QUESTION : Vaccine hesitancy and the digital divide are among the biggest challenges in Covid-19 vaccination in India. Discuss the various aspects related to these challenges and suggest measure to deal with these challenges. 

INDIA’S VACCINE POLICY NEEDS CLARITY 
WHAT ? 
India’s Covid-19 Vaccine Policy and Issues 
WHY IN NEWS ? 
India’s vaccine policy appears to be one of experimentation, it continues to lack clarity in its intent, design, funding and outcomes. 
CURRENT COVID-19 VACCINE POLICY :
•  The final policy has the following elements:  
o The stated objective is universal access to free vaccinations in all government and accredited facilities and
o The design for achieving the objective is creating a dual market under which the Central government will procure 75% of the total quantity manufactured, leaving the residue for commercial sale.
• The funding will be a mix of public finance and out-of-pocket expenditure.
• The outcome is to ensure that all 95 crore adults are fully vaccinated by the end of this year.
• The policy has two caveats related to pricing and volume of sales.
o While Covishield and Covaxin are supplied to the Central government at ₹150 per dose. 
o The price for a consumer in the private market is capped at ₹780 for Covishield, ₹1,145 for Sputnik V and ₹1,410 for Covaxin.
• To avoid cornering of vaccines by corporates and enable medium and small hospitals to participate in vaccination, the Central government will specify hospital-wise and State-wise quotas for private sales. 
• Based on the quota allocated, the said hospitals will procure the vaccine directly from the manufacturer or use the option of the National Health Authority portal, if accredited.
POLICY UNDER UNIVERSAL IMMUNISATION PROGRAMME :
• The Central government indicates the quantity required, the delivery schedules and the rates as per global tender.
• The Centre supplies quality, ready-to-use vaccines to the States to be provided free.
• The manufacturer is left to dispose of excess quantity, if any, in accordance with market forces and without interference from the government.
• Under this system, the government has negotiated incredibly low prices due to the volume of its orders.
• In view of its wide reach, the private sector’s participation, catering to the better-off sections which have the ability to pay, has averaged 5%-15% depending on the vaccine.
CURRENT STATUS OF PROCUREMENT :
• It is estimated that the Central government has procured and placed advance purchases for 79 crore doses for ₹12,405 crores (including ₹1,485 crores from PM CARES).
• The private sector (nine corporate chains and 300 hospitals) procured 1.2 crore doses.
• Selling at ₹1,000 per dose of Covishield and an average of ₹1,400 for Covaxin, the household expenditure on vaccines comes to about ₹1,332 crores.
• Of the total 190 crore vaccines required for covering the eligible population with two doses and 83 crores already secured for supply till year-end, the gap is 107 crore.
o In the absence of spelling out the population segments that the government proposes to cover, it is unclear whether the 75% procurement cap refers to the stocks manufactured or by implication the eligible population. 
 If it refers to stocks, then the position can vary due to uncertainties and externalities associated with production.
 If 75% of the population to be covered, the policy assumes that 24 crore people have the ability to pay such high prices for a vaccine.
• As the number of people earning less than $2 a day has doubled from 5.9 crores to 13.4 crores as a result of the pandemic.
• The demand may be more for free vaccines while the self-imposed ceiling of 75% of stocks may create artificial scarcities.
CONCERNS :
• The ‘two steps forward, one step backwards’ policy fix has given rise to another set of issues.
• Piecemeal orders increase investment risk for a company. 
o Besides, delivering and processing small orders by multiple small entities (private hospitals) located in remote areas would further add to costs impacting the price at the point of delivery. 
• The small and medium private hospitals that have the reach in Tier 2 towns and rural areas do not have deep pockets to buy such costly vaccines.
• Given vaccine hesitancy, heightened by a constrained ability to pay, the mutating virus and constant shifts in vaccine dosage and periodicity due to emerging evidence, the additional burden of organising quality assurance all add to the risk.
• Differential pricing and dual markets provide wrong incentives and result in:
• Unhealthy competition, 
o Illegal charging for vaccines in government facilities,  
o Siphoning, diversion and leakage of the free vaccines to the private markets. 
• Wherein large swathes of the country it is the government doctors that double up as owners of private enterprises.
WAY FORWARD :
• There is a need to simplify the policy with the government as the sole procurer.
• Implementation must be in accordance with district-level micro plans incorporating the public and private sector, to cover target groups as specified in accordance with epidemiological data.
• The objective has to be to restore normalcy, kick-start the economy, start schools and ensure people’s well-being.
• Bridging Human Resource Gap: Engaging medical students, phlebotomists, paramedics and pharmacists can be rapidly and reliably trained to administer vaccines, will bridge the human resource gap.
• Hybrid Financing Policy: India will need a hybrid strategy, where the majority of the population (economically challenged) is vaccinated for free publicly while allowing private markets to operate for rich people.
• Effective Communication: A good communication strategy that envisages removing myths associated with Covid-19 vaccine should be science-led, involve regular communication, utilise respected community leaders to widen reach, and clamp down on the spread of misinformation.
• Need For Vaccine Certification: To resume normalcy and allow free movement of people, every country will need an internal set of protocols regarding proof of vaccination that is interoperable with norms elsewhere.
• Strengthening Vaccine Supply Chain: Enhancing Electronic Vaccine Intelligence Network (eVIN) system will enhance real-time information on vaccine stocks and storage temperatures across all country’s cold chain points. 
CONCLUSION : 
Vaccines are our only lifeline. They should be freely available and accessible to all, not only to the privileged few.

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