Saturday Q&A: India’s vaccine Plan A was the pandemic disappearing... Its new plan makes no sense’

Plus, what McDonalds teaches us about vaccine procurement.

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The Indian government made a dramatic change to its vaccine policy on April 19. Until then it had followed the approach taken by most countries around the world – the Centre procures the vaccines, distributes them to states and hospitals for delivery to the people through a phased rollout.

By mid-April, as India was hit by a brutal Covid-19 second wave, it seemed evident that the government’s vaccination plan was struggling. Numerous states were reporting shortages and the pace, instead of picking up, was steadily falling after a high at the start of April.

Suddenly, the Centre announced major changes, which I wrote about here. Despite the shortages, vaccines would be open to all adults over 18. But the Centre would no longer take responsibility for all. Instead, it would continue to buy vaccines for those over 45, while states and private hospitals would be responsible for the 600 million between 18 and 44. The Centre would be cornering 50% of all vaccine production at a price it negotiated, while the remaining 50% would be sold at a manufacturer-set price to states and private hospitals.

Murali Neelakantan, the principal lawyer at amicus and former global general counsel at Indian pharmaceutical company, Cipla, and Ashish Kulkarni, who teaches at the Gokhale Institute of Politics and Economics, Pune and blogs daily at econforeverybody.com, have been looking closely at the vaccine policy.

They have argued that the fragmentation caused by the policy is ‘mind-bogglingly bad economics’ and have asked whether there is any other country in the world that follows this approach. We spoke to Neelakantan and Kulkarni about the new policy, a project on healthcare that they’ve been working on, and what information they would like to see from the government.

Tell us a little bit about your backgrounds and how you came to look at vaccines, among other things

Murali: Most of my life, I’ve been a corporate lawyer. In 2013, I ended up at Cipla. And then that changed my view of the world. It was there that we looked at real issues of access to medicines and to healthcare, the other side of IPR. That’s when I started writing seriously about access issues. It’s not just IP, there are lots of other issues. Ashish and I have been working on a project for the last eight months now, to be published this year, addressing some of the issues in Indian healthcare.

Ashish: I am a professor of economics and statistics at the Gokhale Institute. I was blissfully unaware of all of the issues about access to health in India until as Murali mentioned, we started work on this paper. My interest is in part because of the project we are working on, but also because what little I know of economics just doesn’t match up with how we are approaching not just vaccinations, but everything else associated with the pandemic.

Murali: I keep teasing Ashish, because I have no knowledge of economics. And then I insist that he explains to me the economic model that justifies these outcomes. That’s been our conversation now for almost a year - to test economic theories and economic concepts on behavior that we’re seeing today. And we’re still searching for an answer. We still don’t have one.

What is this project you are both working on together?

Ashish: The idea behind the project is to try and investigate what the Indian healthcare sector or more generally health in India looks like. Whether it is a unified market as it ought to be. Which of course, it is not. There are a whole host of problems when it comes to the provisioning of healthcare in India, there are disjointed markets depending upon, for example, whether you’re a government employee or you’re a private citizen.

It is, at least to my eyes, needlessly jumbled up. And most of the solutions that have been implemented have in fact made the problem worse, such as, for example, the current PM-JAY scheme, which itself is an extension of earlier public healthcare schemes. But in summation, we live in a country where healthcare, especially for a country of this size, is being provided in a piecemeal fashion, in an extremely inefficient fashion with poor regulation, and predictably horrendous outcomes.

Murali: We started last August, and developed this project on our own. It is not funded by anybody, nobody else was interested in it. Aashish and I decided to investigate this, and to see what the problem is. And we have modeled a solution for it, or at least a model that will solve some of the issues that we see. And we find that it’s very strange that nobody has solved many of these issues yet.

There’s been serious writing on Indian healthcare for a very long time. But we’re not seeing anybody put together any of these, so we think the project was worth it.

Let’s go back to August 2020, or mid-2020 in general. We’re looking at vaccines. How should the Indian government have been thinking about them?

Murali: I laid this out in some tweets, some articles I wrote, some conversations I had last year.

The simple question is: What is our plan for 2 billion vaccines? Where are the raw materials, what are the bottlenecks, what do we need to build, what do we need to buy? What is the Plan B? What are the patent barriers?

If we had figured out all of this, assuming we have to make 2 billion vaccines in India, the cost of doing that planning and creating, let’s say additional manufacturing for raw materials, for consumables, some R&D, would perhaps have been some Rs 30-40 crores.

And then the worst case scenario would have been that we would have had additional vaccine manufacturing facilities, the pandemic would not have lasted past, say, January, but we would have created excess vaccine manufacturing capacity.

Ashish: If I had to operate as an economist, I would have said the same thing. What is the quantity that you require, and work backwards. We need 2 billion vaccines. Use whatever power you have as a government to make that happen.

That worst-case scenario – additional vaccine capacity – the opportunity cost of that is hardly a consideration, considering what we knew of the pandemic.

I would only add two things to what Murali said: Especially vaccines, of all things, need to be free. So one of my components would have been that we need to make sure that the vaccine is free for every single Indian. And then we need to figure out how to distribute it as efficiently as possible.

Murali: Ashish and I are clear on this. We have many free-market views. But there is no free market for vaccines. Vaccines have to be free, they have to be universal, and therefore I said 2 billion vaccines.

Would you say India had some political economy constraints, like access to capital or to state capacity, that ought to be considered?

Ashish: The basic model doesn’t change, no matter which country we’re talking about. The fact that we need to vaccinate people in a pandemic is non-negotiable, whether you’re rich or poor. Figure out the plan, figure out the impediments, and then do what it takes.

Murali: On cash, we’re not talking about 1000s of crores. We’re only talking a few 100 crores at best. The opportunity cost for those 200 or 300 crores, versus the vaccine not being available… Frankly we can afford Rs 300 crore. We can afford Rs 3000 crore.

Ashish: We can afford Rs 30,000 crore.

Murali: I’m not going to 30,000 crore, because maybe we would have looked stupid if we spent that on the vaccine and the virus disappeared by December. But Rs 300 crore or Rs 500 crore was a saleable idea. We could have justified the fact that it was building infrastructure, so it’s not just expenditure, it’s actually an investment. It’s not that I’m just throwing money at something. But for many of these, once you fix the problem of money, then everything else is very easy to fix.

As you started looking into these matters for pieces you’ve been writing over the last year, where are you getting your information?

Murali: A lot of it comes from outside India, to give us a perspective from the outside of what’s happening in India. If we just go by what the Indian] government is saying, we couldn’t make any sense of it.

Ashish: And not just on the part of statements by the government, but also in terms of the data reported by the government. Most of what we know comes from stuff that you read, online discussions that you have with other health experts, whether in India or outside.

The biggest challenge has been to reconcile some of the statements put out by the government, especially over the course of the last two to three months or so. Some of it is unfortunately, in stark contradiction to other announcements put out by the government. So to try and make sense of all of it together has been a challenge.

Murali: Even for our project, one of our big challenges was really finding data. Very basic data is so hard to find. What is the total expenditure by line items of the central government on health care? We don’t know. How much does it spend on the CGHS? We don’t know. How does it compute the National Health accounts? We don’t know. Ashish and his team have been trying really, really hard. We’ve called and begged people to send stuff. So that’s the state we’re in, and we still can’t get it.

So let’s talk about India’s new vaccine policy. There are, in a sense, three core elements: open to all over 18, convoluted procurement instead of central, and a private channel. How do you read the changes?

Murali: It was going fine until the second wave hit. And then we lost all sense, and then flapped around and came up with this plan.

If you look at the data, it shows that our prioritisation in the first two phases, which is frontline workers, and then 60 pluses seems to have been good. There is a scientific reason for it, there is a medical reason for it, there is a public health reason for it. There is also an economic reason for it – you want this to go to the right place. We set it up in a way that can be scaled. This is a perfect petri dish to do the scaling up. We learn from the process of the first two phases. And then we junked all of that information and said we will start something new now.

What we’ve seen with allocation is that there’s no correlation between allocation and anything. If you look at data, you may say allocate to states where there are more deaths. That’s not happening. Gujarat has the highest allocation per death. If you say, give it based on population, Chhattisgarh has more than Tamil Nadu, where Tamil Nadu only has 0.2 vaccines for every person over 45. If you go by rate of infection, that’s not work either. What is this blackbox algo that is throwing up figures that say today you will get 2 lakhs, tomorrow you will get 36 lakhs?

You got the prioritisation right initially, but you’re in a crisis on allocation, and that only gets worse with the new policy.

Allocation was always going to be a problem, when there is limited supply. But we added to it by opening up to all and making states procure themselves?

Murali: I think there are two different problems. If you are centrally procuring, then we can hold the Centre to account and ask them questions. Please publish your algo so that we can understand it. So central procurement, you get the benefit of accountability. To say, you know, we had the best price, but you’re also accountable for allocation. With the new policy, there’s no accountability for allocation by private manufacturers.

Ashish: As an economist, it becomes worse when you leave both procurement and obligation to the state. One of the most fundamental things in public policy is you want to leave only one target and not two. [Note: “This refers to a rule of thumb which states that policymakers trying to achieve multiple economic targets need to have control over at least one policy tool for each policy target.”] So when you say to the states that you must now procure and you must allocate, the state has the ability to turn back and say, ‘you know what, I couldn’t procure so how the hell do I allocate?’

It is precisely for this reason, apart from so many others, that we want the Centre, and the Centre to say, on the basis of these publicly available methods of allocation, we’re going to give this much to the states.

Right now what we have is a black box when it comes to allocation, a black box when it comes to procurement. And unfortunately, and most, I think, disturbing, a black box when it comes to pricing as well. What explains the Rs 150 or Rs 300 or Rs 400? The “magnanimity” of coming down from Rs 400 to Rs 300?

Murali: The model that we had for 50 years. It’s not just something that happened. That is the model that the world is using today, which is central procurement, free distribution to the states, free distribution to the people. They’re even incentivizing people to take vaccines: if you take a vaccine, we’ll give you something free.

Even countries that don’t have a universal vaccination program, like the US, they’re doing that. They tried what we are doing now, more than 50 years ago, with polio – a little public sector, a little private sector, markets will deal with vaccination – and it was a complete disaster. They’ve acknowledged it.

It’s really hard to explain that the world has adopted our model, and we’re junking it and saying, we’ll try the bad model that failed you 50 years ago.

Just on states procuring directly instead of the Centre, how do you explain to readers that this is a bad idea?

Ashish: Think about how McDonalds does procurement. If you have 1000 McDonald’s stores across the length of the country, McDonalds doesn’t say each of these 1000 independent franchisees should go and procure the potatoes and the oil themselves from the local daily market. The reason you have centralised procurement is precisely because it’s the most efficient way to do it.

When you order for 1000 stores together, you can say to the supplier – you know what, I need such a large quantity, and that is why I’m going to get the best price possible. And the supplier knows that there’s this one entity that is going to demand a large quantity, and so they can make sure to have the production capacity to meet the demand.

If you imagine a world in which each of those 1000 franchisees goes up to the supplier and says, ‘can I have 10 kilos, 15 kilos, 100 kilos, each’, you lose bargaining capacity, and also enter a world in which the supplier can play off each individual franchisee against the other.

The competition by definition will drive up the price at which procurement will take place. And this is even worse, in the case of vaccines. Because when it’s oil and potatoes, they’re not as inelastic as the supply of vaccines is right now, and the demand for vaccines is that much more desperate.

It makes no sense to fragment demand into as many constituents as we have.

What else jumps out to you from the April 19 change to vaccine policy?

Murali: The 19 April notification has some very strange features. One is that it allows export, and it doesn’t have a cap on export. I don’t think anyone has picked this up, that manufacturers could just stockpile for export, right?

Temporarily you’ve put a ban on exports, but it’s an unofficial one. There’s no notification. That means unofficially it can be lifted also.

So the first risk is you’re allowing exports of a scarce commodity produced in India.

The second problem is, of the domestic sales, the Centre gets 50%. But of the remaining 50%, the states could get zero, because it’s up to the manufacturer who he wants to give to. And the complication is that the prices for the states are fixed, but the private sector can offer higher prices.

Ashish: [Adar] Poonawalla is on record, he used the word ‘hullabaloo’ and said he doesn’t understand why states are complaining, they need not participate in this at all.

In the recent affidavit, apparently the allocation is supposed to be 50% to Centre, 25% to states and 25% to private players. Even within that, the incentive for the seller will be to sell to the highest bidder first.

These so-called decentralised or liberalised market prices for vaccines is a disaster, not just waiting to happen, we see it unfolding in front of our eyes right now.

Murali: There is a twist on that affidavit. Because the notification says very clearly that manufacturers will be free to sell 50% to states and private players. There is no direction to sell equitably, to give 25% to states and 25% to private. I think this affidavit is a fib, it’s making up stories. There is nothing in the strategy that says manufacturers have to do this.

Ashish: Some of this also goes against what Dr Harsh Vardhan said in that message he put out on Facebook and Twitter. He clearly mentioned that states are in fact free to negotiate prices. But if you read the latest affidavit, it says that the Centre has negotiated prices for the states.

The other confusing part, that I can’t make head or tail of, is: You have to negotiate on price, if you want quick delivery of large quantities.

Murali: Or states have to offer non-price incentives. And I wonder what those are. How do you persuade Poonawalla to sell more to Maharashtra and less to Fortis? I don’t know what incentives Fortis is giving Poonawalla. So it becomes like the Mark Twain story of Tom Sawyer painting the fence, everybody will give him either one apple or let him play with their dog or something like that, so that he paints the fence.

What is this non-price incentive that you’re going to give so that he gives more to Maharashtra and less to Fortis or less to Manipal or anybody else? And amongst the corporates, how are they going to bid? What are they going to give Poonawalla?

Unless you say that price is not fixed. But that price is notified. He has declared that price for the private market. So then what remains to be negotiated? You will give him a horse, you will give him a car, what will you give him to get yourself more product?

What do you make of the argument that we needed to unlock private sector energies to ensure vaccines reach everyone in India?

Murali: We have very good rules on energy in physics, in chemistry. I have never heard of energy in economics. I asked Ashish to send me material to read on this, but he couldn’t find any. Seriously, this is not a flippant concept. I was very curious.

As for anyone who says we lack state capacity, it’s very nice, NGO speak. But we’ve successfully run, for 50 years, an immunisation campaign. What is the state capacity that the government is lacking in vaccination ,having done it for 50 years, that magically private parties run by cardiologists will acquire in the next two weeks?

What is the state capacity that Medanta or Fortis or Manipal, any of these hospital chains have, which they will acquire in 11 days, between April 19 and May 1?

Ashish: We have demonstrated state capacity to deliver vaccines, and it makes no sense to not use it. But to come back to the original point of energy being released, because of the April 19 announcement, the only thing that makes sense is that there is energy of both suppliers as well as those who are demanding it.

All you are doing through this announcement is releasing the so-called energies of the people on the demand side. And that takes me back to what we spoke about earlier: Unless you figure out a way to increase the energy of the suppliers, all you’re going to have now is a lot more fragmented energy on the demand side, which serves to do nothing except raise confusion and prices.

If the liberalised vaccination policy was able to augment supply through this magical energy thing, great. That would have been fantastic. But all that has happened is that we have fragmented and energised demand.

I don’t see how that helps. In fact, if anything, that makes it worse.

What do we need to do to augment the supply side?

Murali: This was the plan that I had thought of last year: What will it take for us to make 2 billion vaccines.

The vaccine development cycle for Covid has been exceptional. We got the sequencing in January. We had a vaccine developed in 2 months. We started production in July. It’s unprecedented.

So we have to think about it differently from how the world has been thinking about increasing capacity before 2020. The reality is that 2020 taught us we can quickly ramp up our existing capacity.

If we think through this process, we have the facilities. We’re not building something from scratch. If you look at the Pfizer and Moderna vaccines, Moderna has never made a vaccine before, right? This is its first vaccine, and it brought this vaccine to market in months. So if somebody can produce a vaccine in four months, are you telling me that we can’t do it?

You don’t buy the argument that patent waivers won’t do much because there is no spare capacity?

Murali: It’s a good argument – but we do have capacity. There are manufacturers just waiting for a signal from government. The market issued signals last year. Sadly, the supply side didn’t receive those signals because the government noise drowned that demand signal. Even now we’re not sending them clear signals. Even now, the new liberalised vaccine strategy doesn’t give them any good demand signals.

What would have helped is for the government to say, ‘listen, here’s 300 crores. Let’s sit all of you down around a table, everyone who needs to have a view on this, and simply ask this: How will you get to 2 billion doses by the end of the year?

Murali, from Cipla, you must be familiar with how the government handles companies in situations like this. What do you make of its handling of SII

Murali: Government took a strange view. One, we thought we don’t need Poonawalla, because we seemed to believe that the pandemic is going to go away. And if it does perk up, the Poonawallas owe us vaccines from the Novovax part of the supplies. That was Plan A.

Plan A1 was pandemic disappears. Plan A2 was we have Novovax on board. To the extent of the Astra-Zeneca side of the equation, we will get it from the COVAX facility. So COVAX from Novovax. COVAX from Astra Zeneca. We are fine.

Then we had Plan B. Which is, if the pandemic happens, of course all the vaccines are going to be made in India – that is my backyard. So I’ll just ban exports, and I can keep everything.

That was Plan A and Plan B.

How do you think the government handled its relationship with SII?

Murali: He’s been abandoned by the central government, with the tradeoff being better price. But now he’s going to be chased by the wolves, right? He thought he’s going to make Rs 40,000 crores in profits. But at the moment he may not think it’s worth it.

Can you put your devil’s advocate hats on and say if there is a charitable reading of the government’s policy? Does any part of it make sense to you?

Murali: I’d really love to, but when the whole world’s on the other side – every economist, starting from [Joseph] Stiglitz to Kaushik Basu to Arvind Panagariya to Anantha Nageswaran, everyone you might think of who you might want to have an argument with, are all on this side – then you’re looking for who’s on the other side saying anything sensible about it.

The only arguments that you’ve seen on the other side are that if you increase prices and have a free market, we will get supplies. I mean, then Ashish has got a point to make, shall we agree to pay 10,000 rupees. Will it get us supplies tomorrow? Clearly not. That was one argument.

The other was that we should go and bid in the global marketplace for vaccines. If that was the case, some rich trader at Goldman Sachs would have said, I’ll buy up the whole vaccine supply of the world, and you come and trade with me everyday. I would have created a market for vaccines.

That can’t be the case because there is no marketplace. Otherwise, some dark pool would exist for vaccines right?

I really don’t know whether any fact that helps me say that any part of the policy is good.

You can say that states now have a chance to fight with each other and look better than each other, but I don’t see that as a silver lining. That’s not cooperative federalism. Fighting your brother and giving him a bloody nose so that you look good in front of your dad and his friends.

That part of the competitive market doesn’t do it for me.

Ashish: If you were to put a gun to my head and say, ‘tell me something good about this’ I would say, now it’s open to 18+, but that’s a cruel joke, because you know in practice that doesn’t mean anything. It’s open to everyone in theory.

What if the Centre had done all the government procurement, 75%, and left 25% to the private sector so that the manufacturers could make back the money they couldn’t get from exports?

Ashish: It leads to Zeno’s paradox, right? If not 50%, why not 67.5%? Why not 75%? Why not 87.5%? Why not 99%? The whole point in a pandemic is to keep things as simple as possible. Just have centralised procurement.

Murali: This is a ‘do you choose to lose your left hand or right eye’ kind of argument, right? This is ridiculous. Why do I have to do this trade-off? What does giving 25% to the private market achieve for you, for India? You’re creating friction in the system. You’re going to have prioritisation.

Which 25% is going? 25% of the whole? Of each batch? Of every month? All of these are going to add friction to the process. You are fighting over 50%, dividing it 25-25. Now you’re going to fight over the 25%.

And then you’re going to have fights between hospital chains, corporates… who’s going to sit and do arbitration of that? Is the central government going to say if Reliance wants to inoculate all of its people, and decides it wants X number of vaccines, and then Mahindra wants to do it as well, and Shell wants to do it as well, and Serum Institute of India says I will give it to Shell and not to Mahindra, who will they go and fight with on this?

We’re just adding friction to the system. I have no sympathy for Poonawalla, but is he going to sit with the heads of all the families and decide? What are we asking for? ?Government has created this.

What do you think of how the private channel was operating before the April 19 change? When some could get the vaccines at private hospitals for Rs 250?

Murali: It played out well. I know that a lot of people who could afford it, chose not to go to the public facility, so it allowed those who could not afford to use public facilities. And at that price point, a lot of people could access it. At least the middle class in urban areas were willing to pay that amount so their drivers, the facilities people, building societies, housekeeping staff could get vaccinated.

And there is precedent for this. Even under the immunisation program, if you get bitten by a dog and you thought there was rabies or cut yourself and needed a tetanus shot, the vaccine is available in hospitals. You don’t have to go to a primary health centre.

But there would not have been diversion there, because the hospital doesn’t make a dramatic amount of money. There was no diversion from the public market to the private market. On the demand side you may have thought of it as two markets, but it was still one price.

Ashish: It may be possible perhaps to have foreign vaccines be imported and distributed through the channel that you are speaking of, and leave Covaxin and Covishield for the public vaccination programme. If anyone chooses to use whatever it is, Johnson & Johnson or any other vaccine, maybe that is available through private channels. On the face of it I can’t see a downside to this.

But again, to me personally, I would prefer to keep things as simple as possible.

Murali: Maybe that is the silver lining. The new policy allows imported vaccines by private players. But that will only be a small percentage of the market. So it doesn’t really affect anything, and it doesn’t distract from the main universal vaccination programme.

Just to go back – if we reverted to full centralised procurement today, would you be okay with a private channel to sell them? Then we might be back to the same question for the end user - Rs 250 was fair, why not Rs 500?

Ashish: It’s exactly for that reason that I’m personally in favour of keeping things simple, because this is where state capacity will run into roadblocks. Procure centrally and distribute through the public distribution channel alone.

Murali: If you remember, Rs 250 was only the price to the patient. The price to Serum for the vaccine was the same. That is negotiated between Serum and the government. So what we’re saying is, am I willing to pay 100 rupees more to go to the private hospital. And the hospital is not making money on it. It’s not price gouging. It’s a price that sounds reasonable.

And they all signed up for it. That’s the system the US uses. Which is that you walk into a Walgreens or CVS or anything and take a shot and then go. And then Walgreen charges the government. And then the government pays – has already paid – Pfizer for it. And that’s all invisible to me.

So slightly different approaches there. Just a few final questions. What misconceptions do you find yourself battling all the time?

Ashish: The part that gets both me and Murali apoplectic is that we just don’t understand how anybody could envisage a world in which liberalised vaccine strategy makes sense. Having to correct the impression that this is somehow a good thing is to me the most frequent challenge when I speak to whoever – colleagues, lay people, those who read my blog.

Then there’s the idea that higher prices will incentivise higher supply. It’s treated not just as an economic truism, but as a God-given law. But that’s not how reality works. Supply doesn’t just go up because price is higher. It takes a whole host of other things to fall into place. Magically increasing the price will not drive up supply.

Murali: Following on from this is, every reply to us is, ‘oh now you’re taking us back to socialism.’ Framing this as against the free market. This is the huge pushback that I’ve seen. That universal vaccination is a socialist concept, you’re taking us back into the Soviet era. That usually shuts down when I say the US is doing it. But that criticism continues.

We’ve had this challenge, while Ashish and I are writing the book. In many ways, we believe the market works, but sometimes it doesn’t and it needs to be kickstarted, or sometimes nudged . Largely the government doesn’t understand how the market works, and therefore intervenes in the wrong times and thinks it’s actually nudging or managing it, whenit actually interferes.

This is one of the things that I find very difficult to explain - that Intellectual Property Rights does not mean innovation. People just assume that if I talk about free, free access, more access and anti-IPR, that means I’m anti-innovation. That immediately goes into free market vs government again, with people saying if you don’t give us IPR, we won’t have innovation.

IPR is not innovation. Therefore, saying that if we have patents, we will have more innovation, and if we have more patents, we should pay more money because we will get more patents, by paying more money for the product that is patented… it’s just a very difficult argument to address to most people because they don’t get it.

What other information would you like on the vaccination programme so we can understand it better?

Murali: I’d like to see what the production projections are. What is stopping us from doubling them? We need double what we have at the moment. What I would have expected from the government is to tell us what the supply is, what they’re willing to do to double it in the next three months. And for the manufacturers to tell us what they need to double production.

That is the data I’m asking of government. Show me what that plan was where you told these guys, we need it doubled in three months, what will it take. And they came back and said no amount of money can double it in three months, but we can do it in six months. Here is the plan.

This is what I’d like to see from government.

Ashish: And on supply chain restrictions that hold us back from doubling. All of us keep hearing the same things, but if you could have clearer ideas of where exactly, which products, what supply chain bottlenecks there are, that would be useful.

One final point, if there is to be a wishlist from my side: Clearer and more frequent communication from government about the plan.

Murali: Clearer communication on saying that Harsh Vardhan did not say dark chocolate…

Three recommendations for people interested in this subject to read/listen to/watch

Murali: The two Michael J Sandel books are outstanding – Justice and What Money Can’t Buy. Giving a country cheap or free vaccines is charity. Allowing them to produce vaccines is justice. We don’t need charity or philanthropy, we need justice. And I think everyone who’s thinking about policy needs to read those two books. Amit Varma’s podcast with Ajay Shah throws up some interesting questions and challenges.

Ashish: When it comes to public policy in general, Pranay Kotasthane and “Raghu Sanjaylal Jaitley’s” newsletter, Anticipating the Unintended. They take an opposite view to ours when it comes to vaccine procurement, but that, in a way, is the point. Many more people should be reading this newsletter. Profesor R Ramakumar on Twitter is well worth following.