As CoWIN glitches galore, and states promise free shots for all, experts weigh in on the best course to take.
A senior citizen takes her jab at Nair Hospital. Pic/Ashish Raje
Even as technical glitches plagued the vaccine registration process of those above 18 years on Wednesday, health experts have said it is unethical to charge the public for the vaccine, especially when a substantial number got their dose free. There are also questions about how many Indians could afford to pay for the jab, and what happens if the pricing deters some from taking the second booster dose.
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Take 2nd dose within a year
Vellore-based acclaimed senior virologist Dr Jacob John said, “We must understand that the first dose of vaccination will always lay the foundation in our body and the booster dose will provide a further protective layer of immune cells. Ideally, there will be a specific period within which to take the second dose. However, virology textbooks clearly say the second dose can be taken any time within a year. So, people need not worry about missing the date for second dose if there is any short supply of the specific first vaccine that they had taken. But if someone hasn’t taken the second dose within the year, they need to repeat the full process of taking two doses. Of course, the chances of getting infected between doses will always remain.”
On pricing (Covishield is Rs 400 to Rs 600 and Covaxin Rs 600 to Rs 1200), Dr John said, “Asking people to pay for the vaccine is unethical. It is the moral responsibility of the government to give free shots. A token charge of Rs 100 or Rs 250 is fine, but anything more will scuttle the immunisation programme at the national level, as many poor citizens will not be able to pay. Today, democracy does not seem to be ‘for the people’. Some say India has become a ‘Yo-Yo culture’ — ‘you are on your own’ and the whole vaccine programme is getting affected.”
CoWIN clogged
As the booking window opened on Wednesday, the CoWIN and Aarogya Setu webpages were overwhelmed. The sites were reportedly down for several hours. The severity of Wave-2 had propelled the need for an early launch of Phase 3 by May 1. Those between the ages 18 and 45 had to register on CoWIN and there is no provision for walk-ins. The official sites will allocate either a state vaccine centre (at Rs 400 or Rs 600) or offer a private centre appointment (at Rs 600 or Rs 1,200).
“Under normal circumstances, large pandemic mitigation plans are designed in phases, with clear transition from the completion of one to the start of the other,” said Dr Subhash Hira, health advisor to several UN and Indian health agencies.
“But here, Phases 1 and 2 are still incomplete because new scientific data emerging on AstraZaneca vaccine showed a gap between doses was desirable and was increased from four weeks to 10 to 12 weeks. This provided logistical relief. Beneficiaries of the first two phases should be reassured that the free vaccination policy will not be changed mid-way. It is unfortunate that the insurance industry’s role in covering Covid treatment and vaccination costs has been totally forgotten. The 18+ youth of middle and lower socio-economic classes will find it very difficult to pay for two shots.”
India produces around 65 million vials per month of the two vaccines. The Centre will buy approximately half of this to cater to the over-45 age group. Those below 45 years of age need to pay anywhere between Rs 400 to Rs 1,200.
Dr Wiqar Shaikh, professor, Grant Medical College and Sir JJ Group of Hospitals, said as per UN data, 28 per cent of India’s population are classified as being “below the poverty line”, 37 per cent (50.2 crore) poor, and 14 per cent (18 crore) lower-middle class.
“The current pricing will make the vaccine unaffordable for approximately half the population above 18 years,” said Dr Shaikh. “This is unacceptable for a poor country like India.” Several states have, however, announced that vaccines will be free for all. “This is exactly what one would have expect from the Centre,” he added. “With India adding more than 3.5 lakh cases daily, it is imperative that we have a free, robust vaccine programme for the country.”
Preparation in full swing
An official in charge of a centre in NMMC said they have been directed to continue with their plan for May 1. “We have hired additional manpower and started two extra windows to the existing four. On Wednesday, most NMMC centres ran out of Covishield. Few centres that had Covaxin started administering it as the first dose. Asked about price, the official said, “We are giving free doses as per government directives.”
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