In the midst of a raging second wave, which is touching new peaks each passing day, the Central government has abdicated its responsibility to ensure vaccine equity through free vaccination for the poor across all age groups. While State governments were never consulted or given prior notice about the change in vaccination policy, giving the two vaccine manufacturers a free hand to decide the price at which vaccines will be sold to State governments has made universal COVID-19 vaccination a difficult task to achieve. A large percentage of those aged 18-44 years does not have the resources to pay for vaccines and hence will fall through the cracks. So, the States will have to take a leading role in the free immunisation programme. While nearly two dozen States have already committed to vaccinate for free the target population, it remains to be seen if they use any criteria to identify the beneficiaries. Never before has universal immunisation of nearly 600 million people been left to State governments and the private sector while the Union government restricts itself to vaccinating for free just 300 million. With this precedent, States will probably be required to vaccinate children too, when vaccines become available, thus burdening them even further and thereby actively promoting vaccine inequity. If making States pay for vaccines is an ill-conceived idea, forcing them to shell out more than what the Union government pays for the same vaccines is a sure recipe for exacerbated vaccine inequity. With vaccination being the only safe way to end the pandemic, undertaking any exercise that leaves a large population unprotected will cost the country enormously in terms of lives and livelihoods.
While the Union government has already allocated ₹35,000 crore for COVID-19 vaccination in this Budget and also committed to provide further funds if required, it will spend less than ₹10,000 crore to vaccinate for free all above 45 years. While the sudden change in policy is therefore not due to lack of financial resources, the State governments, which have not factored in funds for vaccination, will now be required to garner funds for the same. There is hence a great compulsion to make pricing more transparent and allow States to collectively bargain for a lower price and assured timelines to receive supplies. The current policy, which has earmarked 50% supplies to State governments and private hospitals, takes the States and the companies to a completely uncharted territory leading to competition among States, and between State governments and private hospitals. Vaccine shortage from both manufacturers is likely to last a few months. The combination of policy pandemonium, profiteering by vaccine manufacturers in the thick of the pandemic and vaccine shortage is unlikely to result in a smooth roll-out of vaccines for the target group. This could lead to a dangerous situation where containment and mitigation measures become even more difficult.