Are the reasons Modi gave for his vaccine policy reversal valid?

At 5 pm on June 7, prime minister Narendra Modi made a televised address to the nation to announce a u-turn of his Covid vaccine procurement policy. That earlier policy (known as the Liberalised and Accelerated Phase 3 Strategy) was detailed in a press release on April 19 and announced in the last prime ministerial address on April 20. It was criticised as “political and perverse” and as an attempt at “centralising credit and federalising blame”.

From July 1, states will no longer be tasked with the responsibility of procuring vaccines for Indians aged 18-44 out of their own meagre budgetary resources. The central government will do all the public procurement of vaccines and supply stocks to states and union territories; every Indian above the age of 18 will be eligible for free vaccination. However, there will still be a provision for privately funded vaccinations. Hospitals can buy 25 percent of the vaccine doses produced and supply to paying citizens with an add-on service charge of Rs 150.

The policy u-turn, welcome though it is, raises fresh questions because of the justification given for it.

First, why is it a welcome u-turn?

Most governments dislike policy reversals, popularly known as a u-turn. If nothing else it suggests that ministers and their policy advisers made a mistake and that their critics were right. But genuine mistakes are often made and on such occasions the right thing to do is acknowledge the error and reverse the policy.

In the case of vaccine procurement, the Indian government neglected to order vaccine supplies from even its own manufacturers until rather late in the day. No one knows what orders were placed, when, with whom, and for how much stock. These are questions that even the courts have been asking in response to public interest litigation. On June 3, for instance, the Supreme Court, describing the May 1 policy as “arbitrary and irrational”, demanded that the government provide answers to a long list of questions.

Criticism of the Phase 3 policy came from politicians as well. Former finance minister P Chidambaram of the Congress party questioned the financial wisdom of asking states to compete with each other to procure their own vaccines, even for 50 percent of the total procured.

Tamil Nadu’s finance minister P Thiaga Rajan was even blunter. He made the obvious point that the central government’s allocated budget of Rs 35,000 crore for the vaccination programme came ultimately from the same taxpayer who would pay for the vaccine whoever did the procurement. It made sense therefore to “procure vaccines on behalf of the people in the most efficient manner possible”.

Particularly hard-hitting was the criticism from former Reserve Bank of India governor Raghuram Rajan in a wide-ranging interview with Karan Thapar. The government had shown a singular inability to learn from its mistakes, he said, adding, “The failure to recognise our failures leads to the conditions for future failures.” He was clear that the central government had both the responsibility and the clout to “take the lead on procuring vaccines and investing in our vaccine producers”. Many vaccine producers “would not want to deal with individual states”, he said, and to force state governments to compete with each other to buy vaccines would merely push up prices.

Second, if the u-turn is welcome, what new questions does it raise?

If a policy reversal was justified, then the government would have been well advised to simply put out a press release to acknowledge that the earlier policy was causing difficulties, announce the new arrangements, and put the health minister up for a press conference to explain the decision.

Instead, by making a drama out of a policy mess and making it the subject of a major and much-heralded prime ministerial address to the nation, the government raised new questions.

For a start, instead of simply acknowledging the earlier mistake, the prime minister sought to explain the reasoning behind the April policy by which states were given procurement and financing responsibilities. This is always a mistake because it makes you look weak, indecisive and afraid of owning up to an error. That earlier policy was in response, the prime minister said, to demands from various states that they be allowed to share in the heavy lifting; that it was wrong for the central government to be deciding everything. And so in consultation with state health and chief ministers it was decided to allow them to procure upto 25 percent of the vaccines produced in the country. This is clearly a post-facto explanation of convenience.

There were indeed criticisms of the micromanagement by the Modi government. State health departments, it is true, did indeed ask for greater operational freedom to decide the mode of delivery of vaccines into people’s arms. Maharashtra, for example, wished to offer door-to-door vaccination for particular sections of its population but the central government was “not in favour”, according to the prime minister’s principal secretary, PK Mishra. The insistence on CoWin-based registration system was another cause of friction but with its penchant for app-based tech solutions the Modi government stood adamantly firm.

It was disingenuous, at the very least, for the prime minister to present these complaints as a demand from states that they be allowed to use their overspent budgets to procure vaccines in their own right.

Even if we posit that state and union territory governments were chomping at the bit to go out and buy vaccines with money they did not have, the question still remains: why did the Modi government give in to those demands? Especially if the union health minister and the prime minister did not agree? Did the central government refer the question to Niti Aayog or to the National Expert Group on Vaccine Administration for Covid, chaired by VK Paul? After all, this committee clearly took the view back in August 2020 that procurement of vaccines should remain a matter for the central government. Specifically, the committee “advised all the states not to chart separate pathways of procurement”.

The question no one is willing to answer is whether this committee had changed its mind between August 2020 and April 2021 and approved the policy of dual procurement that the prime minister announced in April. It leaves the distinct impression that the government is now floundering to find someone to blame for its vaccine policy fiasco.

Furthermore, the prime minister resorted to his usual tactic of castigating the record of previous governments going back five or six decades. Given that the coronavirus pandemic was a 2020 phenomenon this was so obviously a sign of desperation that any good adviser would have counselled against including it in his address.

A specific point that he made is worthy of a fact-check. For the generality of vaccination programmes, he stated, the coverage achievement until 2014 was a mere 60 percent, a matter that he claimed was “of great concern” to his government when it came into office. It would have taken 40 years, he thundered, if improvements in coverage had proceeded at the pre-2014 rate. That is why, he claimed, his government had launched Mission Indradhanush to bring it up to 90 percent.

There is no delicate or polite way of putting it but this is clearly false. Had the text of his speech been circulated in advance within the government, the mandarins in the health ministry would have corrected this factual error.

A June 2016 paper in the Bulletin of the World Health Organisation authored by Indian WHO and Unicef officials stationed in Delhi and a civil servant from the ministry of health reported as follows: “Between 1999 and 2013, estimated national coverages tended to gradually increase: from 74% to 91% for bacille Calmette–Guérin vaccine; from 74% to 90% and from 59% to 83% for DTP1 and DTP3, respectively; from 57% to 82% for the third dose of oral polio vaccine; and from 56% to 83% for the first dose of vaccine against measles.”

In any case, criticism of India’s record on immunisation performance going back decades was not relevant to the present problem of Covid vaccines, nor was this the most appropriate time to open that debate. At best, from a narrow partisan point of view, it was a diversionary argument to suggest that previous governments of a different political persuasion were not all that successful with vaccination programmes either.

Be that as it may, that diversion into a general discussion of vaccination programmes at least confirmed that the prime minister understood the concept of coverage rates and the importance of setting a target for the percentage population to be vaccinated. However, and not in the least surprisingly, when it came to presenting India’s record thus far with the “two Made in India vaccines that the nation launched within a year”, the prime minister reverted to something we have grown accustomed to – he referred to the 23 crore doses, repeated for emphasis, that had been given so far. He did not deign to acknowledge that these 23 crore doses, impressive as the number may be, really amounted to some 6 percent of the adult population getting both doses and a further 17.5 percent receiving the first dose.

To conclude, the policy change is a welcome course-correction but by making a drama out of a crisis, the Modi government has confirmed the suspicion that its vaccine policy is a shambles.