I had blogged earlier here and here arguing against relying on private sector to contribute meaningfully to India's Covid 19 vaccination campaign.
One of the biggest disappointments of India's Covid 19 efforts has been the private sector's response to the vaccinations it was granted to distribute. While the numerous failures of the government are castigated and mocked, hardly any opinion maker has written about the private sector's failures or the pervasive price gouging and profiteering during the heights of the pandemic. In a speech to the CII, the Union Minister Piyush Goyal called this out,
You all (in the private sector) demanded and I remember how much you all fought with me and sought that vaccination be opened up for the private sector. Today, you are not even buying those 25% of vaccines (allotted to you)... I remember one industry group said ‘I will do one crore vaccinations’ and another said ‘we will go to remote areas and do it’. Nobody has gone to Bihar, Northeast, Jharkhand and Chhattisgarh to run campaigns to remove vaccine hesitancy and use up that 25% quota.
The former Cabinet Secretary KM Chandrasekhar has a very good article that cautions against pinning excessive hopes on the private sector.
On July 22... in Andhra Pradesh, out of 3.5 million doses of vaccine allotted to the private sector, only 403,000 have been utilised, while in Tamil Nadu, out of 18.5 million doses administered, the share of private sector was only 5 per cent.
These are four issues the Government of India flagged as concerns with the private covid vaccination centres (PCVCs),
First, many PCVCs were not placing indents for the full quantity of vaccine doses earmarked for them. Secondly, even when indents were made, the required payments were not made by PCVCs. Thirdly, even when payments were made, the dispatched vaccine doses were not lifted by PCVCs. Finally, even when the vaccine doses were lifted, actual administration of doses by PCVCs fell short.
It now emerges that the Government of India have decided to scrap the 25% reservation for private sector and allow vaccines to be distributed by manufacturers based on demand. Accordingly, while private hospitals will continue to place orders, the vast majority of vaccines will go to state governments.
India's experience with Covid vaccination is the strongest case against relying on private sector to vaccinate against epidemics, in any meaningful manner.
On a related note, perhaps the greatest success till date of covid 19 vaccination is the United States. It owes this success in large measure to the Trump administration's Operation Warp Speed, perhaps one of the biggest public policy successes of recent times. Here is what the then Secretary of Health Alex Azar wrote,
Operation Warp Speed committed to funding upfront various stages of development, including testing vaccines in humans to prove they are safe and effective, as well as the manufacturing of the vaccines. We provided funding to test vaccines in large populations, and we got results faster than ever before. The vaccines produced remarkable protection against Covid-19 and were extremely safe. After studying all the data in depth, the Food and Drug Administration granted emergency use authorizations... We did not reach our stretch goal of producing 300 million doses by January, but we hedged our bets by investing in a portfolio of vaccines and had tens of millions of doses of vaccine in production by the end of January. Many governors were able to begin general vaccination programs by March, and we had a surplus of vaccine by the end of the second quarter... We demanded all clinical trials included a diverse, representative sample of participants, and the Department of Health and Human Services provided funding for an effort by the Morehouse School of Medicine to coordinate a network of national, state, territorial, tribal and local organizations to deliver trusted information to racial and ethnic minority communities.
Finally, while talking about the constraints that face the public sector in India, KM Chandrasekhar points to a much under-appreciated point,
The US, for example, under their Operation Warp Speed, liberally financed R&D efforts of private entities and placed huge advance purchase orders, thus making private research and manufacturing activity virtually fully financed and risk free. The National Accountability Office of the US had recommended such action, but would our counterpart organisation, the Comptroller and Auditor General (CAG), have adopted a similar approach? Besides, would we have the courage and the resources to provide big money to private entities in a potentially risky operation?
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