Press reports indicate that a
group of 116 retired civil servants from All India and Central Services that
included former Cabinet Secretary K M Chandrasekhar, former Health Secretary K
Sujatha Rao, former Foreign Secretary and ex-National Security Adviser
Shivashankar Menon, former Adviser to the Prime Minister T K A Nair, et al. wrote an open letter to Prime
Minister Narendra Modi urging him to provide: one, free, universal vaccination
to all citizens of India; two, to ramp up RT-PCR testing in both rural and
urban areas; three, to make adequate funds available to states for provision of
medical facilities; and four, provide a monthly income support for the current
financial year to the needy from the marginalised and deprived sections.
The group has also raised certain
other issues pertaining to governance and shortcomings thereof, but what I am
concerned more about is their request for “free, universal vaccination to all
citizens of India”. It is often observed by the epidemiologists that, there are
only two policy instruments that could help any nation in controlling the
pandemic: vaccination and lockdowns. But lockdowns have an adverse impact on
the economy. It hits marginalised lot very badly, for their daily earnings are
lost under lockdown. Thus, vaccination becomes critical in controlling the
pandemic with minimal economic costs vis-à-vis lockdowns.
Over it, as Dr. Louise Ivers,
executive director of the Massachusetts General Hospital for Global Health
commented, the new variant, which appears to be more transmissible—might be as
much as two times more transmissible as other variants—emerged as the
predominant agent behind the ongoing catastrophic second wave in India that
witnessed 350,000 to 400,000 people getting infected every day for almost a
fortnight. Also, the social context that prevailed in the country during April
had certainly played its own role in spreading the microbe wildly.
This sudden burst in cases has
obviously hit our healthcare system which, according to Dr. Ivers, “is known to
offer the best possible medical care in some centres”, while in others “even
the most basic treatment for a diarrheal disease” is not accessible. That
aside, the real challenge is of having no knowledge of a treatment to save
lives of the infested except for the basic support of oxygen, triaging and some
amount of steroids. And even that basic support of oxygen turned out to be
something not that easy to get even in the best hospitals of the metros either.
So, one can imagine the plight of lesser mortals in the semi-urban towns and
villages. Under these circumstances, the only available means for the nation to
fight out the pandemic is: vaccination.
As against this, let us first
take stock of the ongoing vaccination programme. To begin with, we made a
sincere effort to first vaccinate all the front-end healthcare and sanitary
staff and police personnel. Then we addressed the needs of vulnerable section
of the society by offering vaccination to all those above the age of 65 years as
well as those above 45 with comorbidities. This exercise went on well for some
time, till at least the Central Government announced that those above 18 could
also join the queue for vaccination. But then, its announcement about different
pricing mechanism for Central, State and private purchases turned the
vaccination programme topsy-turvy overnight. All this clearly shows that in our
anxiety to vaccinate the whole nation quickly, we have not done our maths
correctly to match the production capacity of the two known vaccine producers
in the country—SII and Bharat Biotech—with the number of people to be
vaccinated. The result is: chaos and loss of valuable time as many states have
paused the programme in want of supplies.
A report of E&Y shows that
for vaccinating India’s population of about 108.5 crore that is above 12 years
old, we need 217 crore doses of vaccine. Interestingly, the report also states
that if the purchase of such a huge quantity is centralised, government can
“reap economies of scale and have more bargaining power”—a commonsensical
observation. Secondly, “Vaccines”, as Dr. Kizzmekia Corbett of Chan School of
Public Health observed, “are the great equalizer when it comes to addressing
health disparities, especially around infectious diseases”, such as Covid-19.
It thus becomes evident that the Centre should take the whole exercise into its hands and procure jabs from all sources and put a transparent policy of distribution to States making them accountable for ensuring no wastage and vaccinating its populace. Else, each State, as is happening, will take its own time to call for global tenders, evaluation of tenders, negotiation for price, and finally by the time it places the order the whole programme of vaccinations gets inordinately delayed. It means, we would be quite ill-prepared to face the predicted third wave.
There is also a clear
need for a well-tuned coordination between the Centre and the States to ensure
a better harmony in their communication about managing the pandemic. It is in
order here to recall what Dr. K Viswanath, Director, Harvard Chan India
Research Centre said: whether it is in developing policies to handle the
pandemic and their implementation, or enforcing issues of handling oxygen
distribution and medicines in a very unified way across the nation, there is a
strong need for coordination between Centre and States.
Looking to the production capacity of the existing manufacturers and not bothering about digging out faults of the past, we need to focus on future and organize ourselves as a monolith to vaccinate the population in an orderly fashion:
- Prioritize vaccination of super spreaders, i.e., auto and cab drivers, bus drivers and conductors, e-commerce agents, food delivery boys, workforce in the shops supplying essential goods and services
- Divide the population into different slabs of age, of course, matching with the supply of vaccines and proceed step by step to reach the lowest age group in an orderly fashion.
And to carry out the programme in
such an orderly fashion, centre has to take reins into its hands without minding
who is footing the bill, for it is anyway public money, and chalk out a well-thought-out
plan and execute it with finesse. Else, we may not win the war against the
Covid-19!
5 comments:
I am sorry of this, but it reminds me of what John B Barry said in his book, The Great Influenza: The Story of the Deadliest Pandemic in History: “Those in authority must retain the public trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first and best: A leader must make whatever horror exists concrete. Only then will people be able to break it apart.”
The two bullet highlighted points are of course are started by the authorities but the crux of the issue as brought out in the body of the blog in paragraph 7 should be the concluding bullet highlight; namely about bulk procurement of the vaccines from abroad by the Central Govt instead of divesting this vital responsibility to the States. done on priority
I appreciate your observations, Dr Ramchandra. I may reiterate that the central idea of my post is: i) let one agency i.e., the Centre handle procurement of vaccines from the manufacturers for ensuring operational efficiency, ii) distribute them to states transparently, iv) diligently workout the arithmetic of vaccine supply and create a matching demand, iii) divide the population into different age groups using Aadhar data and allocate time slots to each group in accordance with the supply, iv) while dividing people into groups prioritize people who are prone to come in mass contact with public more regularly such as bank staff, delivery boys of Amazon, JioMart, Flipkart, BigBasket, Swiggy, Zomato, grocery shop workers, auto/cab drivers, bus conductors, drivers, etc., (I wonder if this is happening across the country) into one priority group for vaccination, and thus get the whole population vaccinated in a time-bound programme to quickly achieve herd immunity.
I read today that a broad Cold Chain network across the Country forms part of our National Immunisation Program. It helps, to a great extent in storing and distribution of vaccine with focus on our large rural base. During the worst times Central Government could also have utilised the resources under Disaster mitigation program as well. What was missing earlier though not expected of an age old effective administration was a concerted effort to put in place a well conceived multipronged approach.
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