Vaccines for votes

A photograph of a person inserting a piece of paper into a box via a slit, akin to casting a vote in a ballot box.

A week or so ago, the Bharatiya Janata Party in Bihar released its poll manifesto, the first point on which was that should the party win, it would make a COVID-19 vaccine cleared by the ICMR available for free to every resident of the state. It was an unethical move, and Siddharth Varadarajan and I explained why.

Soon after, trolls on Twitter pointed out that Joe Biden had made the same promise ahead of the US presidential elections. And this morning, Indian Express quoted the Election Commission saying the BJP’s promise didn’t violate the poll code; the report also included a curious paragraph: that “the EC had taken the same stand on a complaint received during the Lok Sabha elections last year against the Congress’s NYAY scheme that guaranteed a minimum income of Rs 6,000 per month, or Rs 72,000 a year, for 25 crore people.”

The BJP’s promise still feels unethical to me. This isn’t for reasons that have anything to do with the poll code if only because the poll code’s scope doesn’t extend beyond the election itself, to the bigger picture.

At the outset, I don’t think vaccines should feature at all in election rhetoric (even if this may be wishful thinking with a majoritarian-populist government). But here we are.

The BJP is in power at the Centre – it runs the national government – and is hoping to come to power in the state. It isn’t necessarily including Nitish Kumar, the state’s incumbent chief minister and whose party the BJP is allied with, because the vaccine promise appeared only in the BJP’s manifesto, not in the alliance’s, and was announced with much fanfare by the Union finance minister. So Kumar was nowhere in the picture but the Centre was. This is a slight but significant difference vis-à-vis Biden’s promise.

State is a health subject in India but a COVID-19 vaccine, should one become available, will have significant participation by the Centre, from purchasing to distribution. Note that India’s states didn’t fight polio – they simply couldn’t. The country has a whole did and today COVID-19 presents an even bigger challenge.

A new study, echoing some older ones, has found that antibodies to COVID-19 fade over a few months. Assuming for a moment that vaccine-induced antibodies work like natural antibodies, and setting aside the fact that the question of antibody persistence is yet to be settled, access to vaccines (including the question of affordability) matters as much as its uniformity. That is, the level of access should be uniform across the epidemic’s ‘jurisdiction’.

For example, if a state with poor pubic health care and infrastructure to begin with is forced to administer the vaccine by itself, failures on its part could allow the virus to become endemic to that region, and allow it spread once again through the rest of the population once their antibody responses have weakened. So an additional pitfall here is if the BJP fragments the responsibility of distributing and administering a COVID-19 vaccine to the states, in an effort to legitimise piecemeal agreements based on political expediency, the vaccination drive will fail, especially in states like Bihar.

So while state governments will be able to decide whether to sell the vaccines for free, the decision depends considerably on the Centre’s cooperation. In effect, the BJP at the Centre abdicates the option to ensure everyone gets the vaccine at no cost when it offers to do so only in a specific area, and in exchange for votes.

Biden is not entirely in the clear either: ‘vaccines for votes’ is a prompt for voters to think of their choice of president as a question of life or death, which is nothing but a dire threat. But neither his case nor that of the Congress’s NYAY scheme are ones of abdicated responsibilities. Neither is yet in power in their respective countries, so neither is pulling back on their existing responsibilities, making their exercise contingent on electoral outcomes or vouchsafing the rewards to – from the epidemic’s PoV – an arbitrary section of the population.