Reality always catches up in a pandemic: Albright Stonebridge's Mehul Mehta

Physician and chief medical officer at the Albright Stonebridge Group —founded by former US Secretary of State Madeleine Albright — in Boston, Mehul Mehta’s work over the last 23 years has spanned across 33 countries, developing new hospitals, reforming existing healthcare delivery systems, building medical educational institutions and establishing research ecosystems. Over the past year, Mehta has steadily done his bit to counter the “pandemic of misinformation” through a regular Covid update with groups of around 50-100 participants in India. He spoke to Anjuli Bhargava about the second wave of the pandemic, how the US managed its vaccine rollout better than India, and where India needs to go with its genomics sequencing capabilities. Edited excerpts:

When we last spoke in February, we discussed how well India had done in the first wave. But then things changed dramatically. What went wrong?

Last time, I did mention that I didn’t think India was out of the woods. Things took a worse turn than most anticipated. There is a balance between the pathogen’s infectivity and the population’s resilience to fight the infection. It can go both ways. Either the pathogen strengthens, or the mechanisms to prevent infections are removed, or if the population has inadequate resilience, the equation shifts. In India, all three happened.

Just to give you context, the pathogen changed as it spread, more mutations occurred and it became more virulent. The protection measures that people had taken were eased — life went back to normal. Weddings happened, people met each other even without wearing masks, sporting events, large gatherings. There was a false sense of security and normal activity was resumed with a vengeance.

Nothing happens in isolation: There was a broad change in behaviour across the country. This created a ripe environment for a massive surge. Then, it was clear that there were sections — slum dwellers and those without housing— that had some immunity or pre-existing antibodies that the middle class, upper middle class and affluent did not. The vaccination rate across the country was still low— barely 5-6 per cent at the time the guard was lowered.

How did the US manage its vaccine rollout so well? Where were we lacking?

By distributing a highly effective vaccine as fast as possible. Even as the US was going through waves, it got the vaccines out rapidly through Operation Warp Speed. It provided funding, ramped up production, and used the Defence Production Act to procure supplies to manufacture vaccines quickly. The Pfizer vaccine was even produced by its rival, Merck. Vaccinations became a massive national drive. The 100-day target set by the government was beaten by months. Scientifically speaking, your opening must lag your vaccination. This didn’t happen in India.

But even if we start ramping production and getting vaccines out through this pathway now, it’s going to be weeks or even months. Till that time, the same protective measures need to apply, of which lockdown is the extreme end. Better testing, tracing and isolation all become part of the strategy till the vaccination drive is in full swing.

But in India, we have discouraged testing because more reported cases would reflect poorly on the states…

Suppression of numbers has happened in many countries. The whole pandemic has been a gap between reality and perception. It’s like saying what I don’t know can’t hurt me, which we all know is not true. Reality always catches up in a pandemic. 

But let me say that India is also paying the price for what it never did in the past: invest adequately in public healthcare, ramp up and strengthen hospitals, and invest in manpower and health professionals. Several things have been ignored or taken lightly for decades.

Why did we go so wrong with our vaccine rollout?

I can’t answer that since I’m not privy to all the decisions taken by the government. But I think the general feeling in the country was that we are over this.

Second, healthcare is a regional game. Every region has to conform even if you set national guidelines, like in the US. In India, we saw how differently states responded and reacted. Just to cite one instance, a city like Mumbai did not dismantle all its first wave facilities and that allowed it to pivot faster. Or take a look back at how Kerala handled the Nipah virus in 2018. We need to examine why our regional responses were so varied. 

With a national pandemic or emergency of this kind, we need to have a highly coordinated Centre-state mechanism in place and science has to lead the discussion. It’s far more prudent to act in a more conservative manner. There may be short-term pain in the economy but the long-term gains of acting conservatively are higher. Countries that did that have fared —Israel is an example — well. Israel procured quickly, vaccinated efficiently and then the country opened up.

But for India, the horse largely bolted in April. You cannot be trying to create a strong dam in the middle of a flood. But I hope this is a lesson for both more waves (which cannot be ruled out) and even another pandemic. Pandemics don't switch off and switch on: They have multiple waves. See Japan, Nepal, Laos, Brazil, etc. Even countries that thought they had everything under control have been hit. India did not anticipate this wave and was hit badly. When I say the country, it’s everybody. Leaders may be responsible but everyone plays a part. We must prepare for the worst and hope for the best. 

You mentioned that the Albright Stonebridge Group (ASG) is trying to help India prepare better for future waves, if any. Can you explain how?

We formed a volunteer, pro-bono group within the company targeting three fronts where we think ASG has the ability to uniquely assist India. The first area is in the area of viral genomics. This is fundamental to understanding mutations. India’s genomics network was pulled together in January and it is mostly through our national institutes that are repurposing their gene sequencing capabilities to do Covid genomic sequencing. However, as a country we need a lot more sequencing. We, therefore, have focused on establishing Covid genomic sequencing capability for Mumbai, which currently does not have such capabilities, by facilitating an interaction between one of the world’s leaders in gene sequencing, the municipal corporation of Mumbai and a well-known Mumbai-based foundation. This should come to fruition soon.

Second, we are working with providers of inputs for vaccine manufacture. One of the reasons the vaccine is in short supply in India is because the inputs to produce vaccines are in short supply. Since we have pre-existing relationships with many of these companies, we have tried to enhance their awareness on the criticality of the situation in India. Also, India is one of the largest producers of vaccines and if it does not produce vaccines at scale, a lot of the world will not get them either. 

Third, we are working with a large UK event management company that specialises in expert content to provide short content videos to Indian doctors, nurses and healthcare professionals. The largest hits on the US National Institutes of Health’s website are coming from India: On protocols to be adopted, especially home management. We have turned to some of the leading medical entities in the US to give us content — short videos and so on. We will also ask other platforms to push the content out so that physicians can turn to these sites. Regional language is going to be a challenge but we will source high-calibre technical and clinical content for doctors and nurses.

How are nurses, doctors and staff coping mentally? How do they stay sane surrounded by so much disease, death and grief?

Frontline healthcare burnout is a global phenomenon and one of the most serious fallouts of this crisis. We are trying to focus on the mental health of the healthcare workforce. They are dealing with huge anxiety, depression, post-traumatic stress disorder and other mental health issues. The toll this has taken is enormous.  Many nurses in the US are facing a financial crisis. You can imagine the situation for the Indian nursing and medical staff. Their needs and state of mind need to be dealt with on an urgent footing. If the workforce collapses for any reason, it will be a catastrophe.