Starting from Monday, every Indian adult can get a COVID-19 vaccine dose, that was purchased by the federal government, for free.
The policy reversal, announced by Prime Minister Narendra Modi last week, ends a complex system of buying vaccines that worsened inequities in administering the shots.
India is a key supplier of vaccines around the world, and its missteps have left millions of people unprotected. Less than five percent of Indians are fully vaccinated.
While the policy change is likely to address inequality, questions remain over the distribution of the vaccines. Moreover, poor planning means vaccine shortages will likely continue.
Here’s a look at the changes to India’s vaccine policy and what it means:
The earlier policy
A massive virus surge in March pushed India’s health systems to breaking point. Hundreds of thousands of people were newly infected each day, hospitals overflowed with patients gasping for air and nighttime skies glowed as busy crematoria burned bodies in the open air.
At the time, India was vaccinating those most vulnerable for free, but states flagged shortages.
Vaccinations were opened to all adults in May, but Modi’s government switched from taking the lead on vaccine availability to try to get them distributed to where they were most needed.
Instead, the federal government would buy half of all vaccines made and would continue giving free shots to 300 million healthcare and front-line workers, along with those older than 45.
States and private hospitals would split the remaining shots to vaccinate more than 600 million adults younger than 45.
However, experts warned that vaccine makers might prioritise sales to the private sector to reap more profits.
One state health minister said the Serum Institute of India, which is making the AstraZeneca vaccine mostly used in India, would not respond to the state’s inquiries.
Why it didn’t work
India has one of the largest immunisation programmes in the world and each year 300 million shots are given to infants and mothers.
But states have never bought vaccines before. And a limited supply meant states were competing with each other, while paying a higher price than what the federal government could have negotiated, said Dr Chandrakant Lahariya, a health policy expert.
“That essentially makes it inefficient,” he said.
When India started vaccinations, it aimed to prioritise health workers, essential workers and older people. But expanding the criteria despite shortages created inequities.
Since May, more people younger than 45 have received their first shot than those older than 60. More than 74 million people older than 60 remain unvaccinated.
Modi said these decisions were taken to accommodate states, but the fractured response may have cost lives, said Dr Vineeta Bal, who studies immune systems at the Indian Institute of Science Education and Research in the western city of Pune.
What has changed?
The federal government said it will buy 75 percent of all vaccines made by Indian vaccine makers and likely renegotiate prices. These shots will now be given to states to be distributed for free.
Private hospitals can buy the remaining 25 percent at prices that have been capped.
States will receive the vaccines based on their population, disease burden and how many people have been vaccinated, while wasted doses will be penalised.
But the biggest challenge will be to ensure a continuous supply. Delhi Chief Minister Arvind Kejriwal said, “Where will the vaccines come from is a big question.”
India ordered 300 million shots of vaccine candidate Biological E for $205.62m in its first agreement to secure shots in advance. But it is still being tested and has not been approved, so likely will not make a difference to supplies until later this year.
And with only one such deal made so far, experts do not think India’s reliance on its existing, overstretched suppliers like the Serum Institute will end soon.
Meanwhile, private hospitals do not yet know how they will procure vaccines under the new policy, and some say they are unlikely to continue organising neighbourhood vaccine drives since prices had been capped.