This article attempts to analyse the measures taken by Bharat’s government post Covid in early 2020, the strategies adopted and the issues and challenges encountered in the course of managing this pandemic which has been covered under the Disaster Management Act, 2005 when the nationwide lockdown was declared in March, 2020.
Bharat has tested around 23 crore of its total population by 18th March, 2021. Bharat’s tests per day per thousand population is 1.18 whereas it is 16.28 for UK, 14.93 for Czechia, 4.57 for France and 4.39 for Israel. Though Bharat has ramped up its RT-PCR testing centres infrastructure from 315 government centres and 111 private centres as on 3 rd May, 2020 to 1246 and 1231 respectively by 23 rd April, 2021 we are nowhere near the top five countries as evidenced above. The size of population creates big challenge for our country in this regard.
Of the eight PSA (Pressure Swing Absorption) oxygen plants planned for Delhi, only one has been set up, the Union Health Ministry informed the Delhi High Court on Tuesday 20th April, 2021. The demand raised by the Delhi government to meet the current oxygen crisis is around 700 MT, while the quota allocated is 378 MT.
The Joint Secretary (Health), Nipun Vinayak, informed the court that only one plant, at the Burari Hospital, has been installed so far. He, however, could not answer whether the plant was operational. Four more plants are likely to be installed by April 30, 2021 the Ministry informed the court. For the remaining three plants, paperwork remains incomplete as of yet.
Site clearance for one PSA plant was received by the Health Ministry on April 19, 2021 while the proposed sites at Raja Harish Chandra Hospital and Safdarjung Hospital were found to be “unsuitable”.
“At least the blame is on both Central government hospitals and Delhi government hospitals,” said the Delhi High Court as lawyers for the Delhi government and the Centre blamed each other for delays in setting up oxygen plants.
The government informed the court that 162 PSA plants have been sanctioned in January, 2021 under PM CARES fund at a cost of Rs 202 crore across the country. The government is paying only for the installation of plants, while the centralised pipeline for oxygen has to be set up and paid for by hospitals.
However, the work had stalled while Covid-19 numbers were in control earlier this year. “In January and February, Covid cases came down, so work slowed down. We are working on this,” Joint Secretary (Health) Nipun Vinayak said to the Delhi High Court.
The root cause of the problem:
Until 2019, before the pandemic hit the country, Bharat required just 750-800 MT liquid medical oxygen (LMO), the rest was for industrial use. Since April 18 this year, industrial supply has been completely disrupted in view of the increased demand from the hospitals for oxygen.
The liquid oxygen is filled into jumbo tankers for storage and in turn sent by cryogenic tankers to distributors across the country. These distributors convert liquid oxygen into a gaseous form in cylinders and transport it to hospitals. Some stock is also sold to local vendors, who sell in retail to home patients.
The Empowered Group-VI (EG-VI) tasked to coordinate with the “Private Sector, NGOs & International Organizations for Covid -19 response-related activities in its second meeting, held on April 1 2020, had red-flagged oxygen shortage and this issue was entrusted to DPIIT (Department for Promotion of Industry and Internal Trade). A nine-member committee was set up by DPIIT to ensure adequate availability of medical oxygen in the wake of the Covid-19 pandemic. With the steady increase in the number of Covid-19 cases, consumption of medical oxygen continued to rise and jumped to 3,000 metric tonnes (MT) per day around September 24-25, 2020 (around the peak of the first wave of Covid-19) from about 1,000 MT per day pre-Covid period.
In October 2020 Parliamentary Standing Committee on Health also flagged the issue of “availability as well as affordability” of medical oxygen and asked the government to “encourage adequate production of Oxygen for ensuring its supply as per demand in the hospitals with appropriate price caps.” Secretary, Department of Health and Family Welfare informed the Parliamentary Standing Committee that during pre-Covid days, the consumption of medical oxygen was almost 1,000 metric tons per day and the rest of the 6,000 metric tons of oxygen was being used in the industry.
Maharashtra, on March 30 2021, issued an order to “regularize the circulation and supply of oxygen” from production units located within the state and directed “80% of production to be used only for medical oxygen and to be supplied to the hospitals in Maharashtra. On the day of the order, the national daily figure of fresh Covid-19 cases was around 53,000 — and the second wave had just started.
As the crisis worsened further effective from 22 April 2021, the Centre imposed the prohibition on the supply of oxygen to industries saying that the demand for medical oxygen had reached about 60% of total daily oxygen production. With supply to industries cut since April 18, 2021 oxygen produced in iron and steel plants are being diverted for medical use, and industrial oxygen manufacturers have been encouraged to produce medical oxygen.
From the above developments, one could notice that the government lacked a strategic plan of action and lost its grip on the ground level scenario. The government should have gone for (i) stepping up the oxygen production in the existing plants a year ago in 2020, (ii) enhancing the production of medical oxygen and reducing the industrial oxygen in a phased manner as per the requirements of the hospitals and (iii) improving the logistics management to reduce the transit time for the delivery of the oxygen to the hospitals.
In March 2020, Niti Aayog estimated that we would need 20 million PPE kits and 40 million N-95 masks, which translated to 20,000 PPE kits and 400,000 h-95/FFP-2 class masks per day by July 2020. With the concerted efforts by the MoT (Ministry of Textiles) and MoHFW (Ministry of Health and Family Welfare) and with the active involvement of DRDO, Alternative Energy Promotion Centre (AEPC), and Bureau of Bharatn Standards (BIS) and Confederation of Bharat Industries (CII) dissemination of the important information about WHO quality standards, specifications, processes and the resource issues were duly identified. Today Bharat is the second-largest producer of PPE suits with more than 600 domestic companies certified to manufacture the same, producing around 500,000 PPE suits per day. According to a report by Invest Bharat, a government agency for investment promotion and facilitation, the global PPE kits market is worth $52 billion (Rs 3.8 lakh crore) and Bharat is $1 billion (Rs 7,300 crore) market and which is growing.
Reason for the success story
Ministry of Textiles along with the Ministry of Health and Family welfare took an active role in guiding and hand holding the entrepreneurs (mostly in the MSME segment) who ventured into PPE kit manufacturing post-Covid in Feb-March 2020. The industry representatives and federations were also involved in this exercise actively. By March 22, 2020, four Bharatn firms could successfully produce test samples. Within two months Bharat almost attained self-reliance in the production of PPE kits and started exporting the same!
In April 2020 study done by researchers affiliated to Washington-based Centre for Disease Dynamics, Economics and Policy and Princeton University estimated that approximately 19 lakh hospital beds, 95,000 ICU beds and 48,000 ventilators are available in Bharat. Most of the beds and ventilators are concentrated in seven states — Uttar Pradesh (14.8%), Karnataka (13.8%), Maharashtra (12.2%), Tamil Nadu (8.1%), West Bengal (5.9%), Telangana (5.2%) and Kerala (5.2%).
On 13 May 2020, the government allocated Rs 2,000 crore for procuring ‘Made in Bharat’ ventilators (50,000 ventilators). In Bharat, there were just six to seven ventilator manufacturers. The majority of ventilators are imported, costing anywhere between Rs 15 lakh to Rs 16 lakh. The government estimated that under this Made in Bharat initiative the ventilators that are likely to be made in Bharat would cost between Rs 2 lakh to Rs 4.5 lakh. However, many facilities started under this Make in Bharat initiative stopped production because govt. did not procure the ventilators it had ordered last year the reason being Hospitals are not willing to take ‘made in Bharat’ ventilators. The Centre could procure only 35,179 ventilators out of the 50,000 originally ordered. The Bharat entities started scouting for foreign technology partners in manufacturing the ventilators but without much success. Unavailability of components and issues in accessing the technology partners are posing a big challenge to this Make in Bharat initiative.
Before the pandemic, the sector had eight manufacturers with an annual capacity to supply 3,360 ventilators. The Covid crisis saw nine more players enter the field, raising the manufacturing capacity to 396,260 a year, according to industry data. Interventionists and medical experts had warned that only less than 2% of full-blown Covid patients would need mechanical ventilator support cautioning the industry not to go overboard. In April 2020, owing to a projected shortage of the machines despite the scaled-up production, the government imposed an export ban on ventilators. The Association of Indian Medical Device Industry (AiMeD) had written to the Ministry in July 2020 asking for the ban on the export of ventilators to be lifted in view of the surplus production and scope for exports to the US, Europe, Russia, Poland and Brazil. The ban was lifted in August with some restrictions but was only fully lifted in December 2020. By the time the ban was lifted in December 2020 the export orders had dried up and countries like China had flooded world markets. On the other hand, the government allowed zero-duty import of ventilators leading to the hospitals preferring to go for imported ventilators as the quality of the ventilators produced under Make in Bharat was not meeting their quality standards. This has struck a double whammy effect on the Bharatiya companies manufacturing the ventilators.
The make in Bharat initiative of the government wherein Rs.2,000 Crores were allocated in May 2020 to manufacture 50,000 ventilators has not been successful mainly due to the lack of technology that could meet the hospitals’ expectations. Also, the estimates for the ventilators on account of the covid surge has been over projected leading to excess capacity and losses for the ventilators manufacturers.
Bharat has so far vaccinated 9.4 people in every 100, below China’s 14, Brazil’s 16, Turkey’s 25 and the United States 64, according to data tabulated by the New York Times and sourced from the Our World in Data project at the University of Oxford. Whereas the world average is 12. Currently, 1.3% of our population is fully vaccinated.
The central government has been procuring vaccines manufactured locally, by Serum Institute of Bharat and Bharat Biotech, and allocating them to states to administer. These vaccines are available free at government hospitals, whereas private hospitals can charge up to Rs 250 per jab, of which Rs 150 goes to the centre. Serum Institute is reported to have supplied the centre 10 crore doses and committed to supplying another 11 crores in the next three months and Bharat Biotech is reported to have supplied just over 1 crore doses and is committed to another 9 crores.
As per the phase 3 policy announced recently that becomes effective May 1, 2021, the centre has said it will continue to provide free vaccines at government hospitals for target group 1 (i.e., healthcare workers, front line workers and people aged above 45 years ). These will hereon be provided to states based on criteria such as active cases, delivery speed and wastage. In this new policy, the central government has lowered the age threshold for vaccine eligibility to 18 years. That means 87-90 crore Bharatns are now eligible. However, the burden of vaccinating those between 18 and 45 years of age, an estimated 60 crore people falls on the states and the private sector.
The central government will get 50% of all domestic vaccine production, as per the new policy. The balance of 50% of domestic vaccine production can now be supplied to states and be sold in the open market. States and private sector entities can also import vaccines. Russian vaccine Sputnik V, Cadila and few others will be entering the fray shortly once the necessary regulatory approvals are obtained from the Government of Bharat. If Bharat is able to ramp up from the current 25-30 lakh vaccine shots a day to 50 lakh a day, 50% of the population could be vaccinated by the end of the calendar year, estimates HSBC.
The above analysis reveals that there are few hits but several misses in Bharat’s pandemic management to contain the Covid which could have been avoided by better planning. Now that we are already in the second wave of the pandemic and likely to witness the third wave around October 2021 let us hope both the Centre and the States will learn from these lessons and will not repeat the mistakes forcing the entire nation to go into firefighting mode once again.
Needless to mention that the Centre should take the overall responsibility in managing this pandemic and should also actively involve the States, private hospitals and the industry as key stakeholders in saving the lives of the people, particularly the underprivileged since the human capital is the most precious asset for any country.
(Featured Image Source: Times of India)
Did you find this article useful? We’re a non-profit. Make a donation and help pay for our journalism.