How the Centre’s disastrous decisions on vaccines cost the lives of lakhs of Indians

In July, 2021, Dr Rinchin Neema, a 41-year-old district immunisation officer posted in the mountainous Tawang district in Arunachal, trekked uphill with his colleagues for 12 hours to reach a remote village Lugthang near the border with Tibet. The steep climb on foot amidst pelting monsoon rains was slippery. But the team was resolute. They needed to reach there to vaccinate a community of yak grazers who lived in a mountainous village 14,000 feet above sea level.

They did not regard their efforts as particularly heroic. What stirred them was simply a sense of public duty. This was, after all “just another day if you are an immunisation officer in a remote place like Tawang,” Neema told The Indian Express. “In places like Arunachal Pradesh, where most people reside in remote areas, it is impossible for them to come to us. So we have to go to them… [to] the last Indian citizens.”

Just weeks earlier, on June 21, 2021, an inordinately expensive national publicity blitz, paid entirely by taxpayers, was launched with massive hoardings and posters emblazoned with the face of Prime Minister Narendra Modi appearing overnight at every street-corner and outside schools and government offices.

Each of these posters thanked Modi for “free vaccinations”. Few remembered those who actually needed to be thanked, tens of thousands of dedicated workers like Neema, many of who were until then not even vaccinated themselves, carrying on their backs vaccination equipment into forests, deserts and mountains. Most governments in the world, even the wealthiest, give free vaccines to their people. This indeed was the policy with every previous vaccine in India, be it for tuberculosis or polio.

The prime minister, on the other hand, had a great deal to atone for, to explain and to apologise for, to the Indian people, for so many mistakes, so many inexplicable delays. But there was no regret, no acknowledgement of mistakes that cost hundreds of thousands, and possibly millions of lives, tragic deaths that could have been prevented had the government planned and rolled out a massive vaccination drive in January, rather than in June.

Botched vaccine policy

Time magazine aptly describes as “mind-boggling” the failure of the Modi government to plan well in advance so as to procure sufficient quantities of vaccines well on time to enable it to vaccinate enough people fast enough to save lives, and indeed forestall much of the devastation wreaked by the second wave. “No national leader has talked so much about vaccines and done so little about it, and Indians are not the only ones paying the price for it,” Time observed.

When the second wave hit India in April, as few as 0.5% of Indians were fully vaccinated. Even by the end of May, the tally had risen only to 3.1%. India was not just unable to vaccinate any significant sections of its own vulnerable adult populations, it also was forced to rescind from its contractual obligation to export significant quantities of vaccine to poor and less industrialised countries.

Time points to the liability of this retreat. When India blocked vaccine exports to enable it to vaccinate its own citizens, it was “simply grabbing the vaccines meant for others”, thereby “threatening to wreck the global Covax programme meant to ensure equitable vaccine distribution to help poor nations, creating the risk of a prolonged pandemic for the whole world”.

When India had announced grand plans to fully and expeditiously vaccinate its adult population and export vaccines to many countries, it later became apparent that culpably (and indeed bewilderingly) it just did not seem to have first done elementary back-of-the-envelope calculations of its requirements of vaccines against the capacities of the two companies earmarked by it for this task.

It was only as late as January 2021 that the Indian government first bought only 11 million doses from Serum Institute and 5.5 million doses from Bharat Biotech, a Hyderabad-based pharmaceutical company that manufactures Covaxin, an indigenously developed vaccine (but one which did not have emergency clearance until several months later).

It then placed a demand again with Serum Institute for another 21 million doses in late-February, and then once infections began their alarming rise, in March, for 110 million doses. But, as Time notes, these were “(m)inuscule amounts, given India’s population of 1.4 billion”. By the time India awoke from its inexplicable and unconscionable slumber, it began to scour the world desperately for vaccines but there was just no significant excess capacity in vaccine manufacturing anywhere in the world.

Again, by contrast, by October 2020, Australia, Brazil, Canada, Japan, and the European Union had all placed orders for one or more candidate vaccines.

As Time recorded in May-end, Canada had “ordered enough to vaccinate its population five times over, the United Kingdom 3.6 times, the European Union 2.7 and the US twice over”. Incidentally, by May-end, when the US had fully vaccinated half its adult population, Chad had not been able to vaccinate a single person.

India’s vaccine policy from the start was marked by confusion, ineptness, inequity, and the protection of private profit over the public good. Even after swerving through many U-turns, India remained one of the few countries in the world in which people would pay for their vaccines. The policies allowed both hospitals and the two private firms earmarked by the government for vaccine production to earn profits and on occasion, as we shall see, to earn super-profits.

Planning, procurement failure

“Public investment in research and development and advance purchases, often at risk, has been critical for early access to vaccines,” Krishna Udayakumar, associate professor at the Duke Global Health Center in the US, told The Telegraph. Despite being the world’s largest producer of vaccines, India fell disastrously short of vaccines not just because it failed to plan and place orders in advance, and also because it did not invest nationally in the development and evaluation of vaccines.

By contrast, other countries like the United States and Britain made vast advance payments to vaccine makers and signed early purchase contracts with them. The US government invested about $6 billion across vaccine companies including Moderna, Pfizer and Janssen (Johnson and Johnson) as early as in July and August 2020, even while the vaccines were still being evaluated.

The British government had in May 2020 pledged 65.5 million pounds to the University of Oxford researchers for work on the AstraZeneca vaccine. The Indian government did not transfer funds to help the selected manufacturers expand capacity to meet the massive demand that it should have anticipated, nor did it place bulk orders domestically or in the global market.

“This was a botch-up – the government knew the companies’ production capacities and should have foreseen the need to ramp up manufacturing ahead of inoculations. Others did exactly this,” an epidemiologist told The Telegraph.

Vaccine pricing battle

Confronted with its very low vaccination performance, the Union Cabinet in April was forced to shed its complacency and swagger of being the world’s vaccine guru, and announced a new vaccine policy aimed ostensibly to increase the availability of vaccines.

Its revised regulations, which it called its “Liberalised Vaccination Policy”, included opening up of the private market in vaccines, allowing state governments to purchase vaccines directly and allowing all those above 18 years to also access to vaccines through private hospitals.

The Central government would have the right to half the vaccines produced in the country, and would pay the concessional rate that had earlier been agreed upon between the government and the two vaccine producers, Bharat Biotech and the Serum Institute of India. It would continue to make available these vaccines to all adults older than 45 years.

The two manufacturers confirmed that while vaccines would continue to be available to the central government at Rs 150 per jab, state governments would pay a uniform, higher price – Rs 400, in the case of the Oxford vaccine manufactured by Serum Institute – and the private market would pay an even higher price of Rs 600.

For Bharat Biotech’s Covaxin, the prices were fixed at Rs 600 for states and Rs 1,200 for private hospitals. The Opposition raised an uproar about why the same vaccines were being given at different rates to the Union and the state governments.

Amid the stink this announcement raised, Serum Institute Chief Executive Officer Adar Poonawalla then dropped the price of Covishield for the states to Rs 300, calling it a “philanthropic gesture”. Bharat Biotech followed suit and reduced Covaxin prices to Rs 400 per dose.

The April Covid-19 vaccination strategy, according to experts, allowed the Serum Institute of India to “dominate the vaccine pricing and policy and earn super profits”. It also contradicted the recommendation of the National Expert Group on Vaccination Administration for Covid favoured a single point of procurement for vaccines.

Instead, states and private hospitals would directly procure 50% of the supplies. Serum Institute manufactured the vaccine Covishield, which held about 90% of the share in vaccinations in the country.

R Ramakumar, Professor, Tata Institute of Social Sciences, Mumbai quotes a report in Quartz that the estimated production cost of a Covid-19 vaccine in India ranges between Rs 30 and Rs 80 per dose. “If this is correct,” he says, “the regulated price of Rs 150 per dose already provided a profit of 188% to 500% per dose.

At the same time, Covishield’s liberalised price of Rs 600 per dose for private hospitals provides the Serum Institute a profit of 750% to 2000%. Covaxin’s liberalised price of Rs 1,200 per dose for private hospitals provides Bharat Biotech a profit of 1500% to 4000% per dose”.

The Serum Institute pricing for private enterprises at Rs 600 per dose works out to about $8 per jab, which means that India would be paying more for a single dose of Covishield than people in any other country in the world, including the United Kingdom and the United States.

Quoting data compiled by the British Medical Journal, The Indian Express reported that the 27-nation European Union, despite its steep manufacturing costs, was paying just $2.15-$3.50 for a dose of Astra-Zenika vaccine (the same as Covishield), the United Kingdom was paying about $3, the US $4, and Brazil $3.15 per dose.

Bangladesh, according to Reuters, was being charged an average of $4 per dose for vaccines supplied by Serum Institute. Congress leader and MP, Jairam Ramesh tweeted, “Made in India & highest price for India?”

Ramakumar suggests that contrary to its protestations to the Supreme Court, the new government vaccine policy was designed to secure super-profits to the two selected vaccine manufacturers. It is noteworthy that the profits that were being reaped by Serum Institute was for a vaccine that was developed by AstraZeneca-Oxford University with 97% public funding by the UK government and the European Union.

Dismissing state governments complaints that it was unjust to require them to pay higher rates for the same vaccine compared to the union government, Serum Institute’s Adar Poonawalla said in an interview to CNBC-TV18: “I don’t know why there is such a hullabaloo over every state complaining about this price, because it is their option and not their compulsion…In effect, the states don’t really need to buy anything if they don’t want to…There are enough private hospitals to take care of each state... no state really needs to spend any of their money.”

Noted Supreme Court lawyer Dushyant Dave went so far in an interview with journalist Karan Thapar to describe the April vaccine policy as patently unconstitutional. It violates Articles 14 and 21 of the Constitution, which guarantee the fundamental rights to equality and life. He said “everyone has a right to be vaccinated for free” and added (more controversially) that “it must be compulsory”.

The right to life, guaranteed by Article 21 of the constitution, he maintained, includes implicitly the right to good health because “health is central to the right to life”. Health, he added, is also at the moment the top most priority of the nation. Therefore, he argued that the right to a free vaccination for every Indian citizen is essential to protect their health and without good health the right to life is left unprotected.

R Ramakumar agreed with lawyer Dushyant Dave, that the policy violated the recognition of vaccines as a “global public good” – the free provision of which was a constitutional obligation of the Indian state.

As I have stated earlier, almost every other country in the world administered vaccines free of cost, and indeed this was India’s policy for all earlier vaccines. But India became one of the few countries that charged a price for Covid-19 vaccines.

The policy further fragmented the vaccine market and promoted wasteful competition between the Centre, state governments and private hospitals, rendering it less efficient, less transparent and less equitable.

It also burdened states with financial burdens they could not, and should not have been required to, bear. Importantly, it facilitated, as we have seen, the harvesting of “super profits” by selected vaccine companies, and pushed vaccines that could be accessed out of turn in the comfort of private hospitals outside the reach of millions of Indians.

Inaccessible, expensive

The Wire also noted that the average monthly income for a household of four members after the economic impact of Covid-19 in 2020, was Rs 4,979, according to The Hindu. “If it costs a fifth of one month’s wages to vaccinate just one individual (with one dose out of two), “these prices – exacerbated by unequal access and affordability – are simply anti-poor”.

Serum Institute of India and Bharat Biotech charged the Central government Rs 150 per dose for Covishield and Covaxin, but private hospitals paid for Covishield Rs 600 per dose and for Covaxin Rs 1,200 per dose. These private hospitals in turn charged consumers Rs 850-Rs 1,000 for Covishield and Rs 1,250 for Covaxin. Since one would require two doses, and there would be more than one family member typically who has to be vaccinated, this costs too much for a working-class family to afford.

But this revised policy also floundered in its implementation, and this too spectacularly. State governments were unable to directly purchase vaccines from the vaccine companies, because domestic producers said that they had no additional capacity, and international producers said they were willing only to do business with the central government.

Many state governments rallied public opinion against this policy, and the Supreme Court criticised it for being “arbitrary and irrational”, directing the Centre to review it. It simply fragmented demand, expanded eligibility when supply is severely restricted, allowed suppliers to fix prices and fixed quotas to control sales.

Sujatha Rao, former Union health secretary respected for her insights into health policy, observed that the policy did not conform to any known economic theory nor to any principle, whether of equity, competition or choice. It seemed to her “simply whimsical”, as she wrote in the Indian Express.

Several chief ministers had written to the prime minister asking him to follow the policy that has long governed vaccination in the past: the central government procures the vaccines because of market advantage, and gives these free to the states.

She concludes that “India has a well-grounded vaccination policy with well-defined boundaries between the Centre and the states regarding what has to be done by whom and based on the principle that infectious disease control is a shared responsibility. In creating a Centre vs state vs private sector situation, the central government has created a messy rigmarole”.

Epidemiologist Jammi N Rao went further than Sujatha Rao to describe the policy of multiple pricing as not just whimsical but “mad”. It breached universality, and forced states to compete for a scarce public good, pushing up its price that would ultimately be paid by the taxpayer.

Author Debashish Roy Chowdhury wrote in Time the policies made “India one of the only countries where life-saving vaccines are not only being sold, but sold at varying rates on the open market” States were struggling to procure vaccines on their own, and with multiple buyers competing in desperation, vaccine makers were calling the shots in a seller’s market.

The new policy further required persons below 45 years to apply online for a vaccination slot. This obviously excluded younger people who don’t have smart phones, laptops and internet access. “Deepening the vaccine inequity, India is also conducting the vaccination of the 18-44 age group through an app, having somehow convinced itself that all Indians are literate, tech-savvy and in possession of smartphones — thus privileging those who are on the right side of the digital divide,” Mahima Jain reported in Devex.

As noted by The Wire, “This has created an access gap: using it requires an internet-capable device, an internet connection and digital literacy”. The Supreme Court observed perceptively, “It is the marginalised sections of the society who would bear the brunt of this accessibility barrier.”

But an investigation by The Wire in May revealed that the massive accessibility difference between the rich and the poor in Delhi ran much deeper than that just created by the digital divide.

On June 29, The Wire downloaded details from CoWIN of all vaccine slots and doses available in Delhi city from 2 pm to 3 pm, for the period of June 29 to August 2, 2021. It found that there were 9,729 slots. Of these, 8707 were for free doses and only 1,022 were for paid vaccines. But of the 8,707 free sites, only 1,384 (15.9%) actually had doses available. While of the 1,022 paid sites, 918 (89%) had doses available.

So, while the number of private slots was much smaller, there was much greater availability of vaccine doses in private hospitals. On the website, “N/A” – not applicable – indicated slots that had not even been opened. The Wire found that nearly three-fourths of all slots for free doses were marked N/A – whereas only 5% of all slots for paid doses were marked N/A.

In July 2021, 486 slots were N/A for paid sites, while this was 6,950 for free sites – a difference, The Wire notes, of nearly 14 times. It is not surprising that this was a time when “one struggled to find a free slot for vaccination on the Co-WIN app, while the private hospitals were flush with vaccines”.

Sujatha Rao observed the policy choices by the government were wrong but not mindless: there seemed to her three clear advantages that the policy offered to the ruling government at the Centre.

It diverted attention from the failures of the union government, and pointed instead to the states as potentially inefficient in their duty to directly purchase vaccines from the open market. What actually emerged, however, was “the embarrassing charade of states running around suppliers, competing against each other and the private sector, as if we are many countries and not one”.

The result was that many government vaccination centres were forced to shut their doors because they could not get vaccines, while private hospitals sold vaccines for between Rs 850 to Rs 2,000 per dose. The second partisan advantage to the central government was that it assumed the discretionary power to allocate quantities of short-supply vaccines to competing states, increasing both its authority and powers of patronage.

Profiting in the pandemic

Most importantly, the central government was able to favour two selected private manufacturers and the private hospital industry, by refusing to use its sovereign power of compulsory licensing to bring many more manufacturers, including public sector vaccine companies into mass production to deal with the global emergency.

There is no transparent reason why the government selected these two private manufacturers – one of which did not have World Health Organization’s approval until the autumn of 2021 – and excluded even four public sector vaccine manufacturers. This is inexplicable by any measure of the public good.

A global emergency of the kind that Covid-19 posed, and India’s place as the world’s largest workshop of manufacturing vaccines, should have led the government to resort to compulsory licensing and bringing in many more manufacturers.

Indeed, the motives of the Union government to create this diarchy and exclude both public sector manufacturers completely as well as many private manufacturers can only be speculated. But its April policy choice also benefited only the largest private hospital corporations.

In the first month after the central government revised its vaccine policy to allow state governments and private players to buy 50% of the vaccines produced in India directly from the manufacturers, only nine corporate hospital groups, all located in big cities, bought up as much as 50% of the Covid-19 vaccine stock that the private sector was eligible to purchase in the month of May.

These nine private corporate hospital chains were Apollo Hospitals, Max Healthcare the Reliance Foundation-run HN Hospital Trust; Medica Hospitals; Fortis Healthcare; Godrej; Manipal Health; Narayana Hrudalaya; and Techno India Dama.

Of the total 1.20 crore doses of vaccines procured by private hospitals in May, these nine hospitals purchased 60.57 lakh doses. The remaining 50% was bought by 300-odd hospitals, mostly those based in cities and larger towns, with hardly any of them serving small towns and villages.

Rural infrastructure falls short

Much of rural and small-town India was excluded from vaccine access even beyond the formidable challenges of the availability of vaccines, also by the severely limited capacity of state governments to reach the vaccination to the last citizen in rural and tribal India.

The agency tasked with this task in the countryside was the public health “sub-centre”, each serving around 5,000 people. These sub-centres do not have doctors, but the staff is trained to give intramuscular injections, and have a worthy record of polio and BCG vaccinations – bacille Calmette-Guerin for tuberculosis.

But for Covid-19, they were often hobbled, as Anurag Behar reported in Mint from his ground travels, by gaps in infrastructure such as lack of “refrigeration facilities at the PHC [primary health centre] and sufficiency of ice boxes for distribution to subcentres, transportation adequacy for the movement of ice boxes, and more”.

Once again, in June, following the devastation of the second wave and the failure of states to procure vaccines from the open market, the prime minister in a speech to the nation announced yet another vaccine policy change.

First, that the Union government would revert to a system of centralised procurement of Covid-19 vaccines through which it would ensure free shots for all above the age of 18 from June 21.

The central government would buy 75% of the total vaccine production from vaccine manufacturers. But private sector hospitals would still be able to purchase the remaining 25% of vaccines manufactured in the country, to inoculate in private hospitals those willing to pay for the vaccine doses.

Typically the prime minister made the announcement without admitting to any past mistake, or regret for the disgrace and tragedy of tens of thousands of preventable deaths.

Instead, as R Ramakumar noted in The Wire, “False prestige and lack of remorse was written all over the prime minister’s announcement. Modi refused to acknowledge that his ‘Liberalised Vaccination Policy’ had been a failure. Instead, disingenuously, he said the policy was being changed because state governments had failed to meet the challenge of direct procurement.”

S Subramanian, an economist, raised some pertinent questions in The India Forum. First, “if only 75% of the target population is exempt from paying for its vaccination, then what does it mean to speak of the government providing ‘…free shots…for inoculation of all above the age of 18’?” Second, he points out that India’s 18+ population is around 95 crore.

Since the Central government would not bear the cost of vaccinating 25% of the target population, which is about 24 crore (one-fourth of the 18+ population of 95 crore), and assuming private hospitals will charge at least Rs 780 for a single jab, and given that two doses are required for each person, the total cost of receiving vaccination from private hospitals for 25% of the target population would be a minimum of Rs 37,440 crore.

The Central government has announced it will procure vaccine at a price of Rs 150 per dose, or Rs 300 per person. To cover 75% of the 95 crore target population, that is 71 crore persons, its vaccine bill would be Rs 21,300 crore.

He asks then how it makes any sense at all that private citizens (paying for the equivalent of one-third the amount of vaccine procured by the central government) are expected to foot a bill which is 1.76 times the Central Government’s bill? There were of course no answers from spokespersons of the Union government to these and other searching questions.

R Ramakumar maintained that although it was the Supreme Court’s scathing observations that forced the prime minister to roll back the vaccine policy effected by his government on April 19, 2021, which he described as “disastrous, Tughlaqian”, but it was still only a partial correction.

The irrational burden the policy had placed on the states was reversed. But the prime minister was still unwilling to stop facilitating super-profits by vaccine manufacturers. The problem with the June reformed policy was that 25% of the vaccines would continue to be reserved for private hospitals. “Essentially, this is reservation for the rich, and hence it is perverse in design.”

Private hospitals were left free to continue to resort to what Ramakumar called “predatory pricing”. Private manufacturers were left free to make super profits, even if over a smaller volume of sales. “Here, the Modi government appears to have succumbed, yet again, to the pressures from vaccine companies,” he noted in The Wire. “To allow the extraction of profits in the range of 2000%-4000 % amid the pandemic is not just iniquitous but downright vulgar.”

This could have been prevented only if the Union government took responsibility for 100% of vaccine procurement and if it made vaccine doses available free of cost to all, as is the practice in most of the world. But this was once again a policy choice that the union government refused to make.

Wave of propaganda

Pamela Philipose, veteran journalist and noted media commentator speaks of the ambitions and ironies of what she describes as “two waves” of engineered media exuberance created around vaccine. The first began on June 21, International Yoga Day, the date from which the June vaccine policy became operational.

The massive hoarding and posters that appeared overnight across the country with Modi’s visage looming from each of these, with messages always of thanking him for “free vaccines” (and Modi’s picture on every Covishield vaccination certificate) wilfully created the illusion that Mr Modi was personally responsible for every jab, and that these jabs were acts of high and exceptional benevolence of the Supreme Leader.

These obscured many plain facts – that it is the duty of every government to protect its populations during a pandemic and that the government led by Modi in fact had failed to perform this duty in so many ways leading to uncounted numbers of preventable deaths.

Further, Modi was pushed into making this policy change by an exceptionally severe indictment of the April policy by the Supreme Court. Additionally, all vaccines were not free, that the selected manufacturers and corporate private hospitals were still making super-profits by charging people for being vaccinated.

Monuments were “lit up like Disney Land by the Archaeological Survey of India”, Philipose noted in The Wire, while public announcement systems across the country delivered recorded messages celebrating the milestone. Television channels repeated the Prime Minister’s address to the nation for this occasion while Modi authored signed pieces for many newspapers and full-page advertisements were put out in newspapers by chief ministers of BJP-ruled states, again with Modi’s ubiquitous face dominating all of these.

SpiceJet Airlines covered the outer part of their entire aircraft fleet with images of Prime Minister Narendra Modi and healthcare workers to celebrate India crossing the 1 billion Covid-19 vaccine dose milestone. The new health minister Manukh Mandaviya announced his ministry would celebrate the billion-dose “breakthrough” by launching a film and a song at New Delhi’s Red Fort.

But, as Philipose points out, typically an obedient media did not ask many uncomfortable questions.

First that “India won the battle against polio with the last case reported in January 2011, without the need for a multi-million rupees publicity drive or indeed the claim that the then prime minister was personally responsible for the achievement”. Second, that India did not lead the world in vaccinating its people as the government’s publicity department would want us to believe.

For one, at the time India administered its billionth dose, China had far outpaced India with 2.2 billion doses. India was in fact at a lowly 101st place worldwide in terms of the percentage of people vaccinated. Only around 21.1% of the eligible population had received both the doses.

Several countries, including those with less developed health infrastructure, had performed better than India. Third, would India have changed course in June if it had not been pulled over the coals by the Supreme Court? While the prime minister spoke proudly of this milestone reflecting the accomplishments of Indian scientists, the truth is that 90% of India’s vaccines were Covishield, the Oxford University developed AstraZeneca, not the work of Indian scientists.

These official publicity drives on steroids were actually motivated, according to Philipose, “to bury, once and for all, those bodies that surfaced from the Ganga’s shores, and leave behind extremely bitter memories of the second wave because of the complete abdication of responsibility demonstrated by the governments at the Centre and in several states, including Uttarakhand that staged the Kumbh Mela extravaganza amidst rising cases”.

As Ajoy Ashirwad Mahaprashasta wrote in The Wire: “One would have to struggle to forget how thousands of people died owing to a shortage of oxygen and beds during the second wave earlier this year.… Those who lost their kin in the chaos of the second wave (we)re still reeling under immense trauma, which the prime minister chose to ignore in his multiple messages to the nation.”

Then this also became one more moment to “further the Modi cult”, to build even taller the image of a towering saviour.

It is probably idle to wish that instead of all this celebration, the government instead would be humble, contrite for immense failures of the past, and alert for the formidable challenges that still lay ahead. There was indeed no acknowledgment that there was no way for the government to meet its own target of fully vaccinating its entire adult population.

These would leave wide open the possibility of new and more infectious mutants developing, endangering the people not just of India but the world. Even when India crossed its billionth dose, the government still needed – as pointed out by Congress leader Randeep Singh Surjewala – to administer 1,060 million doses in less than 70 days in order to fully vaccinate the entire 93 crore adult population by December 31, the target that the government had set for itself. This would require them to administer 15.1 million doses daily as against the average 0.35 million doses being administered.

Ramakumar estimated in an interview with Karan Thapar that India would miss its target of fully vaccinating every adult by the end of the year by around five-six months. The months that followed proved him sadly right.

To achieve that target India needed to produce 870 million additional doses in the following two months of November and December. But Serum Institute was by then producing 220 million doses of Covishield a month; this could go up to 240 million a month in December. The shortfall of 210 million doses a month simply could not be made up by Covaxin or any of the other vaccines likely to be available.

Second, the average rate of vaccination for the 21 days of October was under 5 million a day. To reach every adult before the end of the year this needed to rise dramatically to 15 million a day, every day including Sundays, but there is no sign that this would happen. There was no evidence that the government had built its capacities to both access and deliver this high scale of vaccines in the months that were left of the year.

There continued to be other expensive failures resulting from just slipshod advance planning. Rajiv Nath, the chairperson and managing director of Hindustan Syringes & Medical Devices, India’s largest manufacturer of medical syringes, said India faced a shortage of auto-disable syringes necessary for Covid-19 vaccination.

He said that just as there was a grave vaccine shortage because the government failed to place orders for sufficient vaccines in advance, this was almost identically replicated in the case of syringes.

The government could easily have calculated how many syringes it required, but instead it had until September placed on his company a demand for 2022 for just 75 million syringes, although it is elementary math that it would need many times more. The knee-jerk reaction was now again, like when confronted with an acute vaccine shortage, to stop exports. He described this as irresponsible. “This crisis wasn’t necessary.”

Clearly, the government just refuses learn.

‘Everything fell into place’

Ranjita Sabar walked each day more than 10 km on foot through a forest and wading through streams, to the furthest villages in Kurli gram panchayat in Rayagada district of Odisha, The Indian Express reported. The journey is hard enough in normal times, but even more challenging in the monsoons. She needed to reach the distant and dispersed settlements of the Dongria Kondh – a Particularly Vulnerable Tribal Group to vaccinate them.

But often when she would reach a Dongria Kondh hamlet, she would encounter empty homes; the tribal residents would have run to hide in the forest, fearing that the vaccine Sabar was bringing to them might kill them.

But her team and she would not give up. “Everything fell into place eventually”, she told The Indian Express with quiet satisfaction.

In the far north of the country, male nurse Ishfaq Shabir in Boniyar block of Kashmir’s Baramulla district, would carry every day an ice box with vaccines and trek with his team to villages right at the Line of Control, the newspaper reported. They first organised vaccination camps, but no one would turn up for these. So the team would walk door to door, explain, win over and convince the villagers. In the end, he and his team over vaccinated 60% of the population of this block.

When the country crossed the milestone of a billion Covid-19 vaccinations, a celebration was indeed due. It was people like Rochin Neema, Ranjita Sabar and Ishfaq Sabir who made this possible. These are the heroes that India should have remembered, celebrated and thanked.

But we did not.

Read the other parts of the “Tsunami of suffering” series here.

Harsh Mander is a Richard von Weizsacker Fellow, Chairperson of the Centre for Equity Studies and convenes the Karwan e Mohabbat, a people’s campaign to fight hate crime with solidarity and atonement.