Covid-19 Vaccines: India Needs A Win-Win-Win Tatkal Scheme
A health worker injects a person during clinical trials for a Covid-19 vaccine, on Sept. 9, 2020. (Photographer: Eva Marie Uzcategui/Bloomberg)

Covid-19 Vaccines: India Needs A Win-Win-Win Tatkal Scheme

BloombergQuintOpinion

Tatkal (ie, instant, on-demand) was an ordinary Hindi word until the Railways gave it a special economic meaning for millions of Indians struggling to travel because tickets were impossible to get. Now, under their Tatkal Scheme, people could pay a premium of up to 30% and get rail reservations instantly. The response was so grateful and overwhelming that the Railways introduced Premium Tatkal in October 2014, doubling the extra charge under a dynamic pricing model. For the Indian state which thrives on a narrative of ‘pro-poor price caps’ and ‘protection against price gouging’, this was almost like endorsing ‘dirty profiteering’!

Why am I talking about Indian Railways when everybody is obsessed with the ‘big V’ right now? No, mercifully not the Virus, but the Vaccine. After nine months of a graveyard-like stillness, Planet Earth is about to erupt with a child-like yayyyyyy! It’s tatkal (instant) joy.

Covid-19 Vaccines: India Needs A Win-Win-Win Tatkal Scheme

On a serious note, it’s exciting to see the conversation switch from despair to hope. How long will it take to vaccinate the bulk of our population? Which vaccines will succeed here? How can we beef up the infrastructure? What should be the hierarchy of recipients? Must we keep all our production for domestic application, or export significant quantities with twin humane/commercial objectives? How should vaccines be priced?

Also read: Hope, IPR Laws, And A Covid-19 Vaccine

Logistics Vs Economics Vs Ethics

To pick the best from among an array of competing choices, we need to consider logistical versus economic versus ethical issues and options. Let’s go one by one.

Logistics

  • Before Covid-19 hit us, India led the world on every metric – we produced about 2.3 billion vaccine doses every year, ie about 40% of the world’s pre-Covid requirement. Three-quarters of these were exported.
  • India also administered the largest immunisation program, around 390 million doses, aimed at nearly 56 million children and pregnant mothers every year. However, we’ve struggled to meet even 70% of this target.
  • And that’s the horn of an excruciating dilemma. If we shift all our energies towards inoculating 300 million people with a Covid-19 vaccine by mid-2021, our regular immunisation effort could suffer irreparable damage.
So, how do scale up against Covid-19, without compromising the health of our children and pregnant mothers?

Economics

  • India may need to spend Rs 60,000 crore to inoculate its most vulnerable citizens against Covid-19. But the Government of India’s annual health budget is about Rs 69,000 crore. So, you get the rub?
  • Vaccine exports are a significant chunk of our dollar earnings. By some estimates, that could be over 1 billion doses worth $13 billion. This injects a critical commercial angle in the whole trade-off. It would not be prudent to distribute free doses within the country at the cost of devastating our export potential.
So, how can we create an ethical balance between subsidising our poor and vulnerable, while protecting the decades of hard work done in building a commanding capability in vaccine production and exports?

Ethics

Is the Covid-19 vaccine a private good, meaning should we permit a commercial market for it where supply and demand can intersect to create a logical price, like with several other medicines? Of course, there would have to be a parallel ‘welfare distribution channel’ where the state intervenes and subsidizes it for the poor/needy, but the vaccine would nonetheless be available for a price to willing buyers.

Or is the vaccine a public good, meaning the state should exercise complete control over the item, distributing it solely on a social-welfare matrix? Any private, voluntary trade in the vaccine would be strictly banned.

The current debate is oscillating between these two extremes. But I encountered a third ethical theorem in Fareed Zakaria’s latest book, Ten Lessons For A Post-Pandemic World. He describes how we have converted the efficiency of a market economy into the inequality of a ‘market society, one in which everything is seen through the prism of price’. Here is a powerful excerpt:

Want your doctor’s cell-phone number? Some physician will give it to you for $ 1,500 a year. Want a nicer dorm room for your child with access to a fancier cafeteria? Easily done, for a few thousand dollars. There are prisons where an inmate can upgrade his cell for $90 a night…

When everything can be bought, every aspect of life becomes unequal … If money can buy a better house or car or even a yacht, that’s one thing. But if it can buy citizenship, special access to public spaces, preferential treatment at colleges, and favors from politicians, it becomes a corrupting and corroding force.

So now, should some people be allowed to buy the vaccine at a special price? Would that trigger corruption and corrosion in society?

I am unequivocally in favour of a Premium Tatkal Scheme (remember Indian Railways?) that would allow well-off people to ‘jump the queue’ and buy the vaccine at an exaggerated price, especially since that would have the collateral advantage of subsidising the truly vulnerable citizens. Here, check this out:

  • Out of the 100 crore (1 billion) vaccine shots, India would administer in 2021, reserve 10%, or 10 crore (100 million) shots that would be sold under the tatkal category for Rs 10,000 apiece; these could be the pricier Pfizer or Moderna vaccines specially imported for this purpose.
  • The entire tatkal scheme can be easily, transparently administered using our awesome e-governance tools.
  • If the full quota of 10 crore vaccines is snapped up by eager, well-off households @ Rs 10,000 per shot, that would raise Rs 1 lakh crore for the government, effectively allowing the state to fully subsidise a free vaccine for the rest of the population.
  • Finally, existing non-Covid immunisation programs would not get starved of funds; other healthcare initiatives would continue unhindered; and over a billion vaccine doses could be exported, safeguarding that market for our producers.

Also read: Vaccines Present a Global Prisoner's Dilemma

To all the naysayers, I would ask: have you considered what would happen if we don’t allow a Premium Tatkal Scheme in Covid-19 vaccines?

  • Thousands of Indian families would travel overseas to get vaccinated, thereby draining our resources instead of investing those in the local economy.
  • A flourishing black market would emerge in getting ‘priority medical prescriptions’ or accessing stolen vaccines – again, transferring legal cash to the underworld.

Frankly, it would just be a lose-lose-lose proposition. So, will our health policymakers learn from their kin’s success with tatkal tickets sold by Indian Railways?

Raghav Bahl is the co-founder and chairman of Quintillion Media, including BloombergQuint. He is the author of three books, viz ‘Superpower?: The Amazing Race Between China’s Hare and India’s Tortoise’, ‘Super Economies: America, India, China & The Future Of The World’, and ‘Super Century: What India Must Do to Rise by 2050’.

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