A single global tender for procurement

The scramble by the States is destined to be inequitable and inefficient and portrays lack of coordination

ment. This is unlikely to yield much as most vaccine manufacturers hard- ly have any spare capacity for the next few months, but a single power- ful purchaser is more likely to tip the balance in ’s favour, apart from Chandrakant Lahariya & accomplishing obvious efficiency Soham D. Bhaduri and equity gains. The benefits of be- ing the single purchaser are not alien to the current government — the With only 20 million vaccine shots Centre’s own flagship healthcare available for the entire month of May programme, the Ayushman Bharat- for the 600 million people aged 18-44 Pradhan Mantri Jan Arogya Yojana, is years in India, many State govern- an exemplar of such benefits. ments have resorted to floating glo- More specifically, on , bal tenders for COVID-19 . the Centre-State division of labour This situation is another example of has traditionally been one where the political promises being made with- Centre procures vaccines and the out sufficient planning. It also points States administer them. It was effec- to a lack of political will to find sus- tive vaccine delivery that helped the tainable solutions; inadequate coor- state deal with the pro- dination between States and the Un- blem of polio. The Central govern- ion government; and a focus on ment procured the vaccines and optics during a public health emer- States dealt with delivery. An emer- gency of unprecedented magnitude. gency is the worst hour to abruptly Each of these is an indictment of the disturb this equation and saddle the response to the in India. If States with additional procurement not now, when can the Indian state responsibilities. The fact that the fed- be more responsive and responsible? eral government has provided vac- A senior citizen at a vaccination centre in Delhi’s Lajpat Nagar on May 13. * cines free to all even in the United Incoherent on all fronts MOORTHY R.V. States, which is a poster child of lais- There are many cons of the Liberal- sez-faire and arguably, an inspiration ised and Accelerated Phase 3 Strate- If it is intended to be a long-term The solution is to boldly revisit the behind many of India’s recent health gy of COVID-19 Vaccination, which and stable measure, it would exem- policy and use the limited vaccine policy pronouncements, should be began on May 1. We discuss them in plify an imprudent and inequitable supply for the adult high-risk and an eye-opener. this article, particularly in view of the vaccination strategy by any nation in vulnerable group, identified as per scramble among States at the inter- the face of an unprecedented nation- the target population. This can be a A rights-based approach national stage as a result of this al emergency. State-specific decision led by subject Article 21 of the Constitution is often strategy. Second, uniform vaccine prices experts without interference from interpreted as embracing the right to First, was the new liberalised stra- for all States can prevent exploitation the political circle. Don’t give false health. The rights-based approach in tegy primarily intended as a fire- of possible economies of scale. Leav- hopes to the rest, which can only health in operational terms connotes fighting measure in view of limited ing prices to an oligopolistic market lead to disillusionment, further di- accessibility, availability and afforda- vaccine supply or as a stable, long- favours unhealthy competition minish trust in government promises bility, and the significance of these term measure? Reducing Central go- among States. The new vaccination and compound other problems. Re- magnifies multifold during an emer- vernment monopsony can theoreti- strategy has now forced States to consider opening vaccination for the gency of the proportions we are see- cally increase production. However, compete in an unfavourable interna- 18-44 years age group in August 2021, ing today. it is unlikely to manifest quickly tional market, which negates any when vaccine supply is likely to sta- In recent times, various Indian enough to aid in successfully prepar- success at curbing domestic competi- bilise. This can be done earlier if courts have looked at COVID-19 vac- ing for a third wave through vaccina- tion. States will have to procure dos- adequate supplies become available. cines and services from a rights- tion, especially in the presence of es at higher rates than a single na- The current scramble by States on based approach. A health emergency limiting factors like reduced raw ma- tional purchaser would. As a result of the international stage is not only comes largely within the purview of terials, which the government has it- the new strategy, each vaccine dose destined to be inequitable and ineffi- the Central government. It demands self admitted to. Supplies are project- will be costlier in India than in any cient, but also propagates a discor- that the government act responsibly ed to achieve substantial levels only other part of the world, until prices dant image for a country which, until to ensure that COVID-19 vaccines are by August 2021. However, consider- come down substantially. Making late, boasted of extending humani- accessible, available, and affordable. ing that past announcements of vac- State governments pay higher prices tarian aid by exporting vaccines. It It is never too late to take corrective cine production have not met the ti- for the vaccines essentially increases only behoves the Central govern- measures. melines, can we be assured of even government expenditure, though the ment to bear the costs and provide that? Without any increase in sup- burden now has shifted to the States. vaccines to the States. However, the Chandrakant Lahariya has done extensive plies, expanding eligibility to the 18- Overall, the current approach is des- bare minimum that the Central go- work on the vaccination programme of India, 44 years age group will only spread tined to be highly inefficient on all vernment can do now is to coordi- is a public policy and health systems expert and the co-author of ‘Till We Win: India’s vaccines thinly, which makes little fronts for a country that is short of re- nate with the States and on behalf of Fight Against The COVID-19 Pandemic’; epidemiological and operational sources. The concomitant inequity is all the willing States, float a single Soham D. Bhaduri is a health policy expert sense. self-explanatory. global tender for vaccine procure- and Chief Editor of ‘The Indian Practitioner’