Last week, the global number of confirmed cases of novel coronavirus or COVID-19 crossed 110,000 in over 100 countries, with a significant number of new cases emerging in South Korea, Iran and Europe. Concern over the extent of the pandemic has already affected both the world’s financial markets as well as the economy. Although India has been relatively less affected so far — with only 43 confirmed cases as of 9 March— it is too early in the international disease cycle to relax. China managed to contain the spread by enacting a cordon sanitaire around lakhs of people, using authoritarian measures that might be hard to implement elsewhere in the world. So, the global outbreak could get a lot worse, and if it does, we will certainly be affected.
That is why India and the Narendra Modi government must take a national approach to manage the risks of a COVID-19 epidemic in India. Such an approach would not only pull together all government departments and institutions, but also involve the private sector and civil society. (Disclosure: A member of my immediate family works for a private genetic testing firm.)
It is important to say this because thus far, the task of addressing the COVID-19 has been delegated exclusively to the government. Almost all activities, from airlifting Indian nationals, screening arrivals at airports, testing samples, quarantining and treatment are carried out by the government. While this will be effective if the number of cases remains in the current order of magnitude, the government’s facilities alone will not be sufficient if the number of cases rises 100 times or more.
The good news is that India has a private healthcare sector and R&D capability that can be used in the fight. The bad news is that we’re not letting them.
If we even have a few lakh suspected cases, the government’s resources will fall short of what is required. The right time to think about the capacity required to handle such a massive crisis is now. The single most important thing for India to have a national response — as opposed to a government response — is to enable the private healthcare ecosystem to play an appropriate role to complement the government’s efforts wherever possible.
Let private labs test for COVID-19
One of the most critical areas where private capability should be harnessed is in screening and testing. The greater our success in detecting COVID-19 cases early, the greater our ability to contain the outbreak. Faster testing means fewer people in unnecessary quarantine, lower load on hospitals and faster contact tracing.
Currently, there are 52 government laboratories in ICMR’s Virus Research & Diagnostic Laboratories (VRDLs) that are equipped to carry out COVID-19 tests. Another 57 VRDL network labs are authorised to collect samples through state government health authorities. All of these operate under the aegis of the National Institute of Virology (NIV), Pune. As of 6 March, “a total of 4058 samples from 3404 individuals have been tested by the network”. The ICMR-NIV-VRDL network has the capacity to handle perhaps a 10X increase in the number of samples and is bound to have procured test kits to handle such a load.
Currently, private laboratories are not permitted to test for COVID-19. In anticipation of a greater surge, the Modi government must enable the most reliable private players to conduct such tests as well. There are 53 private laboratories in India accredited by the College of American Pathologists (CAP) and hundreds more by the National Accreditation Board for Testing and Calibration Laboratories (NABL). Some of India’s best private laboratories can be carefully selected by the respective state governments based on their technical capabilities, biosafety levels, quality standards and track records.
We can double the number of test facilities in a few precious weeks, and increase it even more over a longer period. Many private laboratories already offer commercial testing for other viral diseases, so with incremental effort, they can test for COVID-19 too. This will also create incentives for private Indian companies with R&D capabilities to consider developing test kits for COVID-19, which currently have to be imported from China and Europe. It is in India’s strategic interest to be able to develop probes, reagents and test kits for the current and future viral epidemics.
In addition to mandating standards and safety levels, ICMR must insist on compulsory and real-time reporting of samples and test results so that the government authorities have a single database to work with. There should be no expectation of government funding or subsidy, just as there is no case for the government to intervene in the pricing of these tests.
As the number of cases crossed 400 last week, the United States not only permitted private laboratories to perform COVID-19 tests, but also changed policy to enable “laboratories to use tests they develop faster in order to achieve more rapid testing capacity in the United States”. Canada has distinguished itself by an open approach – decentralising and opening up testing from the very outset. These are prudent and responsible responses to a feared escalation of a public health emergency. India — with greater vulnerabilities and weaker public health systems — should take a similar approach.
The author is the director of the Takshashila Institution, an independent centre for research and education in public policy. Views are personal