'It didn't have to be this way': India's Covid-19 tragedy

'It didn't have to be this way': India's Covid-19 tragedy
6 min read
25 May, 2021
Opinion: India's total failure to provide effective health governance makes a mockery of the sacrifices of its frontline workers, writes Kamala Thiagarajan.
India has so far recorded 26.8 million cases of Covid-19 [Getty]

I cannot pinpoint the exact moment when many Indians like me, who are not politically affiliated, and who still believe in narratives tinged with hope, completely and utterly lost faith in the government's ability to control this raging second wave of pandemic.

On 20 May, a group of retired civil servants wrote an open letter to Prime Minister Modi. "We write to you in anguish as well as in anger," the letter states. "What numbs our senses daily is not just the cries of the citizenry for medical assistance and the death toll in its thousands, but the manifestly casual attitude of your government to the magnitude of the crisis…"

Perhaps, like the pandemic itself, our disillusionment built up in waves.

"Perhaps, like the pandemic itself, our disillusionment built up in waves"

At first, it was the all the bad science we’ve had to endure.

Recently, we've witnessed these unproven medical claims grow disturbingly mainstream, endorsed fully by India’s Health Ministry, and alarming Indian doctors.

In June 2020, a popular yoga guru Baba Ramdev, launched two herbal and ayurvedic cures for Covid-19, making the unsupported claim that it had 100% effectiveness in clinical trials. In October, the Indian Medical Association, a lobby of 350,000 doctors across the country, questioned the motives behind the Health Minister’s promotion of herbal products as prevention of Covid-19.  They said he was "inflicting fraud on the nation and gullible patients by calling placebos as drugs."

The sales of unlicenced herbal products touted as effective prevention for Covid-19 continued unabated, giving people a false sense of security over a deadly disease.

Then, even as sickness spread and the numbers of deaths were climbing, Modi allowed religious festivals like the Kumbh Mela, which attracts millions of devotees to the banks of the Ganges River, to continue.  This was followed by election rallies that attracted throngs of unmasked crowds in four Indian states.

By then, it was too late to invest in shoring up health infrastructure, something to which successive governments have paid little attention. India spends 1.2 % of it’s GDP on healthcare, one of the lowest public health budgets in the world. In contrast, Brazil spends 9% and the United State 18%.

The country found itself grossly ill-prepared and thrust into a distressing cycle of death.

On 21 May, India had recorded 26 million total Covid-19 infections, averaging over 4,000 deaths daily in recent weeks, numbers that experts say may be five times higher than official records indicate.

Anecdotal evidence from doctors established a change in the way the virus was acting. It was affecting younger people with no co-morbidities, and moving into rural areas. But more importantly, the new wave of infections attacked the lungs more vigorously, and most patients required oxygen support.

Perspectives

The lack of a centralized, co-ordinated supply and distribution of oxygen cylinders kicked off a nation-wide scramble for oxygen. A huge black market began thriving for oxygen cylinders, concentrators and uncertified drugs such as remdesivir. The 50,000 tonne oxygen shortage across the country in mid-April caused untold trauma for caregivers - many Indians worried about where the next oxygen cylinder would come from, and whether or not they could even afford to have their loved ones take their next breath.

It didn’t have to be this way.

In addition to the complete disregard for public health messaging and physical distancing norms, the bewilderingly slow national vaccination programme has made a bad situation far worse. India's vaccine story is a litany of disasters, when it once held so much potential and promise.

The country has had access to not one, but two vaccines. It is home to SII - the Serum Institute of India, which is often touted as the largest vaccine manufacturer in the world. Despite producing 60% of the world's vaccines, India is now struggling to vaccinate its own people.

Licenced to produce the Oxford-AstraZeneca vaccine Covishield, the SII has a production capacity of 70-100 million doses per month.  India also has its own homegrown vaccine called Covaxin, developed by the Indian pharmaceutical company Bharat Biotech. Bharat Biotech has significantly less capacity - currently producing 10 million vaccines per month. But despite their combined capacity of 110 million per month, India has managed to vaccinate just 190 million people with one dose of the vaccine, since the rollout of both vaccines in January.  That's only 14 people out of every hundred, compared to 87 in the UK and 84 in the US.

Between February and May, the SII was committed to providing 100 million vaccines to the COVAX Alliance, (a global alliance that aimed at making vaccines available to 92 lower income countries), but because of the emergency situation wrought by the second wave, SII failed to keep its commitment. Ramping up production of vaccines for India became a critical priority.

 "A huge black market began thriving for oxygen cylinders"

Suffering severe nation-wide shortages, the government has finally approved other facilities to provide 200 million additional doses of Covaxin per year. Even with this increased capacity, the move comes too late for many Indians who recently succumbed to the ferocity of the disease. Online registration for vaccines on a government portal has been made mandatory, but access excludes large swathes of India’s population who are not well-versed in tech, creating a hackathon of sorts among those who are.  

Indians states have been expected to float vaccine tenders so that each one can negotiate with vaccine manufacturers individually to procure supply, a move public health experts have called absurd and discriminatory. Private companies are now floating global tenders too, negotiating for vaccine supply for their employees. Never before has geography and employment status mattered so much. If you live in a state in India with relatively strong healthcare, or work for an Indian conglomerate, you'll now have better chance of survival.

If the end goal is to create herd immunity - administering the vaccine to at least 60% of the population to prevent the spread of Covid-19 - then it will take India several years to do so with these haphazard and piecemeal measures. Meanwhile, the virus will continue to mutate.

India's failure at effective health governance makes a mockery of the sacrifices of its frontline workers. Many of India's Accredited Social Health Activists (ASHA) - recruited by the government to mobilise healthcare in rural communities to encourage people to get vaccinated and pregnant women to get hospitalized care - found themselves fighting for fair wages, while dealing with anger, and physical  and verbal abuse during the pandemic.

In time, the darkest days of the pandemic will be put behind us, but the mental health consequences of the hard decisions we have had to make in the absence of reliable governance, and the outcome of our collective grief, is likely to haunt our nation for years to come.  

Kamala Thiagarajan is a writer and freelance journalist based in India whose work has appeared in leading newspapers and magazines in over ten countries.

Follow her on Twitter: @Kamal_t

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Opinions expressed in this article remain those of the author and do not necessarily represent those of The New Arab, its editorial board or staff.