SC calls Centre Vaccination Policy for State and Private hospitals Arbitrary, Irrational

Not approving of the paid vaccination drive by the private hospitals, the Apex Court bench comprising of Justices L. Nageswara Rao and S. Ravindra noted, "The present system of allowing only digital registration and booking of appointment on CoWIN, coupled with the current scarcity of vaccines, will ultimately ensure that initially all vaccines, whether free or paid, are first availed by the economically privileged sections of the society."

Calling the private hospitals "for-profit entities", the Supreme Court bench further opined "Consequently, they may sell the vaccine doses procured at a higher price unless regulated stringently. Private hospitals also may not sell all their vaccine doses publicly through appointments on CoWIN, but rather sell them for lucrative deals directly to private corporations who wish to vaccinate their employees."

However, the court further mentioned in its order dated 31.05.2021 that it is not against the involvement of private hospitals in the vaccination drive and stated, "Private health care institutions have an important role as well. The UoI has correctly noted in its affidavit that these hospitals will reduce the burden on government facilities."

Also Read: Negligence in administering COVID vaccine: Health worker suspended, medical officer transferred

As the issue pertains to privatizing 50% of all vaccines available for the 18-44 age group, the Apex Court issued directions to the Central Government asking for clarifications in certain matters-

• The manner in which the Central Government will monitor the disbursal of vaccines to private hospitals, specifically those who have hospital chains pan India. Further, whether (i) private hospitals are liable to disburse vaccines pro-rata the population of States/UTs; and (ii) the mechanism to determine if private players are genuinely administering the lifted quota in that State/UT alone. The UoI shall place on record any written policy in relation to this.

• Whether the Central Government conducted a "means-test" of the demographic of a State/UT to assert that 50% of the population in the 18-44 age group would be able to afford the vaccine. If not, the rationale for private hospitals being provided an equal quota for procurement as the State/UT Governments.

• The manner in which the Centre and States/UTs shall ensure an equitable distribution of vaccines across sections of the society, and how these factors into the rationale of equal apportionment between State/UT Governments and private hospitals.

• The nature of the intervention with respect to the final, end-user price that is being charged by private hospitals, especially when a cap on procurement by the private hospitals have been set.

Also Read: Allahabad HC lauds UP for improving Medical Infrastructure in 5 districts

The Supreme Court bench was listening to the Suo-Motu petition and noting that the second wave of the Covid-19 pandemic has started receding across the country, the Court decided to limit itself to hearing submissions on the vaccination policy of the central government and its roadmap for the future.

During the course of the hearing, the court noted that under the Liberalized vaccination Policy of the Central Government, covering persons in the age group of 18-44 years, the total vaccines produced will be divided in a ratio of 50:25:25 between the Central Government, State/UT Governments and private hospitals.

The court also noted that in its affidavit dated 9 May 2021, the Central Government submitted the salient features of the Liberalized Vaccination Policy, in relation to vaccination by private hospitals. These features included,

(i) Out of the 50% quota allocated for the „other than GoI channel‟, 50% will go to the State/UT Governments, calculated on a pro-rata basis as per the population. The balance of 50% would be open for private hospitals‟ procurement, based on contracts with the manufacturers. As such, the State/UT Governments and private hospitals would each end up with 25% of the total CDL doses;

(ii) Vaccination through the private sector of 25% of the total CDL quantity would reduce the operational stress on government facilities and help with issues of crowding at vaccination centres; and

(iii) Paid vaccination through private hospitals has been introduced for persons who can afford to pay, thereby reducing the operational stress on the Government. However, it has also been submitted that this policy may undergo a change based on performance and future availability of vaccines.

However, after perusing the affidavit, the Supreme The court observed,

"As a consequence of this Liberalized Vaccination Policy, 50% of the population of any State/UT in the 18-44 age group is expected to pay for its vaccination. From the UoI‟s affidavit, we understand that this has been done while taking into account the ability of a certain section of the population to pay for their vaccination. However, the present system of allowing only digital registration and booking of appointment on CoWIN, coupled with the current scarcity of vaccines, will ultimately ensure that initially all vaccines, whether free or paid, are first availed by the economically privileged sections of the society."

"As such, even those who may have been able to afford a vaccine, may opt for a free vaccine simply because of issues of availability, even if it would entail travelling to far-flung rural areas. Hence, any calculations of the economic ability of a given individual may not directly correspond to the vaccination route (paid/unpaid) they opt for. Consequently, it is plausible that private hospitals may have vaccine doses leftover with them because everyone who could afford them has either already bought it or availed of a free vaccine, while those who need it may not have the ability to pay for it," further noted the Court.

Further pointing out that even though the private hospitals provide public health service, they remain to be private, for-profit entities, the Court expressed its doubts that the private hospitals may sell vaccines at an unregulated price, may not sell vaccines publicly and sell them for lucrative deals directly to private corporations.

"Finally, private hospitals are not equally spread out across a State/UT and are often limited to bigger cities with large populations. As such, a larger quantity will be available in such cities, as opposed to the rural areas," added the Court.

However, clarifying that the court is not opposed to involving private hospitals in the process, the bench further noted,

"The UoI has correctly noted in its affidavit that these hospitals will reduce the burden on government facilities. This was also happening earlier for the vaccination of those above 45 years of age, where the Central Government was providing these hospitals with vaccines and they were allowed to charge patients a nominal fee (Rs 250). However, the issue is about the effect of privatizing 50% of all vaccines available for the 18-44 age group."

On Liberalized Vaccination Policy, the SC observed:

"The Liberalized Vaccination Policy requires some of these persons to pay for the vaccines; limited vaccines are made available for this category with the State/UT Governments/private hospitals and an additional requirement of mandatory digital registration and booking an appointment through CoWIN has been imposed, among others. Unlike the prior policy, the Liberalized Vaccination Policy does not prioritize persons with comorbidities and other diseases, persons with disabilities, or any other vulnerable groups. This is especially at issue because the experience of the second wave of the pandemic has provided an experiential learning that the COVID-19 virus is capable of mutation and now poses a threat to persons in this age group as well. Reports indicate that persons between 18-44 years of age have not only been infected by COVID-19, but have also suffered from severe effects of the infection, including prolonged hospitalization and, in unfortunate cases, death. Due to the changing nature of the pandemic, we are now faced with a situation where the 18-44 age group also needs to be vaccinated, although priority may be retained between different age groups on a scientific basis. Hence, due to the importance of vaccinating individuals in the 18-44 age group, the policy of the Central Government for conducting free vaccination themselves for groups under the first 2 phases, and replacing it with paid vaccination by the State/UT Governments and private hospitals for the persons between 18-44 years is, prima facie, arbitrary and irrational."

To view the original court order, click on the link below.

https://medicaldialogues.in/pdf_upload/sc-vaccinationwatermark-155376.pdf

Also Read: Covid-19: Center issues guidelines on vaccinating elderly, differently-abled near home