Two years of COVID-19: India fares better, but still not indefensible against another wave, another pandemic

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Two years into COVID-19, India seems to have learnt its lessons the hard way, particularly after the devastating Delta wave last summer, and is better off today.

The country has filled the gaping holes in health infrastructure in districts and has built a safety net of extensive vaccination coverage against coronavirus. Yet, concerns remain.

For one, not enough attention is being paid to build a robust disease surveillance programme and budgetary expenses on health are much lower than expected.

Union health ministry data shows that only 1.4 hospital beds are available per 1,000 people. Also, it has taken a year for isolation beds to double from 9.6 lakh in May 2020 to 18.03 lakh in August 2021.

Experts say while the government has been able to make some positive changes by installing oxygen generators in district hospitals, there is still a lot to be desired when it comes to allocation of funds for strengthening them.

Statistics confirm what they say. While the revised Union budget for health in 2020 was nearly Rs 83,000 crore, it grew by 9 percent the next year, just before the second wave of the pandemic hit the country. Yet, in this year’s budget, health saw a year-on-year (YoY) increase of a negligible 0.2 percent from the revised budget for 2021-22.

Former Union health secretary Sujatha K Rao pointed out that, while as a direct outcome of COVID-19 there is a greater focus both by the Centre and states on capacity-building of district hospitals and diagnostic laboratories, primary healthcare is not getting the attention it deserves.

“The long-term implications of that neglect may not be good,” she warned. 

Steps that raise hope

It looked almost like an incredible task, says a senior official in the health ministry, when the COVID-19 vaccination opened for all adults beginning May 1 last year.

“We were doubtful since we had no experience of vaccinating adults at such a big scale and this looked like a humongous task,” she said.

The journey, however, turned out to be far smoother than anticipated. As on March 9, nearly 98 percent of the adults in India have received at least one dose and 83 percent of them are fully vaccinated. What’s more, nearly 75 percent of the 15-17 year-olds in India have also received at least one shot against COVID-19 since January 3 this year.

In other words, nearly 60 percent of the total population in India has now got at least one dose against coronavirus, and that, according to many, could be the reason why the Omicron-led third wave stayed mild in the country.

Preeti Sudan, who was the health secretary when the pandemic broke out in 2020, told Moneycontrol that India’s incredible COVID-19 vaccination programme is a global case study.

“It’s a feat that we experienced no major vaccine hesitancy, got together all states and Centre and got people to the vaccine booths in large numbers,” she said.

As of April-May last year, a massive oxygen crisis in India, exacerbated by a large number of COVID-19 patients who developed hypoxia (low oxygen level in blood), hit global headlines. The government also swung into action to ensure that the painful experience is not repeated again.

According to Sudan, the massive expansion of oxygen supplies thereafter—under which pressure swing adsorption (PSA) plants were installed in districts -- will not only help during possible future COVID-19 waves but will also be beneficial to pregnant women and cancer patients, among others.

Sudan pointed out that the ramping up of other facilities, such as teleconsultation hubs -- from 53 to 20,000, an extensive network of diagnostic laboratories at district and sub-district levels, and paediatric isolation beds are not only defences against future COVID-19 waves but will help patients in small towns and rural areas on a day-to-day basis.

 Still a long way to go

In response to whether India is better prepared for another round of COVID-19, Rao’s answer is a straight “no”.

“While investments in health infrastructure may be useful for treating those who become sick, a wise government should want to see that such a pandemic does not ever create the disruption it did,” she said.

In other words, according to Rao, India needs to ensure that people are prevented from falling sick and that is possible only if there is an excellent disease surveillance system and a sound primary health care system to deal with disease outbreaks at the local level and not allowing it to spill over.

Also read: India records 4,184 fresh COVID-19 cases, 104 deaths in last 24 hours

Senior virologist Dr Shahid Jameel, who is a fellow at the Green Templeton College, University of Oxford, UK, and a visiting professor at the Ashoka University, too, pointed out the complete lack of attention on the disease surveillance programme.

“During the last 50 years, about 50 percent of the emerging diseases are viral, with more than 75 percent of the viruses being zoonotic (infectious disease transmitted from animals to humans). It is likely that the next pandemic may be caused by a virus that is likely to originate in South or Southeast Asia, including India, as these areas are both densely populated and are biodiversity hotspots,” he said.

Dr Jameel, however, expressed concern that, in India, not enough is being done for a higher level of synergy towards the surveillance of humans and domesticated and wild animals as they fall under different ministries.

“It will need a one-health approach and good investment,” he said. 

Vaccine booster dose policy needs a boost

An inordinate delay in opening up the COVID-19 vaccination policy for the most vulnerable population groups has also worried many.

Dr Jameel pointed out that the vaccination-boosting policy in India is not in line with evidence from scientific studies.

As of now, only healthcare and frontline workers and those above 60 years of age with underlying diseases are allowed to receive precaution doses, provided that they have completed nine months since their second jabs.

“All those who are above 60 years should be offered booster doses 5-6 months after their full vaccinations and shots should be offered to 12-15 year-olds as well since there are now adequate supplies and vaccines are approved for this age group,” he stressed.

He also said that more money is needed for health research and development for vaccines and therapeutics, while the regulatory processes, too, need to be streamlined.

Also read: Explainer: Intranasal vaccine against COVID-19 and why it is awaited so eagerly

“The entire biologics development pipeline -- from R&D to approvals -- needs to be strengthened, and I am not sure if that lesson has been learnt,” he said.

“For instance, when the country has approved nine vaccines against COVID-19, why only 2-3 vaccines are being used and why groups like National Technical Advisory Group on Immunisation (NTAGI) and National Expert Group for Vaccine Administration on COVID-19 (NEGVAC) are so hesitant in approving the usage of the new vaccines?”