Dr. Syama Prasad Mookerjee Research Foundation

Addressing Challenges of the Second Wave

India ended the last winter on a positive note. After a huge 24 percent contraction in June following countrywide lockdown, GDP had beaten (de)growth estimates in September and came back on the growth path in December. The recovery was distinctly faster than the projections by forcing global agencies to go for upward revision in estimates.

Some bumps in IIP (Index for industrial production) number notwithstanding, things were panning out well in the January-March 2021 quarter as well, with the composite index of the homegrown SBI Research (one of the most conservative agencies) touching 70-month high in March. Market was soaring and the industrial outlook was getting brighter as both FII and FDI were pouring in record numbers.

Public sentiments were high as the incidence of covid infection was as low as 13 (seven-day average) in every one million (10 lakh) population, as on March 10.

Centre was issuing regular alerts to States, particularly those where new infections were concentrated, asking them to remain on toes and step-up tests and vaccination.

But it is questionable, if many paid attention to those alerts. As on March 3, 86 percent of new cases were from six States Maharashtra, Kerala, Punjab, Tamil Nadu, Gujarat and Karnataka. At least two of these States, both rich, Tamil Nadu and Punjab were laggards in vaccination.

According to Prof Shamika Ravi, senior fellow of Brookings Institute as on May 23, 4.43 percent of India’s eligible population is vaccinated. The ratios stand at a mere 3.39 percent in Tamil Nadu and 3.21 percent in Punjab. The credit goes entirely to vaccine hesitancy, which States failed to address.

In India the role of States is highly important in public health, as it has near complete control over the delivery infrastructure – both hard and soft. Role of the Centre is limited to policy making and facilitating creation of infrastructure through projects like National Health Mission.

No Models Predicted This

Covid infections started zooming from the second half of March and hit the second peak, and a higher one than the first, of 283 cases per million on May 8.

PK Mishra, principal secretary to the prime minister, admits the error of judgement. In an interview to The Times of India on May 21, 2021, he said: There were at least half a dozen meetings at the official level to monitor the situation from mid-February to mid-March. We expected an increase (in infection) but we did not anticipate such a steep rise. None of the models predicted this.”

New cases are now falling as fast as it went up and was 191 per million (almost the same level as of Malaysia which is now heading for a new peak) as on May 22.

Death ratios follow the infection curve with a lag effect. It has now hit a plateau of 3.04 per million, slightly ahead of Germany’s 2.15, which has passed its second wave peak of 10.68 deaths per million on January 13. Death ratio came down from 10 to 1.68 per million in the USA.

Notably Germany and USA both witnessed way higher case-loads than India. Both started vaccinations ahead of India. Germany was nearly a month ahead. It is a technology and manufacturing superpower and has one of the best public health and social security systems in the world. Most importantly, Germany has barely 8 crore people.

Despite that, according to ‘Our World in Data’ only 13 percent Germans are fully vaccinated so far (as against 4 percent in India). The USA did better with 38 percent.

Everyone was learning

The moot question, however, remains: Has India been exceptional in making an error of judgement. The question is important as the Opposition is blaming the government for failing to take precautions for the second wave and failing to ramp up vaccination.

To answer, let’s turn our focus to South Korea, which is not merely an economic and technology super power, but also known for its highly disciplined and consistent approach in policy making.

South Korea averted much of the impact of the pandemic through highly efficient testing and tracking initiatives. As in January, when countries were scrambling for vaccines, South Korea didn’t join the rush. It was bargaining for the right quality of vaccine.

As in May, Seoul is reeling under a vaccine shortage (Reuters, May 12) and there is growing fear that the country may miss the target of full vaccination to all by November. According to Our World in Data, only 3.4 percent of Koreans are fully vaccinated so far.

Japan is in even bad shape. It is in the middle of a second wave and only two percent of the population is fully vaccinated.

Manufacturing power, Taiwan is blaming China for sabotaging its attempt to get vaccines, while it is witnessing first major spike in covid cases. Taiwan, if one may remember, alerted the world about the outbreak in China and had put up one of the strongest resistance to the pandemic until recently.

Take a look at the rich economies in Southeast Asia and the situation is similar. They were considered a model to keep the pandemic under control during the first wave. Now all are falling to the second wave.  If you blame India, will you also blame policymakers of all these countries for failing to prevent a second wave?

With a few times higher per-capita GDP (than India), even Thailand has better resources to fight against the pandemic. Yet, it is running out of beds, oxygen and critical care capacity – something akin to what Delhi witnessed for barely two weeks, before the Indian government moved heaven and earth to bring the situation under control.

You do not hear about the oxygen crisis any more. Leave data pertaining to Uttar Pradesh’s dramatic turnaround aside, we do not see much SOS for beds or oxygen from cities in UP or Delhi anymore, on social media.

Second wave is receding

That situation improved too fast is evident in public reaction. Smartphones are a great tool that is available even in the remotest part of the country. There may be discrepancy in information. But it is impossible to hide information in today’s world, at least in India.

This takes us to the last question. Could India ramp up vaccination? Yes, of course. If Gujarat or Kerala could vaccinate 25 percent of its adult population, why Tamil Nadu and UP should score nine percent, lower than the national average of 16 percent?

Vaccine shortage is a worldwide phenomenon. There is limited availability of imported vaccines. Moreover, many such vaccines require delivery logistics which are not easy to facilitate in India. The dependence is on domestic production.

India is the fourth largest covid vaccine producer in the world after China, USA, Europe (Germany, Belgium) – but a distant fourth. The biggest producer is a licensee manufacturer. The second one is India-made (Covaxin) vaccine. Both were administered on emergency approval and the India-made vaccine cleared the third and final trial only recently.

Govt is funding the producers to expand the manufacturing capacities manifold. Fresh capacities will come on stream beginning June-July. The decision coincided with the second wave, which triggered the rush for vaccines beginning at the end-April. Spike in demand created a temporary short supply scenario in May.

To address the issue, the government has put a temporary embargo on overseas distribution (25 percent of domestic capacity) of vaccines including those contracted by some countries and the Covax distribution programme led by the World Health Organisation beginning April. The embargo will be removed after domestic capacities are augmented.

One may argue that India could have been more proactive in funding the companies in expanding manufacturing capacity, thereby saving a month or two. Government is yet to clarify this issue. Presumably, it had low leveraging capacity with respect to the licensee manufacturer and was waiting for Covaxin to establish its efficacy before going overboard on production.

Shortage vs incapacity of States

In retrospect, however, the so-called “shortage” was as much a contribution of low availability as failure of the States to vaccinate faster. Right at this moment, the Centre has distributed 22 crore doses to States. 20 crores were consumed. This includes two percent (40 lakh) wastage.

States are having an inventory of two crore vaccine doses. Such high inventory, that too at a crunch situation, points at capacity constraint at State level.

The constraint is understandable. Before Covid arrived, India was carrying out its door-to-door immunization programme through village level community health workers (ASHA) who carry the vaccine in a regular ice-box.

But, Covid vaccines require a consistent cold chain. Under ‘emergency use’ guidelines, the vaccine is administered by trainer nurses ensuring supervision and availability of doctor and healthcare facilities to address post-vaccination illness, if any.

This takes us to a critical gap. According to the World Bank, India has only 0.9 doctors per 1000 people against the world average of 1.5 doctors, 4.2 in Germany and two in China. The world average of nurses and midwives is 3.8 per 1000 population. India has 1.7 nurses per 1000 population against 2.7 in China and 4.2 in Germany.

This is the result of prolonged neglect to healthcare, which cannot be mitigated overnight. You can create a hospital in days or months. But it takes five years to become a doctor (MBBS) and 3-5 years in nursing.

To take a more comprehensive view, India fared way better than the majority of the world, including the developed world, in covid management so far. Given its population (2.5 times denser than China) and resource position; it showed better results in case load, death ratio, vaccination and economic recovery.

Economy is the king

Covid is a once in a century phenomenon. It will die its natural death. What is important is to take the economy forward. All indicators point that the economic damage has been distinctly less in the second wave.

The FDI and FPI (foreign portfolio investment) inflow continued to remain high even in the first week of May when fresh infections peaked. With second wave fast waning out and lockdown restrictions are likely to be removed in many States in weeks, things should improve faster.

(The writer is a well-known former journalist, public policy expert and a writer. Views expressed are his own)

Image Source: https://assets.ey.com

(The writer is a veteran journalist and public policy expert. Views expressed are personal.)