Faltering health infra gets a shot in the arm as vaccine roll-out nears

As an extraordinary year is drawing to a close, a seven-part series looks at the key areas that are on the cusp of dramatic changes

If the year of the coronavirus pandemic stretched India’s health infrastructure to the limit, the sector seems to be much more battle ready for the challenges of 2021. The fight against Covid-19 has expanded now — from treatment to prevention — with the country preparing to roll out the massive and unique exercise of adult vaccinations.

Government officials say that by next year, India could have a bouquet of half a dozen vaccines to choose from, since various vaccine candidates are in advance stages of clinical trials. 

The pandemic, though, is far from over. “Every time there has been a pandemic — from smallpox to wild polio, it lasted at least two years, so sporadic outbreaks will continue to happen. Though we are at the cusp of vaccinating, it will take two years to vaccinate the entire world,” said Dr Satyanarayana Mysore, head of interventional pulmonology, Manipal Hospitals, and a member of Karnataka’s Covid task force.

The year 2021 will test the government’s infrastructure as it plans to manage the cold chain logistics needed to carry out the Covid vaccination programme. Around 29,000 cold chain points, 240 walk-in coolers, 70 walk-in freezers, 45,000 ice-lined refrigerators, 41,000 deep freezers and 300 solar refrigerators across the country have already been identified, and detailed guidelines have been issued to the states. The health ministry plans to draw from the country’s universal immunisation programme that inoculates 24 million children annually, and also India’s massive election exercise. 

As for the vaccines, the year has been one of unparalleled achievement. Never has the world seen a vaccine being developed in less than five years, except the mumps vaccine, which took four years. The technology used for developing the vaccines, from the messenger RNA to the viral vector, is likely to pave the way for future scientific developments in the treatment and detection of illnesses such as HIV-AIDS, Alzhiemer’s and cancer. 

This has also put the focus on the future of research and development in India and whether 2021 could lead to some affirmative action in this area. “As policy makers and facilitators, we have been laying great emphasis on inter-disciplinary and translational research linked closely to the basic research. For Covid-19 also, platforms established for other diseases are being considered along with repurposing efforts,” Renu Swarup, secretary, department of biotechnology, told Business Standard. 

Dr V K Paul, member, Niti Aayog, and head of the national expert group on vaccine administration, said recently that the country needs to have institutions from research and development and data analysis for the health sector. 

Others are sceptical of India’s efforts to develop a 21st century health infrastructure. “India has not learnt the real lesson, if we are talking of Ayurveda doctors doing surgery. The solution is not fit for the 21st century...We have not understood modern medicine, epidemiology,” said Jacob John, former head of the Centre of Advanced Research in Virology at the Indian Council of Medical Research.  

Last month, the government did sanction Rs 900 crore for the research and development of a Covid-19 vaccine. Homegrown companies, such as Gennova Biopharmaceuticals, Mynvax, Premas Biotech, Hester Biosciences and so on, are working on vaccines even as the drug regulator is deliberating the authorisation of emergency use of three vaccines — by Bharat Biotech, Pfizer & BioNtech and Serum Institute of India. 

One of the biggest transformations in India’s healthcare system in 2020, which could gather momentum in 2021, is rapid digitisation. With a limited number of intensivists, hospital network chains such as Fortis introduced tele-ICUs. Faster adoption of technology such as telemedicine was also required in order to take the evolving knowledge of treatment protocols to the hinterland.

It was also in the middle of the pandemic that the government launched the National Digital Health Mission (NDHM). Experts say that the programme, which is voluntary for citizens, has the potential to bridge the gap in the healthcare data of the country.  

The pandemic also put much of India’s healthcare infrastructure in the fast lane. For example, though the country had a huge shortage of PPE kits at the start of the year, it turned into a net exporter of these kits by July, as several textile majors came together to manufacture them. The same holds true for ventilators, masks and sanitisers. From importing ventilators at the start of the pandemic, India has gone on to build the capacity to make around 50,000 ventilators a year and is now looking for export opportunities.

Indeed, reducing import dependency was a major theme of 2020 — the factory shutdowns in Wuhan in China exposed the dependence of the Indian pharma industry on imports of bulk drugs.

In a major boost to the local manufacturing of high-value pharmaceuticals, the Union Cabinet in November gave in-principle approval to a Rs 15,000 crore production-linked incentive (PLI) scheme for pharmaceutical products. The government expects to attract investments worth Rs 50,000 crore from domestic and multinational drugmakers through the scheme. 

Though 2020 witnessed great strides in most aspects of the healthcare sector, the overall spend on health in India continues to be low — 1.5 per cent of its GDP (according to 2018-19 data) as compared to 7-8 percent of GDP in the European countries. In the coming year, though, healthcare will likely be front and centre of the government’s priorities and draw a larger share of the public expenditure.