"India needs to rethink on the state-vs-centre allocation of resources, which ultimately plays a vital role to spruce up healthcare infrastructure..."

"The way economic activity was promoted by central and state governments, without ensuring proper restructuring of the healthcare infrastructure, mapping resources, calculating risks and allowing mass gatherings in the name of religious and election campaigning, led to the big and sudden spike..." 

"India still has inadequate healthcare spending, and the focus is to build new establishments rather than fixing old issues to rehaul the existing healthcare infrastructure..."

Public Health Communications and Policy Expert Dr Rajiv Chhibber explains to Asianet Newsable's Anish Kumar about the shortcomings that led to the second wave of Coronavirus cases in the country.

As per government data, over 5.27 crore people in the age group of 45-60 took the first dose, but only 37.7 lakh have received the second dose till May 1. Why has such a big difference come about in the vaccination drive? What are the areas of improvement?

The first drive of vaccination for the first dose of the 45-60 was overwhelming since the government was prepared with the doses while there were logistics and raw material issues. But when the drive progressed, the veracity of the drive proved to be a stumbling block for the second dose. 

A few factors such as the report on blood clots being formed in elderly comorbid people, followed by the renewed gap between doses, especially for Covishield being increased created a scare and confusion amongst the larger population, who had taken the first dose. 

Again, the fact that even after getting vaccinated people were getting Covid-19 damped the spirits of many. 

And finally, the icing on the cake was the fact that suddenly there was a supply shortage of vaccines, which the health ministry did not anticipate. The government blamed the fact that people -- in the garb of healthcare and frontline workers -- were getting doses to be vaccinated, as opposed to the genuine population which was targeted.

As an area of improvement, vaccination needs to be looked at as a service and based on populations estimates. Procurement of raw material should be secured. It cannot be that the CEO of a company goes on social media asking for raw material, and another company presents its data in a manner that outshines the other. This creates hesitation. 

Another reason was the management of the COWiN App, which is still persistently giving glitches, followed by the politics of state governments offering free vaccines in some states, and others asking for nominal payments. Health is a state subject, and a national decree should have been formulated without getting into petty politics. 

Lastly, management at the district level and wastage because of improper facilities became a penalising issue for many hospitals, which were already asked to make arrangements at a meagre cost, and low human resource setting. Just fixing the above will make the drive a success.

Has the second Covid wave exposed serious lapses within India's medical infrastructure? Where are the immediate concern areas?

There is no doubt that the second wave exposed the underbelly of the healthcare system in India. The sudden manifold rise not only takes us back to the drawing board to recreate a Universal Healthcare vision plan for India, but also the need to have pandemic preparedness as another setup that works beyond the regular medical infrastructure. 

A plan of action needed on war footing to map the entire last year's learnings was missing, and further, the centre-state subjectiveness in the era of disaster management has costed many lives. 

Surveillance systems, stockpiling of minimum inventory of medicines, medical devices, SOP preparedness, industry adequate buffer time, and availability of manpower and logistics went amiss. 

The fact that we have enough oxygen nationwide, but not readily available when required is a lame excuse. Ultimately data analytics is where India went wrong. Had we instilled a robust data capturing system, had the latest scientific tools to know about mutant variants, analytics could have prepared us well to at least anticipate an economic opening. 

All this simmers down to the fact that India still has inadequate healthcare spending, and the focus is to build new establishments, rather than fixing old issues to rehaul the existing healthcare infrastructure.

India was till recently exporting oxygen, vaccines and Remdesivir to other countries. Was the central government caught napping? How much of the blame rests with state governments?

The plateauing of Covid-19 cases in the latter part of 2020, until early February 2021, made economic upheaval a quest. Hence not only did the government eye to earn quick gains by being exporters but also ignored the colossal damage without credible health insights. This ultimately turned the tide and became the second dreadful wave. This cannot be called napping but is a simple process of not having resources to map the future pandemics. Again, the question comes on data analytics and healthcare mapping which went amiss due to laxity. India needs to rethink the state-vs-centre allocation of resources, which ultimately plays a vital role in spruce up healthcare infrastructure.
 
What are the factors that mitigated the sudden spike in Covid cases in the country?

As Dr Anthony Fauci, Chief Medical Advisor to the Biden administration recently said, India declared victory prematurely, which cost us the second Covid wave. The way economic activity was promoted by central and state governments, without ensuring proper restructuring of the healthcare infrastructure, mapping resources, calculating risks and allowing mass gatherings in the name of religious and election campaigning, led to the big and sudden spike. 

As late as February, India was considered a Covid-19 success story. Experts were thinking that declining infections might be due to India's warm climate, young population and high population density, which some speculated might have given residents a form of natural immunity. But all those hypotheses fell apart. Today we have hospitals are overflowing with patients, oxygen supplies dwindling and ceaseless fires burn at crematoriums and makeshift funeral pyres, where families have been forced to forgo traditional ceremonies to make space for more bodies to be cremated. Today we have an unprepared public health system and a returning deadly virus that knows no economic, religious or political boundaries.

NOTE: Asianet News humbly requests everyone to wear masks, sanitize, maintain social distancing and get vaccinated as soon as eligible. Together we can and will break the chain #ANCares #IndiaFightsCorona