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Covid-19: How to be safe... and secure

Patralekha Chatterjee | Updated on March 27, 2020 Published on March 27, 2020

Not got you covered: Medical personnel treating Covid-19 cases need to wear full-body hazmat suits, N95 masks, shades and gloves — all of which are woefully in short supply at the moment   -  K MURALI KUMAR

The pandemic has laid bare the country’s acute vulnerabilities in its health sector

As countries scramble for medical supplies, testing kits and personal protective equipment (PPE) to combat the novel coronavirus, it is becoming obvious that ‘health security’ — which determines a country’s ability to protect its people from severe illnesses — should be part of its national security strategy. For, as in a war, during a pandemic, too, each country looks out for its own.

“A growing number of governments have been ‘sickening’ their trading partners by banning or limiting the export of medical supplies,” warned Simon Evenett, professor of economics at the University of St Gallen, Switzerland, in a recent article for VOXEu, a policy portal. “It is important to appreciate that governments can restrict exports of medical supplies in many ways. Not all of them are as salient as a publicised export ban. For example, a government can decree that all relevant medical equipment supplies produced in a country must be sold to the state, which in turn decides not to make any product available to foreign buyers,” wrote the coordinator of Global Trade Alert, which looks at State interventions that can affect foreign commerce.

Twenty four nations have already imposed export restrictions on medical supplies. India is heavily dependent on imports for critical medical supplies, from digital thermometers to ultrasonic scanners. Indian companies are known for producing cheap medicines, but 70 per cent of the important chemicals (called active pharmaceutical ingredient, or API) in these medicines come from China.

Now the Indian government is jostling globally for Covid-19 testing kits, ventilators and PPE. In 2019, India was ranked 57th among 195 countries in the Global Health Security (GHS) Index — a joint project of the Johns Hopkins Center for Health Security and the Nuclear Threat Initiative (NTI), with research by The Economist Intelligence Unit (EIU). Most countries are unprepared for any major infectious disease outbreak. But India also has the largest population among all countries making a global dash for medicines, PPE and other kits.

Stronger health security preparedness is not really dependent on whether a country is rich. It is driven by many factors, including effective governance and a strong disease surveillance system. Kerala is a good example of a state whose health system functions in times of crisis because it functions well also during normal times.

Not all doctors in India attached to medical college hospitals — including Covid-19 testing sites — have the required PPE. Last week, resident doctors at the Jawaharlal Nehru Medical College Hospital (JNMCH), Aligarh, threatened to go on strike if the administration did not provide frontline workers with N95 masks and other PPE.

A medico in Uttar Pradesh told this reporter that, even in the best of times, doctors and other healthcare workers in government hospitals did not have the full range of the required PPE. For tackling Covid-19, medical personnel need to wear hazmat suits (full bodywear), N95 masks, shades and gloves. All these are woefully in short supply at the moment.

“Deep concerns stem from the fact that it has become fairly obvious that the government has neither created stockpiles of PPE based on rational forecasting, nor is it making sincere efforts to procure PPE kits and components in large volumes, as necessitated by the delay,” Malini Aisola, co-convenor, All India Drug Action Network (AIDAN), a Delhi-based civil society group, told BLink. “Several serious anomalies have come to light regarding the procurement of PPE through the centralised body, HLL Lifecare Ltd.” Lack of an open process in the public sector company, which is the sole procurement agency for PPE kits, in finalising vendors and setting specifications could curtail supplies because it leads to delays in the approval process, Aisola adds.

Things have started moving, though slowly. Testing centres have expanded. On March 21, the Centre announced a ₹14,000-crore package that would spur production of API and medical devices in the country. Earlier this week, the Indian Council of Medical Research said two Indian Covid-19 testing kits had been fast-tracked for commercial use.

The textile ministry points out that foreign makers of body suits that meet World Health Organization guidelines are now unable to supply because of export restrictions in their countries. The government says it is working with local industry bodies to ramp up indigenous supply of PPE. Clearly, India did not have a stockpile, and shortages of PPE continue.

The nub of the matter is resources and priorities in normal times. One example: The Union Budget 2020-21 allocated ₹69,000 crore for the health sector, of which ₹6,400 crore was earmarked for the government’s flagship health insurance scheme. Contrast this with the allocation towards defence expenditure: ₹4,71,378 crore.

Getting testing kits ready for use after clearing regulatory approvals could take anything up to four weeks. If PPE kits require certification by SITRA (South India Textile Research Association), as is the norm, they could take an additional two weeks, says an industry insider.

The trouble is that until there is an epidemic, the fact that health security has national security implications is hard to sell to policymakers. That India’s public hospitals are under-resourced and overstretched is no secret. That India needs to invest more money in research is also no secret. Covid-19 has only laid bare the country’s acute vulnerabilities.

Patralekha Chatterjee is an independent journalist based in Delhi

Published on March 27, 2020

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