Centre-state discord blunting fight against Covid

At long last, there was an acknowledgment, albeit a tangential one, that the Centre’s vaccine policy, that was twisted and tweaked to suit political exigencies, might have gone awry. Prime Minister Narendra Modi, in an address to the nation on Monday, reversed his government’s Covid-19 vaccination policy and announced that the Centre would revert to a system of centralised procurement of vaccines, provide vaccines free of cost to the 18-44 age-group and set aside 25 per cent of the procurement open for the private sector.

Since the pandemic erupted, every measure taken by Delhi was framed as a joust between the Centre and the non-BJP-ruled states in the zeal to score brownie points. The competition that at times looked like play-acting, unfortunately ensnared some of the chief ministers.

Be it an endeavour to unsuccessfully stem the outflow of migrant workers from the big cities to their villages after a national lockdown was suddenly declared and managing the collateral losses from a near-economic collapse in the first wave in 2020 to coping with the ravages wrought by a brutal second hit, politics became the bane of India’s pandemic combat.

Unfortunately, Modi could not resist playing politics in his June 7 speech in which he implied that the country’s vaccine programmes since Independence to extirpate smallpox, measles, polio and diphtheria etc. were actually below par for the “decades of wait” for the relevant vaccines the exercise supposedly entailed. In fact, India’s universal immunisation programme has been the world’s envy for decades.

The destruction wrought by the second wave that apparently caught the Centre unaware — despite the heads-up that the B.1.1.7 and the P.1 variants could have entered the country from abroad — got amplified by the government’s attitude that was characterised by seeming helplessness and marked callousness.

The states, waiting for ‘directions’ and ‘action’ from Delhi, were left to fend for themselves amid an undocumented number of deaths in the most agonising conditions, forced upon by oxygen crunch, shortage of hospital beds and scarcity of life-saving injections and drugs. As the US and UK battled the new variants by procuring advance quantities of vaccines, ramping up indigenous production and spreading their use across demographic groups, India was curiously lethargic. Flush with the purported ‘success’ of the “Vaccine Maitri” diplomacy, when it came to inoculating its own people, the country ran woefully short of doses.

Let’s map the course that the Centre’s vaccination programme went through. At the first meeting of the National Expert Group on Vaccine Administration in 2020, the Centre announced it would take full control and advised states “not to chart separate pathways of procurement”. Therefore, the states had no choice but depend on the Centre for the vaccine supplies as and when the programme rolled out. On April 8, 2021, at an online Covid review meeting with chief ministers, Modi’s stress was on “aggressive testing and micro-containment to break the chain of transmission” that by then had become uncontrollably predatory. The PM termed the vaccination as a “long-term and continuous strategy” in the fight against the pandemic. The choice of the word ‘strategy’ suggested a coldly clinical approach. By then, most countries had accepted the vaccine as their only lifeline for surviving the virus and saving lives, and not just as another weapon in an arsenal.

The meeting was held against the backdrop of a confrontation between the Centre and the non-BJP ruled states over the availability (or lack) of vaccine doses. As the states despaired of being short of meeting their targets, Harsh Vardhan, the Union Health Minister, accused the Opposition-ruled states of “politicising a public health issue” and “purveying lies” while not doing enough of testing, contact tracing and enhancing infrastructure.

Later in April, when the caseload got too large for comfort, when vaccine shortages were reported the country over and the Centre’s mismanagement came into sharp relief, the government resorted to another plan. It put the onus of vaccinating those in the 18 to 44 age-group entirely on the states and private hospitals. The plan was dressed up as a “liberalised and accelerated” strategy, but in reality it gave the states no leeway in determining the volume of procurement or pricing.

Health experts saw the policy as a tactic to deflect attention from the Centre’s mismanagement and pass the onus on to the states. The policy accentuated the plight of the states that ran around for vaccines with supplies drying up periodically and resulting in inoculation centres shutting down even in the national capital. Meanwhile, private hospitals jacked up vaccine prices to as high as Rs 2,000 per dose. In the opinion of some health experts, the ‘model’ constructed by the ‘liberalised’ policy came close to the template adopted by the BJP-helmed government in sectors such as telecom and civil aviation where the state seemed unwilling to use its sovereign power of compulsory licensing at the cost of favouring a few conglomerates and the private health industry.

However, the scenario changed after the outcome of the state elections, notably West Bengal where the BJP trailed the Trinamool Congress as a poor second instead of emerging as the projected victor. The Opposition stepped up to the plate. Pinarayi Vijayan, re-elected as the Kerala CM, mobilised support for centralising vaccine procurement from his counterparts. The CMs of Odisha and Andhra Pradesh, classified as ‘neutral’, pitched in with Vijayan.

The pushback from the states was supplemented by a recent Supreme Court judgment in a suo motu case. The court concluded that the Centre’s decision to not provide free vaccination to the 18-44 age-group was “prima facie, arbitrary and irrational”. It called on the Centre to account for the Rs 35,000 crore earmarked in the budget for vaccines and asked if it at all regulated the end-price charged by the private hospitals.

While Modi’s announcement seemed timed to blunt the Opposition’s attack and answer the court before the next hearing on June 30, certain questions went unanswered. How will the drastic vaccine shortfall be suddenly made up? What about the differential pricing for public procurement of vaccines by the Centre and the states? How will the private sector, which can procure up to 25 per cent of the vaccines, be regulated?