Saturday, May 8, 2021

The Vaccine "Free for All"

Independent policy experts have been highlighting that vaccines should be "free for all".  Instead we have ended with a vaccine "free for all" policy where states have to compete with each other and the center for vaccine supply.  It is set to become a "no holds barred", "free for all" battle for vaccines.

Why should vaccines be free? An extreme argument offered by health experts is that unless everyone is vaccinated, no one is safe. It is reasonable to say that a high percentage of the population needs to be vaccinated, to ensure fair protection of the population and early return to normalcy. Maximisation of vaccination is possible only if it is free. People who can afford it should be able to opt for costlier vaccines or vaccination process.

The vaccination policy of the country was riddled with mystery.  Elements of the mystery include:

1. An "atma nirbhar" wait to approve vaccines for use in India, while one vaccine was already being manufactured in India and exported abroad;

2. An "atma nirbhar" refusal to approve import of vaccines that were already approved and being used in other developed countries;

3. A limited order of about 100 million units of vaccine supply - enough for the dual vaccination of about 50 million people out of a population of 1.3billion.  Maximisation of vaccination was clearly not considered;

4. Non-transparent allocation of vaccines to the States.

When the supply constraint blew up with the second wave, the initial attempt was to blame it on wastage of vaccines in the states.  We order 5 per cent of requirement, and the blame falls on the 5 per cent wastage!

Wastage is no doubt a problem.  But some wastage is unavoidable in the process of transportation logistics.  Further, when the same vial has multiple doses, some wastage during vaccination is inevitable.

The opposition built pressure on the Central Government to open vaccination for all adults, instead of limiting it to people who are 45+.  Unbelievably, the center yielded.  With more people joining the vaccination queue, the supply constraint problem aggravated.

One would have expected the center to at least make its vaccination allocation to the states more transparent.  Instead, the supply problem was queered further, by making the states (and private hospitals) buy vaccines directly from the manufacturer, at prices higher than what the center would pay.  50% of the vaccine supply was to go to the center, while the 28 states and 8 union territories would have a "free for all" fight for the balance 50%.  The early states quickly found from vaccine manufacturers that 100 percent of vaccine supply was already tied up with the Center for several weeks.

Belatedly, foreign vaccines are now approved.  In the meanwhile, other countries have already logged their purchases in the international vaccine supply chain.

An unmitigated mess.

The Oxygen Mess

The judiciary of the country appears to be shaken by the pandemic.  The timing of this awakening matches the appointment of the new Chief Justice of India.

One High Court after another (Delhi, Karnataka) is ordering the Central Government to ensure supply of whatever oxygen the respective Chief Minister (CM) asks for. The Supreme Court refuses to stay such judgements. Oxygen supply is constrained. The center finds itself pushed to the corner.

CMs are bound to exaggerate their requirements. A most basic approach would have been to draw a transparent state-wise oxygen allocation plan, based on objective measures such as number of serious cases and deaths. This will have the salutary impact of getting states to report their real numbers, without any cover-ups.  But then, it shows a worse (but real) face of the country to the world, than it already is.   Yes,  this will remove the Central Government's discretionary power.  But that is a better situation than being cornered by multiple high courts and the supreme court.

One gets the feeling that the government is missing on the fundamentals to manage the pandemic.    

Thursday, April 29, 2021

Lockdown or MCZ for Covid control

 In March 2020, India had only a few hundred Covid cases. That is when a nation-wide lockdown was announced, giving people hardly 3 hours notice.  The economy crashed and migration pangs shook the world. It is widely believed that Micro-Containment Zones (MCZ) - an approach of localized containment of people - would have served India better.

In April 2021, India is adding about 350,000 new cases every day - with fears of it going upto 500,000 new cases per day. The Central Government is suggesting that states should prefer MCZ strategy - and adopt lockdown as a last resort. With this kind of build up of cases, is MCZ even practical? 

Many Indian states are governed by the same party as the Central Government; a few others are governed by the opposition.  The former states avoided lockdowns - and saw their cases spiral; some of the opposition-ruled states went for lockdown (by whatever name called). At least the ones that adopted a lockdown early are seeing their new cases plateau.

The writing is perhaps on the wall, and the tide seems to be turning.  A southern state which is ruled by the party at the center has finally announced a lockdown.

Wonder if the Central Government is carrying forward its learning from the past, when the ground reality has changed drastically. Time to update the tool kit?