India reported more than 4.6 Million cases till date(12/9/2020) and deaths more than 76 thousand. Also, India is reporting the global highest single-day spikes with more than 95000 cases on average. These spikes seem like India is reaching peak points. However, it is still unclear if the peak is yet to come because the first serosurvey by Indian Council of Medical Research(ICMR) shows that India could already have some 6.5 Million cases where 2 Million cases went unreported by this date. In early July ICMR said that the COVID-19 vaccine COVAXIN manufacturing by Bharat Biotech India Limited(BBIL) in coordination with National Institute of Virology(NIV) would be ready by August 15, the Independence Day of India. The date was passed and it’s been a month now.
Russia has registered the first COVID-19 vaccine SPUTNIK V on August 11, administering the first dose to Russia’s President Vladimir Putin’s daughter. It was officially confirmed that Russia is expressing to partner with India in manufacturing SPUTNIK V vaccine in India after a successful Phase 3 trials.
Both Russia’s SPUTNIK V & India’s COVAXIN is yet to come to the manufacturing unit. Now the most asked question in India is “To Whom the vaccine priority will be given”?
Does India need a COVID-19 vaccination policy?
If vaccine ready to dispatch, then to whom the vaccine priority should be given because it is not possible to administer everyone in just weeks or months. So we need a COVID-19 vaccination policy for priorities, regulations, illegal trafficking, accessibility & affordability, price control, distributions and others.
At the global level, World Health Organization is working with a vaccine alliance GAVI on a collective platform COVAX to ensure equitable access by every country irrespective of their economy or it’s the ability to purchase the vaccine. GAVI estimates that a minimum of 2 Billion doses as an immediate requirement. However, no country can get vaccine doses more than 20% of its population until every country in COVAX group gets the same amount. If India is a member or COVAX group or not(yet to confirm officially), the challenge is still ahead.
Here are a few points on why India should focus on Covid-19 vaccination policy.
- The Serum Institute of India estimated that each COVID-19 dose would cost around $3(210 INR approx.) and could double the price in the private market. The is a bit expensive to the lower middle class and highly unaffordable to poor to get the vaccine for the entire family. According to World Bank out-of-pocket expenditure on personal health care is around 62% in India($60.6/$97.1 Billon). Of this out-of-pocket expenditure, 40% end up in debts or assets selling.
- In India 76% of people don’t cover health insurance, 6.7% of people are Below poverty line(BPL),23% of people can’t afford health care. India needs to address how these people can afford the vaccine.
- India’s Health care Access and Quality (HAQ) ranking are very poor i.e. 145 among 196 countries in 2016. India spends less than 2% of its GDP on health care sector to 1.3 Billion population.
- The Universal Immunization Program(UIP) is mainly concentrated to immunise only children and pregnant women. UIP covers vaccines for 12 diseases. It doesn’t cover people of all ages and sections since COVID-19 is infectious to all ages.
- Counterfeit drugs account for 25% in India either they are substandard or fake. ASSOCHAM reported that fake/counterfeit drug could be $10 Billion market by 2017. This indicates the potential to a fake COVID-19 drug.
If the vaccine is available in India then to whom it should prioritise is also important. World Health Organisation(WHO) suggested three stages of prioritising vaccine
- Medical Health care and Social care workers i.e. 3% of the population since they were first-line worries in Covid-19 war. The doctor to patient ratio in India is 1:1445 but WHO’s recommendation is 1:1000 and there were some 9.27 lakh active doctors in India. The nurse to patient ratio is 1.7:1000 in India whereas WHO’s recommendation is 3:1000 and there were a little more than 3 Million nurses registered in India.
- In stage 2, 20% of the population should be given prioritise. 20% should include the vulnerable and high-risk group. The most vulnerable age group area above 60 and person with pre-health problems like heart diseases, lung infections and other respiratory problems.
- In stage 3, the 20% population and others. This target lies at the far of the journey and would take a long time maybe years.
India’s population and demographics are the main challenges in delivering the vaccine to the target. Immunising at least 30% population with 2 doses each would take 3 years reported by livemint. Immunising the entire population would cost $6 Billion to government. However, if India doesn’t come up with COVID-19 vaccination policy, would make inequalities in vaccine access. The private market could take advantage of this further increasing the inaccessibility and affordability to the poor. At the same time, there is no assurance that there will be no irregularities if govt. takes the vaccination to all. Based on the Healthcare condition in India, a COVID-19 vaccination policy with distribution taskforce and strict protocols could make at least accessible to needy or in the emergency conditions.
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