Centre should follow global example and make COVID vaccine free for all, says economist Ramakumar

The Central government should follow global examples to make vaccination, which is free for all citizens, against the novel coronavirus, economist and a professor in the School of Development Studies at the Tata Institute of Social Sciences (TISS) R Ramakumar told Firstpost in an interview.

The economist's comments comes in the backdrop of the Serum Institute of India’s hiking the price of its COVISHIELD vaccine. The vaccines will be available to state governments at Rs 400 per dose and to private hospitals at Rs 600 per dose, it said.

Meanwhile, the Centre on Monday asked the Serum Institute and Bharat Biotech to lower prices of their COVID-19 vaccines amid criticism from various states who objected to profiteering during such a major crisis. The issue of vaccine pricing was discussed at a meeting chaired by Cabinet Secretary Rajiv Gauba. Now, the two companies are expected to come up with revised pricing for their vaccines.

Last week on Wednesday (21 April), the Centre, in a document laying out the policy on liberalised pricing from 1 May, stated, "...The present dispensation where private COVID vaccination centres receive doses from the government and can charge up to Rs 250 per dose will cease to exist." The move is linked to the new vaccination strategy to be implemented from next month, under which vaccine manufacturers would supply 50 percent of their doses to the Central government and will be free to supply the remaining 50 percent doses to state governments and in the open market at a pre-declared price. Responding to these changes, several experts and activists have raised concerns about the possibility of rising costs of the vaccines.

Speaking to Firstpost, Ramakumar said, "When the Centre announced the new vaccine strategy a few days back, a fear was expressed that it would lead to a sharp increase in the prices of the jabs. This indeed seems to be happening now. It will have major implications in the way that it will push and exclude millions of poor people in India out of access to this health measure. Further, states will have to buy the vaccines from manufacturers, and this will impose a huge financial burden on them. Lastly, the strategy will open the door for the private firms to make 'super profits' (over and above 'normal profits,' as described by SII chief Adar Poonawalla) from the inoculation exercise."

Similar concerns have been raised by some Opposition leaders, who have questioned why the prices of vaccines are different for the Centre and the state governments.

Speaking on the extent of the burden it is going to place on state governments, Ramakumar said, "Let us broadly assume that the Centre will fund 30 percent of the vaccinations for frontline workers, people above 45 years, etc; and the state governments will pay for the remaining 70 percent of the vaccinations. In my estimate, this will lead to a burden of over Rs 80,000 crore on state governments."

According to the economist, global precedents also point to the importance of giving free COVID-19 vaccination to citizens. “Most countries, including the United States, France, Germany and China, are giving the vaccines to their citizens free of cost. They are not charging a single penny. This is so because it is considered as an enlightened role of a welfare state. The vaccine policy being followed by India is not an appropriate one.”

He added, "We must consider the vaccine to be a public good which should be given free to people. This is also a constitutional right of the people. After all, the right to health is a constitutional provision, and the right to free vaccines is a subset of that right. Therefore, providing vaccines free of cost must be a commitment of the Indian State, and this is a commitment that the Centre is currently evading. It is completely unbecoming for a country that claims the mantle of being the pharmacy of the world."

The Directive Principles of State Policy in the Indian Constitution provide a basis for the right to health. Further, the Supreme Court, in cases such as Bandhua Mukti Morcha vs Union of India and State of Punjab and Ors vs Mohinder Singh Chawla has held that the right to health is fundamental to the right to life under Article 21.

Apart from pricing, another persistent concern with respect to vaccination has been that of supply, with shortages being reported from several places. This threatens to slow down India's inoculation efforts, at a time when daily coronavirus cases have crossed 3 lakh.

To this, Ramakumar said, “The timeframe of the vaccination will naturally depend on manufacturing capacity and supplies. Even assuming that Serum Institute of India and Bharat Biotech expand their production capacities in May 2021, India will still face a deficit in the near future. If India wants to move very fast — let’s say with the aim to complete the vaccination exercise by January 2022 — we need to vaccinate the population at the rate of about 67 lakh people a day. Our present rate of vaccination is much slower, and at this rate, we will take over two years to achieve protection to the entire country through inoculation. The process could be even slower if more vaccine shortages come up.”

On 6 April, the country witnessed a record high number of single-day vaccinations, with over 43 lakh doses administered in a day. After that, daily vaccination figures have fallen and on Wednesday, the total number of vaccine doses administered was 29,90,197.

The Centre, in its official statement, has claimed that its new strategy gives all stakeholders flexibility to customise the process to local needs. However, in practice, this may mean that state governments will have to compete with each other for vaccines, Ramakumar said. “There is a possibility that inter-State disparities will rise, and richer states may benefit at the expense of poorer ones,” he noted.