India’s new Covid-19 vaccine policy

India will dramatically expand its vaccination coverage from May 1, including for everyone 18 years of age and older. The fourth phase of the mass inoculation program incorporates several changes in vaccination policy.

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What are the changes in procurement?

In the first three phases, when health workers, front-line employees and those over the age of 45 were vaccinated, the Center procured the full amount of vaccines from producers, the Indian Serum Institute (Covishield) and Bharat Biotech (Covaxin). ) and distributed it to the states. States distributed the stock to government vaccination centers, which administered the vaccine free of charge, and to private hospitals, which received Rs 250 per dose per recipient.

From 1 May, the supply will be divided into two baskets: 50% for the center and 50% for the open market. Through the second channel – India’s non-governmental – state governments, private hospitals and industries that have facilities for administering the vaccine will be able to procure doses directly from manufacturers.

What changes in distribution?

First, the basket of 50% of vaccine doses intended for states and private hospitals on the open market will be used to vaccinate those over 18 years of age.

Second, free vaccination would be available in all vaccination centers receiving doses from the Government of India – with these doses, health workers, front-line workers and those over 45 will be vaccinated.

Will private vaccination centers administer the vaccine at Rs 250?

Not. As no doses will be made available to the private sector, private hospitals will have their own rates.

So what will be the cost of a photo in a private center?

In the first three stages, out of the 250 lei charged for vaccination, private hospitals received 100 lei for the administration of the jab. As they will now purchase the vaccine at a higher price, the cost of a jab is expected to be much higher than in the first three phases.

The center said Monday that prices charged by private hospitals would be monitored. A mechanism will be implemented and vaccine stocks and prices will be captured on the Co-win platform.

Covid-19 vaccinations

States will receive doses from the center and also make additional purchases from the open market – so how will they plan vaccination sessions?

This is not yet final. However, the Center said it would be able to allocate vaccines for 15 days – which means states will know in advance that they will receive a specific number of doses in the next 15 days. Therefore, they will have both a large and granular picture of availability on and for the next two weeks.

How will the Center decide which dose to receive?

The center will allocate its 50% share to states based on the degree of infection (active cases) and performance (speed of administration). Currently, states receive vaccine doses on demand (number of registrations and walk-in vaccinations). Now, low waste will be stimulated.

Will imported vaccines also be shared between the center, states and private hospitals?

Not. The center will allow imported, fully ready-to-use vaccines to be used entirely in the non-government channel of India. Thus, if and when a foreign pharmaceutical giant brings its vaccine to India, it will be free to sell the entire stock directly on the open market at a competitive price.

Will priority be given to those who received the first dose – and whose second dose is due?

Yes. The center said the second dose of all existing priority groups, “wherever due, will have priority, for which a specific and focused strategy will be communicated to all stakeholders.”

On what basis will vaccine manufacturers decide whose sales – and at what price?

There are no guidelines yet. The center said only that private vaccination providers must transparently declare self-established vaccination prices. States were not free to negotiate prices.

Serum Institute of India (SII) announced on Wednesday the prices for its vaccine – Rs 400 per dose for states and Rs 600 per dose for hospitals. Bharat Biotech and Dr. Reddy (who will distribute the Russian shot Sputnik V) have not yet made an announcement.

SII CEO Adar Poonawalla voiced the supply of hospitals, rather than states. He believes that hospitals are better placed to carry out the vaccination exercise; In addition, states are expected to receive free supplies from the center anyway. Buying is an “option” for states and is not mandatory, he said.

“We want to sell to private hospitals, which will take care of all these states and corporations. I don’t know why there is such a hullabaloo in relation to every state that complains about this price, because, look, it is their choice, it is not their constraint “, Poonawalla declared in an interview given to CNBC TV-18 on Wednesday.

And how will producers divide their share for states? Which states will receive the first and others?

Again, there is little clarity about the mechanism that manufacturers will use to decide between states placing orders. And in the absence of a formula or guidelines, shifting control over private vaccine manufacturers will mean that there will be no social basis for allocating vaccines to states, according to Professor R Ramakumar of TISS.

“It is possible that only commercial considerations predominate. States will compete for a fixed amount of vaccines, which will continue to be in excessive demand, “he said.

“Private companies would give priority to selling at Rs 600 per dose and not Rs 400 per dose. This means that selling to states will be a lower priority for vaccine manufacturers than for private hospitals. States may be squeezed as a result, “he said.

That being said, however, it is likely that producers will follow the center’s lead in setting priorities – and burdensome states will be put in front.

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Could it be first come, first served?

It would depend on how many states enter into agreements with manufacturers and the availability of doses. Wealthier states, which have the capacity to procure large quantities, and states with large private hospital networks, are expected to receive a higher proportion of doses on the open market.

What other countries in the world have allowed vaccines to be sold on the market?

None so far. The main reason is that vaccines used worldwide have only received an emergency use authorization (EUA) – none of them have yet provided sufficient evidence of their safety and effectiveness to receive full regulatory authorization.

Under normal circumstances, it could take 8-10 years to develop, test and receive approval for a vaccine. But in this extraordinary pandemic scenario, development, clinical trials and approvals have been accelerated to ensure that people have a chance of escaping severe illness or death.

“No other country is doing this (open market sale) yet, as all these vaccines are still under restricted or emergency use and have not yet been fully licensed in their countries of origin, except probably in Russia “, vaccine expert and professor of Christian Medical College Christian Gagandeep Kang said.

Given the public health priority of vaccinating a large segment of their population, several countries, including the United States, the United Kingdom, Japan, France and China, offer free vaccines to citizens.

Once approximately 600 million new beneficiaries become eligible on May 1, when and where will the necessary stockpiles of vaccines be purchased?

To date, about 130 million photos have been taken in India and more than 111 million people have not yet received a second dose. Depending on how many people in the priority groups still receive the second blow until May 1, the country may need more than 1.2 billion doses of vaccines. Given the country’s current production capacity and the delay in the introduction of foreign vaccines, supply will certainly be lower than demand.

SII will give priority to Covishield doses for India “at least” for the next two months, which means that a potential supply of between 120 and 140 million doses will be available for the country between May and June. However, the company expects to start delivering for the open market only in the third or fourth week of May.

Sputnik V is expected to begin arriving in the country by the end of May. Reddy’s Laboratories has an agreement to distribute 250 million doses of Russian vaccine, but it is unclear how many of those doses may become available to India. The company is still in talks with the government about the price and number of doses needed.

It is unclear whether Bharat Biotech will be able to supply for the open market from May 1. Otherwise, the company could supply about 29 million doses in all states throughout the month. The company announced an expanded capacity of approximately 700 million doses per year (approximately 58 million doses per month).

It is also unclear how many doses J&J, which intends to conduct linkage studies in the country, can provide India. This process itself can take several months.

Pfizer said it intends to supply only to the government, but it is not known when an agreement can be reached and how many doses it can offer.