Another momentous year is coming to an end. The Delta variant of the novel SARS-CoV-2 virus struck India in mid- February. As many as four lakh cases were being reported per day in mid-May. It left a trail of human misery and devastation. No one anticipated or was prepared for the kind of surge that the country witnessed. As we near the end of the year, India has reported ~35 million positive cases and nearly 500,000 deaths since the outbreak of the COVID-19 pandemic. As per the last seroprevalence study, there were ~40 asymptomatic infections for every reported positive case. An attempt is being made to arrive at the true number of COVID-19 deaths for every state, from death registries. When the country did finally start heaving a sigh of relief with daily positive cases dropping below 10,000, the news of Omicron raised the specter of a third wave.

India reached the milestone of fully vaccinating 50 percent of its adult (18 years and above) population in December in less than a year of starting the vaccination drive. More than 80 percent of its adult population have received their first dose. Two indigenous vaccines have been tested in children and one has received approval for use in children 15-18 years old, to be rolled out from January 3. The central government also released guidelines on ‘precaution’ or booster doses for frontline workers and people above the age of 60 years with co-morbidities, to be started from January 10 onwards.

Export of vaccines has been reinitiated to honor India’s commitment to other countries. The year saw a remarkable turnaround in the access to personal protection equipment, COVID-19 tests, oxygen and ventilator beds, and essential drugs. These are testimony to India’s resilience in times of crises. They demonstrate a people who learnt to be innovative when faced with adversity. A combination of robust public R&D institutions along with dynamic private enterprise has been responsible for the above.

Central and state governments struggled with hard choices between lives and livelihoods. The year saw a pragmatic balance in various decisions. Few policy decisions made this year standout in the context of health systems in general and COVID-19 in particular. The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) with an outlay of Rs.64,180 crores over 5-years was announced to strengthen public health infrastructure especially in the areas of critical care, disease surveillance systems, and combating health emergencies. The Ayushman Bharat Digital Mission (ABDM) was launched to leverage digital technologies to strengthen health information system through a well-designed digital health blueprint. Production linked incentive (PLI) schemes have been announced in pharma, medical devices, and digital technologies towards self-reliance and future resilience during unexpected crises.

There is a growing realization that health security impacts every tenet of social life – be it economy, employment, education, environment, entertainment and more. Today, health security assumes as much or even more importance than national security. The concept of health is being expanded to include every living being (One Health) and every non-living being (One Earth) as pandemics and climate change crises do not differentiate. COVID-19 brought out the criticality of social, food, and financial security during a pandemic. Direct benefit transfer (DBT) has been increasingly used to deliver various social and financial benefits to the intended beneficiaries during the year. Mahatma Gandhi National Rural Employment Guarantee Act (MG-NREGA) has been put to use to help migrant laborers. Food rations provided the needed food security to many. The investments India has been making in various social benefit schemes over the past many years have shown result when needed during the pandemic. Investments in digital technologies have improved the efficiency of delivering these benefits. In the absence of well-studied evidence, it is not clear as to the impact of Covid on core social issues of food, job, housing, education, and health.  

The year ahead

Omicron has suddenly brought in an uncertain year ahead. Given its transmission ability, third wave looks inevitable. We may not prevent it, but we can definitely reduce the surge through responsible behavior and nimble policy directives. Omicron is not the last variant. The world will continue to encounter new variants. What can India do given the above reality?

  1. Leverage the available vaccines while continuing efforts to develop better vaccines

There is enough evidence that vaccines in children and boosters are beneficial. However, the policy decision is to balance between the demand for vaccinating the unvaccinated including children, boosting the immunity of the most vulnerable and if needed to all, honoring the global commitment towards supply of vaccines. We have witnessed the limitation of targeted vaccines. We have to continue to invest in new vaccine development towards a vaccine that is effective against multiple variants.

  • Easy access to low cost reliable tests

There should be continuing efforts in bringing out easy to use, low cost, and reliable tests. These will enable people to test themselves and self-isolate if found positive.

  • Intense pursuit of affordable oral antiviral drugs

Vaccines alone are not sufficient to face the pandemic. We need safe and effective oral antiviral drugs that are effective against multiple variants. We need to put in place a way to generate dynamic evidence to enable approval of these drugs without compromising on the scientific rigor expected. It is equally important to ensure that these drugs are made available to all people.

  • Leverage digital and molecular technologies to strengthen disease surveillance

India should push its ambitious digital health mission to strengthen disease surveillance across the country. Healthcare providers (doctors, hospitals, labs, pharmacies etc.,), public health workers, and health insurance managers should be mandated to adopt interoperable health data systems. Data privacy and security laws have to be passed to facilitate data sharing. India should invest more in genomic surveillance to be able to alert when a new variant of concern is noticed. Artificial intelligence is best suited to analyze vast amounts of health and related data to provide live dashboards on any suspicious emergence of a new pathogen or variant.

  • Accelerate plans to reach the goal of Universal Health Coverage (UHC) to access safe, effective, and timely care in an equitable way

While the PM-JAY is designed to cover 500 million poor people, there are many more millions (the so-called missing middle) who are vulnerable to impoverishing health expenses. They should be brought under financial protection without further delay. In parallel to UHC, India needs to invest in its healthcare provider system so that people living in villages and small towns have timely access to high quality primary care and acute care. While it is easy to create infrastructure, India should find a way to increase the health work force with needed competencies to meet the growing needs of its people. Ayushman Bharat program that encompasses health & wellness clinics to strengthen primary health care, PM-JAY to offer financial protection to as many people, ABDM to leverage digital technologies in transforming our health systems, and ABHIM to strengthen health infrastructure needs to be given the maximum funding and political support for them to be impactful.

  • To enlarge social protection during crises times

COVID-19 has clearly demonstrated the social cost of the pandemic. No one should go hungry because they lost their jobs. No one should be sleeping on roads because they cannot afford decent housing. No one should sell their meagre assets to survive. No child should leave their education because they cannot afford it. It means that India should have a system of knowing its people and their socio-economic conditions to transfer the benefits directly to them. The fruits of green revolution should be used to feed millions during times of need. Crores of jan dhan accounts should be used to transfer monetary support. The best way to provide social protection is to create more jobs. Technological advances drive efficiency. However, they also have the risk of stealing jobs. There should be a fine balance between efficiency and redundancy needed for resilience.

  • To become resilient against supply chain disruptions

We have experienced the helplessness of supply chain disruptions during the pandemic. India has taken sound policy decisions to support indigenous capacity and capability through PLI schemes. It should create emergency national stockpiles of essential drugs and tests.   

  • To press for global response systems at multilateral bodies

India should play a responsible role in strengthening the WHO. It should press for intellectual property waivers on critical drugs and vaccines. It should honor its commitments to other countries in accessing drugs and vaccines. Global collaboration and response are essential to face global problems like pandemics and climate change.

  • To learn from the pandemic to strengthen its health and social systems

India should invest in taking stock of various lessons that the pandemic has thrown at us. It should learn from other countries and it should share its experiences with others. It should enable its states to learn from each other. There should be collaborative learning between public and private health sector players. Innovations that arose in response to the pandemic should be nurtured to become new normal. It should put a pandemic prevention program in place. Threats from zoonotic viruses and microbes should be analyzed and mitigated.

India should enter the new year with a resolve to turn adversity into opportunity, weakness into strength, and fragility into resilience.

Dr Krishna Reddy Nallamalla
President, InOrder
Regional Director, South Asia
ACCESS Health International

Photo Credits: The New York Times

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