For this one time, the country needs to step up its game and ensure that the choice and the correct information for the Covid-19 vaccine reaches the most disadvantaged end of income groups in India
The year 2021 will be the year of the Covid-19 vaccine. It will be the topic of our greatest relief and utmost anxiety. Which vaccine? How to avail it? Will it work? What are the side effects? We will not know the answers to all these questions at once, not even at the time regulatory approval is given for each vaccine.
Choosing the vaccine to use in India’s vaccination programme will therefore certainly not be easy as they will each be based on very different technologies, with differing degrees of efficacy and side effects that will likely be revealed with time. Many millions will be vaccinated every week, and perhaps an effective tracking system could help us identify problems with particular vaccines which were not caught in the pre-approval tests.
Procuring the vaccine would indeed be initially difficult but I don’t anticipate it to be our greatest challenge in the long run either. India has a large vaccine production capacity. The Serum Institute of India is the largest vaccine manufacturer in the world and it is producing the AstraZeneca-Oxford vaccine and will also produce the Novavax vaccine. It is expanding capacity to 1.2 billion doses per year, and half of this could be available for India. There are other Indian manufacturers engaged in clinical trials to produce a vaccine, such as Zydus Cadila, Bharat BioTech, Dr Reddy’s Laboratories and Biological E. There will undoubtedly be difficulties in this unprecedented situation.
However, funding the programme will be a major challenge and a heavily debated one too. Should the vaccine be free for all beneficiaries or only for some? Will the government pay for vaccines for all? India has a vast spectrum of social and economic inequalities. We have some of the world’s richest and the world’s poorest, with health care distribution that also mirrors this enormous gap. Without free vaccines provided by the government at least to some extent, we can not ensure that the last mile in rural India are offered the vaccine. We can not ensure that the population left out in vaccinating 70% of India and hoping for herd immunity for the rest, are not the poorest.
We can anticipate two other major hurdles in vaccinating India for which, I believe, the private sector must step in to help.
First, how will we distribute the vaccine to the last mile? Our existing systems for distributing medicines to the anganwadis and rural medical centres are fraught with pilferage. Already we see a black market for vaccines preparing to suck out the vaccines from the system to offer it to those with greater buying power who might want the vaccine at the soonest. How can we then ensure that the vaccine is offered to all individuals in an equitable manner? Some have suggested a lottery system for offering vaccines, but even then how can the lottery winners belonging to economically weaker segments be sure of receiving their vaccine?
Here, the network of the local kirana stores and freelance entrepreneurs in small towns and villages who are already being mobilised by the government for distributing Covid testing kits and masks could be tapped upon. They are the government of India’s best last mile connect. This network has been leveraged by the government already and so it can be leveraged for vaccine distribution as well, to be then picked up by the government healthcare workers in villages, slums, small towns. Large companies could include their supply chain and distributors within that network for vaccine delivery. The supply chain of large companies such as Hindustan Unilever Ltd. and others will thus bolster this existing network further — if a Lifebuoy can be delivered to the furthest hut in a village so can the Covid vaccine. Indeed thereafter, the government healthcare workers would be best suited for door-to-door vaccinating. In our experience of setting up 11 Covid hospitals and recovery facilities over six months, we leveraged public private partnerships to set up these hospitals and facilities in urban pockets that lacked healthcare facilities, bringing in government healthcare workers to operate them. A similar PPP model can be put in place for vaccine distribution and vaccine administration in rural India.
Second, how do we overcome India’s biggest malaise — corruption — in this regard? The black market is picking up already, making ‘bandobast’ to get the vaccines out to people with resources as soon as possible. There are even travel companies such as Gem Tours offering Mumbai-New York-Mumbai tickets, 3 night/4 day packages with breakfast and one vaccine dose. Further, even if the kirana stores in villages and slum zones are looped in to distribute the vaccines, there might be cases where they instead sell off the vaccines at high prices. In the case of the latter, the government can not entirely check the corruption and the private sector might be silenced by the fear of losing the supply chain for their own products.
What are ways in which we can pre-empt this corruption? Communication might be key here. An intensive anti-corruption campaign for vaccine distribution can be planned in order to remind the public of being ethical during the worst global pandemic in history that has ravaged the lives of millions. The public involved in vaccine distribution can be encouraged and named as ‘heroes’ , much as the frontline warriors were referred to as ‘Covid Warriors’. The communication on vaccines must cover factual information about the various vaccines, removing rumours and baseless fears. The vaccine cannot be made mandatory, which makes the dispersion of effective and accurate communication all the more important.
In India, since the past three months or so the private sector has already stepped in to assist the government in articulating and dispersing the message around Covid precautions. At times the government pays companies for spreading the message while in some cases companies and even some advertising agencies have stepped up to do so on a pro-bono basis. This trend can be further strengthened towards an anti-corruption campaign for vaccine distribution.
We can not afford to lose the battle to Covid, especially once an effective basket of vaccines arrive. The distribution of anything to the last mile in India is a challenge. This is at least once when the country needs to step up its game and ensure that the choice and the correct information for the Covid vaccine reaches the most disadvantaged end of income groups in India. They can not be left to gain ‘herd immunity’ while the top 1% get their choice of vaccines. This is the challenge that the government, private sector, me and you need to win in 2021.
The writer is CEO of Sustain Labs and Adjunct Professor at SciencesPo Paris. She is also a columnist and author of the 2019 bestseller Indian Instincts — essays on freedom and equality in India