Dr Krishna Reddy Nallamalla
It is unsettling to see the plight of our second wave struck country splashed across the global media. Some of the coverage openly exhibits the prevalent tendency of “blame and shame”. Constructive criticism has yielded to destructive discontent. There is an urgent need to objectively assess what was good, what was bad and what was ugly in India’s response to the pandemic over the past one year.
The good…
The discipline that a billion plus people exhibited during the country-wide lockdown last yearwas praiseworthy. In hindsight, we may give credit to the lockdown in preventing the cataclysm that we are seeing during the second wave. The entrepreneurial spirit of our people was in full display as face masks, hand sanitizers, personal protection equipment flooded the market in no time. After initial hiccups, we had enough capacity to test and diagnose Covid. Our doctors were a step ahead in rapidly adopting a flood of new information on Covid coming from across the world. WhatsApp became de facto telemedicine tool to provide remote consultations and monitoring. When people were struggling to get the RT-PCR test done due to the surge in its demand, our doctors found a way out through the high-resolution CT scan of chest in confirming or ruling out clinical suspicion. Home diagnostics were put to best use giving the comfort of getting tested at home and avoiding the risk of outside exposure. Most households have equipment to monitor their pulse, blood pressure, temperature, and oxygen saturation.
Our million plus frontline workers (ASHA, ANMs, anganwadi workers, community volunteers) rose to the occasion in villages. They visited every household, counseled them, tested people for flu like illness, guided them to testing and isolation centers. They educated people on face masks, hand washing, and social distancing. Nearly 80 crore low and low-to-middle income people received food items through thePublic DistributionSystems. Poor people received direct benefits through cash into their accounts. Scores of immigrants who walked from the cities back to their native villages could get work under Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA). Most employees of the formal economy had their jobs despite companies facing financial hardships.
India is among the few countries that could develop a vaccine of their own from scratch within a year of the pandemic. We are or will be producing at least five types of vaccines in the country. We have the ability to ramp up the production to meet not only the needs of our own people but also of other countries. We had the magnanimity to export and donate the vaccines to other countries. Our pharma industry rose to the occasion in repurposing existing drugs, working on new drugs, and ramping up their production to meet domestic and international needs.
Our vast network of public research institutions (CSIR, ICMR, DST, DBT, DRDO etc.,) has been doing tremendous work. The National Institute of Virology isolated the initial strain of the virus in no time. It was put to use in developing various diagnostic tests and the indigenous Covid vaccine (Covaxin). There have been several public-private partnerships in developing and testing different technologies to fight the pandemic. Our labs have been undertaking genomic surveillance, though in limited numbers. We have been uploading new variants of interest and concern to the global database.
Our family and social systems ensured that people had food to eat. We helped each other in the spirit of community. We realized the value of joint family systems as it offers one of the best security nets during periods of crises. Higher innate immunity might have come to the rescue of people living in slums, where people do not have the luxury of water to wash hands and large enough living space to maintain a distance with each other. Dharavi, the densest slum in the world, became a case study for the way it escaped the anticipated disaster from Covid.
Our economy bounced back in no time as the first wave cededtowards the end of last year. Our industry seized the opportunity presented by the pandemic. People adopted innovative ways to work from home and be productive. We attracted large foreign investments during the year of Covid. As each country realized the fragility of global supply chains, we have been rapidly adapting to become self-reliant in critical products and technologies. Digital technologies have become mainstream. Molecular technologies have taken wings. Our markets, for some puzzling reason, reached the highest levels ever achieved. Our agriculture sector performed the best despite the pandemic ensuring food security of our people.
Our country faced one of the toughest years at our borders. Our resolve and resilience were evident to the world in the face of simultaneous challenges of a potential war and the raging virus. Our response on both fronts won international respect and admiration. Our vaccine diplomacy, though being criticized in the face of the second wave, won the hearts of many countries.
The bad…
The sudden national lockdown may have been a bad decision. The plight of people, especially the migrants, was not thought through before the decision. While the lockdown gave us time to prepare, in hindsight, it may seem like it could have been planned better. Not engaging the private health sector, that accounts for nearly two-thirds of healthcare, in planning and implementing the pandemic response, was another example of bad governance. Pooling of resources and collective planning could have mitigated some of the challenges.
The Indian Council for Medical Research (ICMR), that at the forefront of steering the pandemic response, was found wanting in sharing data, in guiding policy, and in communicating effectively. Its reluctance to take help from national and international experts was most puzzling. Its lack of transparency in sharing indigenous vaccine trial data led to a major controversy in vaccine approval and consequently to initial vaccine hesitancy. It could have undertaken clinical trials to test unproven therapies so as to avoid unscientific use of a cocktail of unnecessary drugs. It could have independently evaluated the efficacy of Remedesivir as the evidence from international trails is confusing. It could have undertaken more elaborate serosurveys to guide the responses at state and district levels.
Health in India is a state subject. A majority of the states were found lacking in basic public health responses. On one hand, states demand autonomy in running their health services, but are quick tocomplainabout the central government’s lack of support. It is unfortunateto see political actors blaming each other while the pandemic continues to devastate the country during this second wave. There are states which do not have a qualified public health professional even at the state level. Many states do not have an expert group to guide their responses.
People, in general, do not trust public healthcare in India. Poor people too tend to turn to private providers even if it means spending beyond their means. As the cost of providing safe and quality care in the face of a highly contagious pandemic rose, the bills for every admission also became unaffordable to even upper middle-class people. People started fearing hospital bills more than the virus itself. Health insurance, which is supposed to come to the rescue of the insured at the time unforeseen catastrophic health expenses, failed in its objective. Health insurers either declined preauthorizations or claims. Hospitals unsure of disallowances and reimbursements resorted to refusing cashless facility. As the packages of public health insurance and social health insurance schemes are non-viable to many empaneled private providers, coupled with long delays in receiving the amounts, many of the beneficiaries of these schemes were declined admissions on some pretext or other.
The medical community, either due to ignorance or deliberate intent, resorted to ordering tests and drugs with no due consideration for scientific evidence or the rising health expenses of people. While these practices may be justified last year at the beginning of the novel SARS CoV2 virus pandemic, continuing themdespite enough scientific evidence andwell conducted clinical trials disproving them, is unethical and unprofessional.
The media has a significant public responsibility owing to its power to influence people’s behavior. Sensationalism, shouting matches, smear campaigns, and partisan behavior are not expected from a responsible fourth pillar of democracy. Social media with its faster and larger reach has been of immense help to people in distress, but has also been the cause of the infodemic with a potential to cause as much harm as the real pandemic.
Ultimately, people are responsible for not only their own safety but also that of others. If people are not responsible enough to wear a face mask, to wash their hands, or to maintain social distance, they lose the right to blame politicians, administrators, and hospitals. While freedom is a fundamental right, it has a boundary when it comes to others’ safety. If people do not pay their taxes, do not disclose their incomes and wealth, do not disclose their jobs, they cannot expect their governments to spend adequate money on their healthcare.
The ugly…
Politicians removing their face masks for a photo opportunity is ugly. People look up to their leaders and follow their example. Holding massive social, political, and religious public gatherings while the pandemic is devastating the world, is ugly. Trying to making money off other people’s suffering is ugly. Hoarding and indulging in black market practices, being unmindful of people’s suffering is ugly. The moving images of lakhs of people walking back to their villages will remain in memory forever. Hospitals capitalizing on the demand for precious beds is ugly. Voyeurism towards a failed state,by flashing images of burning bodies across the world is ugly. The rich becoming richer while millions become poorer is ugly.
The hope…
Let’s hope that our politicians repent. Let’s hope that there is more respect for science. Let’s hope thatall of us can introspect to become responsible citizens. Let’s hope that we become more determined to achieve the goal of universal health cover. Let’s hope our crumbling public healthcare is strengthened. Let’s hope that we allocate financial resources as per the growing health needs of our people. Let’s hope that we deploy more robust disease surveillance and control systems. Let’s hope that thousands of lives lost in this pandemic trigger a transformation in our dysfunctional health, political, governance and social systems. Hope should lead to resolve. Resolve should lead to resilience.
Dr Krishna Reddy Nallamalla
President, InOrder
Country Director, ACCESS Health International