Covid-19 vaccines for India... but at what cost?

Over the weekend, a whopping ₹80,000 crore was pitched into the discussions on getting Covid-19 vaccines for India, when one is available for mass use.

Tagging the Union Health Ministry and the Prime Minister’s Office on a social-media site, Serum Institute of India (SII) Chief Executive Adar Poonawalla wrote: “Quick question; will the government of India have 80,000 crore available, over the next one year? Because that’s what @MoHFW_INDIA needs, to buy and distribute the vaccine to everyone in India. This is the next concerning challenge we need to tackle.”

While the details of Poonawalla’s math are awaited, the SII had said in early August that it had pegged vaccine prices at not more than $3 per dose . SII has a production and supply alliance on the AstraZeneca-Oxford University Covid-19 vaccine candidate, a two-dose vaccine. It also has a tie-up with US biotech company Novavax.

The Centre has a taskforce in place to address procurement and distribution of the Covid-19 vaccine, but healthcare experts say that public interest should guide decision-making.

Former Union Health Secretary Sujatha Rao observes that by mid next year, more than one company would be making the vaccine and competitive prices would bring down prices“very sharply”.

If that does not happen and the vaccine became a monopoly/ patented item and assuming the World Health Organisation does not intervene, “India can enforce compulsory licensing (CL) as allowed under the patent law during national emergencies”, she added. (A CL allows a third party to make a product at a reduced price, on payment of royalty to the innovator.)

“Such a step will enable the government to cap the sale price at a price that is affordable to people and the government. With the negative economic growth, the government will need to ensure that it gets this vaccine for the high priority target groups – health care givers, elderly and the poor – at very affordable rates.” And even if some better-off sections were to buy the vaccine, “the price will need to be affordable as this is one case where the option to not take the vaccine should not arise”.

Fund-raising

At any price, the vaccine would still need to be bought by the Centre. And to that, Rao said: “India has various options to raise funds – it can resort to borrowing from agencies such as World Bank or ADB etc.”

The Gates Foundation has been active in expanding access to vaccines and “they can provide substantial funding support to GAVI to procure the vaccine at discounted rates for supply to needy countries”.

Since Gates Foundation also has a large program in India, she said: “The government can, perhaps, also negotiate with them to provide financial support as a grant to help the government procure this vaccine. That measure will certainly help reduce the immediate fiscal burden on government.”

The government would be able to make the vaccine available to people, as it has a huge and wide cold-chain network and human resources who are well-trained on immunisation-related issues, she said. The challenge was in ramping-up production to get adequate doses and at “a price we can afford”, she added.

Another health expert, who did not want to be named, said on the funding: “The government of a country of 1.3 billion people can deprioritise something else to support vaccine delivery to our population.”

On leveraging the immunisation network, the expert saidthe present system was currently equipped to reach only children and pregnant women. And, immunisation was already under pressure due to the pandemic, so the effort should be on catching-up, rather than thinking of more diversions of staff and resources, the expert added, outlining issues that will have a bearing on the Centre’s decisions.

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