In seeking to pursue conflicting objectives , the policy architecture is complex and difficult to implement
Contrary to popular perception , public policies are made without full knowledge or facts . More often than not , they embody assumptions arising from experience , an understanding of history , and present conditions . Considering the vast sea of unknowns surrounding COVID-19 , it would be understandable to place a greater reliance on historical experience . Instead , India ’ s vaccine policy appears to be one of experimentation . Despite several modifications , the final policy as articulated by the Prime Minister on June 7 continues to lack clarity in its intent , design , funding and outcomes . In seeking to pursue conflicting objectives , the policy architecture is complex , difficult to implement , and could be a nightmare for accountants . The Vaccine Policy
After much loss of time , the final policy has the following elements : the stated objective is universal access to free vaccinations in all government and accredited facilities ; the design for achieving the objective is creating a dual market under which the Central government will procure 75 % of the total quantity manufactured , leaving the residue for commercial sale . The funding will be a mix of public finance and out-of-pocket expenditure . The outcome is to ensure that all 95 crore adults are fully vaccinated by the end of this year .
The policy has two caveats related to pricing and volume of sales . While Covishield and Covaxin are supplied to the Central government at Rs . 150 per dose , the price for a consumer in the July - 2021
India ’ s Vaccine Policy Needs Clarity
( Former Union Health Secretary K . Sujatha Rao ’ s Comment , The Hindu , June 22 , 2021 )
private market is capped at Rs . 780 for Covishield , Rs . 1,145 for Sputnik V and Rs . 1,410 for Covaxin . To avoid cornering of vaccines by corporates and enable medium and small hospitals to participate in vaccination , the Central government will specify hospitalwise and State-wise quotas for private sales . Based on the quota allocated , the said hospitals will procure the vaccine directly from the manufacturer or use the option of the National Health Authority portal , if accredited .
Compare this maze with the policy followed under the Universal Immunisation Programme – the Central government indicates the quantity required , the delivery schedules and the rates as per global tender , and supplies quality , ready-to-use vaccines to the States to be provided free . The manufacturer is left to dispose of excess quantity , if any , in accordance with market forces and without interference from the government . Under this system , the government has negotiated incredibly low prices due to the volume of its orders . In view of its wide reach , the private sector ’ s participation , catering to the betteroff sections which have the ability to pay , has averaged 5 % -15 % depending on the vaccine . Current Status of Procurement
It is estimated that the Central government has procured and placed advance purchases for 79 crore doses for Rs . 12,405 crore ( including Rs . 1,485 crore from PM CARES ). The State governments in May procured 2.6 crore doses incurring Rs . 810 crore , while the private sector ( nine corporate chains and 300 hospitals ) procured 1.2 crore doses . Selling at Rs . 1,000 per dose of Covishield and an average of Rs .
1,400 for Covaxin , the household expenditure on vaccines comes to about Rs . 1,332 crore . The private sector ’ s share in the total 82.8 crore doses procured and amount incurred is 1.45 % and 9.1 %, respectively .
The total number of people who got vaccinated by June 21 with a single dose was 23.2 crore and with two doses was 5.05 crore . Of the total 190 crore vaccines required for covering the eligible population with two doses and 83 crore already secured for supply till year-end , the gap is 107 crore . This brings us to the first level of policy confusion . In the absence of spelling out the population segments that the government proposes to cover , it is unclear whether the 75 % procurement cap refers to the stocks manufactured or by implication the eligible population . Clarity on this is important . If it refers to stocks , then the position can vary due to uncertainties and externalities associated with production . Besides , in the absence of credible information regarding real-world manufacturing capacity and wide price differentials , arriving at what that 75 % of manufactured stocks would entail is difficult , creating an unstable environment for operation and planning .
If it is 75 % of the population to be covered , the policy assumes that 24 crore people have the ability to pay such high prices for a vaccine . How far is that a realistic assumption , given that as per data of the Pew Research Centre , the number of people earning less than $ 2 a day has doubled from 5.9 crore to 13.4 crore as a result of the pandemic ? Due to the pandemic , under every income segment , the numbers have reduced — the number of people in the high and uppermiddle class is estimated to have fallen to 1.8 crore from 2.5 crore ,
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