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:
- free, universal vaccination to all citizens of India;
- to ramp up RT-PCR testing in both rural and urban areas;
- to make adequate funds available to states for provision of medical facilities; and
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!
In conclusion, I may quote 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.”
Image (c) istock.com