A shift in the vaccine strategy

From May 1, India will become one of the first large countries in the world to let all adults seek coronavirus vaccines, as well as allow doses to be sold through private channels. Experts and public health officials long sought decisive steps to open up recipient eligibility and availability of doses, and the government has taken the right call. Allowing anyone who wants a vaccine to get it will improve uptake, and a greater private sector role will improve availability. India has a formidable pharma manufacturing and services industry it can leverage, leaving government resources to focus on containing and mitigating the outbreak. Monday’s decision complements an earlier decision to expedite approvals for foreign vaccines authorised by credible health regulators, and signals a recognition that an unparalleled crisis needs steps that could involve breaking conventions.

The two key conventions India breaks from next month are: First, making the programme decentralised and, second, letting the private sector choose how it sells and prices its doses (for India-based manufa-cturers, this prerogative extends only to 50% of what they produce in a month). This is important to tap into private networks and provide adequate incentives; letting India’s diverse states and market forces interact is good. But it also carries some risks — in particular, because of a crucial fine print in the announcement. Those in the 18-45 age bracket will need to pay for a vaccine, unless their state decides to sponsor it. The free doses available at present will continue to be available only for people above 45, frontline workers and health care workers.

Experts have flagged concerns about the potential for vaccine inequity in such an approach. Consider Serum Institute of India CEO Adar Poonawalla’s comments that he expects to sell doses of Covishield at the rate of ₹1,000 when private sales open up. This may be among the cheapest of prices, but will likely put the vaccine out of reach for the bottom 20% of households on the economic ladder (the Longitudinal Ageing Study in India released by the government in January estimated this category earns ₹25,825 per year — or ₹2,152 per month — per capita). The onus will now be on the states to serve these populations. As a new — and welcome — vaccine strategy takes shape, it will be important to address concerns about equity, and ensure that the drive is free from profiteering and corruption.