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Mismanaged Covid-19? US firm with 'no expertise' in public health crisis advising GoI


By Surabhi Agarwal, Shobha Shukla, Bobby Ramakant, Sandeep Pandey*
It is becoming increasingly obvious that the government’s response to the coronavirus pandemic over the last three months has failed on almost every front. Not only has the government been unsuccessful in containing the exponential spread of the disease but has through its actions given rise to one of the biggest humanitarian crises our country has ever seen. 
It has violated the basic human rights of lakhs of Dalit, Adivasi, Bahujan people through its narrow-mindedness, short-sightedness and insensitivity.The top ministers and officials of the government have given short shrift to scientists and doctors, and thereby failed to ground their decisions in the latest scientific research concerning the progression of the pandemic. 
The Government of India (GoI) chose to hire the American corporate consulting agency, Boston Consulting Group (BCG) for advice on how to handle the crisis. BCG is best known for providing strategic advice on management solutions and claims no expertise in responding to public health crises. More importantly how will an American company advise us to become self-reliant is unclear? 
It is surprising that those within the Bhartiya Janta Party or Rashtriya Swayamsewak Sangh who are advocats of Swadeshi have gone silent. Or is it that for clinging to power they are willing to sacrifice national interests?
In a joint statement released by the Indian Public Health Association, the Indian Association of Preventive and Social Medicine and the Indian Association of Epidemiologists, the country's foremost doctors, epidemiologists and public health activists have criticised the government for not consulting experts: “Policymakers apparently relied overwhelmingly on bureaucrats. The engagement with experts in the areas of epidemiology, public health, preventive medicine and social scientists was limited.”
The government has been unable to build up adequate healthcare capacity, something which should have been top priority right from the initial days of the lockdown. There have been reports of patients having to share beds in hospitals and shortages of medical equipment and staff. 
In addition, regular medical services for life-threatening conditions such as tuberculosis, HIV and cancer have been severely disrupted which has led to thousands of people being denied life-saving treatments. People with common ailments but requiring medical care were anyway left to fend for themselves as all Out Patient Departments were closed. The mismanagement in (not) handling patients of all kinds was astounding. 
There has also been a failure to prevent blatant private profiteering. Private labs have been accused of taking advantage of the erroneous government-imposed price cap of Rs 4,500 on the Covid-19 test which does not cost them more than Rs 1,500 to conduct. Since the announcement of the price-cap, the government’s own agency, the Indian Council of Medical Research, has evaluated 83 test kits, and found 35 satisfactory of which 20 are of Indian companies.
One of the tests found satisfactory is manufactured by a Pune-based company which quoted its cost as Rs 100 per test. But in spite of this the price-cap was not revised. In fact, it was recently removed altogether, without any clear guidelines on how the new price-cap would be determined.
The AIDS Society of India, a national HIV medical experts’ network, has pointed out how private laboratories are earning profits of Rs 10-15 crores per day from these tests, including those done on people with non-Covid-19 conditions but for whom the test has been made mandatory in order to receive treatment. Private hospitals are also charging thousands of rupees for personal protective equipment (PPE).
The alarming number of Covid-19 cases among healthcare workers is exposing the weaknesses in the infection control strategies and protocols being followed by our healthcare system. The shortage in PPEs has been a major factor in this.
This problem has been around since the beginning of the pandemic but is yet to be adequately addressed. Corruption in PPE procurement has also come to light in some states like Himachal Pradesh.
The government has also been accused of suppressing Covid-19 related data and making misleading claims about their success in containing the pandemic.
The plight of India’s migrant workers over the last few months has been covered extensively by the media for all to see. The fact that the government, in imposing the lockdown, failed to consider the perspective of the millions of people who live far away from home and subsist on daily wages, shows how out of touch it is with the day to day lives of ordinary Indians.
Its move to disallow migrants from travelling resulted in widespread violence and hardship and had adverse consequences for the fight against Covid-19. These events point to the dire need for the decentralisation of power and much greater representation of Dalit, Adivasi, Bahujan and other people from marginalised sections of society in public offices.
If the migrants had been allowed to travel to their homes in the first week of the lockdown, or even at a later point when the government realised the lockdown was going to be a long haul, they would have completed their journey before the disease entered the community transmission phase. 
Boston Consulting Group chosen to advise on Covid-19 is best known for strategic advice on management solutions, not public health crises
They would have been far less likely to take the virus with them to their communities and families at that time than they are now. Instead many were compelled to undertake arduous journeys on foot, bicycle or in overcrowded vehicles which resulted in many deaths due to accidents, hunger and exhaustion.
Once special trains for migrant workers began to be arranged, their functioning was ridden with mismanagement and negligence. Over 80 people have died of hunger and exhaustion on these trains even though the government says it was because of some illnesses from before without providing a proof of that.
A long-awaited Supreme Court order came to organize free transport for migrants. All the people who have had to pay earlier for their return to their homes either on government or private transportation should be given refunds. Likewise, all those who had to pay for Covid-19 testing in private laboratories should be given refunds.
Covid-19 has made it clear that it is only government healthcare facilities that are reliable in times of pandemics. Nationalization of healthcare services is an urgent requirement. Nationalization of healthcare facilities (infrastructure, staff, etc.) including diagnostics, medical devices and drug manufacturers, pharmacies and biotech firms must be done without any further delay.
Senior government doctors who were leading the Covid-19 response have resorted to private hospitals for care when they themselves tested positive which raises serious questions on the quality of healthcare even in the best government facilities.
The 2018 High Court order of Justice Sudhir Agarwal of the Allahabad High Court which makes it compulsory for all government staff and elected representatives to seek medical care from government-run facilities and from the available on-duty doctor only, should be implemented in UP and entire country with immediate effect.
Also, those government staff and elected representatives who are seeking Covid-19 and non-Covid care from private healthcare facilities should not be compensated from public funds (such as CGHS etc.). 
How strange is this reality that influential people were able to get healthcare from private hospital at government’s expense but when migrant workers out of sheer desperation were forced to resort to private transport to return to their home, they were debarred from the government relief amount of Rs 1,000 and food ration packets.
On one hand the coronavirus pandemic is on the rise as never before and on another hand, government has announced the ‘Unlock-1’ phase. Then what was the rationale for the lockdown in the first place? The Covid-19 response as well as the cascading humanitarian crises have unleashed havoc in the lives of millions of people.
Those who are responsible for this unconscionable and unjustifiable mismanagement must be held accountable, which should include the Prime Minister and Home Minister, as well as other highly placed officials who have held the reins of the government’s Covid-19 response.
---
*With Socialist Party (India); Sandeep Pandey is also Magsaysay award winning social activist. A Socialist Party of (India) statement, updated by authors as article 

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