Fourteen states have said the vaccine will be free. More will follow. They should - it makes ethical, economic and political sense. But just realise when we all casually say 'health is a state subject', what this implies for all spending on health, and not just vaccines. (1/7).

States likely to spend 2.5-3% of budget on vaccines. Rajasthan has said ~3000cr over next 6months. The question is: what's the immediate trade-off? Income support for workers? NREGA/PDS expansions? Preparation for health infra expansion for third wave? It isn't free. (2/7).

For perspective, Rajasthan also had Rs 3000cr budgeted for NRHM and Health Insurance this fiscal year. Does Centre want states to make such trade-offs? This after handing them a Rs 400/600 ticket price that the states didn't even have a chance to negotiate themselves? (3/7).

What states really need is transparency in basis of allocation (is it population? disease prevalence?) + clarification in supply schedules/timelines + a breakdown of where the 35000cr for vaccines in the Union Budget has gone. Critical esp in a supply constrained market. (4/7).

Disease disrespects state boundaries. Vaccination works if it isn't a patchwork determined by state capacity to pay and pay quickly. The Centre should be focused on easing possible differential coverage across states, not exacerbating them. I hope they do so even now. (5/7).

At the very least, if the Centre is handing over costs (it shouldn't), it can also offer financing - the same kind of long-term (30-50yr), interest free loans it offers for the capital infra we have no trouble giving money for (see https://tinyurl.com/xvfcc3z8 ). (6/7).

Squeezing state budgets amidst a pandemic has health consequences far beyond the vaccine. State + Central health expenditures should be protected, bolstered, and expanded at this point, not be forced into impossible choices. None of us are safe unless all of us are safe. (7/7)