Tuned to Privatisation Policy
Modi government’s Covid vaccine policy has to be seen in the background of this government’s healthcare policy which mainly is privatisation of entire healthcare system including national health policy and the drug policy.
Drug Policy: Establishment of public sector pharma companies, Patent Act 1970 and Drug Prices (Control) Order 1979 were the three instruments with which India could become self-reliant in almost all medical products, including vaccines, at economically affordable prices; and major supplier of generic (non-patented) medicines in different countries of the world.
With neoliberal policy the drug policy were systematically diluted in all three areas and finally all public sector drug companies are being sold out by Modi government.
Health Policy: Having objective of national health policy for free universal public healthcare system, from primary to tertiary treatment, also went on getting diluted since adoption of neoliberal economy. Finally, Modi government made big push in privatising the entire healthcare system making business of ‘health for profit’ through (a) giving up Health Planning along 5 years plans; (b) adopting National Health Policy in 2017 which includes side by side private healthcare system with that of the governmental healthcare system; (c) Ayushman Bharat – National Health Protection Mission (AB-NHPM) renamed as Pradhan Mantri Jan Arogya Yojna (PM-JAY), announced in the budget speech on February 1, 2018, which is insurance driven policy with private healthcare network participation; and (d) in 2020 introducing National Digital Healthcare Mission (NDHM), a governmental platform for promoting Tele-medicines and E-pharmacy with private sector participation.
Modi government’s Covid vaccine policy was tuned to the above mentioned health and drug policies as against the need of free public universal vaccination in the situation of pandemic.
Failures in the management of Covid pandemic and the Vaccine Policy
Modi government failed in overall handling of the pandemic — in organising and building public healthcare capacity, medical equipment, oxygen, equipping medical and paramedical personnel etc. Their folly on the vaccine front is monumental.
After the first wave of Covid, Modi government came to the conclusion that Covid-19 attack ended and there was no need to take defensive measures against its further attack.
Manufacturing Failure
Since January 2020, during the very first wave of Covid-19 pandemic, there should have been a roadmap of Covid vaccine’s development, production, procurement, distribution and vaccination.
Government did not take any initiative for indigenous capacity of vaccine’s production by (a) Placing advance orders; (b) Extending bank credit for expansion of production capacity; (c) Take initiative for public sector production; and (d) Share with other vaccine manufacturers Covid vaccine technology of Covaxin.
Covaxin technology is available with the Central government, as it was only vaccine technology available and developed in India by ICMR (Indian Council of Medical Research) and NIV (National Institute of Virology) from inactivated virus and produced by BBIL (Bharat Biotech India Ltd) at Hyderabad.
Again, only recently, the Government said that it will be using three public sector enterprises for manufacturing Covaxin to augment the manufacturing capacity under Mission COVID Suraksha. These PSEs are (1) Haffkine Biopharmaceutical Corporation Ltd, a State PSE under in Maharashtra; (2) Indian Immunologicals Ltd at Hyderabad of National Dairy Development Board; and (3) Bharat Immunologicals and Biologicals Corporation Ltd, Bulandshahr, a CPSE under the Department of Biotechnology.
All other PSEs like IDPL, HAL etc, including heritage companies like BCPL and Bengal Immunity are in the sale list of the Govt.
Not Diversifying Production: Government did not diversify the production of Covaxin geographically and involving more public sector companies as well as smaller biological manufacturers. This would have given the government greater leverage in its dealings with the MNCs like AstraZeneca, the owner of Covishield and produced at SII.
In contrast, the production model of RDIF (Russia Direct Investment Fund), the owner of the Sputnik V vaccine, is spread over nearly 10 different companies in India, mostly small and medium-sized biological manufacturers with easy transfer of technology. Dr. Reddy’s Laboratory (DRL) is playing a “facilitator role” by coordinating production among these companies.
In China, they are utilising all technologies and wide bases of production. There is cooperation between China and Cuba, while Cuba brings its biotechnology capabilities, China offers its manufacturing expertise.
A vaccine for mass inoculation is produced on getting orders. For a vaccine, it takes time for production, distribution, inoculation, time gap between two doses and time for the body to develop antibody. Therefore, early mapping for vaccination is important to complete the process.
Delayed Order: To face the Covid pandemic while several other countries placed their first order for vaccines in 2020 - UK in May, Japan and USA in July, EU and Brazil in August and Australia in September; Modi government waited till January 2021.
Measly Quantity: Modi government placed delayed order for vaccine in measly quantity – in January 2021 for 16.5 million doses to last for 10 days; next order was in February of 14.5 million doses. In all, the government placed orders for the supply of just 311 million doses as against nearly one billion people in the 18+ age group with two doses each.
Distribution Failure
1st Phase of Vaccination: In the first phase, healthcare workers, frontline workers and those above the age of 45 selectively were supposed to be vaccinated. The Centre procured the entire quantity of vaccines from the manufacturers and distributed it to States to administer the vaccine free of cost and to private hospitals that charged recipients Rs 250 per dose.
Next Phase: In the disastrous next Policy Statement effective from May 1, 2021 the supply was divided into two baskets: 50% for the Centre and 50% for the open market.
GOI’s 50% would be available at all vaccination centres to vaccinate healthcare workers, frontline workers, and those above 45.
Second 50% include state governments, private hospitals and industries to procure doses directly from manufacturers. This is to vaccinate the people above 18 years of age.
Short Supply: Between 3-9 April, 2021 an average of 3.54 million doses a day were delivered. In the first week of May, it dropped to 1.80 million doses a day and by end of May grim reality of shortages was exposed.
Already short supply to States put them in tremendous pressure to inoculate health workers, front line workers and 45+ age group. Central government’s sudden direction to include 18+ population without ensuring adequate supplies of doses has collapsed whole inoculation drive.
Within the 45+ age group, many are facing the danger of overshooting the medically prescribed time interval between the two shots.
Manufacturers’ Refusal: Situation has, further aggravated when the manufacturers refused to deal with the State Governments against the State Government’s tenders and said to deal with the Central government only.
Black Market
There were several deficiencies in Modi government’s vaccine policy announcement effective 1 May, 2021 just at the onset of Covid’s second wave of attack. These are (a) 3-tier procurement and distribution by the Centre, States and Private health care; (b) Of the Centre’s procurement, the Centre would keep half and split the remaining half between the States and the private channels; (c) it added ‘free-market’ adage by prescribing that the States and the two manufacturing companies are “free” to “direct” negotiation for rate and supplies; (d) it introduced layered pricing regime, which in the name of “free” market was promoted for notional entrepreneurial zeal for abundant vaccines supply; (e) the decision to extend the vaccination drive to the 18-44 age group from May 1 despite short supply situation; (f) it was aggravated by naming as “Liberalised and Accelerated Phase-3 Strategy” of Covid-19 in the vaccination policy announcement in April by Modi Government.
As a result, the vaccine “market” is having a field day. The three-way split between the Centre, the States and the private channels is facilitating rampant profit and thriving of black market across India. It is evident that private channels are adding their own mark-up to the prices set by the two main suppliers, SII and BBIL.
Covid vaccination in the private sector, in large corporate hospitals, smaller nursing homes and even pathology labs shot up to Rs.1,800 a dose. It is reported in the print media that 9 top corporate hospitals cornered 50% of the doses, meant for private sector in May 2021, procured at higher prices from the manufacturers. These hospitals include Apollo, Max, H N Hospital Trust of Reliance Foundation, Medica, Fortis, Godrej Memorial, Manipal Health, Narayana and
Techno India Dama.
Wide Spread Protest & Victory of the People
Such a vaccination policy, the only medically defensive mechanism against predicted third wave of Covid attack, led to wide spread countrywide protest and agitation. All opposition parties, the Chief Ministers of opposition-ruled States, several mass organisations of workers, farmers, agri-workers, women, youths and students, other social and cultural activists raising their voice of protest. CITU protested against the market-based policy statement of the Modi Govt of May 1 calling for countrywide protest and agitation. The joint platform of trade unions also launched protest demanding universal free vaccination for all. Latest round of independent campaign by CITU is now going on 1-10 June inter alia raising the issues related to Central Government’s vaccine policy. SFI’s case was heard by the Supreme Court and criticised Modi Government’s April 2021 Vaccine Policy as irrational, arbitrary and lack of mapping and directed for free vaccination and Central government’s responsibility.
Ultimately, the BJP’s Modi Government retreated and reversed its Vaccine Policy of 1 May 2021. The new Vaccine Policy, announced by the Prime Minister on 6 June, will come into effect on and from 21 June, 2021.
By this policy the Central Government would procure 75% of the entire doses of vaccine and supply to the States free for free vaccination of entire adult population of the country; and restricting Rs.150 per injection cost plus vaccine cost by private sector for those who would like to avoid public mass inoculation centres.
This is big victory of the people demanding free universal public vaccination. Modi Government not only retreated from its announced “Liberalised and Accelerated Phase-3 Strategy” of Covid vaccine, effective from 1 May 20121; but also a reversal from its announced health policy.
The author, J S Majumdar, is a Trade Union Leader and Central Committee Member of CPI(M)
