Managing a ‘Once in a Century’ Pandemic Challenge


Some of India’s leading opposition parties who have not been in power for more than half a decade now, must be thanking their stars for not being in power in the current circumstances. In one of the toughest and unprecedented phases that India is facing right now, owing to Coronavirus, for them it is much more convenient to be in opposition and tweet, than to be in in the hot seat and manage the crisis.

Frankly speaking, no country, not even the United States of America, with one of the most modern healthcare systems, was prepared for the onslaught of the coronavirus, as it has happened over the last one year. Last year also witnessed Europe’s leading countries being ravaged by covid, and had almost given up in spite of having a far lesser population to manage.

India was not spared either. In reality, to manage a population of around 140 crore people and with a healthcare system far from being at par with their American or European counterparts, it was always supposed to be a major challenge for India. Yet no country had to face a multitude of challenges as India had faced over the last one year including a face-off with China as well as making sure that the livelihoods are not affected beyond a point.

Confronting a Pandemic Against all Odds: Political and Otherwise

For some of the opposition leaders and vested interests, sadly, the coronavirus crisis was almost like newfound opportunity to target and vilify Prime Minister Narendra Modi and singularly hold him responsible for everything, as if India is a unitary state and not a federal republic with each state having a functional government headed by an elected Chief Minister. For every action of his, there was a readymade script to criticize and ridicule. It was as if, ‘damned if he does and damned if he does not’.

Over the last one month, even as a section of media and political opportunists barraged the Prime Minister with all kinds of allegations and accusations, the PM maintained stoic composure and did not get into a mudslinging match. Instead, he and his team remained focused on the job at hand, i.e. to mitigate the oxygen supply issue and address the issue of vaccine, which is far more complex than writing a critical tweet of a hundred alphabets.  In less than a month, no one talks anymore of the oxygen issue because it has been sorted out. The Government of India worked tirelessly to mitigate the logistical issue associated with delivery of oxygen without even for once seeking credit for it. But for the critics, the goalpost has shifted.

How India Fared in the Last 14 Months

It is true that over the last one year, when both the first and second wave of coronavirus is combined, India has certainly witnessed many fatalities, which is tragic but in most cases was unavoidable, in spite of best efforts of both central, state level governments as well as the medical fraternity.  Yet, it could have been far worse given the enormity of population that India has and the density of the same.  To understand what the Government of India has done over the last one 14 months to confront the covid crisis, one has to look at it from the perspective of where India was in January-February 2020.

Circa 2020: From Importer of PPE kits and N-95 Masks to Net Exporter

In January, 2020, India was not even making sufficient number of PPE kits and N-95 masks that were so very required as basic ingredients to combat a pandemic as contagious as coronavirus. The Government of India took the initiative to address the issue on a mission mode. For dealing with any kind of pandemic situation, one requires PPE kits with class-3 protection levels that most domestic manufacturers, at that time, did not have capacity to make. The same was the case with N-95 masks. The Government was racing against time considering that the demand was estimated at around 20 million PPE kits and 40 million N-95 masks from July 2020 onward.  In March 2020, Ministry of Textile launched ‘Operation PPE Coverall’. It was not an easy task considering the level of effort that was needed to create a robust supply chain as well as having WHO level testing protocols in place.

Yet, thanks to concerted effort of both Centre and private sector, by May 2020, India was manufacturing 2 lakh PPE kits and 2 lakh N-95 masks daily. By July, India’s supply exceeded demand and India had become the second largest PPE kit manufacturer in the world.

Further, to boost the production of hand sanitizers, a large number of distilleries and more than 500 other manufactures, including sugar mills and FMCG companies, were granted permission to produce hand sanitizers.

The production of all these critical elements namely, PPE kits, face masks and hand sanitizers have so seamlessly been expanded that the country did not realize the enormity of efforts that were put behind it to make sure that the supply matched the rising demand. Also, during the same period, Government of India also ordered 60,000 ventilators for disbursal among hospitals in various states. Of the 60,000 ordered, 50,000 were funded by PM Cares Fund and almost 96% of them were procured from Indian companies.

India’s problem, over the last one year, has not been covid alone

Sadly however, while the rest of the world had time to grapple only with Covid crisis, India had much more than that to handle. The misadventure of China along the LAC and the clash in Galwan compelled India not only to start a major logistical operation to fortify its borders with China and deploy battle ready troops in lakhs, but also had to commit an additional Rs 20,000 crore to buy emergency weapon systems.

Also, because of the ongoing face-off with China and India’s decision to ban a large number of Chinese mobile apps as well as debarring Chinese investments in various critical sector projects, it was quite apparent that India had to take measures to reduce its dependence on import of Active Pharma Ingredients (API) that India was important in huge quantity from China. This means that while India was one of the largest manufacturers of generic drugs in the world, it had a near 70% dependence on China for API.

To address this issue, Modi Government started work on a Production Linked Incentive (PLI) Scheme to increase the production of pharma ingredients within the country. In February 2021, Modi Government, finally approved Rs 15,000 crore worth of PLI scheme for the period 2020-21 to 2028-29 that is aimed at garnering incremental sale of Rs 2,94,000 crore of pharma products and at least Rs 1,96,000 crore of incremental exports during the period.

The overalls scheme also includes approval of 33 applications under PLI scheme for production of API in India. One of the biggest lessons of the covid crisis as well as face-off with China was that it was important for India to develop a resilient supply chain that would be immune from global shocks. From pharma to other critical sectors, Government worked on a ‘Atmanirbhar Bharat’ policy to make India more self-sufficient in production of both finished good as well as intermediary ones.

Further, Government of India did something last year which is unthinkable even in many of the western countries. The Government of India under PM Modi announced in June,2020 that it would given free ration to 80 crore Indians for five months, which would be in addition to their existing quota of foodgrain that they get from ration shops. This was later extended by some more months. In one go, Government of India had ensured that people need not have to worry about basic food during lockdown period.

The Vaccine Saga: Truth Vs Disinformation Campaign

On the vaccine front, while Serum Institute of India was getting ready from late last year with production of covid vaccine, namely Covishield, in India under a contract with Astra-Zeneca, another Indian company Bharat Biotech was developing an indigenous covid vaccine, namely Covaxin, with help of National Institute of Virology.

From 16th January, 2021, Government of India started a massive drive to vaccinate around 2.36 crore frontline healthcare workers. This was followed by another massive drive to vaccinate India’s armed forces. Giving priority to vaccination of healthcare workers and armed forces was a critical decision in combating covid while keeping India’s borders secure from external aggressions. Yet a narrative was set as if nothing was being done by Government so far as vaccination was concerned.

Also, some of leading voices of opposition parties have been planting apprehensions about utility of vaccines and safety of vaccines for quite some time. Therefore, in the initial days of March, when vaccination was opened up for people above the age of 60, many of the centres were running half empty since many people thought that they did not need the vaccine anymore and also had apprehensions. Later on, as the second wave gathered pace and people became more aware about the efficacy of vaccines, there was a sudden rush to vaccinate. While some from opposition have continued with their doomsday projections by predicting that India would not be able to vaccinate all before 2024, the reality is that by December 2021, India is expected to vaccinate all eligible people and perhaps even more.

To bust the fake rhetoric of naysayers, it is therefore important to consider a few points since a considerable amount of misinformation is being spread by vested interests.

  1. Making vaccines is not like making instant noodles or popcorn. It takes nothing less than 100-120 days to make one batch of vaccines ready for inoculation, starting from production, testing by Central Drugs Laboratory, delivery of produced batches of vaccines and then eventual logistical process through which it has to go before it reaches a vaccination center. Bharat Biotech in a statement asserted the same in the recent past.

 

  1. Therefore, however one wishes for, vaccines cannot be made available instantly. Covid-19 appeared in the global arena in 2020 and since then vaccine makers have been racing against time to make vaccines. Never in the past have vaccines been made available at such a short notice as it happened with Covid vaccines. The time that vaccine makers need to deliver a quality vaccine has to be given to them. It does not mean that either the vaccine makers or the Government have been lackadaisical.

 

  1. Not every pharma company or vaccine maker can make coronavirus vaccines since it requires BS Level-3 of safety parameters and not many have been willing to work with such a contagious virus. Therefore, while it has always been easy to make claims as to why not 20 odd Indian companies been allowed to make vaccines in one go, reality is that it was practically not possible unless those entities develop BS Level-3 of safety.

 

  1. While both Serum Institute of India (SII) and Bharat Biotech agreed to ramp up their production to meet the rising demands and for which Government of India approved vaccine supply credit to the tune of Rs 3000 crore and Rs 1500 crore respectively to SII and Bharat Biotech, one has to understand that physical capacity building for ramping up of vaccine production cannot happen overnight. It takes a minimum of a few months. While Bharat Biotech is expected to gradually scale up its vaccine production in the Bangaluru facility to 700 million annually by September-October, Serum Institute too is expected to scale up its production to 11 crore or more in the coming months.

 

  1. To further scale up production, in April 2021, Government of India granted approval to Haffkine Bio Pharmaceutical, a state level PSU owned by Government of Maharashtra, to co-produce Covaxin in collaboration with Bharat Biotech, and for that Government of India also approved a grant of Rs 65 crore to Haffkine Bio Pharmaceutical. Likewise, grants were also approved by Government of India for Indian Immunologicals Limited, which is expected to start production of drug substance for covid vaccines of Bharat Biotech and initiate its delivery from July onward. Indian Immunologicals is expected to produce drug substance for 10-15 million vaccines doses every month.

 

  1. Likewise, Government of India has also roped in another state-owned vaccine maker, namely Bharat Immunologicals and Biologicals Limited (BIBCOL). In its Bulandshar plant in Uttar Pradesh, BIBCOL would be coproducing 2 crore doses of Covaxin per month.

 

 

  1. Further, Government of India granted approval for initial import and subsequent production of Sputnik-V vaccines in India. Russia Direct Investment Fund (RDIF) backed Sputnik-V has entered into collaboration with Dr Reddy’s Laboratory, Hetero Drugs, Gland Pharma, Virchow Biotech, Panacea Biotech, Shilpa Medicare and Stelis Biopharma for local production of Sputnik vaccines in India. Production has already started as at least a 100 million are expected to made available annually.

 

  1. This apart, Indian biotech companies such as Biologicals-E, Gennova and Zydus Cadilla are also working on covid vaccines to be made available soon while Government may also allow imports of vaccines from Pfizer and J&J.

 

  1. Overall as it stands, from middle of June onward the vaccine shortage is expected to be gradually addressed and by July- August onward supply is expected match with demand or even exceed it.

Mitigating the Oxygen Challenge: An Uphill Task that Eventually was Accomplished

While some opposition parties and their leaders left no stone unturned to play politics on the vaccine front, on the issue of oxygen shortage as well, some found it as an opportunity to catapult themselves keeping perhaps 2024 elections in mind, instead of working with the Government to address the issue.

In this context, it has to be understood that India has not faced any pandemic like this since independence, and theories aside, there was certainly no reference point or benchmarks to embrace from. Secondly, it is always an extremely difficult proposition to anticipate the trajectory of a mutating RNA virus. Therefore, while there were anticipations of the possibility of a second wave of Covid, few would have imagined it to have come in the manner in which it created a ‘tsunami’ since late April.  For the Government, it was always supposed to be a Catch-22 situation. Being extremely strict and not opening commercial and public places including offices and other utilities, would have meant huge of employment bankruptcy of business holdings as well as sustained negative growth rate of economy. The same opposition blaming Central Government for unlocking too soon, and thereby ‘inviting second wave’ would then have accused it for ‘destroying economy and livelihood’.

It was also beyond anybody’s guess as to how the second wave  would create an exponential increase in demand for medical oxygen.  Government of India, nevertheless had anticipated a part of it last year itself as is evident from the fact that way back in October 2020, it had invited bids for setting up of 150 oxygen plants in hospital premises for reducing dependence on oxygen cylinders. Yet sadly, only 33 were up and running by April 2021. There was apparent reluctance on part of many hospitals to move ahead with the proposal with alacrity. Doubts therefore remain if lobbies of oxygen suppliers prevented the setting up of Pressure Swing Absorption (PSA) based oxygen plants in hospital premises.

Nevertheless, it was precisely the absence of PSA based Oxygen plants in hospital premises that resulted in shortage and not because of overall shortage of oxygen in the country. In the month of April, 2021, India was producing around 7500 tons of oxygen on a daily basis. This also included oxygen used for industrial purposes. And yet India a mere 1200 odd cryogenic containers to transport the much-needed oxygen to hospitals. It was a logistical nightmare considering the distance that each of such vehicles had to travel from far flung areas to hospitals.

Secondly, there was also an apocalyptic rise in the demand of oxygen concentrators. It was during this phase when the opposition parties instead of showing solidarity were busy playing politics that Modi Government silently went on the operation mode to address the issue. Indian Railways commenced operation of ‘Oxygen Express’ to ferry oxygen laden trucks to different parts of the country. By the end of May, 2021, the Indian Railways had already delivered 20,000 metric tonnes of oxygen across various parts of the country with the help of 300 Oxygen Express Trains.

The Indian Air Force and Indian Navy likewise, were also pressed into service to bring in the much needed cryogenic containers from abroad since in the shortest possible time it was not possible to domestically manufacture them. By the end of April, 2020, IAF had already airlifted 47 oxygen containers having a payload carrying capacity of 830 metric tonnes of oxygen.

The Air Force, eventually made hundreds of sorties to bring in several such containers and critical supplies from abroad. By the first week of May, 2021, India had already received 3000 metric tons of medical aid including oxygen concentrators and oxygen plants, and here too, in spite of the process of disbursement being extremely transparent, some unnecessary fake controversies were attempted to be created by vested interests. Meanwhile even as Government of India came out with directives to restrict supply of oxygen to nine industries for making sure that adequate amount of industrial oxygen could be directed towards medical emergencies.

Through some humongous efforts, Government of India made sure that by the end of April 2021, India’s daily production of oxygen was ramped up to around 9000 metric tonnes while under the aegis of Prime Minister Modi, by first week of May, 2021, funds were allocated from PM CARES for installation of 500 PSA Oxygen plants within three months.  In the last week of May, Union Minister Anurag Thakur stated that in all 1500 oxygen plants would be set up across India with the help of PM CARES FUND and PSU Funds. PSUs like ONGC chipped in with pledge to procure 1 lakh oxygen concentrators for Centre.

One also has to mention about the incredible contribution of India’s industrial majors such at the TATA Group, Reliance Industries, Adani Group, Jindal Group and many more, towards mitigating the oxygen crisis in India by diverting thousands of tonnes of industrial oxygen towards medical purpose on a daily basis.

Meanwhile, Government agencies like DRDO worked tirelessly to come up with a new oral medicine for combating covid and it is expected to revolutionize India’s war against Covid. DRDO not only worked on the 2DG medicine but also on developing technology for setting up of PSA Oxygen Plants and supplemental oxygen delivery systems. Further, in the private sector, production of anti-viral drug remdesivir was ramped up by almost 10 times.

The Abominable Politics Around Medical Aid that India Received from Abroad

Incidentally, when at a very short notice, India received around 3000 metric tonnes of medical supplies from abroad, a shocking narrative was created by vested interests and political opportunists that as if India has been turned into a ‘beggar’ country since these deliveries were coming from abroad free of cost. In the first place, none of the things that were coming to India could not have been made in India. Yet, those essential medical equipment were necessary for Government of India to receive because India was racing against time and in such occasions, it was more important to make sure that equipment are delivered rather than allowing inhibitions and ego to prevent acceptance of such aid.

Last year, India too gave the US millions of doses of hydroxychloroquine when they desperately needed it. The fact that India was helped by so many countries is because on several occasions in the recent past India stood by them. Also, as an economic powerhouse, the world values India as a nation and it simply did not want the India to face the crisis alone and thus extended their helping hand. For the myopic and self-serving vested interests, it might be too difficult to comprehend as to how global diplomacy works and why India was helped in crisis by genuine friends. Acknowledging it would mean accepting the success of Modi Government’s foreign policy, something many cannot admit even with a grudge.

It was time for the Country to act in unison: Sadly, it did not!

On a concluding note, it has to be said that a pandemic of this proportion is a national crisis that requires cooperation of all. Instead, some political opportunists and vested interests tried to piggyback the second wave to vilify the Prime Minister on the presumption that this would help them in their prospects in future elections. Nothing could be more unfortunate than this.

Apart from mindless political bickering and a twenty-four-seven obsession to vilify the Prime Minister, what also has not worked for India is the sheer wastage of resources that has often happened at times. While many states, in spite of political differences did extensively cooperate with the Central Government, in certain cases, lack of cooperation and sheer wastage of resources did hamper the management of pandemic.

Take for example the controversy surrounding ventilators supplied by Government of India to Punjab through PM Cares Fund. While claims were made that almost 237 of 320 ventilators received from Centre were not functional, an audit by Central Government found the sheer mismanagement of delicate devices including absence of basic recalibration of settings as per geographical location, or checking of the O2 pressure levels or the basic fixing of electrical settings that resulted them from not functioning properly. Instead of managing them well they were dumped in stores and kept unutilized for months. In many cases in Punjab, the hospitals did not even have the basic infrastructure necessary for installation of ventilators, as was revealed in a letter by Union Health Secretary. Therefore, instead of creating basic trained manpower and infrastructure in place for adequate utilization of ventilators, the state was more eager to engineer a political issue even as patient suffered while ventilators were kept unutilized in stores.

In the same league, sheer wastage of vaccines has been another major issue that the country has been grappling with. Many states have been extremely lackadaisical in management of vaccine vials resulting in wastage. As per a report by Union Health Ministry, wastage of vaccine is disproportionately high in case of some states. In Jharkhand for example, wastage of vaccines has been as high as 37%, in Chattisgarh the figure states at 30.2%, followed by Tamil Nadu at 15.5%, Jammu and Kashmir reportedly was wasting 10.8% of vaccines while Madhya Pradesh is alleged to have wasted 10.7% of allotted vaccines. Recently Union Government has accused Rajasthan of wasting 11 lakh doses of vaccines. An investigative report by a media house revealed that the wastage in Rajasthan is to the tune of 25%. Why states are wasting vaccines to this extent and how can India eventually beat covid and vaccinate all, if wastage of this proportion continues, is a million-dollar question.

Lessons Learnt: Time to prepare for future eventualities

Even as the number of active cases are on a decline, the second wave showed how ferocious and unexpected can be the advent of a new wave. The tragic losses of lives would take time to heal. When things would settle down, it would be time to introspect more on certain pertinent issues including the need for setting up of a National Healthcare Regulatory Authority for bringing uniformity and standards in medical treatment in India, the need for setting up of a large number low cost hospitals especially in rural areas, prioritizing telemedicine and promoting technology based consultations for expanding the reach of medical consultations in far flung areas, creating a new wave of revolution in the realm of biotechnology sector and emulating the same success in biotechnology as has been in case of software services, better engagement of public health experts in national healthcare planning, potential need for strategic storage of essential and critical medicines much on the lines of storage of crude oil, to name a few. However, having learnt lessons, India is poised to be much better prepared for future pandemics, one lingering question that remains unanswered is whether India faced a pandemic or a biological war. In case of the latter, India needs a whole new architecture to secure itself in future.

(The author is a public policy analyst and a well-known commentator. Views expressed are his own)

Leave a Reply