Skip to main content

Why India's response to Covid was in striking contrast to the reaction against TB

By Nihir Gulati*
On January 16, 2021, the first-ever dose of the Covid vaccine was administered in India. With the Ministry of Health and Family Welfare claiming to have administered both doses to a mere 10% of India's 94.5 crore adult population, I reached out to Bobby Ramakant, director, for policy and communications at Citizen News Service (CNS), to gain a deeper insight into the snail-like pace of covid vaccine administration in the country.
According to a Delhi  and West Bengal study, more than 75% in each State were willing to get vaccinated. Hence, that is not an issue that is causing the population not to get vaccinated.

Health infrastructure

To get a glimpse of the healthcare system in India, we deep dive into a discussion about tuberculosis. This disease has been plaguing India since the time that Bobby was at college. Contrary to popular belief that TB is a disease of the poor, Booby believes that it is not limited to the lower class of society. However, he does agree that TB is prevalent among the poor because one of its major causes is malnutrition.
India's motto against tuberculosis is: "Pakki jaanch, pakka ilaaj," meaning that if we can detect TB with surety, we can treat it definitely. Sadly, this is not the case, and India has the most number of deaths due to tuberculosis than any other country.
One of the main reasons for this dubious distinction is India's lack of public healthcare infrastructure and awareness. Here is how - 13 different drugs can be used to treat tuberculosis. However, a combination of four out of these 13 drugs is chosen for each person based on their genetic makeup.
This test of genetic makeup is done by a piece of medical equipment known as gene expert. This test helps determine the combination of four drugs that would be the most potent against TB for that person. Successful treatment requires regular medication for a certain period of time. Failing to take those medications on time causes drug resistance, i.e., the bacteria causing tuberculosis become immune to the drug.
Once the drug resistance develops, a new combination of four out of 13 drugs has to be created for that person, and the treatment has to start all over again. The main reason that this happens is poverty and lack of awareness in India.
Although the drugs are free of cost in the government centers in India, the transportation is not, and many people from the poor and remote villages in India failed to reach the government centers for their regular dosage against tuberculosis.
This problem was handled well by the State of Kerala, where they ensured a zero default rate, ensuring that no one missed their medication once the treatment began. This was done by conducting regular surveys and outreach by the government center. If the people cannot reach the government centres, they deliver the drugs to the remote villages to reduce the default rate.
Although this was an excellent reactive strategy, India, with the highest number of TB deaths globally, needed a more proactive approach to counter tuberculosis. Eradication, rather than treatment, should be the goal here.

Contrast with Covid

The response to Covid was in striking contrast to the reaction against TB. Until as late as 2010s, TB in children was treated by giving them partial doses made for adults by breaking the capsules according to the child's weight – a grossly unprofessional method.
On the other hand, the manufacturing of Covid vaccines had already been done before the clinical trials, with the plan that shipping would start as soon as the clinical trials were completed.
However, such urgency and importance were not given to other scientific breakthroughs in the healthcare domain like TB medicines, female condoms, etc. Although the initial enthusiasm was overwhelming, Covid did uncover some gaping holes in the public healthcare system in India.
During Covid's peak, India had one of the lowest number of beds per unit population in the country, and there was an acute shortage in both the private and the public sectors.
To provide health as a human right, we need safer roads, a cleaner environment, better public health systems, more robust public transport
A robust public healthcare system became a need. We need to introduce sustainability in public health by reducing the privatization of and profiteering from healthcare. There is a need to reduce the catastrophic healthcare costs and make sure that emergency healthcare doesn't push people into poverty.
An example of healthcare exploitation is the per-dose cost of Covid medicines which went up from Rs 250 to Rs 780 for Covishield and to Rs 1,450 for Covaxin within 1.5 months (May 1, 2021 to June 21, 2021). These costs made the coronavirus vaccine out of reach for the general public.

Holistic development

Bobby, taking inspiration from Professor Sandeep Pandey (current IIMA professor, previously IITK professor), emphasized the need for developmental justice - a holistic improvement in human development in the country.
He talked about the subtle difference between Universal Health Care and Universal Health Coverage – the former being a proactive approach projecting health as a human right and the latter being a reactive approach concerned with the provision of insurance for the affected. A country should always aim for Universal Health Care rather than coverage because it is a sustainable and stable approach.
To provide health as a human right, we need safer roads, a cleaner environment, better public health systems, more robust public transport, less malnutrition, etc. We would have to progress on all fronts simultaneously to achieve health as a human right.
Bobby proposes that the litmus test for any intervention should be that if it benefits the poorest of the poor in the country, it should be accepted. He firmly believes that the opposite of poverty is equality, not opulence.
An activity that changed Bobby's perspective about development was shunning motorized vehicles and taking up cycling. He realized that the system of highways and wide, fast roads were designed in favor of car-owners, who are less than 5% of the total Indian population.
Road safety, he surmised, was not just about helmets and airbags; it is also about caring for the non-motorized vehicle owners – the pedestrian, cycle rickshaws, etc.
As a cyclist, he felt the safest in the crowded lanes of Lucknow's old city and not on the so-called developed highways. Authentic development, he says, would occur when the collective feeling of safety goes up, not just the safety of the car owners.

Political motives

Taking the example of Thailand in the 70s, where, at the time of recession, the healthcare infrastructure budget for the large cities was instead used to develop the small basic healthcare facilities in the small villages. They have the 30 Bhat scheme, where the state covers all the healthcare costs for 30 Bhats annually (equivalent to Rs 60).
Even in India, we saw the response of the State of Kerala towards TB was superior to that of the other states. They aimed for healthcare rather than economic benefit, which should be the target of all public policy.
After this discussion with Bobby, one thing is clear to me: the only way to change is when we, the citizens and our elected representatives, unlearn our definition of development and healthcare. We need to pressure policymakers to introduce interventions that are socially just and ecologically sustainable.
Rather than treating gender upliftment, environment protection, and universal health care as three separate silos, we need to understand the complex interlinkage between them and simultaneously better the country in all the fundamental human development areas – because only then it will be real development.
---
*PGP 2020-2022, Indian Institute of Management, Ahmedabad 

Comments

TRENDING

What's behind public sector banks showing huge profits in 2nd quarter of 2022-23?

By Thomas Franco*  The quarter two results of the public sector banks (PSBs) appear to be noteworthy compared to a few years ago. All these banks showed good profits in the financial year 2021-22. Twelve PSBs made a net profit of Rs 25,685 crore in quarter 2 of FY23 and a total of Rs 40,991 crore in the first half of 2023. The combined profit of 12 banks in March 2022 was Rs 66,539 crore which was 110% more than 2021 – Rs. 31,816 crore. The Asset Quality Review of 2015 saw a surge in NPAs of PSBs jumping to Rs 8.96 lakh crore in March 2018 from Rs 2.17 lakh crore in March 2014. This was simply because the norms for NPAs were changed from 180 days to 90 days, and all restructuring of even genuine accounts was done away with. In 2018 NPA of SBI was 5.73% which has come down to 0.8% in Q2 of FY23. The NPA of Canara Bank has come down to 2.19% from 7.48% in Mar 2018. The same trend is seen in all public banks. Now SBI has seen a jump of 74% in its net profit, while Canara Bank’s profit is

Economist-editor's allegations on Narmada defamatory, baseless: Medha Patkar

Counterview Desk  In a reply directly addressed to well-known economist, journalist and columnist Swaminathan S Anklesaria Aiyar’s two articles in the Times of India (republished here and here ), calling them defamatory and wondering whether they were borne out of “ignorance or a conspiracy through political alliance”, Narmada Bachao Andolan leader Medha Pakar has said that the Narmada Sardar Saravar Project and the people's movement by adivasis, farmers, labourers, fish workers, potters and all the generations’ old communities from the river valley have suddenly come to be focused on, since the Gujarat elections are in the doorstep. She believes that while the “defamatory accusations with baseless conceptions such as ‘urban naxals’ are to be laughed at as the electoral strategic moves, one gets shocked to read the articles by a known old columnist like Swaminathan Ankalesaria Aiyar, published in a reputed daily like the Times of India." According to her, Aiyar’s two articl

Business back to normal? IIM-A survey says, sales expectations have sharply improved

By Our Representative  The Indian Institute of Management’s Business Inflation Expectations Survey (BIES), which polls a panel of business leaders to find out their perception of slack in economy, including their inflation expectations, year-ahead cost expectations and the factors influencing price changes, such as profit and sales levels, etc., has said that the cost perceptions data indicates signs of moderation in price pressures. Carried out for September, the survey says, the cost pressure of the reporting firms has shifted from “very significant increase (over 6%) to moderate increase (3.1% to 6%).” It adds, “The percentage of firms perceiving over 10% cost increase y-o-y has declined. Over 21% of the firms in September 2022 round of the survey perceive that costs have increased very significantly (over 10%) – down from 26% recorded in August 2022.” Claiming to be a unique survey, in that it goes straight to businesses -- the price setters -- rather than to consumers or household

Hindutva groups threat to peace, freedom: US diaspora groups tell FBI, other govt depts

By Our Representative  The Islamophobic and neo-Nazi ideology of Hindutva is a clear and present danger to peace and freedoms in the United States, a coalition of civil rights organizations told key officials of the U.S. Attorney General’s Office, the US Department of Justice (DOJ), and the Federal Bureau of Investigation (FBI) at a recent event in Edison, New Jersey. At the event titled United Against Hate, activists from American Muslims for Democracy (AMD), Hindus for Human Rights (HfHR) and Indian American Muslim Council (IAMC) made detailed presentations on this ideology of Hindu supremacism that is committing mass persecution of India’s Muslims and Christians and is rearing its ugly head in New Jersey as well as across the US. Attending the event were David S Leonardis, Special Investigator from the New Jersey Department of Law & Public Safety; Michael E Campion, Chief of the Civil Rights Division for the US Attorney General's Office; and Jonathan R Norbut of the U.S. Dep

Buddhist shrines were 'massively destroyed' by Brahmanical rulers: Historian DN Jha

Nalanda mahavihara By Our Representative Prominent historian DN Jha, an expert in India's ancient and medieval past, in his new book , "Against the Grain: Notes on Identity, Intolerance and History", in a sharp critique of "Hindutva ideologues", who look at the ancient period of Indian history as "a golden age marked by social harmony, devoid of any religious violence", has said, "Demolition and desecration of rival religious establishments, and the appropriation of their idols, was not uncommon in India before the advent of Islam".

GoI's productivity linked incentives to corporates 'without independent analysis'

Counterview Desk  Wondering how prudent is the Government of India's (GoI's) Productivity Linked Incentive (PLI) scheme, EAS Sarma, former secretary, GoI, in a representation to Nirmala Sitharaman, Union finance minister, has said it appears to be nothing more than subsidy to the private sector without any responsibility. Giving a specific example against the backdrop of announcement of 50% subsidy covering the project cost of the Vedanta Group's decision to set up a semiconductor fabrication plant in Gujarat, in collaboration with Foxconn, Sarma says, "The total cost of this project is reported to be Rs 1,54,000 crore. 50% of this works out to Rs 77,000 crore." Stating that this creates the impression that the entire subsidy allocation for the semiconductor manufacturing sector would be appropriated by this company, Sarma says, "The Gujarat government did not lag behind in liberally announcing similar incentives for the Vedanta-Foxconn project. It offered 7

As polls approach, electorate 'failing to realise': Gujarat model is in a shambles

By DN Rath*  Gujarat assembly elections, scheduled to be held on 1 and 5 December 2022, is viewed by many as dress rehearsal for the 2024 Lok Sabha elections. When the suffering people have been pointing towards redressal of some local issues like absence of cleanliness, sewage problem, shortage of water supply, troubles created by stray cattle, insufficiency of streetlights, etc., it is evident that they are not fully aware that assembly elections are being fought on ideological standpoints and policy decisions. Nor is there the realisation that the state is in a shambles and the much-trumpeted ‘Gujarat model’ of development has proved to be a hoax. Like other states, the people of Gujarat are also back-broken by steep rise in prices to the tune of 400% in last 20 years. It is not that the government cannot control the spurt in prices if it so wants. Apart from the fact that price rise is an inevitability in a capitalist economy, artificial shortage triggered by massive hoarding, b

BJP poll gimmick? Bilkis Bano rape case 'pardon' vs Rajiv assassins' release

By Sandeep Pandey*  Supreme Court has released six convicts in the Rajiv Gandhi assassination case. This was bound to happen as earlier AG Perarivalan was released in the same case, setting a precedent. Even though four of them are Sri Lankans but a popular Tamil sentiment favoured the release of these convicts which is why Tamil political parties supported this and resolutions were passed by different governments in Tamil Nadu to his effect.  Rajiv Gandhi paid the price of sending Indian Peace Keeping Force to Sri Lanka where it got entangled with Liberation Tigers of Tamil Eelam and eventually the whole operation ended up is a fiasco.  However, most importantly Sonia and Priyanka Gandhi and probably Rahul too do not have any objections to the release of these convicts. In fact, Sonia Gandhi played an important role in getting the death sentence of the only lady among the convicts Nalini commuted to life term through the Tamil Nadu Governor. Priyanka visited Nalini in Vellore Jail and

Amit Shah accused of inciting communal passion: Demand to postpone Gujarat polls

Counterview Desk  In an email representation to the Election Commission of India (ECI), Dr EAS Sarma, former secretary to the Government of India, has objected to the statement reported to have been made by Union home minister Amit Shah, who allegedly justified the 2002 Gujarat riots stating that certain sections of people “taught a lesson” to the rioters. Noting that the statement, if correct, “in effect implies those other than the law enforcement authorities had taken law into their hands”, Sarma says, “Shah's statement needs to be viewed by the ECI in conjunction with the reported fact that it was the Union Home Ministry that cleared the release of the eleven rape convicts in the Bilkis Bano case, directly related to the infamous Godhra incidents in 2002, which triggered the shameful sequence of events that shook the nation's conscience.” According to Sarma, if the statement is true, “I am constrained to draw the inevitable inference that it would have already impacted th