The Centre Shows How To Profit From A Pandemic By Increasing Vaccine Inaccessibility

The ongoing vaccination drive against COVID-19 has singularly been the most disorganised and irresponsible vaccine drive India has ever witnessed. To call it anything short of a joke is to do a disfavour to the considerably undercounted yet fairly high recorded number of lives lost so far due to COVID-19. In the face of it all, we cannot pretend that India’s vaccination drive has been anything other than a class collaborationist project between a fascist central government and billion-dollar private institutes insistent on profiteering. 

Right from 2020, we could sense that the central government was privileging political gimmicks over public health. After the pot banging and lamp lighting episodes, another important indication came in July 2020, when the ICMR wrote to various medical institutions demanding that an indigenous vaccine be made available by August 15, 2020. Such a prod was absurd, given that Covaxin had only just gotten a nod for human trials and the Serum Institute of India (SII) was at least three months away from starting its phase 3 trial for the Oxford-Astrazeneca jab (marketed as ‘Covishield’ in India). The ICMR letter was clearly sent because the central government hoped to stoke nationalist sentiment which would help them in several state elections in 2021. Four states and one union territory were scheduled to go into elections within a year, in early 2021.

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On January 3, 2021 both Covishield and Covaxin received conditional emergency use authorisation from the Drugs Controller General of India. There was barely enough data to recommend Covaxin for authorisation but again, nationalist sentiment triumphed over science. Between January and March 2021, the Indian government exported some 6.6 crore doses to 90 plus countries under its Vaccine Maitree initiative, created as a response to China’s export of vaccines. This information is not being provided to make a claim that vaccine manufacturing nations should keep doses to themselves but to point out how flawed India’s approach to vaccination has been to start with.

Vaccine Maitree is now falling apart as the USA, the UK and the EU all demonstrate less than enthusiastic responses to the export of vaccines to India. We cannot ignore the advantages the Global North nations are exacting from the Global South ones, even as the Indian government remains structurally oppressive. Shutting down India’s vaccine export has now hit Global South nations, particularly countries in Africa, hard. Vaccines should never have been a weapon at the hand of nationalists and capitalists. Moreover, vaccines should never have been patented in the first place.

Not only has the Indian government shown absolute inefficacy at the export and import of vaccines, but also changed policy several times on the gap between doses. In the first phase of the vaccination process, the second shot of the Covishield vaccine was to be administered 4-6 weeks after the first. However, hospitals reportedly often asked recipients to report 3 weeks after the first shot. This was increased to 6-8 weeks later. As of May 13, 2021, the suggested gap between the two doses of Covishield has been increased to 12-16 weeks. While some scientific evidence exists that the efficacy rate of the Oxford-Astrazeca vaccine can be increased by administering the second dose at a gap of 12 weeks, there is absolutely no evidence in favour of administering the second dose after 16 weeks. This has been done to obfuscate a nationwide vaccine shortage which has only been exacerbated with the central government’s policy of opening up vaccinations for the 18-44 age group at private facilities.

Moreover, state governments are buying vaccine doses at a higher price than the central government and are competing against each other for the limited number of vaccines made available through Serum Institute of India and Bharat Biotech. Private vaccination centres are buying at an even higher level and are charging a bomb to the masses eager to save themselves from the pandemic.

In West Bengal, where I live, the number of first doses administered so far has been 89,16,777. In contrast, the number of second doses administered is 36,45,913 till May 14 (data procured by the author from Arogya Setu app). This means that there is a lag of at least 52 lakh between people who have received both doses and those who have received only the first. At least 52 lakh people, most of them overdue for the second dose (assuming the initial Covishield gap of 3 weeks, and considering first dose administration has all but stopped) are waiting in line to get the second jab. The SII and Bharat Biotech are sending doses in the early lakhs. At this rate, it will take months to even clear this lag, even with first doses stopped. The West Bengal government, emerging freshly from elections, has made a promise to vaccinate everyone for free. But so far (as of May 13) it has not moved ahead with regards to importing vaccines for all. 

Healthcare staff at state hospitals are helpless and are doing what they can with limited resources. Long queues of people fidget at state hospitals, waiting for their second vaccine dose even as dozens of corpses leave the same premises. The biggest concern at the moment is to prevent the spread of infection at vaccine sites. In this, state hospitals have done a better job by enforcing physical distancing by means of police surveillance. Many ward healthcare centres have failed at doing the same in Kolkata. Those ideologically opposed to the usage of police for control and surveillance (like this author) do not see how else can physical distancing be enforced when hundreds are queueing up from 3 to 4 am to receive a vaccine dose at 10 am. In such situations, tempers are bound to rise and often physical fights break out. To make matters worse, there are reports of persons trying to use their connections to skip lines, something the police do not seem to be very good at preventing (one wonders why).

At this point, receiving a vaccine is a function of privilege. Disability rights groups have demanded doorstep vaccination for persons with disabilities. Even though the UIDAI has stated that the Aadhaar card is not mandatory for availing any COVID-related services, lakhs of people in the country, such as trans queer persons, have in reality been denied vaccination already due to the absence of documents. High migration and immigration levels among working class trans populations make it difficult for them to have access to the same large number of documents that the middle classes in India have. Moreover, barriers placed by the state in the process of self-determination of trans identity blocks many transgender persons (across classes and castes) from accessing documentation and thereby healthcare and vaccination. As long as self-determination of trans identity is not made accessible and mandated centrally by the Indian government, many trans persons will continue to be undocumented and uncounted. The same debate is likely to unfold in West Bengal soon where the government has promised to vaccinate “transgenders”.

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Vaccine centres are not open 24X7, which means that workers who cannot afford to stay at home have to stay away from work in order to get a shot. The vast majority of food and other delivery workers are unvaccinated. Yet, these workers are extremely likely to visit homes where relatively well-off COVID-19 patients are isolating. The vaccination of domestic workers, most of them women, is left at the mercy of the families they work for. Most of the domestic workforce does not have the technical expertise to register themselves on an app that malfunctions a several times a day. 

The government is well aware that its entire population is not tech-savvy but likes to pretend otherwise for insidious reasons. Access to technology depends on people’s privileged access to the English and sometimes the Hindi language, other than the obvious knowledge of the internet and smartphones. The central government’s liberalised policy follows a logic of capitalism that dictates that access to vaccines for the poor is limited while access to vaccines for the rich is opened up as much as possible through private healthcare facilities. This would allow vaccine manufacturers to make enough profit through the private sector, even as states pay a price higher than the centre, bringing manufacturers further profit. This, despite the SII receiving grants from the centre to expand manufacturing and Bharat Biotech receiving the same for vaccine development. 

To add to our woes, private hospitals are charging people a fortune for treatment. Some patients report paying between 30-40 lakhs for two weeks of hospital stay. The state healthcare system is crumbling and the central government’s much trumpeted nationalistic and liberalised policies have completely failed. This current COVID crisis in India is as much a natural disaster as a crisis brought on by aggressive neoliberalism. It goes to prove why defunding government-sponsored healthcare in favour of a profit-based model is a terrible idea which ultimately results in the loss of lives.

Just when we needed a socialist healthcare system, we have been served arch-capitalist vaccine princes on a platter. One can only hope that there is a mass epiphany against the privatisation of healthcare and health research. But such an epiphany will not bring back the dead who are floating down the Ganga and Yamuna rivers, partially cremated and discarded as loose change in a billion-dollar profit machine.

Featured image source: The Daily Guardian