The consequences of less-than-desired coverage, because vaccine costs proved a hurdle, are too adverse to risk
The verdict is still out, meanwhile, on the first vaccines. Early data from front-runners will probably come this fall, with Pfizer Inc. predicting it will have results as soon as October.
The government will do well to mull over the essence, rather than the specifics, of the question Adar Poonawala—whose Serum Institute of India (SII) is at the forefront of global Covid-19 vaccine development & production—has asked, regarding the funding plan for vaccine roll-out in the country. Poonawala had asked on Twitter if the government has the Rs 80,000 crore that will be needed to distribute a Covid-19 vaccine over one year from it becoming available.
It isn’t clear how Poonawala arrived at the figure, but it should spur the government to brainstorm on a funding plan—apart from the larger roll-out requirements. The committee tasked with coming up with a roll-out plan has reportedly asked vaccine manufacturers to submit quotes and the government will likely have a realistic estimate soon enough.
At the moment, there are about 182 vaccines in different stages of development and testing—from pre-clinical trials to late-stage human trials (36 are in clinical trials with nine in the final stages of this). In India, there are about eight candidates under development, with two having entered late-stage human trials.
While the Covax initiative of the Gavi (The Vaccine Alliance), the WHO and the Coalition for Epidemic Preparedness Innovation aims to make the vaccine available to 92 low- and middle-income countries at $3 (Rs 221), countries like the US, the UK, have signed deals with manufacturers for supply. SII, bear in mind, has just agreed to double its supply to the Covax initiative, adding 100 million more vaccines to the 100 million it had committed to last month, after the Bill and Melinda Gates Foundation doubled its contribution.
Given how wide vaccination coverage needs to be—more so given the lenient effectiveness standard that has emerged as a global consensus—it will be disastrous if people were to opt-out of vaccination because of the cost. To that end, many countries are looking at ways to make the vaccine either free for a large chunk of their population or all of it; for instance, the US Congress passed the CARES Act that defines the Covid-19 vaccine as a “preventive health service”, enabling its inclusion under health insurance in the country.
This doesn’t make the vaccine free—since a premium is paid for the insurance—it does mean that Americans covered under the insurance won’t have to pay any additional charge for the vaccine. There are loopholes that leave out a significant number from the CARES Act umbrella, but the US federal and state governments are trying to find a way around this; given how vaccines included in the US’s Operation Warp Speed are likely to cost as much as $20 (a $37 tag has also been reported for the Moderna candidate), without CARES protection, it would have been a significant amount for a large number of Americans.
Australia, too, has announced that it will make the vaccine free for citizens. To that end, India needs to look at ways to make the vaccine free or subsidise it considerably so that cost doesn’t become a hurdle to the aim of controlling the pandemic. While the government will have to do the heavy-lifting on this, it can also look at ways to draw in CSR funding, with incentives rather than coercion.
The last thing that India should be doing is ‘compulsory licensing’, as a leader of the Swadeshi Jagran Manch (an RSS-affiliate) unwisely warned of invoking in response to Poonawala’s question on vaccine-funding. That approach will keep out effective vaccines produced abroad from the Indian market if makers fear their R&D being commandeered by the government. Given India’s low R&D spending, arm-twisting SII—and by extension, AstraZeneca and Oxford University—isn’t going help India’s Covid-19 fight.