Long-awaited roll-out begins

Questions linger about implementation of vaccine programme

The long-awaited second stage of India’s Covid vaccination programme has finally arrived. The good news is that the government has recognised that a roll-out on this scale, which aims to get 300 million people vaccinated by the summer, will not be possible without the involvement of the private sector. As a result, the official announcement mentioned not just the thousands of government-run vaccination centres but also the use of 10,000 private hospitals that are part of the Ayushman Bharat scheme, as well as those empanelled under the Central Government Health Scheme and by various state governments. This is a crucial step towards expanding the reach of the vaccination drive, and will hopefully allow the number of those receiving their shots to be raised significantly from the current figures.

However, much remains to be determined in terms of implementation. For one, while initially walk-in appointments will be possible at several centres, there is a dependence on the Co-Win platform, which appears built into the system. This should worry the government. The platform has struggled just with the roll-out so far, and it is not certain how the second iteration of the platform — in which those above 60 and those with co-morbidities above 45 are to be registered — will perform. The government has not had a good record with adapting its apps on the fly. Indeed, even with previous Co-Win lapses, the officials in charge tried to blame state governments and the quality of data uploads. This is not the right approach — a platform should be flexible enough at this scale to manage problematic data, or it should not be used for a nationwide roll-out programme.

Other questions will also have to be answered, and may require swift adaptation from the government. For example, a list of co-morbidities has now been released for those above 45 to get the vaccine in Phase-II. These include various forms of heart disease, conditions related to the immune system, and so on. However, all that is required in these cases is a certificate from a doctor. Has the government thought this through? It is an unfortunate truth that there may well develop a thriving market in such medical certificates, which might allow individuals to jump the queue. Such scandals are best avoided through proper institutional design early on.

The involvement of the private sector is also not being done in the best possible manner. For one, the pricing of the shot is problematic. The government has set a ceiling of Rs 250 per shot, of which Rs 100 will be for service charges. The question that arises is whether this will be worth many hospitals’ while, particularly in urban areas. There should be more flexibility when it comes to service charges to be levied by hospitals. The government may have to revisit its ceiling, depending on the uptake from hospitals. Also, the price cap for the vaccine may not be enough to encourage higher supplies. Additionally, the question of vaccine scepticism now needs to be addressed full-on. A lower uptake for any reason will only delay the containment of the virus. The government will also need to pay more attention to cities that are witnessing a rapid increase in new infections.