Black market

REASON:

The main reason for increasing demand for Covid-19 vaccine in

black market is attributed to the state government’s decision to
complete administration of the second dose of vaccine to people
aged above 45 years on priority basis before starting the first dose
of vaccine for people aged between 18 and 44 years. However,
given the surge in the number of Coronavirus infections and the
resultant deaths, young people are increasingly becoming
panicked. As the majority of them are either studying or at work,
they prefer to get the jab by any means and at any cost, assuming
that they will be safe from infection.

On the other hand, Covid-19 vaccine is also getting misused as

health officials are succumbing to the pressure from local
politicians and other influential persons to allow administration of
the jab to youngsters despite state’s clear direction to optimise the
available doses of the vaccine by giving to the people aged above
45 years as a second dose only. Some people in the guise of
healthcare workers and frontline workers also got the jab with no
bar on their age.

SOLUTION:

The government will track coronavirus vaccine shipments once the vaccines
are ready to prevent black marketing of COVID-19 cure. The government
has said it will procure COVID-19 inoculations centrally and shipments will
be tracked in real-time to make sure that they reach directly to those who
need them the most, and there is no black-marketing.
Politics of vaccination & State and central dispute:
Many months later than would have been wise, the Union Cabinet has taken steps to
increase the supply of vaccines. Last week, it announced a new set of regulations
governing the third phase of the vaccine rollout. These included the opening up of the
private market in vaccines; allowing state governments to purchase vaccines directly; and
allowing all those above 18 access to vaccines through channels other than the existing
one supervised by the Union government. That channel will have the right to half the
vaccines produced, and it will pay the concessional rate that had earlier been agreed upon
between the government and the two vaccine producers, Bharat Biotech and the  Serum
Institute of India.  It will continue to be open to all those above 45. In the time since then,
the two manufacturers have announced a price schedule. While vaccines will continue to
be available to the Union government’s channel at Rs 150 per shot, state governments
will pay a uniform, higher price — Rs 400, in the case of the Oxford vaccine
manufactured by SII — and the private market will pay a yet higher price of Rs 600. For
Bharat Biotech’s Covaxin, for which manufacturing is more difficult to scale up, the
prices will be Rs 600 for states and Rs 1,200 for private hospitals.
It is unfortunate that it took the explosive second wave of the pandemic within the
country, which is now ravaging Delhi and the north and threatening many other states, to
force the government’s hand. Even so, it is welcome news. This move has, however, been
attacked by several stakeholders, including the leading opposition parties. It is important
to try and disentangle what aspects of their criticism are fair and what is mistaken.

There are good reasons to suppose, for one, that the opening up of purchases to states is a
clever political ploy rather than a well thought out plan. The Union government’s political
reaction to the raging second wave has been to dump responsibility for it on the states.
Shortly it will also be able to say that state governments that are not buying vaccines are
the problem, thereby evading accountability for its failure to enable the production or
manage the purchase of enough vaccines for a speedy rollout. Meanwhile, federal tensions
will escalate. Some states will find themselves short of money, and, unlike the Union, will
not be easily able to tap the capital markets. Other states will seek to strong-arm vaccine
producers or even waylay shipments of completed vaccines. This anarchy has already
been observed when it comes to the production and transport of medical oxygen, and the
Union government has let it happen for whatever reason. It would be far better for the
Union to up its own purchase of vaccines, if necessary at a higher price, and distribute the
additional sum between states with a transparent and public formula. If that logical
formula has not been followed, then most believe the only reasons could be political. If
so, it is unfortunate that, even at this stage in the pandemic, such calculations are still
influencing policy.

That said, the arguments being made by the opposition and others against the private
market also do not stand up to scrutiny. Many have argued that most other countries do
not have a private market for vaccines, and all of them are available free. But these
arguments cannot be applied to India today. First of all, there is the problem of past
actions by the government. If the government had paid enough to begin with, or if it had
made serious advance purchase commitments that allowed the vaccine producers to
mobilise necessary investment, then it is possible to imagine more free or subsidised
vaccines such as are available in developed economies.

Vaccine pricing:

1) The Centre on April 19 loosened the eligibility criteria for COVID-

19 vaccination and allowed private manufacturers like Serum
Institute of India or Bharat Biotech to have greater flexibility in
fixing prices for their vaccine output.

From May 1 onwards, state governments and private hospitals will be able
to procure vaccines directly from manufacturers at the price that the latter
choose to set.The Centre has, so far, not placed a cap on what this price can
be. In addition to the amount set by manufacturers, other factors like GST
and transportation costs may be added to the final price tag of a particular
shot.

In the meantime, the central government will continue its free vaccination
drive for those above 45 years, healthcare workers and frontline workers.

2) SII was selling the first 100 million doses of Covishield to the
Central government for Rs 150 plus GST. This means that the Centre
was paying Rs 150 and GST for each dose of Covishield it bought
from SII.
Initially, it was thought that state governments would alone have to buy
Covishield from SII for a price of Rs 400 and GST while the Centre got it
for Rs 150 + GST.

However, as SII chief Adar Poonawalla clarified to CNBC-TV18, SII would

now begin selling Covishield to the Central government at Rs 400 too and
no such disparity would be there. The ‘Rs 150 plus GST’ tag was only for
the initial contract for 100 million doses.

3) The Union health ministry had announced a new policy to be adopted in the third of
the inoculation drive, wherein states were given the responsibility to procure and
administer the vaccine to people in the age group of 18 to 45.
All adults will be provided free anti-Covid jabs from Monday as the central
government revises its ‘liberalized and accelerated' vaccination policy.
As per announcements made by Prime Minister Narendra Modi on 8 June, the Centre will
now buy 75% of vaccines and give them free of cost to states. “No state government
would be spending anything for vaccines. Till now, crores of people got free
vaccine; now the 18+years segment will be added to this," PM Modi had said.

importance of covid vaccine Economic

recovery:

The finance ministry said that quickening the pace and coverage of vaccination is

critical to helping India heal and regain the momentum of economic recovery.

It further said manufacturing and construction activities are expected to experience

a softer economic shock in the April-June quarter of the current fiscal year due to
state-imposed restrictions.

“The onset of the second wave of Covid-19 since mid-February 2021 and localised or
state-wide restrictions adopted to combat its spread, have posed a probable
downside risk to the momentum in India’s economic recovery in the first quarter of
FY22,” said the finance ministry’s department of economic affairs (DEA) in its
monthly economic review for May.
It added that the economy was still recovering from last year’s supply and demand
shocks. The report, however, emphasised that India’s second wave situation has
been improving lately with a continuous decline in 7-day average of active cases
since May 13. Data shows that the second wave reached its peak of 7-day average of
daily new cases around May 8, with the pace of decline being as fast as the rise. The
daily case positivity rate has plummeted sharply from 24.9 per cent in early May to
3.6 per cent as on June 2. This is below the World Health Organization (WHO)
standard of 5 per cent.

High frequency indicators in real and financial sectors like power consumption, E-
way bills and foreign portfolio investment (FPI) flows witnessed a slight uptick in the
second half of May 2021.

However, sequential slackening was observed in eight core industrial sectors,

factory manufacturing, steel consumption, auto sales and tractor sales. They also
include petroleum product consumption, rail freight, port and air traffic, PMI
services, highway toll collections, GST collections and UPI transactions. The report
pointed out that the intensity of the second wave could not be predicted by
epidemiologists. This led to uncertainty on the trajectory of the pandemic, as
economic activity is linked to the path of the pandemic.

"A ramp up in the pace and spread of vaccination on a war footing is critical to help
India restrain the impact of the pandemic.

Continued vigilance, in terms of pandemic preparedness, upscaling health spending

and health infrastructure, faster rollout of vaccines and vaccination; and investing in
research and development, among others, are essential to maintain the delicate
balance of lives and livelihoods, it said.

It added that continuous upscaling of India’s vaccination drive and pro-active

application of the first-wave’s management policies raise hopes that the impact of
the second wave on the economy may not be very large.

The Indian economy was expected to grow by 12-13% in 2021-22, primarily on

the back of the contraction it saw in 2020-21. But with the second wave of the
covid pandemic spreading across the country, the expected double-digit growth is
now in peril.

Vaccination in controlling COVID pandemic in India: A SWOT analysis

COVID Vaccination Strategy by India:

The massive vaccination drive initially targeting HCWs, then frontline workers followed by high-risk population is

being undertaken targeting around 300 million people in next 6 months. There is a need to analyze the rationale

for this strategy whether the economics, epidemiology, and ethics support this strategy. 

Strength:
1. Safe vaccine: Evidence available till date based on findings of a clinical trial reflected favorable safety
and efficacy data of both the currently available COVID vaccines. Moreover, they are expected to
significantly decrease serious infection and mortality, which would be immensely beneficial in managing
the pandemic.

2. Cold chain and other resources: The storage temperature for both the vaccines currently used in India is
between 2°C and 8°C. The vaccines used in routine immunization in India are also stored in this
temperature, so maintaining a cold chain for COVID vaccines will not be much challenging. India has a
considerable number of vaccinators, other helping staffs, and logistics for running universal
immunization program, the same machinery could be utilized for COVID19 vaccination, which seems to
enhance operational feasibility. The Indian health system has experience of planning and executing
similar mass vaccination campaigns in selected areas (i.e., Adult Japanese Encephalitis vaccination),
which could be helpful in this context.

3. Building trust of HCWs: As in the first phase, all the health-care workers are being vaccinated in India, it
is expected to motivate them to continue the herculean task of managing this pandemic which they are
doing for the last 1 year. This may also be done to see that the HCWs are in a position to handle
“second wave” scare due to the present or newer strain of SARS-CoV-2 that is being played in the
public domain.

 Weakness:

Effectiveness and safety

Decision to introduce any vaccine to a large segment of population should be taken after ensuring its

safety beyond reasonable doubt. History has revealed adverse consequences of the 1976 swine flu

mass vaccination program in the USA which had to be halted, which was criticized as being

overenthusiastic decision, resulting in a large number of adverse event following immunization (AEFI)

in the form of Guillain–Barre syndrome.[18] Till date, enough evidence is not available on the efficacy

and safety of COVID-19 vaccines when introduced to a large population. Certain subpopulation were
exempted from the trial, such as pregnant and lactation women, children <18 years,

immunocompromised population, and >65-year-old population. Hence, safety and efficacy related

information are absent for this subpopulation. Unfortunately, they are major vulnerable population in

relation to mortality and morbidity due to COVID-19. Further, CDSCO has given permission of two

COVID 19 vaccines for restricted use on emergency situation in India, but more clarity is expected as

to what are the “restrictions”. The data related to trials are still not available in the public domain.

AEFIs need to be stringently monitored and reported in Co-WIN app so that single adverse event

should not get missed. The pooled information on safety obtained from the first phase of vaccination

should be made available in the public domain, which could guide decision-making by future

beneficiaries. Further, as HCWs and Frontline workers are being vaccinated in the first phase in India,

and they are predominately in working age group, data on AEFI obtained from them may not

represent that of the general population. Rare but serious adverse events are not known till date, as

they could only be exposed when the vaccine is being administered to a large population. There

should be transparency in reporting AEFI and that should be made available in a public forum at a

regular interval.

Economic sustainability

The costs and benefits of adding the COVID19 vaccine as well as its potential short- and long-term impact on

national health budgets need to be considered before taking a decision. A standardized economic evaluation

should include affordability of operational cost, potential funding gap, and prospects of financial sustainability. A

cost-effectiveness analyses need to be carried out to ensure that cost-effectiveness ratio is low enough to

introduce it.[19] As per the WHO's Commission on Macroeconomics and Health considers, a cost/disability-

adjusted life year averted of less than three times the gross national income per capita of the country is “cost-

effective” – that is, a worthwhile investment. This criterion could be useful for taking a decision.[20] No such

information is made available by the authority in this respect. A huge cost is being incurred for this vaccination

drive, which may possibly be better utilized for health system strengthening.

Prioritization for vaccination

Enough vaccine for the entire population may not be possible in the near future, and a prioritization system is
required to decide who should be vaccinated at the earliest. A scoring system may be developed and used,

considering age, area of residence, comorbidity, and immunity level into consideration. The vaccination drive is

not being guided by results of seroprevalence studies which have been done. Vulnerable people residing in low

prevalence regions could be prioritized for vaccination.

Opportunity:
 Political commitment and felt demand: The COVID19 vaccines currently introduced in
India for HCWs are being produced indigenously, so it will be economically beneficial for
the country to administer it to a large segment of population. The resources available for
vaccine production and administration seem to be sufficient because there is a strong political
will. Moreover, there is a strong demand from the provider side for vaccines

 Innovation and improvisation: India's success in developing and implementing COVID19

vaccination will showcase India's global leadership in health. Use of digital platforms like
Co-WIN application for web-based monitoring of the vaccination drive is commanding. The
vaccination and AEFI can be strictly monitored through this app, thereby enhancing
transparency of the campaign. It will generate a robust database, which will guide future
decision making
 Vaccine diplomacy: As India is helping other countries in supplying vaccines it will
create an opportunity for the country to enrich the international relationship and assume
global leadership in this crisis.

 Threat:

Efficacy of vaccine against a new strain of COVID-19

New strains/subtypes of COVID19 have been reported from the UK, USA, and some other countries. Existing

evidence is insufficient to comment whether the currently used vaccines are effective against those strains.

Distribution of vaccines

Equitable distribution of vaccines needs to be ensured so that the most vulnerable population could get the

vaccine at the earliest. Inequity in distribution among nations, states, and territories could lead to adverse
consequences, which is pointed out by the WHO in a recent press report.[25]

Poor social mobilization, risk communications, and advocacy activities

From the beginning of this COVID-19 pandemic, it has been witnessed that very less attention has been paid on

risk communication, leading to social isolation and discrimination of COVID patients, community resistance

toward testing, etc., It is of utmost importance to carry out intensive risk communication and advisory activities to

make people aware who actually require it and how much protection it can give. In due course of time, the

demand of vaccine might keep on decreasing. Further, acceptability of vaccine for the general population is also

questionable. History revealed poor utilization of flu vaccine introduced after H1N1 pandemic.[26] Hence, a

preintroduction acceptability survey among the general population is recommended. Underutilized vaccines may

create an economic burden for the society.

Vaccination certificate

Although vaccination against COVID19 is voluntary, generating a certificate after vaccination may point to a

purported design to force people to adopt vaccines as it may be mandated for travel and other businesses.

Conclusion:

From the above discussion, it can be commented that rollout of COVID-19 vaccination campaign needs to be

guided by the evidence generated by the existing surveillance system. Defining and enlisting the target

population, confirming safety and effectiveness, and ensuring adequate supply and cold chain are essential

prerequisites before taking this vital decision of vaccine rollout for the general population.