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 3rd 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.
