Karnataka, like many other Indian states in the country, has been facing a severe shortage of COVID-19 vaccines currently since April-end. This crisis had started well ahead of May 1 when the Union government opened up vaccination for the age group of 18-44 years. Owing to the shortage, the state government has deferred its decision to open up the vaccine drive to all individuals of 18+ category twice so far. This comes at a time when Karnataka has been under a strict lockdown since the night of April 27 in the wake of a massive jump in cases and COVID-19 deaths.
The Karnataka High Court, which is hearing a host of issues in connection with the pandemic management, on May 12 noted that “the situation regarding availability of vaccines in the state of Karnataka is very disturbing”. On May 20, the same bench led by Chief Justice AS Oka observed “the situation regarding vaccination in the state continues to be critical”.
According to the norms set by the Union government, the vaccination drive in Karnataka had progressed in phases with health care workers, then other frontline workers, and 60+ age groups and followed by people of 45+ years with comorbidities. Other than Covishield and Covaxin, Sputnik V is the only vaccine to clear regulatoratory approval from the Union government. So far the global tendering process is yet to see any major movement
So where does Karnataka stand as far as vaccinations go? As of May 27, the state has administered 1,27,54,056 (1.27 crore) doses including 26,65,137 (26.65 lakh) lakh people who have got both doses. The total number of adults in the state is at least 5 crore given the number of voters in the 2019 Lok Sabha elections were 50,307,182. Considering the adult population to be 5 crore, then only 5.3% has got fully vaccinated.
But the pace of vaccination has reduced. Between April 1-27, the state had given 51,93,389 shots - an average o f 1,92,347 (1.92 lakh) shots every day. But the average daily doses administered between May 1 and May 26 fell to 1,07,146 (1.07 lakh) with a total of 27,85,789 shots given in the same period.
The shortage has meant that while many are yet to get their first dose, many who took their first dose are also at risk of not being able to take their mandated second dose within the stipulated time period. And for the people needing a second dose, Covaxin beneficiaries are at a greater risk.
According to the data submitted by the state government to HC, till May 20, the state had 97,440 doses available when 4,55,084 (4.55 lakh) were already eligible to take the second shot.The Union government protocol mandates taking the second shot within 4-6 weeks, so this would mean that many would be at the risk of missing their second dose within the stipulated time frame. In addition to the 4.55 lakh, 39,457 more beneficiaries have completed three weeks, 22,780 more beneficiaries have completed two weeks and 16,000 beneficiaries have completed one week.
“Thus, only one-third of the beneficiaries who have completed six weeks will get the second dose and the remaining two-third will not get it. This is a very sorry state of affairs,” the HC noted.
The same May 20 HC order noted, “As of May 17, out of 58,34,050 (58.3 lakh) beneficiaries who need to take a second dose, 1,53,571 (1.53 lakh) beneficiaries had completed a minimum 12 weeks from the date of the first dose. So, the remaining 56,80,479 (56.8 lakh) beneficiaries will require the second dose in the near future.”
But the order noted that according to the state government as of today (May 20), the total stock of Covishield is 7,14,140 (7.1 lakh). According to the submissions made by the state and Union government, the state is expecting to get a total of 16 lakh vaccines in the near future.
“Thus, as far as Covishield is concerned, looking at the larger picture, by taking the aforesaid figures as correct, there is going to be a huge shortage. The state government will place on record what efforts it has made to procure 7,04,050 doses,” the HC noted.
The HC has asked both the state and Union governments to tackle the issue keeping in mind vaccines to be part of Right to Health as guaranteed under Article 21 of the Constitution. In connection with this, the state government has said that it will restrict use of vaccines to prioritise those who need it for their second dose.
While shortage is an issue, liberalising vaccine procurement has meant that some have more access to the vaccine over others from weaker economic sections.
According to the Union government submissions on May 25, a total of 16,16,660 (16.16 lakh) doses (15,31,000 doses of Covishield and 85,660 doses of Covaxin) have been contracted by private hospitals (28 for Covishield and 11 for Covaxin) in Karnataka of which 6,58,860 doses (5,73,200 doses of Covishield and 85,660 doses of Covaxin) have been received.
“This corporate friendly policy has meant that if you don’t have money you can’t get the vaccine so you are treated as a second class citizen. And somebody having money can access it even if they are less risk prone,” Akhila Vasan, a member of the Karnataka Janarogya Chaluvali, an organisation of health activists and petitioner in the case, said. She questioned the government’s focus on safeguarding interests of private healthcare setups over the interest of efficiently vaccinating the public.
“In our 70 years history, never has this happened that people are made to pay for the vaccines. Furthermore, the method of mandatory Co-Win registration has created unnecessary hindrance to the system which has been functioning efficiently for a good number of years across the country,” she added.
On May 27, the High Court bench also took note of the issue. While it did not pass any order, it observed that the state and Union government has to ensure that no more than 25% of the stocks are supplied to private companies.
So far responding to the state's global tender, no global manufacturer of scale has come forward. The two respondents are both third-party Indian suppliers who have proposed to supply Sputnik V and Sputnik Lite (awaiting approval).
Ashwin Mahesh, former NASA scientist and entrepreneur, based in Bengaluru said that no major vaccine manufacturer will come forward to negotiate with the state government for numerous reasons. Punjab and Delhi have both stated that Moderna and Pfizer have refused to sell vaccines to the respective governments, stating that they would only deal directly with the Union government. Criticising the Union government, he said, “For things that are meant to be done centrally, they are asking states to do and things meant to be done in a decentralized manner they are taking full control. For large manufacturers, it's not worth their time to deal with state governments as firstly they are not sure if they have money and there is no sovereign guarantee and also it's not practical for them to deal with every state of 15-20 countries,” he said.
“We have shown a tremendous reluctance to let go of the normal procurement procedures. Last June itself, the US government said that it will pay all major vaccine makers upfront. The same happened in all major economies. But we took the view that once it’s ready, we alone will procure it,” he said, suggesting tenders at a time of emergency is not a good idea.
“So in certain emergencies such as this, it is not feasible to follow certain set protocols as they are too slow. Also, the problem with sudden large scale demand is that you have to make massive investments to suddenly create increased production capacity but after this demand is met there is no utility of that huge investment. So who will help the manufacturer to recover these costs?” he added.
He also suggested that the unsaid policy of using vaccines only made in the country is part of the problem. “There are vaccines for diseases like dengue but they are not allowed to be sold in India while we have widespread dengue,” he said.
Like Ashwin, Dr Anand Lakshman, a public health professional and CEO Address Health, said ideally the Union government should call for a global tender and distribute among the states. “The reason why global tenders won’t work for states as some manufacturers will ask for exemption in liability clauses. This only the sovereign government is capable of doing. Otherwise at least the Union government should come forward and say that they will take care of these liability clauses and allow states to procure,” he said.
The only other way possible for the state to explore is to approach COVAX facility in Gavi and wait in the queue system along with other countries, he said. “But this might take months of waiting,” he added.