A masterstroke needed from the PM to accelerate Universal COVID-19 vaccination – A letter to the PM

Dear Honorable Prime Minister Shri Narendra Modiji,

Vaccinating nearly a billion people in time to achieve a reasonable level of herd immunity needs radical solutions. 

The country has discussed enough on “what went wrong”. We must focus now on “what can be set right quickly”

Let us challenge ourselves with a bold vision.

India must vaccinate all eligible adults by Mar 2022, with no “out of pocket” cost to its citizens, removing all barriers to access – identity, geography, literacy, digital connectivity, economic status, disability, gender – everyone must be vaccinated. While doing so, it must create enough reserve stock to provide “booster doses” against evolving variants as well as for those sub 18 years of age to prepare for any future vulnerability to our children. All this must be guided by Science and Science alone. 

I summarise below our present situation:

1. Addressing the demand-supply gap. Prof R Ramakumar has estimated the very immediate needs. One would need to factor in imminent mutating strains and the possible expected risk to the youth and children. 

2. Addressing the distortion in vaccine access due to the recent policy liberalization. The benefits of “one procurer system for universal vaccination” are undeniable 

3. To eliminate barriers to access – technology and connectivity being the most notable though not the only ones

In private sector parlance, these are simply strategic supply chain issues coupled with some much-needed policy decisions. 

India’s pharma supply chain is the best in the world. It is technically sophisticated, well networked, fiercely competitive and routinely agile. 

I recommend that the first two of the above problems be solved by a National Task Force for Vaccine Procurement, manned by talent sourced from the Indian pharma industry. The NTVP must be headed by an ex or current pharma CEO, who enjoys the respect of the industry and the health sector. The top 20 Indian Pharma companies must nominate their best talent for a full 12 months, fully paid by their respective organizations, to this body. This talent should be from across Vaccine science, Infectious disease and epidemiology, Procurement, Planning, Finance, Vendor Support, Quality& GMP, Technology Assessment and Process Transfer, Intellectual Property and Compulsory Licensing, etc. 

The CEO must have full authority to engage this talent including those from the Union or State administration pool. 

This body, NTVP, must be set up as an autonomous body by the Government of India, empowered to do the following:

• Set the mandate for the “One Procurer” policy – including a ceiling price for procurement and commercial terms with full flexibility to waive off “standard government procurement processes” that may be cumbersome for an emergency and deploy creative procurement and funding models. The terms must be set on universal understood norms of compassionate pricing and access and must deal with attempts at “price gouging” firmly. 

• Set the “quantitative need” for vaccines, considering factors like priority for risk populations, emerging risk factors such as mutant variants and need for booster doses, etc. guided by the Scientific horsepower in its member body. 

• Negotiate with both Serum Institute of India and Bharat Biotech in a manner that ensures transparency, balances need for supply urgency without mercenary pressure, helping debottleneck “prioritization of national v/s international commitments” as well as their internal supply chain constraints, with calibrated diversification of supply sources

• Set the terms for Compulsory licensing of the Bharat Biotech vaccine, which was developed using Indian taxpayer money, and engineer the transfer of its know-how to other sites in India where capabilities for upstream, downstream, formulation and fill-finish value addition exist. There are possibly half a dozen Indian sites at the bare minimum that can absorb this know-how and get to commercial scale in record time. 

• Negotiate with alternate sites using creative solutions such as leasing, pay for service or paying even “business disruption premium” for sites that need to disrupt existing business commitments to free capacity and capability. 

• Qualify and negotiate with both Russian and Chinese vaccine suppliers, waiving off geopolitical pressures and considerations. 

The NTVP must be funded with at least Rs 70,000 crores – Rs 35,000 crores of the budget set aside for this explicit purpose and the balance from the PM CARES fund and other sources. This fund must be fully under control of the CEO and his CFO with the Union Finance Secretary being the joint signatory. Any savings made in this fund must be distributed to the various unions and associations that represent Indian medicos, paramedical staff and other frontline workers who have helped in containing the pandemic. 

The NTVP must be supported by an equally responsible and able task force to accomplish the third goal of universal barrier-free access. This force must be manned with the finest from our own past and present central and state-level health administrations – those who have helped achieve past success in the management of Polio, TB, HIV and Malaria programs. 

There is no time left for anybody in the country to cry over spilt milk or ponder over what could have been done. We cannot procrastinate either. India at risk puts the whole world at risk and negates efforts across the world to reach herd immunity. Saving lives must be our sole objective for the near term. 

I urge you to take bold and decisive action

In anticipation and in hope, 

Chandru Chawla

Indian Citizen

Mumbai

(About the author: Chandru Chawla has spent three decades in the global pharma industry. The views expressed here are his own)