No time to lose in increasing vaccine supply

India’s plan to vaccinate the 18-45 population presents a daunting challenge. Besides pricing, it is a question of making vaccines available to very large numbers of people. According to Census 2011, 65.2 per cent of the population is in the 15-64 age group. The 18-45 population group can be conservatively assumed at 50 per cent of the total population. The 45 plus age group could account for over 20 per cent, while the below 18 age group accounts for about 30 per cent of the population.

From May 1, a supply of about 75 million vaccine doses per month is meant to be equally procured for two population groups of vastly varying numbers. So far, these 75 million doses have apparently fallen short for even the 45-plus population.

Assuming that about 10 per cent of the total population has been vaccinated once, it would mean that about half the population of the 45-plus group remains uncovered. Vaccine supplies may increase by July-August to 150 million doses a month (owing to a ramping up of Covaxin facilities in particular), which can merely cover the remaining 45-plus population of about 150 million in two months.

India’s output over the next six months — assuming that this is the horizon over which the 700 million have to be vaccinated apart from the remaining numbers in the 45-plus category — will have to be about 1,600 million doses. A monthly output of at least 250 million doses, about 3.5 times the current output, will have to become a reality. This, however, seems achievable, with the public sector too being roped into the production act.

But at present, if vaccine supplies are less than adequate for 150 million people in the 45-plus age group, surely they cannot cater to the younger population if they show up at hospitals for a jab — unless vaccine hesitancy releases some stocks.

Vaccine hesitancy in the 45-plus group remains a concern in a number of States. This could increase the availability of doses for the below-45 age group, but by how much is anyone’s guess. In any case, it is absurd to rely on vaccine hesitancy to actually widen coverage with limited supplies!

The situation at least till August seems grim. Vaccine hesitancy is subject to change. It would have dropped in April as the cases surged. The demand for vaccines is likely to rise over the next two months, coinciding with the rising casualties among the young and the middle-aged.

Blackmarketing fears

With no new supplies on the horizon till July or August, the situation is ripe for blackmarketing of vaccines — no matter what the agreed price, whether fixed by the States and the Centre, turns out to be.

Blackmarketing could also increase in the absence of a Centre-State coordinating agency that ensures a balance in availability across States on the basis of real time data. This could really hurt the poor, whether old or young, who need the vaccines the most. They can fall prey to virulent infection and death.

From where the doses will materialise in the near future, is the moot issue.

The Foreign Office should leave no stone unturned to procure doses for the short term – be it from US, EU, UK or China. India’s Covax contributions should stand it in good stead.

In the medium term, India must ramp up production and counter vaccine hesitancy by being transparent about adverse events. The public sector must play a key role. This will ensure that we are not brought down to our knees in an emergency.

A report by Down To Earth magazine earlier this month observes that seven PSUs have the capacity to produce vaccines. “But the manufacturing licences of three of these PSUs...had been cancelled in 2008... In 2012, a decision was taken to revive these units. However, they were not made fully functional.” An ‘integrated vaccine complex’ in Tamil Nadu lies defunct, it observes.

By the time the new supplies enter the markets, there could oddly enough be a dip in demand coinciding with the possible ebbing of the second wave. ‘The worst is over, now we can manage’ mindset may set in. If vaccine prices are pegged high, vaccine hesitancy will harden. It can compromise our preparedness for the third wave (which is likely to come).

Meanwhile, vaccinations have fallen below the three million doses a day mark — at a time when the pandemic is raging. This can lead to a further rise in serious cases. Hence, the Centre must mass-vaccinate over the next two months, keeping a third wave in mind — and tackle the supply constraint. A budgetary allocation of ₹35,000 crore should be revised if required.

An output of over three times the present level may materialise by the end of the year when both private (Sputnik and J&J, if not Moderna) and public sector capacities (the Centre has roped in three PSUs) enter the scene. But till such time, the young will be exposed to risk.

The vulnerable young

They cannot afford to stay in their homes, as they have families and dependants to look after. Cruelly enough, the second wave has been attacking a higher proportion of the young than the first — by all accounts, more than cited by the Indian Council of Medical Research.

A good number in the 18-45 group survives in the informal sector, with next to no social security benefits. They are wage earners in the construction sector, data entry operators, BPO employees, agriculture workers, food delivery boys, receptionists, tea shop owners, photocopiers, provision shop owners, drivers of taxis — and many others. Surely, they deserve the vaccine quickly and at an affordable price, if not free of cost.

An expensive vaccine can be life-denying at a time when, according to Pew Research, 32 million in India’s middle class slipped into poverty in the course of the pandemic. Market economics cannot work for those who do not have the capacity to pay. As for the fiscal deficit, India Ratings and SBI have pointed to the modest outgo on vaccination, “significantly lower than the economic cost of GDP due to lockdown”. The rich can pay more taxes at least in such dire times.

India must act soon to secure vaccine supplies. It is another matter that within a year or so a superior remedy may hit the stands, persuading the world to change course.

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