India’s handling of the pandemic…
On 24th March 2020, the Prime Minister (PM) of India announced a complete lockdown of the world’s biggest democratic and second largest populated country, home to roughly 1.4 billion people, to be imposed within four hours from his office’s notice. With just ~600 reported cases by 24th March 2020, PM’s swift action to call for a complete lockdown was imperative and inevitable. But like every other surprise his office gave us since he was elected to power in 2014, it came with poor planning and any visibility to execution.
Post his message by 8:30 PM, there wasn’t any time for people nor a concrete policy in place for the nation to enter into a complete lockdown. Even though he went to sleep not worrying about his food and shelter, the people of India were wide awake not knowing how tomorrow was going to be. India’s migrant workers had no choice but to migrate back in massive numbers, others rushed to their nearby grocery stores to stock up on house supplies, India Inc set up Zoom calls to prepare a strategy to continue smooth operations during the lockdown.
As with every nation that is faced with a pandemic, the first and foremost sector to go head on is its Healthcare System. With the pandemic looming in front of them, they didn’t have the resources to prepare for this war. The pandemic exposed the inadequate healthcare infrastructure that the nation had to deal with a pandemic of this scale. Not only in terms of equipment, we lacked in medical professionals as well.
It’s been nearly 75 years since India achieved its freedom from the British rule in 1947. Within these past 75 years, India has failed to take healthcare with considerable seriousness. India is ranked among the lower middle income countries according to the World Bank even today and as per the latest data (2018) available with them, the average healthcare spend among lower middle income countries is 4.07%. India ranks lower than countries including Iraq, Afghanistan, Egypt, China and Kenya with 3.5%. And it has been for the past 10 years. We rank 37 out of the 50 countries present in this group. Additionally, India ranks 145th on the global healthcare access and quality (HAQ) index, lagging behind Bangladesh, Sri Lanka and other peer nations.
Countries classified among lower middle income will rely mainly on public healthcare facilities, well obviously, due to lower income unless their health insurance can cover it. There’s a major lack of resources in government run institutions that many Indians prefer the private healthcare providers and pay out of pocket. Around 2/3rd of hospital beds and 80% of the ventilators were present in the private sector just when we entered the lockdown. On PolicyBazaar’s website, you can see that it says medical inflation is at 15% over the past few years and this makes cost of availing good medical service costly and increasing YoY. What adds to this? Only 35% of the population in India is even covered by health insurance one way or the other. When the world was spending around $1,100 per capita, India was roughly spending only $73-lower among other countries in the category. Because of this, we have shortfalls in major requirements like hospital beds, medical professionals, etc. How exactly did the nation expect its citizens to get treated well and bear the cost that is primarily dominated by private sector…
When India was battling the first wave, India ramped up the healthcare infrastructure drastically-temporarily, not permanently. It’s supported by parliamentary documents as mentioned in India Today’s report: “From just 62,458 oxygen-supported beds on April 21, 2020, the figure rose to 2,47,972 by September 22. ICU beds and ventilators too increased from 27,360 to 66,638 and from 13,158 to 33,024, respectively. In other words, between April 21 and September 22 last year, the number of oxygen-supported beds increased by 297 per cent; ICU beds by 143 per cent; and ventilators by 151 per cent”. Along with this, we even increased the domestic production of medical supplies and kits by a multifold. But it was eventually brought down post the first wave peak. Read this (Link). Question remains why, even after acknowledging a possibility of a second wave and when India’s population is not even vaccinated.
Many believe India is widely underreporting the COVID-19 cases and death toll. I believe too and for a simple reason. The nation’s ability to ramp up testing for its population was simply…slow, poor and worst of all, controlled by the government. The logic is simple — More testing more confirmed cases and higher the chances of controlling the spread during the peak. Countries that ramped up testing quickly reported higher numbers and everyone was happy that nation was relatively doing better than them in the first wave. It, however, didn’t last long until the Delta variant hit us hard and we got caught up in a situation that was expected by experts, acknowledged by the Central Government but paid no heed to by the PM.
India thought it was setting an example to the world by declaring victory defeating the COVID-19 pandemic in February 2021 even after they were warned about it. Under the naïve assumption that herd immunity has been achieved, the PM encouraged people to return to normalcy and he even acted on it by conducting election rallies. He even allowed Kumbh Mela to be organized while the country was battling to keep COVID away!
But the only thing that rallied and came out victorious was the virus after all. You see, in a democratic country, when a government is elected by the people, they are meant as representatives for the people but in India, politicians act in their favor first and when anything comes to hampering their reputation, they finally act in interests of the people. However, within a matter of two months since declaring victory, India peaked four times the peak of the first wave. India’s healthcare along with COVID patients gasped for breath. We had Chief Ministers (CM) pleading on live television for oxygen, hospitals pleading for oxygen, doctors pleading people to stay home and follow protocols, and so on. The politicians were busy taking care of their parties’ interest and not people’s interest.
When the second wave hit, a major issue was the shortage of oxygen in India in hospitals. The nature of the virus was such that oxygen became an even extremely important resource for the survival of a patient because of the number of cases. India needed more beds, ventilators, medical oxygen, and so much more. What’s concerning is that even after acknowledging a second wave, there was a decline in healthcare facilities from the peak in September 2020 in majority of the states. I’m not blindly saying this — the earlier India Today article I mentioned says it clearly. There is adequate production of oxygen in the country and there were even projects to ramp up the oxygen supply for medical purposes alone. Because 85% of the oxygen produced is for commercial purposes, leaving only 15% for medical purpose. The plan for setting up 162 more oxygen plants came in 2020 but by March-April 2021, only 33 were set up. One of the main reasons for set up of oxygen plants across India is mainly to address the issue of supply chain as the current plants (before 162 plants) were concentrated at a few regions making access to it by other states a logistic issue-thus creating supply-demand a mismatch. But as cases dropped, the nation decided to take the project slowly like vaccination. Like other aspects, the act of ignorance or leniency cost us dearly again.
I have mainly pinpointed where it is easy to gauge the hindsight but the impact of the second wave was unprecedented. What could have only been done is how we responded to it and I must say India’s control over the second wave was relatively better despite all the flaws that led to it. I say it was better because we all know how India struggled during the peak of the first wave and India suffered even worse in the second but rebounded well considering the sheer number of cases. It wasn’t just the government that was at fault, we the people of India also couldn’t hold our horses — we couldn’t wait to get out and enjoy in groups, wearing masks as prescribed in public was too mainstream for us, stepped out even if it was unnecessary, etc. Somewhere, we have to admit, we all broke COVID protocol. Keeping us at homes like the complete lockdown during first wave just seemed not possible but, in my opinion, the second wave lockdown should have been imposed earlier than they were and the PM should not have plead to states asking them to consider lockdown as last resort. Nevertheless, India’s military, healthcare professionals and system, testing labs, etc. came into action and did everything they can considering the resources. India Inc and startup ecosystem allocated resources to provide for immediate assistance and the nation united when it was about survival. Foreign aid was accepted from multiple countries and we couldn’t be more grateful for them to help us while in need. We lost more lives in the second wave. It would be hard to imagine if the first wave had daily confirmed cases hovering around 300–400K for many days without any experience of handling a pandemic of this sort.
Needless to say, the higher percent of population vaccinated, the lower the chances and impact of a subsequent wave. The USA, Israel and the UAE are prime examples of this. They are closer to getting back to normal, except us, the country that hosts the largest vaccine manufacturer, Serum Institute of India (SII) in the world. It’s logical but again our PM ignored or delayed the thought process. It was only during the second wave, India’s Finance Minister decided to provide credit to SII and Bharat Biotech to ramp up vaccine production. Considering the commitments already made by SII to Covax (WHO’s global initiative for COVID-19 vaccines to provide to lower income nations) and other exports, it was inevitable that India’s vaccine need will be at a tight spot keeping in mind the production capacity. Bill and Melinda Gates Foundation gave $300 million to SII in 2020 with the last infusion of $150 million in September 2020 to ramp up vaccine production. They accounted it well and it’s no surprise because the pair leading the foundation knew very well the requirements and the drastic impact of a pandemic; Bill Gates even said this during a TED Talk (Link) back in 2015! Realizing that vaccination is the best possible solution to prevent another catastrophic surge, India came to a situation that they had to stop exporting the vaccines to take care of its citizens first. The second wave witnessed more of the youth population being infected with COVID and the government had to open vaccination for people above 18 as well. But as a matter of a fact, India hadn’t even placed enough orders for themselves. This move cost the lives of people in other lower income nations as these nations were committed vaccine by contract signed with SII. India’s vaccination leniency has and will cost people’s life and now the expected calculation is that we have to vaccine 10 million people everyday if we have to vaccine the entire population by the end of the year. Like always, the government is going to take credit for the fastest vaccination in the world but, honestly and painfully, the due credit for this has to go to our lost loved ones who put the politicians to act in the interests of the people. And let’s track vaccination progress in percentage (%) rather than absolute numbers?
As we are in the downward sloping curve of the second wave, until India can vaccinate its people on a war footing speed, I believe a third wave is imminent. The virus mutates and we know that. What we don’t know is at what level or speed it can mutate, how infectious it is, how it may affect the people, and so on. When the third wave hits the country, vaccination is going to slow down leaving people exposed and impacting progress. Even though the PM claimed that India averted a major crisis to over 150 countries, due to the ongoing sheer lack of accountability and vaccination progress, the nation is still exposing the risks for another possible variant to emerge and cause a deadly blow to the world.
Many states have claimed that they are preparing for the third wave. It remains unknown if the preparation was enough. We, the people of the nation, also have a responsibility towards us and others to protect each other. There could have been many things India, not just the government but including us, could have avoided and done better. But only with a responsible and accountable government and us, can India possibly reduce the impact of the next wave. Short term solutions can give an immediate but not permanent result; only long term solutions can. India has to expedite vaccine approvals, get people vaccinated safely and come out victorious. It is safe to assume that the devil will be deadlier the third time when it eventually lost the first two battles, but not the war…
_________________________________________________________________I do not own the rights to any of the pictures attached here; all credit to the photographers. The article expresses my opinion solely based on multiple studies and facts published online by various persons.
