Publisher Health

As we approach the third year of the pandemic, epidemiologist Chandrakant Lahariya writes about what India should learn from its fight against Covid-19.

Anyone travelling through India’s northern states would be forgiven for thinking that the pandemic is over.

In the smaller towns, few people wear masks, fewer practise social distancing and Covid-19 rarely comes up in conversations. The only visible reminders are the billboards thanking politicians for tackling the virus.

In the national capital, Delhi, most people are masked because of rules that demand it. But the city is once again in full swing, from crowded markets and busy restaurants to packed social calendars.

Low case counts (India has been recording around 10,000 new Covid cases daily) and the ongoing vaccination drive (nearly 80% of the 940 million eligible adults have received at least one dose so far) seem to have dimmed the memory of a brutal second wave in April and May this year.

But the fact is the pandemic is not over. Cases are rising in Europe again, prompting the World Health Organization (WHO) to say it is “very worried”.

The emergence of a new variant, initially named B.1.1.529 and now Omicron by the WHO, is another cause for concern – although more research is needed to determine how dangerous it is.

So the inevitable question to ask is: Will there be a third wave of Covid-19 ? And if so, is India prepared?

It’s likely India may not see a major rise in cases because studies suggest the majority of Indians have antibodies against the currently predominant Delta variant, and four-fifth of all adults have also been partially vaccinated.

But that isn’t enough cause for cheer.

The recent reports of a dengue virus outbreak – an endemic disease – in many Indian states is proof that the health system is still not equipped to detect and tackle emerging and re-emerging diseases.

And therein lies the problem. When the pandemic arrived in early 2020, the hope was that the stringent lockdown would afford an opportunity for the government to strengthen an understaffed and under-funded public health system.

Top political leaders and senior health policy makers repeatedly said that was the objective of the first lockdown.

But a year on, a second Covid wave devastated India as hospitals ran out of beds, medicines and oxygen. Medical bills soared in a fragmented market with spotty insurance coverage, and people borrowed money or sold family assets to pay up.

Soon after, in July 2021, the government did announce a second Covid-19 package to strengthen health infrastructure. But some argued that the amount set aside was too little, and there was no visible urgency to put it to action.

India’s national health policy, announced in 2017, had proposed raising government spending on health to 2.5% of GDP by 2025. But spending has only marginally increased since – it accounted for just 1.3% of GDP in the fiscal year ending 2022 – and is clearly not on track to reach the target.

The government has often claimed that its Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is one of the world’s largest public health insurance schemes. But several news reports suggest that the scheme barely helped those who desperately needed it.

The challenge ahead is even bigger and goes well beyond the pandemic.

While much of the health system was focused on tackling Covid-19, other essential services took a hit. It’s one of the reasons many Indian states have struggled to deal with the dengue outbreak.

The WHO said in October that the pandemic reversed “years of global progress in tackling tuberculosis” as people struggled to access treatment. India accounted for 41% of the total global drop in reporting the disease between 2019 and 2020, the WHO said.

People suffering from non-communicable diseases have also found it difficult to get the care they needed.

So, what should India do?

First, the government should commission independent experts to conduct an impartial assessment of its pandemic response.

Second, India needs to recommit to strengthening its health systems. If the promises made on this front in the last five years by both federal and state governments can be fulfilled, the country would have a far stronger health system.

Third, all policymakers, medical experts and technical experts should be trained in science communication to avoid panic and misinformation.

Fourth, India’s pandemic response has to be integrated into primary healthcare services.

Fifth, India needs to immediately fill vacancies at all levels in the health workforce and draw up a detailed plan for equitable distribution across urban and rural areas, giving priority to underserved regions.

Complacency and fatigue at different levels have led to a slowdown in the adoption of Covid-appropriate behaviour, vaccination uptake in adults and even genome surveillance.

The emergence of Omicron should be used as an opportunity to reassess pandemic preparedness across the country – including enhanced and targeted Covid testing, genomic sequencing and accelerated vaccine coverage in adults.

But a note of caution – the emergence of a new variant should not lead to hurried decisions on vaccine dose intervals, boosters or even the functioning of schools, which have only now begun to reopen after more than a year.

Those decisions should be determined only by a calm assessment of scientific evidence.

India may or may not face another major Covid wave, but other outbreaks and epidemics will continue to be a reality after this pandemic – as they were before it.

If a country is prepared for preventing and controlling any disease outbreak, it’s also prepared for a pandemic.

So, let’s prepare for responding to every outbreak.

The struggle to control the dengue outbreak in 15 Indian states is proof that India is not ready yet.

Action is needed now, and one can only hope that someone is listening.

Chandrakant Lahariya, a physician epidemiologist, is a public policy and health systems specialist, based in Delhi.