When 2021 began, there was wind of a boom as the number of COVID-19 cases dropped so much that travel, business, elections, religious gatherings and social gatherings resumed without restraint. Faulty forecasts were made that India would not experience a second wave and offered explanations extended from magical herd immunity to a mysterious spell of genetic protection against Covid. Vaccine production, procurement, priority administration and export plans were based on a calendar that would be COVID-free.
Alas, this was not to happen. Even when the Alpha version sneaked in and began to exhibit high infectivity, the stage was being set for a more dangerous Delta version and launched a ferocious attack. After India stabilized itself in the second half of 2021, it appeared that the year 2022 would end with confident moves not to be dominated by the virus. It may well have been, if it had only been the familiar but aging Delta who was still the lead actor. However, with the arrival of a new version that had far more infectiousness, the focus was on the young Omicron.
India’s experience with COVID in both the first and second wave has focused on the need to strengthen our under-resourced healthcare system. While the emergency provisions made during the first wave and the Fifteenth Finance Commission focused on health infrastructure and workforce, the commitment to reform the health system was clearly articulated in the 2021 budget. Digital Health Mission and Health Infrastructure Mission were followed under the umbrella of Ayushman Bharat. They aim to strengthen rural and urban primary health care, expand critical care hospital capacity and establish robust surveillance systems for infectious diseases, ranging from block level laboratories to regionally distributed National Institutes of Virology. District hospitals will be strengthened, new medical colleges will be set up and allied health workers will be trained in large numbers.
If well designed and implemented, the digital transformation of India’s health services will advance tele-health in diagnosis and treatment, while enabling health information systems to collect and analyze data in a more representative, timely and accurate manner. enables.
Health system performance will also become more efficient with better supply chain management of drugs, vaccines and equipment while streamlining health insurance programs.
Investment in health infrastructure will take time to show impact. While digital transformation may first improve system efficiency, the biggest area of need is primary healthcare. Apart from building or upgrading infrastructure, training and deployment of technology-enabled non-medical health workers will also strengthen primary care in a relatively short period of time. People’s participation will strengthen the health system.
In India, the number of ommicrons will increase in the new year. It appears to be a milder form than Delta but its high infectivity and vaccine evasion pose a risk of many new, recurrent and ‘successful’ infections. They can cripple the health system through the exercise of testing, tracing and treatment. Then, many non-Covid health services will be compromised.
To avoid this, we must slow the spread of omicrons by ensuring that people wear masks, good ventilation and avoid crowded places. We also need to protect people, especially vulnerable groups, from serious disease by rapidly completing the double immunization programme. Boosters for high-risk groups may follow later if the supply of vaccines is limited, or may be run in parallel if sufficient supplies are ensured. Homecare will be the main support for most mild cases, while oxygenated beds will require a small portion.
Domestic capacity to develop, test and manufacture vaccines increased in 2021. India’s role as a global supplier of vaccines will be increased in 2022, as COVID is calling for the development and manufacture of new vaccines, boosters of existing vaccines, which can combat variants and provide mucosal immunity. The approval of the new antiviral tablets will generate high demand for pre-hospital use, with Indian firms calling for larger quantities to be produced at a lower cost. While India’s health sector will pursue its mission of self-reliance, the dynamics of the pandemic will need to play a bigger role in the global response.
The new year calls for a new resolution to build an efficient, equitable and empathetic health system that can build on the hopes and promised programs of 2021 and allay the oppressive concern that the virus will emerge with every new version of it. Together it piles on us.
Of. Srinath Reddy is a cardiologist and epidemiologist, and is the chairman of the Public Health Foundation of India. Thoughts are personal.
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