The Covid-19 pandemic has come back with a vengeance in India with the second wave and continues to devastate many lives, especially of the poor. As of 9 May 2021, the country has registered 22.6 crore Covid-19 cases and 2.4 lakh deaths, which many experts believe is heavily underreported. The vaccination numbers are not very inspiring either. About 17 crore people, or 12.5 per cent of India’s population, have received at least one dose as of 9 May, while about 3.5 crore, or 2.6 per cent, have been fully vaccinated.
Amid all this, India’s health system has been exposed for the worse. The health infrastructure is teetering on the brink and the task of containing the virus’ spread and saving people’s lives has become impossible. And the experts say that the pandemic is only going to get worse in the coming weeks. In its study ‘COVID-19 projections’, published by the University of Washington’s Institute for Health Metrics and Evaluation (IHME), more than 8.5 lakh people may lose their lives between 1 May and 31 August this year — with the baseline figure being the institute’s own estimate of the total number of Covid-19 deaths in India, as against the reported figure.
Only an effective vaccination drive can help tide over this crisis of epic proportions. It is also the only bulwark against the third wave of the coronavirus.
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Twin shocks
Anecdotal evidence from all over the country is showing that the Ayushman Bharat health insurance scheme, which had roped in thousands of private hospitals to provide public health, is failing the poor miserably. Private hospitals are not admitting Ayushman Bharat beneficiaries on the pretext of “no vacancy” while providing beds to patients who are paying more. It is not clear if the Rs 2 lakh insurance cover provided under the Pradhan Mantri Jan Dhan Yojana is being paid out to the beneficiaries.
In addition to the devastating impact on the medical infrastructure resulting in the loss of so many precious lives, the Covid-19 pandemic is also disrupting livelihoods in an unprecedented manner. As per a report by the PEW Research Center, the number of people below the poverty line in India is estimated to have increased by 7.5 crore — from 6 crore to 13.5 crore — in a year since January 2020. It may be recalled that between 2005-2015, about 27 crore people had come out of poverty in India. Considering the impact of the second wave, these poverty numbers are likely to go up exponentially.
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7 steps for the Centre
The Narendra Modi government, which seems to have completely receded and is heard only in the Supreme Court and the high courts, must take charge again and initiate the following actions to stave off a much bigger tragedy staring at the country in the form of the impending third wave.
- As in the past, when the Government of India took a lead in ensuring universal free vaccination, the Centre should procure the coronavirus vaccine and make it available to the states. A rough calculation shows the total vaccination cost to the central exchequer will be between Rs 28,000 crore to Rs 35,000 crore (depending on the cost negotiations). This amount has already been allocated in this year’s Union Budget. The cost of delivering the vaccines will anyway be borne by the states and so, the Centre would create a true partnership in the fight against this scourge. This would also ensure proper pricing of the vaccine.
- The Centre must work with the state governments towards quickly establishing one oxygen plant in every district hospital in India. These plants would also cater to the private hospitals and other satellite hospitals in the district. Centralised time-bound procurement, importing if necessary, would ensure price competitiveness as well as timely execution.
- About 50 crore Indians fall within the age bracket of 18-44 years, for whom a total of 100 crore vials of vaccine would be required. To ensure the pandemic is contained quickly and to prevent the third wave, it is necessary that the entire vaccination programme is completed within the next six months. For this, a two-pronged strategy must be followed. First, we allow import of all those vaccines that have been approved by highly regulated jurisdictions such as the US, the UK and the European Union countries without any condition of localisation, as was suggested by former prime minister Dr Manmohan Singh in a letter to PM Modi last month. Second, the Centre may resort to the emergency provision of compulsory licensing under the Patents Act and allow every facility with the capacity and capability to produce vaccines in large volumes to scale up production. The US has already shown its support to India and South Africa’s proposal to the World Trade Organization (WTO) to waive the intellectual property rights (IPR) on Covid-19 vaccines. Once India expresses its intention to use compulsory licensing, the WTO may move quickly on its own to lift IPR protection. This will ensure adequate and timely availability of vaccine vials and will also bring down prices due to competition.
- The Modi government should work out vaccination protocols with the states on the lines of chicken pox, polio and other similar national vaccination programmes in the past. As former Union health secretary Sujatha Rao has pointed out, CoWIN, the government’s vaccine registration portal and app, “doesn’t work and is not the solution”. Not everyone in India, especially the poor, has access to a computer, smartphone or even reliable internet connection, nor do they have the capacity to register and wait for their turn. CoWIN is a fanciful idea bound to fail. The vaccination has to be taken to the people on a mission mode. ASHA workers and other on-ground medical staff, revenue staff, and teachers must be roped in to get people to the vaccination centres. That is the only way to saturate vaccination in six months to kick in herd immunity.
- Considering the second wave will result in much greater destruction of livelihoods than what we have seen so far, with work and wages drying up, and manufacturing and services sector already devastated, it is necessary to put in place a direct cash transfer programme for the poor and the unemployed. Most advanced economies have a social security programme designed to provide a safety net for the unemployed. In India, the need has never been greater. If a sum of Rs 5,000-6,000 is transferred every month to all the Jan Dhan accounts, it will provide the poor immediate relief and reduce hardship. This would also give much-needed fillip to sagging demand and consumption, which will create a virtuous cycle to spur economic growth immediately after the pandemic.
- The Centre should immediately order a full-scale audit of Ayushman Bharat scheme, and ascertain whether the poor are really benefiting from it. All major empanelled private hospitals in the country must be subjected to official as well as social audit, a system very well established in India, to discover whether they have really delivered and whether the much promised largest health insurance scheme for the poor in the world has stood up to the test of Covid pandemic.
- It must also ask Insurance Regulatory and Development Authority to conduct a public enquiry on whether Rs 2 lakh insurance cover provided under the Jan Dhan Yojana is being paid out to the beneficiaries by the insurance companies.
The time to act is now.
Arvind Mayaram is a former union finance secretary and currently economic advisor to the chief minister of Rajasthan. Views are personal.
(Edited by Prashant Dixit)