Supreme Court Directs Consideration of Suggestions for Vaccinating Pregnant and Lactating Women: Delhi Commission for Protection of Child Rights vs. Union of India (25 January 2022)

Date of the Judgment: 25 January 2022

Citation: 2022 INSC 98

Judges: Dr. Dhananjaya Y Chandrachud, J and Sanjiv Khanna, J.

Can the government be directed to modify its vaccination protocols for pregnant women and lactating mothers? The Supreme Court of India recently addressed this question in a Public Interest Litigation (PIL) filed by the Delhi Commission for Protection of Child Rights (DCPCR). The Court considered the need for effective access to vaccination for this vulnerable group, while also balancing policy considerations and the government’s expert-driven approach. The bench consisted of Dr. Dhananjaya Y Chandrachud, J and Sanjiv Khanna, J. The judgment was authored by Dr. Dhananjaya Y Chandrachud, J.

Case Background

The Delhi Commission for Protection of Child Rights (DCPCR) filed a Writ Petition under Article 32 of the Constitution of India, seeking to ensure that pregnant women and lactating mothers have effective access to COVID-19 vaccination. The DCPCR requested several specific reliefs, including categorizing pregnant women and lactating mothers as high-risk, prioritizing their vaccination, setting up a task force for post-vaccination health monitoring, developing educational materials, creating a registry, establishing separate vaccination centers, engaging Anganwadi centers and ASHA workers, and adding an option on the Co-WIN portal for self-identification to prioritize slots.

Timeline

Legal Framework

This case was filed as a Writ Petition under Article 32 of the Constitution of India. Article 32 provides the right to individuals to move the Supreme Court to seek enforcement of their fundamental rights.

Arguments

Petitioner’s Arguments (DCPCR):

• The petitioner, DCPCR, argued that pregnant women and lactating mothers should be prioritized for vaccination due to their high-risk status. They raised concerns about the existing framework’s reliance on voluntary verbal declarations at the time of vaccination, suggesting that many women might not be aware of the need for such declarations. To address this, they proposed modifying the Co-WIN portal to include a mandatory declaration at the time of registration. This would ensure that the status of pregnant women and lactating mothers is properly recorded, allowing for better monitoring of their health post-vaccination.

• The DCPCR also emphasized the need for targeted tracking of pregnant women and lactating mothers to bolster the existing surveillance measures for monitoring Adverse Events Following Immunization (AEFIs). They argued that this would enhance the process of monitoring and provide better data for analysis.

• Furthermore, the DCPCR submitted that the publication of data, once adequate datasets become available, would enhance public confidence in the vaccination process.

Respondent’s Arguments (Union of India):

• The Union of India, represented by the Additional Solicitor General, stated that the government has carefully evaluated each of the petitioner’s suggestions through its expert bodies. They acknowledged the ongoing evolution of the vaccination process and expressed openness to further deliberation but also raised concerns about implementing the suggestions at the present stage. The government highlighted that the decision to vaccinate pregnant women and lactating mothers was based on recommendations from the World Health Organization and other experts.

• The Union of India explained that the verbal declaration at the time of vaccination was deemed sufficient to avoid dissuading people from seeking vaccination by introducing additional requirements at the time of registration. They also emphasized that a robust mechanism for monitoring AEFIs was already in place.

• Regarding the publication of data, the Union of India submitted that publishing raw data might be inappropriate at this stage. They stated that data is published only after due scrutiny and assessment by experts to avoid increasing vaccination hesitancy.

Issues Framed by the Supreme Court

The Supreme Court did not explicitly frame issues but considered the following concerns raised by the petitioner:

1. Whether the framework for vaccination of pregnant women and lactating mothers, which envisages a voluntary verbal declaration at the time of registration, is sufficient.
2. Whether the Co-WIN portal should be modified to incorporate a declaration at the time of registration to facilitate better monitoring of the health of vaccinated women or mothers.
3. Whether targeted tracking of pregnant women and lactating mothers should be considered to further support surveillance measures for monitoring AEFIs.
4. Whether the publication of data, once adequate datasets become available, will enhance confidence in the vaccination process.

Treatment of the Issue by the Court

The following table demonstrates as to how the Court dealt with the issues:

Authorities

The Court considered the following:

• World Health Organization (WHO): The Court noted that the government’s decision to vaccinate pregnant women and lactating mothers was guided by the WHO and other international experts.
• National Technical Advisory Group on Immunization (NTAGI): The Court referred to the NTAGI as one of the expert bodies guiding the government’s vaccination policy.
• National Expert Group on Vaccination Administration for Covid-19 (NEGVAC): The Court mentioned NEGVAC as another expert group that provided guidance on vaccination administration.

The Court did not cite any specific case laws or legal provisions other than Article 32 of the Constitution of India.

Judgment

How each submission made by the Parties was treated by the Court?

How each authority was viewed by the Court?

• The World Health Organization (WHO): The Court relied on the WHO’s guidance as a basis for the government’s decision to vaccinate pregnant women and lactating mothers.
• National Technical Advisory Group on Immunization (NTAGI): The Court acknowledged the NTAGI as an expert body that provided guidance on vaccination policy.
• National Expert Group on Vaccination Administration for Covid-19 (NEGVAC): The Court recognized NEGVAC as an expert group that provided guidance on vaccination administration.

What weighed in the mind of the Court?

The Supreme Court’s decision was primarily influenced by the following factors:

The Court recognized the importance of vaccinating pregnant women and lactating mothers and acknowledged the concerns raised by the petitioner regarding the existing framework. However, the Court also recognized the government’s expert-driven approach and the policy considerations involved in implementing the petitioner’s suggestions. The Court emphasized the need to balance the welfare, safety, and dignity of pregnant women and lactating mothers with the practical and logistical aspects of the vaccination program. The Court was also mindful of the need to avoid any measures that might dissuade people from seeking vaccination. The Court also acknowledged the robust mechanism already in place for monitoring AEFIs and the government’s commitment to publishing data after due scrutiny.

Logical Reasoning:

The Court considered the alternative interpretation that the government should be directed to implement the petitioner’s suggestions immediately. However, this was rejected due to the policy implications and the need for expert evaluation.

The Court’s decision was based on a balanced approach, considering both the need to improve vaccination access and the government’s existing policies and protocols. The Court emphasized that the government should continue to evaluate the suggestions made by the petitioners and take a considered view.

The court quoted the following from the judgment:

• “The decision to enable vaccination for lactating mothers was taken on 19 May 2021 while the decision to permit vaccination for pregnant women was announced on 2 July 2021. The Court has been apprised of the fact that in taking these decisions, the Government has been guided by its own expert groups as well as by a consensus which has evolved at the international level through the World Health Organization.”
• “This Court is cognizant that the suggestions which have been made on behalf of the petitioners do raise issues of policy. For instance, any mandate for disclosure at the stage of registration has to factor in and balance concerns over the privacy of the person. There may well not be one answer or a single acceptable solution particularly because pregnant women and lactating mothers belong to different social and economic strata. The government has to take a decision bearing mind their welfare, safety and dignity.”
• “The three suggestions which have been made by the petitioners would undoubtedly involve an application of domain knowledge by experts in the area. The Court may not be in the best position to take a decision unaided by an expert determination.”

The Court did not have a dissenting opinion. The judgment was authored by Dr. Dhananjaya Y Chandrachud, J.

Key Takeaways

• The Supreme Court acknowledged the importance of vaccinating pregnant women and lactating mothers against COVID-19.
• The Court did not issue specific directions to modify the vaccination framework, recognizing the policy implications and the government’s expert-driven approach.
• The Court directed the Union of India to consider the suggestions made by the petitioner through its expert groups.
• The decision highlights the need to balance public health concerns with privacy rights and practical considerations.
• The case underscores the importance of expert guidance in formulating public health policies.

Directions

The Supreme Court directed the Union of India to place the three suggestions made by the petitioner before the concerned expert groups for deliberation at a policy level. The suggestions included:

• Modifying the Co-WIN portal to include a declaration at the time of registration for pregnant women and lactating mothers.
• Considering targeted tracking of pregnant women and lactating mothers to bolster the process of monitoring AEFIs.
• Considering the publication of data to enhance confidence in the vaccination process.

Specific Amendments Analysis

There was no specific amendment discussed in the judgment.

Development of Law

The ratio decidendi of this case is that while the Supreme Court recognizes the importance of vaccinating vulnerable groups like pregnant women and lactating mothers, it will not interfere with the government’s policy decisions, particularly when those decisions are guided by expert bodies. The Court emphasized the need for a balanced approach, considering both public health concerns and the government’s practical limitations and policy considerations. The Court also highlighted the need to protect privacy rights and avoid measures that might dissuade people from seeking vaccination. There was no change in the previous positions of law.

Conclusion

In the case of Delhi Commission for Protection of Child Rights vs. Union of India, the Supreme Court addressed a Public Interest Litigation concerning the vaccination of pregnant women and lactating mothers against COVID-19. While the Court acknowledged the concerns raised by the petitioner regarding the existing framework, it did not issue specific directions for modifications. Instead, the Court directed the Union of India to consider the petitioner’s suggestions through its expert groups, emphasizing the need for a balanced approach that respects the government’s policy decisions and expert guidance. The judgment underscores the judiciary’s role in overseeing public health policies while respecting the executive’s domain in policy formulation.