Chacha Vidhayak Hain, Let the Rich Pay for the Vaccine

They Will Anyways Get Hold of It.

By Gaurav Parab, #thatwriterfromindia

Just minutes after that glorious Mohali semi-final in 2011, a friend sent three messages in quick succession. Awesome Man!! I have tickets for the final. You want?

After DRS +Sachin he was the second most wonderful thing in the world that day. My mind flashed forward to me at the Wankhede. Amir Khan to my right. Rajni to my left. Anu Malik in his fluorescent shirt humming Tan Tanna Tan Tan Tan Tara somewhere close by.

‘How much’

’45 K’

‘How did you..’

‘Chacha Vidhayak hain’

‘Are they 100% genuine?’

He paused longer than he should have. ‘Yeah, I guess so. But no guarantees man. You know how it is’

I promised to get back soon.

This time he did not pause. ‘5 minutes. There are others I can ask, you know’.

The politicians, associations, and the rich through the world cup had cornered all the tickets. The measly numbers left for the public were sold out in a few seconds online. I should not have hesitated. The amount was not orbital, as everyone had heard rumor's of tickets costing lakhs in the black market. My friend was connected. This could be the experience of a lifetime. I made up my mind.

I texted my reply to him.

 

***

From those dark September days, when we all knew someone who was infected or worse – the decline in Covid cases has been sharp. Vaccine candidates also seem to be on track for a mid-2021 launch if not earlier. The Oxford/Serum effort & ICMR/ Bharat Bio candidates for India are in phase 3 trials. The Russian potion swirling through the veins of Putin’s daughter is at our gates.

From whether a vaccine will be found, we have come to when will it be jabbed.

Recent Government announcements indicate activity in planning the rollout and fixing supply chain gaps. Apprehensions about failure rate of vaccine candidates in the past, and long periods of discovery are now retired by human ingenuity, technology and resources.

We have two questions remaining. When and Who Gets it first. These will define the future of our pandemic response and in many ways define the final human costs.

Who Gets it First?

Most governments (including India) have prudently announced that emergency service personal and vulnerable populations like the elderly will to be the first to get a shot. This makes sense as pandemics, especially those triggered by viruses, don’t get stamped out overnight. Viruses like society maintenance charges in Pune have an annoying habit of lingering around, with cases popping up just when you thought the price was paid. At this stage, the smart play is to focus on saving lives, instead of breaking transmission chains. That ship sailed a long time ago.

For some nations with manageable populations and large financial resources – access priority is a temporary issue. Doses are already being manufactured at risk, and deals have been stitched together with pharma giants to reserve stocks. With small populations, some developed nations will vaccinate enough citizens to achieve herd immunity in months with the virus eventually tapering off. It is countries like India, US, and some Latin & African nations that face a challenge due to the scale and size of our populations and other challenges.

India too has agreements in place (Like Dr Reddys + Sputnik) and is also the global vaccine manufacturing capital. If the situation gets really bad in subsequent waves, India can whisk away large quantities in national interest. But we are a smart and fair people, and hopefully won’t go that way since all it will do is nudge other nations to ramp up their own capabilities while lining us up for punishment through other means.

Given gaps in distribution mechanisms and the fact that we may need two does per individual – here are India specific approaches for two objectives - Save Lives and Save the Economy. And then at the risk of losing my Che Guevara T Shirt, let’s look at how can we Save the Rich. Below both objectives, I have listed the priority populations to immunize first.

OBJECTIVE 1: Save Lives

Priority 1: A Country for Old Men

 Vulnerable due to work, age, or disease

Nature of Work: No brainer. The Govt is right in reserving initial vaccine supplies for healthcare, and emergency services like police and Defence forces. Doctors and cops have paid a disproportionate price for being in roles that demand high ‘engagement’ with the public. However, given initial supplies will be limited, further nuance instead of a blanket rollout should be exercised to identify highly vulnerable groups within these communities. For example, for defence forces, while it is tempting to go the emotional way - prioritize the Northern and Western sectors given the military situation there while assigning lower priority to administrative roles like in Army HQ and peace postings.

The old, the vulnerable and those with co-morbities: Assuming the vaccine is conclusively proven to be safe – any hospital admission related to a set of diseases like diabetes, cardiac conditions should have the bundled option of getting a vaccine at the time of admission or doctor’s visit. This will help reduce mortality significantly as the data indicates those with co-morbities make up a large chunk of fatalities.

For the old, there should be a blanket rollout without nuance for those who are open to vaccination.

Priority 2: Hotshots

Targeted Vaccination of clusters and hotspots

Hotspots at the time when the vaccine is rolled out should be smartly and surgically targeted for breaking transmission chains and reducing mortality. Guerrilla warfare like programs including rapid pop up kiosks, mobile clinics, election voting booth like infrastructure can be deployed for societies, slums and at Gram panchayat offices if infection rates are high in a micro region.

Additionally, high density areas like slums should be covered given most of our sanitation workers, drivers, construction professionals live in improvised conditions. This will also help reduce the economic impact. Which brings me to objective 2.

OBJECTIVE 2: Save the Economy

The lockdown has taught us that tangential economic challenges cause as much damage as the health-related issues. Even if green shoots are already visible across sectors, subsequent waves may leave us struggling. After mortality is slowed, we move towards innovative approaches to fix the economic disease. The government should draw up top down list of sectors that employ the highest Indians - including the disorganized construction sector, hospitality, travel and education. Doses should be provided to these groups through their unions, trade bodies and NGOs to trigger recovery and instill confidence. 

All of this should be done keeping in mind principles of equality, where every individual, whether at a private enterprise, or a PSU is an Indian. We should not give into instinct and inoculate Government employees first. We are all in this together.  For example, in transport while railways should get high priority do not ignore private airlines for early access.

Additionally, it would be nice to somehow embed gratitude in early rollouts to Textile manufacturers (For PPE effort) , IT support services, Chemists, Bank Employees, power generation companies, telecom and utilities and other professional groups that were the backbone of the nation's response, took disproportionate personal risk, and deserve an early shot of the good stuff once the program is running smoothly.

Back to my text reply on the night of March 30, 2011.

Sorry. You go ahead with your other friends, I texted back.

Not because I am some self-righteous, doing it the proper way sort of guy. I was just not sure if the ticket was genuine or not. I was not going to risk that sort of money, only to take the Neeta Volvo to Mumbai and be ticked off by the guard at the metal detector. The trouble involved was fine, but the thought of missing the final on TV for a dodgy promise to be inside the ground was a risky bet.

The acquaintance did make it to the final. Tuck Fhat. The ticket was good.

I saw the pictures. I heard him sing AR Rehman’s Vande Mataram with the thousands when Dhoni and Yuvraj were batting.

An old lesson reinforced. They always find a way. Which brings me to the 3^rd category of folks who should get early access. This is not going to read pretty, but hear me out.

Monetize the Leakage, and Save the Economy

Let’s be realistic. Like in that cricket match, the rich and connected always find a way. This is a human reality that has lasted for a thousand years around the world. We need not fight it. What we can do is ensure this comes with a hefty price so they get vaccinated legally, and safely and not in the black markets that will soon emerge.

Call it the caveman mentality, or a Darwinian truth – a lot of people will dodge the gates, the ticketing system, the priority lists and get hold of a vaccine shot before their sanctioned turn comes. 

As sure as the Sun rises in the East, the rich always get to the feast.

Cringy rhymes aside, we need to make peace with this reality, and properly channel it for the larger good.  Charge a premium for early access, and subsidize the doses for the poor.  

This premium early access can also creatively help solve sector specific issues when procured by enterprises and not individuals.

For example, say an airline can bundle the premium access vaccination with a flight ticket to the UK at a cost to the traveler. Most western nations, including the UK have existing travel related requirements like a No TB certificate. Similar Covid related measures will come into play when the western world has immunized their populations and are weary of cases from outside coming in.

Similarly, large IT and Consulting firms will also need to enable employees to travel abroad or return to the secure networks at some point next year.

There are political and ethical issues with this approach. But this situation is unique, and given there is going to be ‘leakage’ why not pre-empt it and design methods to positively channelize human instinct of self interest.

So what is the ideal Amiro ka quota so it does not eat into the stock of the poor. There could also be a situation where early on people are not willing to take the shot. A wait and watch approach – letting the cat drink the milk and see if it survives for 10 minutes. This may open up stocks for those interested in paying for it.

The quota can be calculated basis the ground situation when the first batch breaks skin. If it is Ramsay brother level scary, junk the plan and do right while stopping leakages. If the situation is not critical, a Yash Raj cringe fest but without songs – have a stock of at least 1-3 % reserved for premium early access.

Finally, as I wrap up my views and wait for the hate mail to arrive – lets take a pause and acknowledge the fight we have all put up. No matter how the rollout happens in India or elsewhere, the work put in by scientists, researchers, government planners, economists, statisticians is a phenomenal human achievement with no parallel in our history.

The experience of this pandemic, the tools, computational capabilities, and ideas developed around the world will serve us well the next time someone fancies a bat soup or whatever led to this outbreak.

Look forward to your views.