand.

1. SII will prioritise doses of Covishield for India “at least” for the next two months, which means a potential supply of around 120 million to 140 million doses for India between May and June. 
2. Sputnik V is expected to begin arriving by the end of May 2021. Dr Reddy’s Laboratories has an agreement to distribute 250 million doses of the Russian vaccine, but it is unclear how many of these doses may become available.
3. It is unclear whether Bharat Biotech will be able to supply for the open market from May 1. If it does, the company could potentially supply an estimated 29 million doses across states over the whole month. The company has announced an expanded capacity of around 700 million doses per annum (around 58 million doses a month) but that's for later.
4. It is also unclear how many doses J&J, which is planning to conduct bridging studies in the country, can supply to India.
5. Pfizer said that it plans to only supply to the government, but nothing is known.

• Summary: India is now entering a decisive phase, and if the "vaccination for all adults" plan is pulled off properly, the pandemic will be tamed soon.

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