Lancet study on urgent actions needed to tackle COVID-19 resurgence in India: Key highlights

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A host of recommendations to mitigate the impact of the COVID-19 pandemic on India’s over-stressed healthcare system were published in the Lancet Journal last month in a study titled “Reimagining India’s Health System: A Lancet Citizens’ Commission”.

This month, in a fresh study titled “India's Resurgence Of COVID-19: Urgent Actions Needed”, Lancet recommended measures such as introducing a centralised system of procuring and distributing COVID-19 vaccines free of cost, identifying priority groups and optimising available vaccine doses, among others to curtail the loss of life due to COVID-19 during the second wave of the pandemic.

Here are the key highlights of the latest Lancet study on India's COVID-19 crisis and immediate actions that need to be taken to minimise the loss of lives that has hovered around 4,000 daily for the past many weeks.

To begin with, the study recommends a shift in India’s coronavirus vaccine procurement structure. Instead of the current policy of decentralised procurement of a chunk of the vaccines through state governments, Lancet suggests the entire procurement process must lie with the Centre, which may then distribute the vaccines free of cost among states and UTs.

This way, they said, India will be able to optimise vaccine prices and minimise inequities between states that may emanate from varied fiscal capacity.

The authors of the Lancet study pointed out that only three percent of the country’s population had been fully inoculated by May 19, 2021. India currently needs around 250 million doses of COVID-19 vaccine every month to equip vaccination drives to full capacity. However, at present, only 70–80 million doses per month are made available in the country, the Lancet Citizens’ Commission stated.

The study noted: “State governments must decide on the priority groups for vaccination on the basis of evidence to optimise the use of available vaccine doses, which can be incrementally expanded as supplies improve. Vaccination is a public good and should not be left to market mechanisms.”

The Lancet paper then went on to list a host of other measures that must be implemented right away for better COVID-19 pandemic management, such as decentralising financing of essential health services to districts, transparent national pricing policy, and an upper limit on the price of all essential health services.

The government must disseminate clear, evidence-based information on the management of COVID-19, including guidance on what not to do, the Commission recommended.

These guidelines must focus on home care and treatment of COVID-19, primary care, and district hospital care in local languages that incorporate local circumstances and clinical practice.

The guidance must emphasise what not to do and ensure that only evidence-based therapeutics are used. Specific guidance must be offered by the Centre on the appropriate use of Indian systems of medicine, especially for prevention and health promotion interventions, such as yoga.

It should also provide information to help prevent increasingly concerning reports of other impacts of COVID-19, including secondary infections such as Mucormycosis.

The information should underline essential non-COVID-19 health services that must remain fully accessible in specific facilities, for example, for tuberculosis, maternal and child health, and emergency medicine.

Additionally, there must be widespread access to teleconsultation and care delivered by front-line workers needs to be expanded to reduce the burden on hospitals.

Speaking about resource management, the Lancet Citizens’ Commission recommended that all human resources, including in the private sector, must be marshalled for the COVID-19 response and should be adequately resourced and supported. They ought to be provided sufficient personal protective equipment, guidance on the use of clinical interventions, insurance, and mental health support.

Notably, the Lancet authors backed the decision to deploy final-year medical students and AYUSH students in the COVID-19 response team. They even suggested that the policy is extended to include nursing and paramedical students too.

Citing the example of Mumbai to highlight how community engagement and public participation can enhance COVID-19 response, the Lancet Commission recommend “active collaboration between government and civil society organisations to create and disseminate accurate information, enabling home-based care, emphasising prevention, helping navigate access to life-saving treatment, and promoting vaccination”.

The paper urged the Centre to withdraw existing restrictions on the capacity of NGOs to access foreign or domestic CSR resources and human resources.

Next, the Lancet paper highlighted the importance of transparency in government data collection and the need to share details such as age and sex of patients, hospitalisations, mortality rates, community-level coverage of vaccination, community-based tracking of the effectiveness of COVID-19 treatment protocols, to help districts proactively prepare for caseloads in the coming week.

“Additionally, surveillance needs to include urgent investment in genomic sequencing, adequate institutional capacity, and trained personnel to provide real-time alerts of SARS-CoV-2 variants, hot spots, and breakthrough infections,” the Commission said.

In its final recommendation, the Citizens’ Commission said: “the profound suffering and risk to health caused by loss of livelihoods should be minimised by making provisions for cash transfers by the state to workers in India’s vast informal economy who have lost their jobs.”

“If lockdowns are deemed necessary, on the basis of local epidemiological data, they must be announced well in advance and entail planning for all essential services.”