Why are you in India at the moment?

“I live in Utrecht, but my parents live in Chennai, in the south of India. I came here in March because they had health issues. When I arrived, the situation was very positive in the sense of Covid cases. However, there was a sense of complacency and the government relaxed almost all restrictions: no masking, no social distancing, and they allowed elections and permitted a number of large festivals to take place. Then the situation exploded. In Chennai, there is a complete lockdown now. Shops are closed, trucks come to your home to deliver fresh produce. You can go for a walk, but you’re not allowed to drive.”

Arjun Singh Bedi is professor of Development Economics and Deputy Rector for Research at the International Institute of Social Studies (ISS) at Erasmus. Prior to joining ISS in 1999, he held positions at the University of Bonn (1998-1999) and Columbia University (1996-1998). His research focuses on labour and human resource economics in developing countries.

Do you feel safe?

“For people over 45, at least regarding vaccination, it was arranged quite well. It is only now that the situation has become chaotic. I have had both shots since I arrived, but it seems that even with both shots, protection from the Indian variant is only about 70 percent.”

How has vaccination been organised in India?

“There were two stages. In the first stage, as in other countries, healthcare workers and those above sixty could get vaccinated. The process commenced slowly. Initially, around mid-January, the government ordered 11 million vaccines, while the needs are close to 1.6 billion. The central government procured the vaccines from two manufacturers in India and distributed it to state governments and private hospitals. Those over 60, and gradually those over 45, could go to a public health centre and get vaccinated for free or go to a private clinic and get vaccinated for 250 rupees, which is about 3 euros.”

“In the second phase, when cases began rising dramatically to 400,000 new cases a day, panic set in. The central government decided that from 1 May, everyone over 18 was eligible to get vaccinated. The announcement was made, demand shot up, but supplies were and still are just not there. Within minutes, slots are taken, and it has become a race to try and get an appointment.”

“Furthermore, the central government announced that state governments and private hospitals may negotiate directly with manufacturers. The result of this decentralised procurement is that in private clinics, the price has risen to between 10-14 euros per dose for AstraZeneca and 15 -17 euros for the domestic vaccine. At the public health centres, it is still free, but supply has declined. In Chennai it’s now impossible to get an appointment if you’re younger than 45.”

How do you perceive this change in strategy?

“It’s not a smart policy. Due to the price differential, manufacturers would prefer to sell vaccines to private hospitals rather than to central and state governments. My fear is that supplies will be diverted to the private sector and those who rely on the public health system will not be able to get vaccinated. Vaccines are a public good; you benefit if I get vaccinated and I benefit if you do. So there is a very clear role for the state to play in this. I was pleasantly surprised by the enlightened strategy in the first phase, but it has gone downhill since then.”

em-vaccindiplomatie eng-def
Image credit: Bas van der Schot

Is the healthcare system in India well equipped to organise such a national program?

“The country has a reasonable infrastructure to distribute the vaccine. Each state has central and regional vaccination storage points. Cold chains for vaccination are in place, and there is a 35-year-old child immunisation programme. In addition, India has two vaccine manufacturers on home territory.”

“On the other hand, the Indian government underinvests heavily in healthcare. Public expenditure on health amounts to about 1.3 percent of GDP. That’s why it was a smart policy to buy centrally and, recognising the weaknesses of the system, involve the private sector while controlling prices. There was no need to create panic and let go of the strategy. With decentralised procurement, decentralised distribution and an open market, it became very messy. You now have hotels offering vaccine packages, including a night’s stay, breakfast and lunch. The central government is trying to stop such practices, but it is responsible for creating such incentives.”

Do you have any notions on why the government chose this strategy?

“The central government has a history with and a penchant for dramatic gestures. They don’t plan ahead. The initial lockdown was the same: within four hours, the entire country was in complete lockdown. There is a desire to show toughness and decisiveness and an unwillingness to back down, although the country’s Supreme Court has challenged the government’s vaccine policy. The response was a 200-page affidavit defending the policy. Support for the main governing party and their leader Modi is declining. However, there is a sense of bitterness against political leaders of all stripes at the moment. The positive story is that there was a large response from civil society, NGOs and support from social networks. When the government fails, the people respond. Through family and friends, they import oxygen concentrators and other materials and direct each other to available resources, as it’s hard to rely on the government and the public health care system.”

There are reports on people that were threatened with arrest after posting on Twitter on the lack of oxygen.

“I’ve also heard of these cases, but I don’t know how widespread it is. The bigger issue is supressing information. One of my friends runs a clinic where they do PCR testing, and he was told not to show too many positive Covid 19 results. Rather than focussing on the crisis and the tragedy, substantial government effort is being spent on managing the public image. The focus is again on the show, rather than the substance. But this is not today’s story; it’s the story of the last seven years, when it has become systematically harder for people to be critical.”

I read that in certain villages, there are protests because the available vaccines go to people from outside the village?

“Yes. The vaccination policy has inequity and injustice built into it. The app to make an appointment is in English and a smartphone is needed to make an appointment. This allows those who are tech-savvy and have transportation to book appointments in clinics that are far from their place of residence, while those in the catchment area may not be able to access the vaccines. Regarding inequity, what is new in the crisis, is that the middle and upper middle-classes have also been badly affected by the disease and have had to experience the pain of not being able to access medical services.”

Can you explain how the crisis in India has led to delays in vaccinating other countries?

“Yes. The Serum Institute of India agreed to provide vaccines for the Covax programme, which aims to provide vaccines to a group of 92 low and middle-income countries. The programme relies on AstraZeneca, which is cheaper than other vaccines and does not require minus 70-degree storage. Since India does not have enough supplies, exports have been banned. So in addition to not placing large enough orders for vaccines in the first place, the current policy of banning exports is harming the vaccination programme and the people in these 92 countries.

“I think it is a pity, an unflattering reflection on the Indian government and a potential tragedy for countries relying on vaccine exports from India. Unless alternatives can be swiftly found – for instance – countries with greater supply sharing vaccines, the actions of the Indian government will have sabotaged the Covax scheme.”

em-vaccin nieuwe variant westen -eng-def
Image credit: Bas van der Schot

Have you been disappointed in how the Western world acted in this crisis, buying up all the vaccines?

“One of the things I admired about the Indian government at the start was that 60 million vaccines were sent to countries around the globe. It’s a pandemic, so we should think globally and not in narrow-minded ways, just about ourselves. Of course you have to think about protecting your own population as well, but India’s vaccine diplomacy and swaggering was based on the mistaken idea that the disease had been beaten in the country. So its actions have ended up harming its own people and have had negative implications for those countries relying on the Covax facility.

“With regard to the Western world, I don’t have a problem with countries procuring the vaccine, but if they don’t use it, they should supply it to other countries. There are countries in the world where not even one person has been vaccinated. So good if you were smart and had the foresight to procure the vaccine. But now share it if you want to protect yourself. Even if it’s in your own narrow interest. You are not going to help yourself by not protecting the rest of the world. If countries in the Western world have enough supplies to cover their population several times over, don’t hoard it, share it. If you just leave it lying there, that’s criminal.”