Vaccinating India: What next?

We must pull out all the stops to win the race against the virus. And trust each other to do the right thing

In “Vaccinating India Brilliantly” (Business Standard, February 17), I argued that we needed to dramatically speed up our vaccination drive. Having established the right protocol for the vulnerable (health care workers, frontline workers, older people, then others), the state needed to step out of the way and let the private sector get on with the job.  Others in these pages have argued that we need to consider markets and incentives, and quickly approve more vaccines to ensure adequate flow. Let’s put all this together with our current experience. In this last month, we have indeed seen a much-speeded up vaccination effort. Having done eight million in our first month, we are now beginning to vaccinate two million a day. Private sector hospitals are now fully involved in the effort. All this is good news, and the direction is right. But to win the race with the virus, we must do much more. In the last month, we have seen a surge in daily Covid infections. For reasons that no one seems to have been able to explain, this surge is concentrated in particular districts and cities. My own city of Pune once again has the dubious distinction of leading the country in fresh daily infections, which have now consistently been above 3,000 a day, and rising. So what’s next? How do we win the race against the virus?

Our task: Let’s start with our task. We have 850 million people above the age of 20. We need to vaccinate enough of the population for herd immunity to protect the rest, so what is our time-frame for India? A target of six months to vaccinate 75 per cent of the adult population means 7 million a day (850 million x 0.75 x 2/182). We do not yet have assured supply of 200 million doses a month. So we need to adjust our ambition down. Let’s plan for 100 million a month for three months and then step up to 200 million from July. That will get us past 75 per cent of the adult population by November, not great, but still the world’s most ambitious vaccination programme. Achieving 3.5 million a day now is quite a manageable increase from the 2 million we have hit a couple of times this last week. 

Lay out the protocol: The present protocol covers over 60 and those over 45 with comorbidities. Our target must be to complete over 75 per cent of these by April. What’s next? Let’s do all over 50, and all ages with comorbidities. At 3.5 million a day, we can complete all by June. Having protected the vulnerable, then open it to all over 20, as capacity ramps up to 200 million a month. That still leaves some vaccine availability for dealing with places that have seen a surge in infection. Let them move to the next age tier ahead of other places. Pune with 0.5 per cent of the country’s population accounts for 12 per cent of the country’s fresh infections. It should start 50+ and all with comorbidities now, and move to 20+ from April and complete all adults by early June. The same applies to other districts seeing a surge in cases. Maharashtra alone accounts for almost all of the increase in active cases nationally.  Including a few more cities and targeting them rapidly could fundamentally slow the spread. But we must act now.  Delaying two weeks could be too late. And as we are doing this, we must maintain safety protocols of masking and social distancing until the pandemic is behind us.

Illustration: Binay Sinha

How to scale: Most large private hospitals confirm that they can expand capacity to 1,000 per day in a week — if they get the vaccine. And all hospitals must deliver in full each day. If they do not have enough people show up within the age band to take the vaccines on a given day, let them extend to the next band. Let’s not slow down for any reason.

Second, ensure vaccine availability. Order doses six months ahead from Serum and Bharat Biotech and other manufacturers now, in line with our 3.5 million and 7 million a day goal, so they are certain what their demand will be and can invest in capacity accordingly.

As Mihir Sharma said, clear other vaccines that have passed Phase III trials in other countries now, without waiting for our own to show the same thing. The Johnson and Johnson and Sputnik vaccines should be approved now, as should the Pfizer and Moderna ones. Leave it to the companies to figure out how to put in place the right chilling infrastructure. Don’t let a lack of approvals deprive the country of availability. 

Third, expand delivery capacity by bringing in the corporate sector. Encourage companies to come together and take on the responsibility of vaccinating whole wards and districts. Sixty per cent of Pune district’s 10 million people are urban. Let corporations work closely with the local administration, using our implementation capability to set up large scale vaccination camps. Companies can help with every district that, like Pune, has a significant industrial presence. And yes, we can help pay for it too. The government can then focus its effort on rural areas. 

Principles: Follow two principles. As Ajay Shah has said, use the market. We have fixed Rs 250 per dose of vaccine.  Should we increase the price to Rs 500 per dose for only the next two months? With the increase split between vaccine supplier and hospital? And let the price revert to Rs 250 from June 1? And experiment with freeing prices to find their own level in one or two districts? Incentivise vaccine manufacturers and hospitals to put in more capacity immediately instead of over time. The virus moves incredibly fast, in the spread of infection, and in mutation. The only thing that can move faster are market transactions. Equity can be sustained by the government scaling its own free vaccination programme, but don’t come in the way of willing buyers and sellers.

For this to work, we need an abundance of one thing alone: Trust. George Shultz, who died last month, wrote a wonderful article in The Washington Post to celebrate his 100th birthday. Trust, he said, was the “coin of the realm.  When trust was in the room … good things happened.  When trust was not in the room, good things did not happen. Everything else is details.”  So let us trust the government to set the right protocols, let the government trust the hospital system and industry to follow them without trying to control what each does, and let us, as citizens, trust vaccines. Everything else is details.  

---

ndforbes@forbesmarshall.com. 
 

The writer is co-chairman Forbes Marshall, pastpresident CII, Chairman of Centre for Technology Innovation and Economic Research and Ananta Aspen Centre