India's Covid-19 vaccination challenge needs a private sector helping hand

The Indian state faces one of the world’s most formidable challenges: rolling out a Covid-19 vaccination program for 1.3 billion people. To succeed, many things have to go right in a country that usually gets a lot wrong. The government would be wise to enlist the country’s private sector in this gargantuan effort — and soon.

The vaccine rollout is already off to a shaky start. The government last week announced emergency approval for two vaccines. The first, a joint effort from AstraZeneca PLC and Oxford University, is being produced by the Serum Institute of India, the world’s largest vaccine manufacturer. The other has been developed by the Indian company Bharat Biotech International Ltd.

The media and opposition figures have justifiably asked why Bharat Biotech’s candidate was approved at the same time as AstraZeneca’s, when it hasn’t even finished or published results from Stage III trials. There’s no evidence that Indian drug regulators allowed political considerations to affect their decision. Still, the timing is suspect, given that the approval comes after right-wing legislators began to attack regulators for preferring “foreign” vaccines, and the government itself has begun to show a distinct protectionist tilt.

If the approvals appear rushed, unfortunately the rollout seems anything but. India’s health administrators just completed a massive practice exercise in four states — something that surely should have been wrapped up weeks ago.

Worse, even though the Serum Institute has already produced 50 million doses of the AstraZeneca vaccine, CEO Adar Poonawalla  admitted in an interview published on Monday that he hasn’t yet been given a purchase order from the government or even a “letter that says, ‘We want the vaccine.’” He needs to get those 50 million doses on trucks and out of his factory fast, so he can start producing and storing more.

Nor has the government allowed the Serum Institute to export any of its existing doses to other poor countries, even though Prime Minister Narendra Modi himself promised at the United Nations that India’s manufacturing would be the solution to the pandemic in the developing world. Of the billion doses that the Serum Institute intends to produce, half are ultimately expected to go to other developing countries.

This has the whiff of typical Indian bureaucratic delays and lack of accountability. The ugly truth about India is that its problems rarely revolve around production; too often they center on distribution. We produce more than enough food but can’t distribute it to our population, so we have a third of the world’s malnourished children. While we generate more than enough electricity, our distribution system is inefficient and unprofitable — and so businesses and homes are plagued by constant power cuts.

The government can’t afford to let something similar happen with Covid-19, which has already killed 150,000 Indians. Having a massive domestic research and manufacturing base will mean little if bureaucratic delays and state inefficiency impede vaccination programs. As the U.K. — facing pressure to inoculate its population before a more infectious strain of the virus spreads further — can attest, such delays will cost lives.

What does work in India is the private sector. The Serum Institute intends to sell the vaccine on the open market as well as to the government — and at the very reasonable price of $14 a shot. (The government will be charged $2.70.) Private sales of the vaccine would address several problems. Allowing private healthcare providers to give out shots would ease the burden on the creaking state healthcare system. Even for regular healthcare, Indians tend to turn to the private sector because it has a better track record of delivery. Without a private component to vaccine delivery, scaling up quickly will be impossible.

Furthermore, the easy availability of the vaccine at a reasonable price should reduce the chance that rampant black markets emerge and disrupt the government’s own program, which will be targeted at high-risk and high-exposure groups.

Finally, parallel private delivery keeps the Indian state accountable. Voters will be right to ask questions if the government doesn’t get the vaccines it requisitions delivered with an efficiency that is at least in the same ballpark as private actors.

The fact is that Indians are accustomed to our private sector stepping in to fill the gaps left by a very imperfect state. But companies can’t set up their own vaccine distribution networks until the government allows them to do so. In facing its greatest challenge in decades, the Indian state had better start looking at the private sector as not just a partner, but an essential one.