The TLDR: The union government will kick off phase three of its vaccination drive on May 1. Unfortunately, while the intent is to expand access to younger Indians, the actual effect may be to create chaos, confusion and ultimately serious shortages that will affect everyone at every age. 

The phase 3 plan

Here are the basic deets of how this is supposed to work:

• Everyone above the age of 18 is now eligible for vaccination.
• But they will have to first register on the CoWin portal. No walk-ins allowed for the 18-44 age group.
• 50% of all available vaccines will be sold to the union government—which will now only administer them via government hospitals.
• And these vaccines will only be administered to the 45-plus category.
• The other 50% will be available for state governments and private hospitals to purchase directly from the vaccine manufacturers—at a price negotiated with them. 
• Those between 18-44 will have to get their jabs either at a private centre/hospital. Or at a government hospital if their specific state decides to open up vaccinations to all ages. 

This convoluted plan has raised more questions than answers to the vaccine dilemma—at a time when stocks are running low across the board. 

Where are the vaccines?

There are simply not enough doses to vaccinate the far bigger pool of eligible Indians—as the opposition-ruled states have made crystal clear. Chhattisgarh health minister T. Singh Deo laid out the math:

“Currently we are producing close to seven crore vaccines both including Covishield and Covaxin. If half of this goes to the Centre, then only 3.5 crore doses are available for the States to vaccinate those above 18 years. The 18-45 years category is at least 35-40% of our population. Just 3.5 crore doses for them... this is a joke!”

Also this: Vaccine manufacturers have told states like Maharashtra that their current stocks are fully committed to the union government—and they will not have anything for the states until at least May 20. Another example: Chhattisgarh has placed orders of 25 lakh vaccines each with Bharat Biotech and Serum Institute of India. But Bharat Biotech says it won’t be able to fulfill its commitment until the end of July. The Chief Minister said, “We are capable of vaccinating three lakh people a day. If the Centre doesn’t give us the vaccine, then how can we function?” Indian Express has the shortfall numbers for various states.

At what price? Many states do not have any firm commitments from either Bharat Biotech or Serum Institute. They are still negotiating prices and supply. For example, Maharashtra officials said Serum has only given a verbal promise of supplying one crore vaccines a month—and a written assurance is still pending. And Serum seems to be setting its prices in a totally arbitrary manner. It first announced that the purchase price will be Rs 400 per dose. But yesterday CEO Adar Poonawalla tweeted: 

“As a philanthropic gesture on behalf of Serum Institute India, I hereby reduce the price to the states from Rs 400 to Rs 300 per dose, effective immediately; this will save thousands of crores of state funds going forward. This will enable more vaccinations and save countless lives.”

Meanwhile, Bharat Biotech still plans to charge them Rs 600 per dose. 

As a result: Phase 3 appears to be dead on arrival. Most states will not be inoculating the 18-44 age group for at least another month. The BJP-ruled states like Uttar Pradesh will do a token drive on May 1, while Madhya Pradesh astonishingly is suspending vaccinations for the 60+ and 45+ for two days so that it can kick off the drive for the 18-44 age group. No prizes for guessing which are the more vulnerable groups here.

Point to note: The number of vaccines administered is already dipping due to depleted stocks:

“Only 1.8 million doses were administered on Wednesday, a far cry from the 4.5 million peak on April 5. India has so far administered at least 145 million doses, and less than 10% of the country has been fully vaccinated.”

What about the private hospitals?

Hospitals are no less bewildered than the states. Dr Aqsa Shaikh shared a letter from Serum Institute—written in response to a request to directly buy vaccines. Here’s the key bit:

“However, due to our current obligation to meet the Government’s existing requirements and to meet the additional demand emanating from state governments under liberated and accelerated vaccination, it is challenging to meet independently the requirement across from large number of Private Hospitals. Therefore, we urge you to access the vaccine when it becomes available in the private market supply chain channels, which will take about 5-6 months from now. In the meantime, it is suggested to approach the state government for vaccine ssupplies which was provided earlier for the category of citizens over 45 yrs of age.”

Five to six months? Also: The letter makes clear that private hospitals are at the back of the line—behind the union and state governments. 

Waiting on hold: So we now have private hospitals waiting to see what the state government will give them, as the director general of their trade organisation made clear: 

“As on date, the private sector has no clarity about delivery of vaccine for 18+ population, who will be looking forward for vaccination from May 1. We have suggested to the government that as there is very little time left to have dialogue with vaccine manufacturers, we should continue to get supply through states as presently being done.”

Also this: No one—including the vaccine manufacturers—seem to have figured out how many vaccines there are, and who will get them, according to one hospital executive:

“Discussions are in early stages and are still ongoing. Manufacturers are also trying to understand the order levels that would come from state governments and private hospitals and maybe try to balance it with the inventory and capacity they have. We would have some understanding of [what] the situation may be in the next two weeks, and notable quantities are only likely to be available by end May or early June.”

The big kicker: Starting May 1, the government will no longer inoculate the 45-plus in private hospitals. This creates two immediate problems. Problem #1:

“The announcement has already caused chaos, with people whose second dose was scheduled at private clinics in May rushing to get it early for fear that they might not get it at all. The result has been long queues at overcrowded vaccination centres, raising the risk of catching the virus.”

Problem #2: A number of private hospitals have supplies given to them by the union government in phase 2—to inoculate the 45-plus age group. Now they may be asked to return those unused doses. This in turn will trigger greater shortages at private hospitals in May.

Where’s my appointment?

While there are no hard figures, according to The Hindu, 8 million rushed to register on the CoWin portal on Wednesday—and most of them were in the 18-44 category. The portal as usual had a series of tech glitches—which appear to have sorted themselves out by the evening. But here’s the catch: while younger Indians could register, almost none of them could get an appointment. The reason, of course, is that the government has left it to the states to vaccinate the 18-44 cohort—and, well, we’ve covered that ground already. 

The bottomline: As of now, the phrase ‘central planning’ has become a bit of a joke.

Reading list

• The Hindu reports on the registration snafus. 
• Indian Express details the vaccine shortfalls across states. 
• The Telegraph looks at the Serum Institute price cut. 
• Mint has more on the dilemma facing private hospitals—and a good read on what an effective vaccine rollout would look like. 
• BloombergQuint has a good piece on glaring deficiencies in the government’s data on reinfection among those vaccinated. 
• Also in BloombergQuint: A detailed analysis of the government’s phase 3 strategy. For a sharper critique: Read Pratap Bhanu Mehta in Indian Express on the government’s ‘vaccine Darwinism’ (h/t subscriber Ayesha Mangaldas).
• And if you’ve been vaccinated, you’ll be happy to know that US health authorities say it's okay to be outdoors without a mask—and indoors—as long as you are not in a crowd. Washington Post has that story.