Vaccination programmes in India date back to the early 19th Century – the smallpox vaccine was one of the first initiatives. It was administered by the Vaccination and Sanitary Departments supervised by the Sanitary Commissioners at the provincial level. Vaccine distribution was decentralised, and institutional mechanisms varied across Provinces. The autonomy given to Provinces was formally encoded in the Government of India Act, 1919 which assigned the responsibility of providing health services to the Provinces and this was later adopted in the Constitution of India 1950. But the Constitution placed ‘Infectious disease control’ under the dual responsibility of the Union and the States.
In the early 1950s, the Union government took an active role in vaccination campaigns. With tuberculosis becoming a widespread disease, the Union government set-up a plan as part of the BCG vaccination programme and laid down the institutional frameworks for implementation in each State. Eventually, this became a part of the National Tuberculosis Programme in 1962. In the same year, the Government of India also started the National Smallpox Eradication Programme.
India’s renowned polio vaccination drives were initially piloted by States like Tamil Nadu and Kerala in the late 1980s and the Union Government joined the programme in 1995. A concerted effort of both Union and State governments led to the World Health Organization (WHO) removing India from the list of polio-endemic countries in 2012.
In all of these cases, there was a reasonable (or more) level of cooperation and coordination between the Union and the States, the institutional division of labour was explicit, and the programmes were more or less considered to be successes. Indian federalism was operationalised effectively in the service of vaccinating the population against diseases.
The COVID-19 pandemic particularly the second wave has been rather different. Admittedly, the challenge is novel and urgent owing to the high transmissibility of the disease and the exponential increase of positive cases and deaths (which many argue could have been avoided in the first place). To overcome this predicament a high degree of cooperation and coordination between the Union and States is required. Unfortunately, it appears that the Union government has not facilitated the emergence of such a Union - State relationship.
Let us take for example the Union’s new vaccination policy. The Union wants States to individually negotiate deals with the manufacturers for vaccines thereby fragmenting the vaccine market. The Union has effectively pitted States against each other in the boxing ring of the free market – with the winner rewarded with vaccines earlier than other States. Adequate safeguards in terms of pricing or fair distribution (some States might more require vaccines more urgently than others) have not been laid down raising serious concerns about supply management and distribution.
Also, the execution of the recent vaccination drive for the 18-45 age group has proved faulty and reflects a failure in Union – State coordination. On 1 May the Union in a self-congratulatory manner announced the opening of CoWIN - a pan India online portal on which Indians aged 18 to 45 years are required to schedule their vaccination appointments. However, only a few slots for 18-45 aged persons are available on the site and those who were lucky enough to get an appointment scheduled were often turned away from hospitals for the lack of vaccine stock. Why would the Union open a portal and encourage vaccinations for the age group of 18-45, without ensuring and checking if States had sufficient stock?
Historically, the Union and States have shared the responsibility of immunisation and vaccination efforts and have worked well together within the constitutional framework that regulates the Union - State relationship: infectious disease control is in the Concurrent List – over which the Union and State Legislatures have legislative competence and executive powers. Laws like the Disaster Management Act, 2005 , under which many COVID-19 related Union and State executive action is taken, provide for cooperation with the Union and State governments working together to tackle crises.
Could the Union government take inspiration from successful vaccination drives in independent India’s history to ensure that it collaborates and coordinates effectively with States to deal with the second wave of COVID-19?