Absent oxygen cylinders, apathetic administrations, amorphous governance — India’s Covid-19 strategy seems to have gone kaput with the second wave of the pandemic claiming thousands of lives, making the country the world’s Covid hub.
In January, India’s Covid-19 cases stood at a little over one crore. Today, May 7, the number has soared to 2.15 core. In January, the Narendra Modi government at the Centre seemed ready to roll out what many considered the world’s largest vaccine rollout and there was hope in the air as the (first) wave of the pandemic seemed to be getting over.
By January 3, India had not one but two vaccines approved for use. The Drugs Controller General of India (DGCI) had already given its nod to Serum Institute of India’s Covishield, also known as Oxford-AstraZeneca ChAdOx-1 vaccine. This was the first vaccine granted “permission for restricted use in emergencies subject to certain regulatory conditions,” by the regulatory body. The second vaccine was Bharat Biotech’s Covaxin. It was developed in a collaborated effort with the Indian Council of Medical Research (ICMR) and the National Institute of Virology (NIV), Pune.
However, both the vaccines met with controversy as health experts conveyed their scepticism regarding the efficacy of the vaccines. “When India’s regulators considered Covishield, they did not have trial data from the Indian trials,” wrote Dr Jammi Nagaraj Rao, an epidemiologist. On Covaxin, health experts questioned its approval by the DGCI as there was no data available in the public domain on its Phase 3 trials. Even the vaccine makers had no figure regarding its efficacy.
But many ministers and a section of the media expressed confidence and pride in the indigenous vaccines. They were soon endorsed by Prime Minister Modi. In a virtual address to the public on January 22, Modi was jubilant: “Our preparation has been such that vaccines are fast reaching every corner of the country… we are completely self-reliant… India is also helping out many countries with vaccines.”
But what followed was chaos.
Based on the guidance of a National Expert Group on Vaccine Administration for Covid-19 (NEGVAC) constituted by the Centre, the vaccination programme for the SARS-CoV-2 virus was supposed to be introduced in a phased manner. Phase-1 was launched on January 16, with a plan to vaccinate nearly 30 crore people.
The first phase of the campaign was supposed to focus on the vaccination and protection of Health Care Workers (HCWs) and Front Line Workers (FLWs). The health ministry placed a target of vaccinating 300 million frontline and healthcare workers by July 2021. Phase-II of the national drive was initiated from March 1. The focus: protecting the most vulnerable (the 45-plus population, as they account for more than 80 per cent of Covid mortality in India).
In the first week of March, India had the second-highest number of cases in the world after the US. Vaccination numbers were looking up for the country. Around 27.5 million people had registered for vaccination in the second phase by March 10. However, India had reported above 100,000 confirmed cases in a week, for more than two consecutive weeks at this point. On a week-on-week basis, the number of confirmed cases went up 12.7 per cent in the second week of March. Active cases logged an increase of above 10 per cent for two consecutive weeks — 13.3 per cent within the first week and 13 per cent in the second week of March.
Reports indicated many logistical problems during the second phase. People were facing problems in registration thanks to technical glitches in the CoWin portal. Senior citizens queued in long lines outside vaccination centres, braving the hot sun, in many states.
The turning point
When the daily average of new cases had begun falling below 9,000 in February, Harsh Vardhan, Union Health Minister, was confident that the country was “in the endgame” of the Covid-19 pandemic. However, the optimism came crashing down in March. By the end of February, the Election Commission had announced polling dates for Assembly elections in four states — Assam, Kerala, West Bengal, Tamil Nadu and the Union Territory of Puducherry. Soon, political rallies started emerging across the country, paying scant regard to Covid-19 protocols.
By March 12, fresh Covid-19 cases within the country started increasing. The 7-day average for fresh Covid cases crossed 20,000 on March 12. Within 10 days, this average doubled. By the last week of March, the 7-day average for new Covid cases in the country stood at 50,518 (data recorded on March 26).
While the surge continued, the country also celebrated two huge social festivals – Holi and The Maha Kumbh Mela. Crowds assembled in different parts of the country, violating all protocols to celebrate Holi on March 29. A week later the 7-day average for fresh Covid-19 cases was at 93, 207 on April 6. A total of 96,982 cases have been reported in 24 hours, while the death toll increased to 1,65,547 with 446 daily new fatalities, the data updated on the morning of April 6 showed. The Maha Kumbh Mela saw more than 90 lakh pilgrims who assembled in Haridwar. The festival officially ended on April 30.
While cases surged from mid-March, the already fragile healthcare infrastructure in the country neared its collapse. States started suffering from a shortage of medicine, beds and oxygen supply. Labs had either stopped or delayed testing allegedly due to instructions from the respective State governments, while many had run out of testing capacities.
Manufacturing plants were unable to ramp up their capacities of vaccine production, states had exhausted their oxygen capacity. Social media feeds were and still are flooded with videos of Covid funerals, choked cemeteries, wailing relatives of the deceased outside hospitals.
But what led to this collapse of healthcare?
That takes us to the grave issue of shortage of vaccines in the country. In January, as a gesture of goodwill and to strengthen ties with other nations, the Indian administration began exporting supplies to nations under grant assistance. The exports were aimed to assist 13 countries fighting Covid-19 which included- Bangladesh, Bhutan, Maldives, Mongolia, Myanmar, Nepal, Bahrain, Brazil, Mauritius, Morocco, Oman, Seychelles and Sri Lanka.
Public health experts noted that as of April 22, India had exported 66 million doses of Covid vaccines, to 94 countries. Out of which only 10.61 million were exported under grants; the rest had been exported by Serum Institute of India (SII), partly to sell their vaccine to foreign countries and partly to meet its contract with the COVAX alliance. Experts say India is capable of producing only 21 per cent of the world’s vaccines in contrast to the popular percentage of 60 per cent.
Andy Mukherjee, a columnist for Bloomberg, wrote that it was a mistake to restrict the drive to just two Made-in-India vaccines. He criticised the pricing of the vaccines as well, saying they should be made free. The companies were selling vaccines to the state and the centre at two different rates causing huge uproar. While Centre could procure the vaccines for Rs 150 per vial, the states had to shell out Rs 400 for Covishield (this was later reduced to Rs 300) and Rs 400 for Covaxin. R. Ramakaumara, an economist, said the existing disparity of vaccine distribution between states is only bound to worsen if private players get involved.
Whither institutional accountability?
The friction and consistent dodging of responsibility and accountability of oversight by both the Centre and State governments, sparing a few exceptions such as Kerala, contributed to the loss of thousands of lives. Public health experts say that had the State governments been vigilant and more restrictive of gatherings within their governed region, the spread of Covid-19 could have been effectively reduced, if not prevented.
Meanwhile, the Centre’s callous and porous governance methods are at fault, too. It let crowds assemble and celebrate festivals as the spread of Covid-19 was peaking. This was an unforgivable failure, along with the lack of transparency and lack of vigilant follow-ups with state infrastructures.
Media reports point at the absence of plants that were to be installed in several states for ensuring enough oxygen supply. According to fact-checking reports from The Scroll and The Quint it was the Central Medical Services Society, a body of the Union Health Ministry, that failed to deliver. But the problem is not just the installation of industrial oxygen plants.
There are also logistical challenges. According to the information obtained by The Indian Express, the plants don’t have enough tankers to carry supplies. An executive of a Kolkata-based plant told the publication that most of the plants are located in eastern India, apart from a couple in the west which means long distances and a lot of turnaround time. He also called out the added problem of states stopping these tankers from reaching their designated sites which further delays the shipment.
Already, the Centre and states have been pulled up by courts for the shortage in medical oxygen. Social media continues to be inundated with requests of people crying for oxygen cylinders or refills..
Before Covid, India needed 700 metric tonnes of liquid medical oxygen a day. Now, that demand stands at around 8,400 metric tonnes today. Clearly, the situation calls for urgent measures, not rhetoric. But alas it seems action is absent. Public health experts who point out that universal, free vaccination is the only permanent solution to the problem at hand, calls for urgent action and rejigging of GoI’s policies and strategies.