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May 9th, 2021 
Awake Goy 
To
Smt Nirmala Sitharaman,
Union Finance Minister
With the daily new Covid cases exceeding 4 lakhs and the daily number of deaths exceeding 4,000, with nationwide shortages in terms of ambulances, hospital beds, ICU facilities, ventilators, Oxygen and even cremation space, and in view of the nationwide shortage of vaccines, people are losing their patience, looking for immediate corrective steps by the Centre and the States. Though the country is taken unawares by the fury of the second wave, the Centre, the States and all the political parties need to assume direct/ indirect responsibility for this, as it is they that have deliberately added fuel to fire.
While the second wave may reach its peak soon and start abating, there is no guarantee that it will not be succeeded by yet another wave, as it happened in the case of the Spanish Flu of 1918-19 and the successive Covid waves more recently in the Americas and in Europe. Unless one takes an objective view of the scenarios likely to unfold, we may end up in a similar state of unpreparedness, when the next wave of Covid or another similar pandemic hits the country. The nation cannot afford such a situation.
National Covid emergency:
I therefore suggest that the Centre takes the States and all the political parties in confidence and declare a National Covid Emergency, that will comprise of (i) a nationwide lockdown till end of May, 2021, with a comprehensive social security cover for migrant workers, those in the unorganised sector and all other disadvantaged groups likely to be affected by such a lockdown, (ii) prohibition of all gatherings exceeding five persons, subject to physical distancing, including deferment of all elections, conducted either by the Election Commission of India or the State Election Commissions, scheduled to be held during the next six months at the least, prohibit all political gatherings, all religious congregations etc. (iii) declare all healthcare equipment, drugs, facilities as “essential” ones to be subject to State regulation.
Need for putting an end to mutual political bickering and all political parties working together for the good of the people:
The National Covid Emergency should be monitored by an all-party National Committee consisting of senior representatives of the Centre, the States and all political parties on one platform. The people of this country are looking for solutions to problems, not lame excuses. What is urgently called for is participative decision making, not unilateral decisions disrupting the people’s lives.
Patient-centric approach called for:
Persons affected by Covid are in need of empathy from the government, not harassment created by red tapism.
Instead of driving the patients from pillar to post for help, a reach-out-to-patient system, on the lines of what the Bombay Municipal Corporation (BMC) has put in place, needs to be adopted nationwide. The moment a patient calls a helpline number, the official agencies should take over, get him quickly screened, tested if necessary, hospitalised if necessary, based on real time data on both government and private hospitals. At the national level, availability of oxygen, ventilators, drugs etc. should be monitored by the National Committee. For all BPL families, free Covid care should be provided and the fees charged by the private hospitals need to be regulated.
There are vacant large buildings, marriage halls, sports stadiums etc. which can be converted into hospital space with the help of the Central and the State agencies including the defence services. Patients are entitled to hospital care at any cost.
Need for prioritising vaccination:
Whether the Centre denies it or not, there is a serious shortage of the vaccines. For getting my second dose of the vaccine, I, at my age of around 80 years, had to stand in a 4-hour long queue, though I ought to have got it as a matter of right. There were many aged and physically infirm persons standing in endless queues for getting their second vaccination doses. Web portals ArogyaSethu/ CoWin were practically of no help. The government should do what the citizen wants, not the other way.
The Centre should also know that the vaccine production capacity in the country falls short of the total demand. “Tika Utsavs” fail when there are no tikas available. Hard facts and science, not conjectures, should determine decisions from now onwards.
India’s population exceeds 1.3 billion. Assuming that around 100 million out of this have already got vaccinated, at least 80% of the remaining population i.e. 960 million need to be vaccinated within the next three months, the daily vaccination rate required works out to 10.7 million doses, as against a production capacity (after it is ramped up to its maximum level) of 4 million doses per day. It is not going to be easy for the country to rely on vaccine imports as we are in competition for the same with several other countries. Therefore, in all likelihood, to cover even 80% of the population with a vaccine in 3 months may be far too ambitious. Even if a 6-month target were to be fixed, it will still call for vaccination at the rate of 5.3 million doses per day, which will imply 1.3 million doses/ day of vaccines still to be imported. In arriving at these estimates, I have assumed that a citizen gets one dose only. If it is two doses to be taken, which is going to be the case, the problem becomes doubly more difficult. Also, according to reports, despite the help extended by the government to the two vaccine manufacturing companies, their capacity cannot be ramped up within the next two months or so.
In other words, keeping in view the wide vaccine deficit, there is no other alternative than to prioritise the vaccination campaign in the following order.
- Vaccinate on first priority all frontline workers left out of the first phase. This should include not only regular employees but also contract employees involved in Covid-affected activity, especially the sanitation workers, ambulance drivers, those working at cremation grounds and so on.
- 65+ & 45+ with comorbidities and pregnant women/ children
- 18+ population
It was imprudent for the government to have opened up vaccination straightaway to anyone above 18 years in one go as such a step would have accentuated the adverse impact of the vaccine deficit and excluded the higher priority groups in preference to lower priority groups. When the Centre imprudently announced opening up vaccination for all 18+ population recently, it was a non-starter and it created a panic among the higher priority groups.
It is of paramount importance for the Centre to ensure that vaccine allocation among the States conforms to a formula based on the requirement as per the population. In order to make sure that the allocation remains transparent and equitable, it should be entrusted to the National Committee proposed above.
A high priority in vaccine development for pregnant women/ children needs to be accorded by providing support to the concerned scientific labs and the vaccine producing companies.
There are new mutants generated in India every day and the labs carrying out genome sequencing for those mutants need to be provided additional support. Despite the knowledge we gained from the first wave, we failed to provide such support for genome sequencing work of our scientists, when there was enough time towards the last quarter of 2020 and the first couple of months of 2021. At least now, we should wake up and act quickly, as otherwise, Indian vaccines cannot be updated to match the new mutants.
Health Infrastructure:
Union Health Ministry’s analytical reports show that the shortfalls in rural and urban health infrastructure are 30-40%. The National Health Policy of 2017 (NHP2017), on this basis, stipulated that the share of the health sector at the national level should increase from 1% of GDP to 2.5-3%. A cursory look at the Union Budget allocations for 2017-2020 shows how NHP2017, approved by the Union Cabinet, stood violated. Even during 2020-21, the first Covid year, the same situation continued, despite the fact that the first wave put to test the country’s entire health infra. No lessons were drawn from the first wave and the 2021 Budget was the same business-as-usual one. We are witnessing today the sad and tragic result of this everywhere. While it is true that the health infra deficit has been a legacy from the earlier decades, what prevented your government from making a beginning at least after your own NHP2017?
The first and foremost step to be taken is to enhance the Union budget allocation for the health sector and enable the States to do likewise, so as to implement, though belatedly, ] what NHP2017 envisaged over the next 3-5 years. This covers primary healthcare systems in the rural and the urban areas, the district hospitals, super-speciality hospitals, investments in science & technology related to the health sector and the indigenous vaccine production capacity. Both the Centre and the States should jointly work on this. The required resource transfers to the States need to be arranged through the latest budget and the subsequent ones.
One could argue that the tax resources of the governments have contracted due to the Covid crisis and it is therefore not feasible ro enhance the health sector allocations. There are many items of expenditure in the budget that can easily be deferred. For example, the Central Vista Project should not have been accorded the kind of priority that is given. This is a project that can wait, creating room for enlarging and upgrading the hospital facilities across the country. If Rs 13,500 Crores proposed to be spent on the Central Vista Project could be purposefully utilised for enlarging the hospital facilities in the rural and the urban areas throughout the country, the social good that will follow from it will far exceed that from the Central Vista Project There are many similar low-priority items of expenditure that should yield place to increased spending in the health sector. There is nothing more important today than safeguarding the health of the people and preventing deaths.
Strategy vs knee-jerk responses:
What we are witnessing today is that the Centre and the States are fire fighting a crisis that has been the result of lack of a cogent strategy. Knee-jerk responses are highly expensive not only in terms of expenditure but also in terms of human misery. No long-term strategy can be put in place unless it comes out of a participative consultation process. There is no place in this for political bickering, as the people of this country are looking for immediate solutions, not new problems. Unless the Centre and the States come out of the trap of self-congratulation, anticipate the emerging situation in a composed and objective manner and adopt a well-coordinated strategy, it will not be possible for the nation to get over the present crisis. Every failure should teach the governments, whether the Centre or the States, valuable lessons. Every successful model needs to be studied carefully and adapted to the other similar situations for effectively dealing with the crisis across the country. In such a widespread crisis of unimaginable magnitude, both the Centre and the States should function in a transparent manner and remain accountable to their respective legislatures and the people at large.
I hope that some of these ideas will be considered carefully and a workable strategy is arrived at within the quickest possible time frame.
E A S Sarma, Former Secretary to GOI
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