Beyond the 'laxman rekha'

Ensuring lasting pharma security is vital

The all-India 21-day lockdown that Prime Minister Narendra Modi announced on Tuesday night to “break the cycle” of the COVID-19 pandemic may be an unavoidable option given the surge in the infection and the limitations of the Indian health care system. A complete lockdown is one element of the fight against the disease, however, and it is unclear whether it can prevent a resurgence once it ends. Widespread testing represents the other element of the challenge and it remains a key weakness for India. Mr Modi announced a Rs 15,000 crore package to fight the disease, with a focus on providing PPE (Personal Protection Equipment), beds, ventilators, paramedic training and so on. This is indubitably a necessary step but it may not be sufficient. The import of testing kits and fast-track licensing of domestic manufacture should be a priority too.

Beyond the immediate crisis, the COVID-19 outbreak provides a unique opportunity to build a more durable public healthcare system, strengthening ordinary Indians’ access to health care and creating the resources and capacity to respond to future health emergencies. The ability of South Korea and Singapore, albeit with far smaller and better-educated populations, to contain the virus underlines the criticality of a robust public health system. The Union health ministry’s own survey indicates that the country has one isolation bed per 84,000 Indians, one quarantine bed per 36,000 Indians, one doctor for 11,600 Indians, and one hospital bed per 1,826 Indians. The danger of the health care system being overwhelmed if the country enters Stage 3 of the COVID-19 pandemic is easy to imagine.  Going forward, building more hospital infrastructure with a minimum of advanced facilities is one obvious answer, but the real conundrum to address is producing qualified doctors and nurses for the woefully underserved rural and mofussil India.

The norm of compulsory rural service by MBBS graduates has not worked in the absence of appropriate incentives, but there are workable models that can be amplified — the setting up of a rural medical corps or Kerala’s barefoot doctors being two examples. No less important is creating and sustaining domestic manufacturing. Several obvious solutions suggest themselves. The crisis has disrupted the Active Pharmaceutical Ingredient (API) supply chain, causing a serious shortage of drugs such as paracetamol for mild COVID-19 cases. Mr Modi has responded to the shortages but only a permanent, exponential expansion of domestic capacity for medical equipment, APIs, testing kits, and even basics such as swabs and masks can ensure lasting pharma security.

The package for health care manufacturing parks may be a sincere attempt to address this problem, but it is a long-term solution of doubtful value, given the history of economic zoning in India. Some have questioned its utility when 40 per cent of domestic pharma capacity lies unutilised. One suggestion from the Public Health Foundation is for the government to leverage the public sector to re-activate the compulsory licensing route to produce life-saving and patent-restricted drugs during crises. The wherewithal to achieve a lasting improvement in the health care system is within this government’s grasp. The Swachh Bharat models suggest one prototype, though “Swasth Bharat” may demand a more complex institutional structure.