Health security is key lesson from COVID-19 crisis

Every time a health emergency confronts the world, the mask comes off. Even the best of healthcare systems struggle to cope with increasing numbers of patients during such times. And they come under severe strain in terms of preparedness, including the ability to provide citizens with medicines and protective gear or masks, as seen in the ongoing novel Coronavirus (COVID-19) outbreak.

Even as this goes to press, reports from developed healthcare systems in the UK and Australia have dentists warning on the shortage of masks, as the COVID-19 crisis continues — the reason being a heavy reliance on an already-under-pressure China for mask supplies. Last week, World Health Organization chief Tedros Adhanom Ghebreyesus red-flagged shortages, as COVID-19 spread across different geographies from the epicentre in Wuhan, China.

India, on its part, see-sawed between stopping the export of masks, fearing supplies may fall short internally, to eventually allowing exports. But this has led to a situation where some manufacturers have stopped taking calls, unable to manage the demand from other countries. Ground reports further suggest shortages of products like digital and contact-less thermometers, used in screening people for infection at entry points into the country.

Overdependence risk

A stronger case, if one was needed, on “health security” could not have been made, as is being illustrated in the wake of the COVID-19 outbreak. And countries like India, recognised as being “pharmacy to the world” should in fact build strong manufacturing bases for medicines and medical devices, besides having a regulatory framework to facilitate the supply of these products to its citizens and those in other countries.

China’s latest health emergency first cast its shadow on the supply of bulk drugs and active pharmaceutical ingredients (API) to drugmakers across the world. Over 60 per cent of India’s API supplies come from China. And as their two-month existing inventory gets used up, concerns emerge on low supplies and a rise in prices.

But this is not the first time that over-dependence has threatened supplies to Indian consumers. It was seen with the Beijing Olympics when plants were shut down for environmental reasons, and the political stand-off at Doklam.

“When it comes to health security, you cannot let the market decide. The market will decide on its turnover and profit,” says Sakthivel Selvaraj with the Public Health Foundation of India. It’s not just man-made crises but natural ones that will put healthcare infrastructure under severe pressure, he says, urging the Government to act on its long overdue promise of strengthening bulk drug capacities in terms of infrastructure, etc. There is no better time than now to upgrade public sector units and strengthen the supply of critical products, he adds.

Rajiv Nath with the Association of Indian Medical Device Industry (AiMED) points out that despite India being a top latex producer in the world, over 60 per cent gloves in the country are imported from Thailand and Malaysia. Pointing to a web of issues, including the price to rubber farmers that pushes up local manufacturing costs, he says it is easier for traders/manufacturers to import finished products.

From adhesive gauze bandages to hot-water bottles to thermometers and medicated cotton wool, to name a few, there is a long list of medical products largely imported from China.

During an epidemic, countries focus on their populations, and rightfully so, says Nath. Thailand has rationed its masks to different departments and manufacturers have a limit beyond which they cannot export, he says, pointing to a good balance between exports and ensuring local supplies.

The US government stockpiles medical products and medicines and this is replenished regularly. The unused supplies go into public health systems, he says, suggesting another model to encourage manufacturers to use existing production plants to full capacity.

IP threat

Another factor that affects a country’s ability to make medicines for itself and patients across the world involves intellectual property and the monopolies it allows over medicines. Health workers caution against diluting India’s legal safeguards on frivolous patenting. Ahead of US President Trump’s visit, representatives with Médecins Sans Frontières (MSF)/ Doctors Without Borders urged the United States Trade Representative to “not pursue damaging policies that are aimed at changing the country’s pro-access intellectual property and regulatory laws. India’s production and supply of affordable medicines is a vital lifeline for MSF’s medical humanitarian operations and millions of people in need in all countries.”

Be it drugs, devices or intellectual property, all roads lead to a country’s health security.

Much, however, will now depend on how India decides to walk this path.

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