Vaccine delivery: Strong Centre-state partnership is key

December 17, 2020 6:15 AM

States must wake up to the PM’s clarion call and get their act together for last-mile delivery of vaccines

vIndia’s regulators approved AstraZeneca’s vaccine with the standard regimen of full two doses between shots, which is 62.1% effective based on phase III clinical trial results published by the company in the Lancet in December.

By Sandeep Verma

The Covid-19 vaccine distribution ecosystem is mindbogglingly complex: it is now clear that almost all countries will use multiple vaccines constantly moving from various manufacturers to the last mile, operating virtually on a ‘just-in-time’ basis. To make matters difficult from procurement and logistical perspectives, different vaccines require different refrigeration temperatures, have different shelf lives, need different time-spacing between the 1st and the 2nd shots, and have vastly differing handling requirements. To its credit, the central government initiated a well-planned exercise for procurement and delivery of vaccination services at a scale never attempted before in world history, outpacing in the process every other country by securing for India’s citizens what is perhaps the largest stockpile of Covid-19 vaccines anywhere in the world.

Given the size and scale of India’s requirements, the Centre has taken charge of delivering vaccines to regional depots; and it is the states that need to pick up that point onwards for on-time, last-mile delivery of vaccination services. It is important, therefore, that states pay full heed to the PM’s clarion call urging them to work constructively with the central government, for ensuring the success of the PM’s vision of protecting every single Indian from the Covid-19 pandemic.

This, of course, will also require states to shed their traditional adversarial attitudes vis-à-vis the central government; and India’s national efforts being expertly piloted for containing the Covid-19 pandemic may well need ‘responsible’ politics on part of India’s states more than ever before.

States-Centre cooperation: A win-win

Governance frameworks that call for states seamlessly cooperating with the Centre have enormous potential to deliver important public policy objectives in times of crisis: the most important one being a uniform approach allowing comprehensive solutions to be forged—these were needed recently when some consuming states in India started stock-piling oxygen supplies and some other producing ones started placing restrictions on their inter-state movement, requiring the central government to gently: (i) ask states to audit oxygen consumption in hospitals—nudging them towards much-needed ‘demand rationalisation’; and (ii) discourage inter-state restrictions on movement of goods—thus unclogging India’s supply chains once again.

Constitutional authority for Covid-19 management

While public health and law & order find mention in List II (the State List) of the Indian Constitution, List III (the Concurrent List) thereof allows the central government to prevail so as to ensure prevention of extension of infectious/contagious diseases (such as Covid-19) from one state to another. When it comes to handling of disasters, constitutional authority is relatively more dispersed sub-component wise amongst List I (the Central List) and the other Lists; however, the pyramidical structuring of the Disaster Management Act (DMA)—unambiguously placing the central government at the helm of affairs—clearly indicates that central initiatives for Covid-19 management are on an extremely firm foot.

Again, while procurement preferences or exclusivity under the DMA architecture may, prima facie, lie with state and district authorities unlike, for instance, the Defense Production Act (DPA) of the United States; a more harmonious and comprehensive reading of the DMA leads instead to the conclusion that it is the National Disaster Management Authority that has overriding powers for management of disaster situations.

Central authority for managing many other vital parts of the Covid-19 mitigation framework is exclusive: it is the only regulatory authority for managing (or even taking over) industrial production under the Industries (Development & Regulation) Act, or for the testing of vaccines and approval of drugs under the Drugs & Cosmetics Act. And again, it is the central government alone that can use its informal (diplomatic) and formal (trade policy) roles for maximising national interest outcomes, both of which were superbly discharged by the central government for ensuring timely availability of Covid-19 testing kits and other medical supplies from all corners of the world.

OWS: USA’s unfolding story

The Operation Warp Speed (OWS) currently underway in the US has benefited from States’-Federal cooperation in a number of interesting ways, enabling the forging of a national consensus on a number of important operational issues. These include invocation of the DPA prioritising federal purchasing; manufacturers releasing only 50% production every week reserving the other half for follow-up second doses thus ensuring 100% second dose administration; and establishment of a ‘vaccine trading’ platform where states can exchange their respective allocations amongst themselves, to the extent of any mismatches between centralised allotments and local/state refrigeration capacities.

Bootstrapping by states in India

In India, the Centre has seamlessly tied up vaccine supplies both from domestic and international sources for making them available to regional depots; and the ball is now clearly in the states’ courts to similarly organise their efforts and preparedness in vital areas of logistical planning such as identification and upgrading of local refrigeration capacities (to help the Centre plan allocation of which vaccine(s) would be most suitable for that area); identification of vaccination venues and targeted information dissemination (so that target populations as prioritised nationally are able to actually avail vaccination services in a streamlined manner once they arrive at such a centre); training of vaccination service providers (VSPs) and providers of other logistics services so as to ensure proper tracking of vaccine movement and of vaccine recipients; and so on and so forth.

States will, therefore, need to have in place appropriate contractual arrangements well in time before the actual vaccination rollout begins, either through rigorous PPP-style SLAs (service-level agreements)/IDIQs (indefinite delivery indefinite quantity) or framework agreements; so that infrastructure upgrade is timely and VSPs in particular are reimbursed immediately and without any unnecessary delay. In fact, an even more ambitious state-level approach could be to make advance or automated payments against automated tracking of vaccination, so that VSPs do not face liquidity crunches that can otherwise endanger timely delivery of vaccination services.

Conclusion

The role of states in last-mile delivery of vaccination services is indeed ‘serious business’; and any district/local level bottlenecks in the supply chain may require reallocation of vaccines to another area in view of the need to constantly move stocks from manufacturers to regional depots to district depots to vaccination centres amidst rigid refrigeration capacity constraints at various levels. This reallocation, in turn, may potentially deprive, even if temporarily, eligible residents of that area/district from the national objective set out by the PM so clearly—all because of some state government or district authority failure to take necessary steps for timely planning, upgrading and procurement. The PM, in his regular interactions with state governments, has repeatedly underlined the need for a national consensus for Covid-19 containment; and the need for India’s states to come forward—irrespective of divergent political ideologies—and to constructively contribute to the central government’s national effort is here and now.

The author is an IAS officer and LLM; specialised in Government Procurement Law from George Washington University Law School. Views are personal

(Not to be cited without prior permission of the author.)

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