Covid-19’s second wave in India has been a ‘perfect storm’. Premature abandonment of caution by people, unanticipated speed of the virus contagion, plus inadequacies of the health infrastructure and response capability have left lakhs sick, and thousands of lives tragically lost. The country has come together to beat the pandemic – and will certainly do so. We must, however, understand the genesis of this ‘perfect storm’ and incorporate its lessons into our healthcare policies.
India’s situation is quite unique. We have a very large and diverse population. We have a federal system, with health being largely a state subject. We are a democracy, not a diktat-driven government like China which can limit inter-province travel or change supply logistics by an administrative decree. Each of these is an asset in normal times, but may complicate responses during a pandemic event.
There is also historical baggage. Health, as the Bengal famine catastrophically illustrated, was not a priority for the British. Post-independence too, healthcare did not get its needed emphasis. The developed world somewhat jealously guarded access to new intellectual patents and vaccines. In India, the private sector played a prominent role in the pharma sector but remained constricted by licensing. The public sector was unable to get plugged into the global pharma knowledge ecosystem.
But the biggest drawback, resulting from constrained resources, was that healthcare was not a priority in the early decades. Majority of Union and state budget speeches did not include a paragraph on it. Polio vaccination in India started in 1979, almost a quarter century after it was launched in the US. Similarly, Hepatitis B vaccines were added to the immunisation programme in 2002, 20 years after they became commercially available in the US.
Smallpox was perhaps the worst ‘miss’. The Smallpox Eradication Mission was launched in 1962, but even in 1974 India was facing its outbreaks. When we finally eradicated it in 1977, it was almost 25 years after the US and Europe had done so. Due to these multi-year lags in vaccination, lakhs of people lost their lives or faced debilities. It was clearly misgovernance harming people more than lack of medical knowledge.
In northern India, thousands of children suffered in JE and AES outbreaks. In fact, this threat was dealt with seriously only after CM Adityanath took office in Uttar Pradesh in 2017. Medical education too did not achieve the required scale. While we built some centres of global excellence like AIIMS in Delhi, fact is that these started getting set up rapidly after 2014 and today we have more than 20 AIIMS coming up. Rural and tier-2 town medical facilities remain poor and Ayushman Bharat is a right push in that direction.
Healthcare started seeing greater interest from the private sector through policy measures ushered in by late Atal Bihar Vajpayee and successors. MNCs saw the attraction of the Indian market, as well as the skilled talent pool. The pharma sector helped India emerge as a major producer of generic drugs and vaccines. India also began to attract clinical trial business, and some R&D. It could have become the global medical hub. However, given other challenges the country faced, economic and geo-political, healthcare continued to slip between the gaps till the Modi government came into office.
Two elements changed. There was a holistic approach – ‘wellness’ beyond merely medical. Secondly, the government took a ‘mission mode’ approach – targeting specific milestones on tight timelines. Swachh Bharat was the first initiative. Mission Indradhanush was started for increasing vaccination coverage. This was followed by Ayushman Bharat, Jal Jeevan Mission etc. Nutrition was brought into focus with initiatives like the one for expecting mothers and infants.
In 2015, a new health policy opened the doors for greater private sector participation. Remote access through telemedicine is being pushed. Medical infrastructure creation became a priority, with an AIIMS planned for each state, and a medical college for every three Lok Sabha constituencies. Private sector participation in medical education is gradually helping fill the massive shortage in trained personnel. Medical equipment, never designated as an industry earlier, has been incentivised. The results have borne fruit. Access to quality medical facilities has improved materially – for people in the most remote parts of India.
Covid-19 has put unmatched pressure on our medical infrastructure. Millions have suffered, and continue to do so. In the first wave, the lockdown along with a massive ramp-up of medical infrastructure helped prevent lakhs from falling prey. The second wave overwhelmed the medical ecosystem with its speed and ferocity. Gradually, the entire country working together is coming to grips with it.
Medical supply production on a war-footing, especially for oxygen, is showing results. The vaccination drive, with more than 20 crore doses administered, is in stark contrast to our earlier vaccination drives for polio and smallpox which were eradicated in developed countries decades before India. In the case of Covid, we were only a little slower than America in administering 20 crore doses.
The Covid battle will be won. The war to ensure a comprehensive health ecosystem that delivers for every citizen has barely started. Some steps taken have borne fruit, but have also raised the expectations that citizens have from the country’s medical system. There is a need to radically step up government investment in healthcare, especially around R&D; and delivery of healthcare in remote and rural India. Private sector has to be suitably incentivised to play a much larger role. Only by working together, prioritisation, and providing the right level of resources, will the journey to transform our medical infrastructure succeed.
Views expressed above are the author’s own.
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