The liberalisation of India’s vaccine strategy comes at a time when healthcare systems have been stretched to the limit, and states are being compelled into reconsidering draconian measures like night curfews and weekend lockdowns, as COVID cases skyrocket.

The move towards universal vaccination could provide a greater impetus to the government’s goal to inoculate as many as 300 mn people by August. But the decision has come with its fair share of criticism. Opposition leaders expressed objection over the differential pricing of the vaccines which could hit state exchequers, adding to their stressed finances. They believe both the Centre and the States should pay the same price for the vaccine. There are also concerns about overcharging states for the vaccine, which could lead to profiteering, and that in the absence of a price ceiling for vaccine doses, it could encourage unhealthy price bidding, which could be disadvantageous for states with limited resources. The onus of procuring the vaccines and providing them to all states equitably and transparently was also placed on the Centre.

Interestingly, states will also be given the option to set the age bar for those being vaccinated at their discretion. It may be recalled that the call to vaccinate all adults had been made by stakeholders in the healthcare policy space as early as January when the nationwide vaccination drive kicked off. The Centre’s Integrated Disease Surveillance Programme (IDSP) reveals that around 70 per cent of patients hospitalised in both waves of COVID-19 fell into the age bracket of 40 and over. The report also said that younger people in the age bracket of 0-39 years were slightly more vulnerable in the second wave as compared to the first, while the hospitalisation of those between the ages of 20-39 had risen from 23.7% to 25.5%.

While frontline and healthcare workers remain a priority for most states, a one-size-fits-all solution cannot be applied when it comes to the vaccination – as in who gets vaccinated first and why. States, where the transmission is accelerating, must incorporate inoculation protocols, considering potential exposure levels of those seeking vaccines. For instance, those working in government offices, banks, petrol pumps, supermarkets, transportation services, and delivery of essential goods, and even migrant workers have a higher exposure to the public, as compared to individuals who might be telecommuting. States might be further burdened if low-risk individuals including millennials begin making a beeline for shots, creating a shortage of vaccines for high-risk individuals.

On the upside, the liberalisation of vaccines is a step in the right direction, as decentralisation implies greater control of vaccine distribution in the hands of respective states. Vaccine makers in India are currently permitted to sell 50 per cent of their production to states and hospital chains at a pre-determined rate. The apportioning of the vaccines between state governments and private enterprises is also being done on a 50:50 basis. In Tamil Nadu, it was announced on Thursday that vaccines would be offered free to all adults, a decision that could place an additional burden of around Rs 800 cr on the state.

The reality is that once vaccines become available in the open market, the well-heeled can opt for a shot of their choice. However, it will be testing times for state administrative heads who have to ensure that the price points at which vaccines are offered become competitive, and those who are unable to afford the vaccine are not left out in the mad rush to vaccinate that will ensue on May 1.