COVID-19: The collapse of India’s health system, an endgame

By Khadeeja Abrar and Nur Sa’adah Batrisyia 

“How did India handle the second wave of infection? Honestly, we take a lot of precautions and follow strictly the SOP standard operation procedures (SOP). Some participated in large gatherings and there is no drastic number of cases reported. Therefore, we are pretty confident we already entered a safe zone but then a second wave came like a storm. Everything bounced back within weeks, daily cases increased, lack of oxygen supplies, and citizens started to question the health system.” 

This view was shared by a former COVID-19 patient on India’s second wave infection that triggered the flaws in their healthcare system. Mr. K. Prasant, 51, is a Regional Provident Fund Commissioner in the union territories of Jammu, Kashmir and Ladakh. He was tested positive for COVID-19 with mild symptoms and recovered without hospitalisation.  

In an interview with this government officer, he shared his experience in dealing with the health care system throughout the recovery period. Unlike what is reported in the mainstream media, his personal experience was different particularly due to his mild symptoms. 

“I am happy with the treatment and services provided by my health care provider. The doctor monitored my condition through video call and phone call, they sent the medicines, supplement and other basic medical necessities needed for my recovery process.” Prasant said his fitness routine helped to speed up the recovery period.

“The good thing about COVID-19 is that people start to appreciate the art of breathing properly. This can only be gained by developing a habit of exercising.” Prasant perceived that having a good level of oxygen concentration (95 percent or higher) is a good indicator to build a strong immune system. 

It may be conceivable that Prasant is among the minority former COVID-19 patients that succeeded to escape the life-threatening scenario, contrary to other patients with severe acute respiratory syndrome. 

Families are denied the chance to save their family lives, and some even have to manage their own oxygen supplies, leading them to opt for the black market.

The real question is, India is among the top countries with excellent medical efficiency. They are even the world’s largest producers of vaccines.  Hence, how did they hit rock bottom with this second wave infection? 

One of the factors is attributable to its massive population, its country ranking number two of the world population after China. Rationally, other big nations like the United States and Indonesia might take a while to achieve herd immunity, the same goes to India. This is partly due to unforeseen circumstances that contribute to the slow vaccination rate. Matters such as delivery shipment hinder the scheduling process for the global world to receive their vaccine supply. 

Let’s take a look at India vaccination rate to understand the factors that lead to second wave infection.    

What vaccinations does India possess?

Covishield and Covaxin are presently available in India for COVID-19 vaccination. Covishield is manufactured by the Serum Institute of India (SII) under licence from AstraZeneca, while Bharat Biotech produces the locally produced Covaxin.

The government announced in May that they ordered 356 million doses of the two vaccinations to be ready for use until July of this year, but that not all of these doses had been delivered. The Sputnik V vaccine, which was licenced for use in April, is now accessible, with Russia supplying three million doses.

What is the maximum amount of vaccine India could produce?

In order to sufficiently vaccinate the whole adult population, the government plans to generate two billion doses between August and the end of 2021. According to India’s 2011 census figures, 900 to 950 million individuals aged between 18 or older are eligible for vaccination. Therefore, if this population estimate is right, two billion doses would largely cover this.

In spite of that, out of the eight vaccines presently being produced in India, only three of them have been approved for use. Meanwhile, the other two are in the early stages of clinical testing, while the other three are in the late stages.

Epidemiologist, vaccinology and public health specialists, Dr. Chandrakant Lahariya opined that they cannot count on those vaccines which are still not approved.  

“The focus should be on scaling up (the production) capacity of existing vaccines,” he added.

What is the vaccination rate per individual?

India started its vaccination in mid-January and has already delivered approximately 210 million vaccine doses. Daily vaccination peaked at 3.6 million in early April, then dropped before ramping up again in the last week.

Source : BBC

Presumably, it might take up to 1.6 years for the adult population to get vaccinated at the current rate. However, because of the shortfall in supply, certain states, notably Delhi and Maharashtra, have announced that vaccinations for those aged 18 to 44 will be suspended.

To make matters worse, India is the largest vaccine manufacturer which indicates they are partly responsible to provide sufficient vaccines to achieve global herd immunity, however, this might not be the case after the deadly second wave. The government of India has halted vaccine exports in March due to the country’s pressing need to provide to its own people.

In terms of vaccine shipment, a limited amount to the Covaxin-sharing system worldwide has been permitted, however, there is no sign that bigger shipments will start, at least soon. It is apparent that the COVID-19 problem in India has impacted India’s vaccine-sharing programme. Further, the SII has stated that it will not begin exporting vaccinations until at least the end of the year.

As the number of COVID-19 cases in India grew at an unprecedented rate, the necessity to vaccinate the Indian people became increasingly urgent, by then, the Covax programme suffered a heavy loss. 

Experts now believe that much more preparation should have gone into maintaining exports while also meeting domestic demands. The paucity of vaccinations to immunise the country’s population has been exacerbated by a lack of advance purchase agreements with producers and a lack of cash to enhance production.

A severe scarcity of vaccinations has been observed in several Indian states, causing several locations, including the capital New Delhi, to re-prioritise persons aged 45 and above. It can be said that the main defect in this vaccine production is that they are financially underfunded! The country has been experiencing a vaccination deficit (expenses exceed revenues). This includes the financial expenses for oxygen supply, hospital beds and medication — the public health has met a dead end.  

“Nothing, nothing is being done. I do not know if the government is sleeping or what they are doing. I am totally disheartened at the situation I am seeing,” an Indian citizen spoke in an interview with the BBC. 

The opposition has accused Prime Minister, Narendra Modi of botching the COVID-19 response, which has made world headlines (for a wrong reason) due to a scarcity of medical supplies. 

Regardless of that, Mr. Narendra Modi received widespread praise for India’s dedication to the Covax sharing initiative. World Health Organisation (WHO) Director-General, Tedros Ghebreyesus thanks India for “showing charity, generosity, and empathy” in vaccinating the world. Brazilian Prime Minister has compared him to Lord Hanuman, who carries the lifeline Sanjeevani to provide vaccination to his people.***

(This is the first part of the three-segment special reports series on COVID-19 situation in India for Feature Writing class)

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