Public policy decisions should be discussed in the framework of desirability of principles driving those decisions. Therefore, the implications of decisions for the wider governance framework and society should be taken into account.

The government has decided recently to grant permission to the private sector to sell Covid-19 vaccine at a price of around Rs 12,000 per person. There are two distinct objections to the government’s decision of outsourcing the task of vaccination to the private sector in the absence of a much-needed government-led massive immunisation drive.

The first objection relates to the price. The high price set by the government makes it prohibitive for the common people to get vaccinated. A possible response to this objection can be that the government desires to reduce the pressure on the public sector by creating an option for those in the society who can afford it to seek recourse to private vaccination.

The creation of this option can relieve resources that can be devoted to immunising the poor. However, this response, couched in consequential terms, goes only so far and fails to address the second and more fundamental concern.

The second objection relates to justice or equality in the provision of healthcare. The government vaccination programme is being run age-wise. The rich can jump the queue and get for themselves private vaccination ahead of others because the private vaccination has been made available to anyone who can afford regardless of the age group. Moreover, in the administration of private vaccination, the mechanism of allocation has not been made transparent. When only a small number doses is available, people at higher rungs of the social ladder will have an undue advantage.

The media has already highlighted instances of using undue influence to get vaccines even at government centres. This undermines the dignity of citizens without adequate income or who do not have the right contacts.

In this way, to make private vaccination available to those who can afford it gives rise to two dangerous implications. One, the rich get a feeling that they are entitled to such privileged treatment as they have paid for it. This attitude extends into seeking and providing a privileged treatment in other domains - like education and justice.

A few months ago, we witnessed a broad consensus in society against the privileged treatment of political people when the issue of allocating such prisoners to different classes of prison cells arose. Concerns regarding the differential treatment in prisons were legitimate and entailed the broader question: should two individuals who have done similar wrongs be treated differently?

There is a similarly class-based division in the types of educational systems available in the country. Children receiving education in public schools are often elbowed out in competition in later stages of life. We cannot blame their lesser abilities because they did not receive a fair opportunity. Likewise, should two citizens who have an equal likelihood of catching Covid-19 be able to get different treatment based solely on their wealth status?

A state cannot abdicate its responsibility of providing life-saving treatment to citizens in a pandemic. The Constitution of Pakistan guarantees its citizens a right to life, interpreted by the Supreme Court to mean a quality life.

There is a striking similarity of moral stakes involved in a privileged treatment in various domains: to what extent should a market-exchange mechanism mediate the dispensation of public goods (e.g., justice, healthcare, education etc.).

Two, the availability of private vaccination, in the absence of government-led massive vaccination, sends a signal to the downtrodden sections of the society that their lives are less valuable than those of the rich. It also makes the poor people feel that it is their fault that they cannot afford a treatment available in the market. Both implications go on to perpetuate class-based discrimination in society and breed resentment among those at the bottom rung.

The above discussion highlights that what lies at the core of the decision is the vision of the state and its relation to its citizens — which is beyond the specific issue of the price of vaccine doses. The above argument is not meant to shut down private healthcare or private educational providers. Instead, the argument is for the government to make basic provisions of life accessible to all citizens if we want to build a democratic, progressive society.

The state cannot abdicate its responsibility of providing life-saving treatment to citizens in a pandemic. The Constitution of Pakistan guarantees its citizens a right to life which has been interpreted by the Supreme Court of Pakistan to mean a quality life. This requires the provision of basic health services to all citizens by the state. To achieve this end, it is important to invest in health infrastructure at public hospitals. This shall also pave the way towards effectively regulating the loot and exploitation by private sector healthcare.

The regulatory action by the government against private healthcare providers is not robust currently because government facilities for healthcare are lacking. A case in point is the reckless attitude of private healthcare providers towards Covid patients when beds and ventilators in government hospitals fall short. In this situation, the government ends up making a compromise with the private service providers and not taking a strong action even when blatant violations are involved.

The writer is a Rhodes Scholar. He is currently a doctoral candidate based in Paris. He can be reached at naumanlawyer@gmail.com