The Vax Games: Centre leads states 4-0

For starters, the vaccination policy under Phase-3 pretty much completely unyokes the centre from the responsibility of providing vaccines to the larger cross-section of Indian citizenry. Fifty percent of the vaccines produced in the country will automatically go to the Centre, while State governments and private players will battle it out for the remaining 50 percent. The Centre will continue to provide the vaccine free of cost to people who were covered under Phase-1 and Phase-2 of the programme, and provide doses to the State governments from its share, which will then be offered free to people eligible under the first two phases. So everyone above 45 years is covered.

However, this group is still only around 25 percent of the country’s total population. According to census 2011, the non-adult population is expected to grow to around 25 percent of the total population only by 2036; so that demographic is also considerably smaller at this point in time. This means that State governments will have to deal with the bulk of the vaccinations on their own—because healthcare is a State subject and not on the concurrent list as yet. This will mean an additional financial burden on States, at a time they are already stretched with higher spending and lower revenues due to the ripple effects of last year’s lockdown. But more interestingly, it will mean that statistically speaking, the Centre will achieve better results with its vaccination drive than any State will. Centre 1, States 0.

While the States start haggling with manufacturers to procure vaccines, the Centre has maintained it will procure the vaccines it administers directly at Rs 150/dose. The two approved vaccine manufacturers turned in (at last count) price charts that range from Rs 400 to Rs 600 per dose, depending on the brand. The price of a third vaccine—Russia’s Sputnik-V—is still not known. The Russian government has indicated that it could cost less than the original pricing of $10/dose, but nothing is final yet. So while it may be less than Rs 750/dose, by just how much is a big unknown. Logic dictates that it would be competitively priced.

The debate over the fairness or unfairness of differential pricing for the Centre and States has already taken centre stage. Graciously, the dispensation in New Delhi “urged” manufacturers to reduce the price at which States procure the vaccine. Consequently, Serum Institute has slashed prices from Rs 400/dose to Rs 300/dose, and Bharat Biotech has discounted the price from Rs 600/dose to Rs 400/dose. A magnanimous Centre to the rescue. Centre 2, States 0.

Numerous State governments have declared that they will inoculate their people free of cost, keeping in mind the constitutional obligation to provide healthcare and bear the additional financial burden. The reality, however, dictates that there just isn't enough manufacturing capacity at present to meet that extra demand quickly. While quotations have been sent in and the intent to place orders made clear, no concrete orders have been placed yet. Vaccine manufacturers have repeatedly said that they can start supplying States only after existing contractual obligations can be met—and a bulk of these orders have been placed by the Centre.

Optimistically, manufacturers have said they will start producing vials to fulfill orders from State governments by mid-May. But remember, the Centre still gets its share of the produced quantity first; States will have to wait their turn. Further, State governments cannot use the vials they get from the Centre to vaccinate anyone who has become eligible in Phase-3. So while the Centre will continue to provide free vaccinations to the people eligible under Phase-1 and Phase-2 of the vaccination policy, the 18-44-year-olds will have to wait, as will State governments. Ultimately, any delay or failure to vaccinate this population will be seen as a failure of the State's machinery, not the Centre's. Centre 3, States 0.

As it is, many of the vaccination centres have been turning people back saying they're out of supplies—supplies that the Centre has been responsible for allocating. This vaccine shortage has been evident in the numbers. In the last 14 days, daily vaccinations have crossed 30 lakhs just 5 times, and the doses administered on April 28 (reported on Apr 29) stood at a 10-day low of 21.9 lakhs. Social media has been abuzz with pictures of centres displaying "Closed" signs, and civic bodies announcing the temporary closure of facilities that have run out of vaccines, or not received fresh stock as yet.

Not surprisingly, the shortage is mainly seen in centres run by State governments or private players (who were allowed into the game only recently, after much begging and pleading). So it's the private players and State governments or local administrations that have been apologising to the people who line up outside. The Centre has maintained that the shortage is not due to a fall in supplies, but due to higher wastage by the people on the ground who are operationalising the vaccine drive. Thus, it's the local administrations that have faced the ire of the people who have been denied the vaccine. Centre 4, States 0.

As May 1 approaches, there's a new wrinkle State administrations will have to contend with, if they are to begin vaccinating people in the 18-44 year age bracket. The new vaccine policy says private players can only vaccinate people who are eligible under Phase 3 with doses procured either directly from manufacturers at contracted prices, or those handed to them by the State governments from their direct purchases. States governments can vaccinate people in the 18-44 year bracket only with doses procured directly for this purpose. This has been accompanied by reports that the Centre has begun recalling any vials already supplied to private vaccination partners as part of Phase-1 and Phase-2. Ostensibly, these supplies will be redirected to vaccination centres being run directly by the Government of India or a State government—and earmarked exclusively for people eligible for the Centre's free vaccination programme.

Now it's true that of the 59,500 vaccination centres operational across the country, only 4,000 are privately managed. But that still means longer lines at centres which have supplies available, and many vaccination centres turning people away because either the stock they had has been repossessed, or been exhausted and not replenished. More crowding, when it's to be avoided; fewer vaccinations, when more should be the norm.

So it is that May 1 will not necessarily be the day India's vaccination drive gets kicked into high gear. It will be the day the drive actually slows down considerably, leaving a significant portion of the population with their hats in their hands. At a time when India’s healthcare infrastructure is groaning and creaking, this latest twist pretty much ensures it will get no reprieve in the form of a significant jump in the number of people getting vaccine protection. Politically (and optically) the Narendra Modi government is leading State governments 4-0. But when the final whistle blows, the People will be the real losers.