Vax plan must adhere to a clear formula to overcome disparities
PremiumStates must, on their part, provide clarity on plans to equitably distribute doses to districts and demographic groups, the experts said
The Union government’s new policy of procuring covid vaccines for states must be backed by a transparent allocation strategy to resolve potential disparities in the inoculation drive started in May, several experts said.
States must, on their part, provide clarity on plans to equitably distribute doses to districts and demographic groups, the experts said.
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About 32% of all doses have gone to the seven richest states since India adopted universal adult vaccination on 1 May. These states make up 26% of the country’s adults. The poorest seven received 30% of the doses, despite having 39% of the adults, according to a Mint analysis.
The period has been marked by an open-market policy for vaccines. However, the failure of most states to procure enough vaccines has forced a policy reversal that comes into effect on 21 June. Now, the Centre will procure 75% of the doses and distribute it to states.
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“Allocation should be fair, transparent, and predictable, so that states can implement vaccination campaigns more effectively," said Krishna Udayakumar, director of US-based Duke Global Health Innovation Center.
“State and national leaders should pay special attention to equitable distribution, especially to vulnerable and disadvantaged populations," Udayakumar said. Proactive tracking and demographic- and region-wise reporting of equity indicators should be done, he said.
The Centre said it will allocate doses on the basis of the population of the states, disease burden and vaccination progress. Any wastage will be penalized, it said. States will get prior information of supply so that they can allocate doses to districts accordingly.
However, states have been asked to prioritize healthcare and frontline workers, people in the 45+ age group, citizens whose second dose is due, and the 18-44 group.
States may need more flexibility to decide how to use their quota, said Rajib Dasgupta, professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University. “The Centre will have to make it very clear what it will supply to states, at least monthly, for a meaningful planning cycle. States will have to be clear on what they need and what they will do with the allocated doses," he said.
The Centre should also prioritize states where a larger proportion of the vulnerable population has not been vaccinated, said K. Srinath Reddy, president, Public Health Foundation of India.
However, some disparity may remain as 25% of doses will still go to the private sector, which was a major reason behind the gaps since May, according to experts. “The disparity arise predominantly because of open markets," said Akancha Singh, a doctoral fellow at the Mumbai-based International Institute for Population Sciences. “Richer states are able to procure more vaccines because of their resources. Their hospitals are also better able to procure vaccines and citizens, having higher purchasing power, were willing to pay for them," Singh said.
Even with fair allocation, vaccination in poorer regions may suffer the effects of lack of infrastructure and human resources, Reddy said.
The WHO last year highlighted “national equity" as one of the values for vaccine allocation. It is crucial to consider that as India prepares for faster immunization, Dasgupta said.
A major problem for states has been resolved with the Centre deciding to procure vaccines. The next test is ensuring that people are vaccinated
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