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On Monday, a senior Indian federal government official told reporters there was no shortage of oxygen in Delhi or elsewhere in the country.
As he spoke, several small hospitals – just a few miles from where he was in the capital – were sending desperate messages that they were running out of oxygen, putting patients’ lives at risk.
The chief medical officer at one of the hospitals – a facility specializing in pediatrics – told the BBC that “our hearts are in our mouths” because of the risk of child deaths. They got their supplies just in time, after the intervention of a local politician.
Yet the federal government has repeatedly insisted that there is no shortage. “We are only facing transport problems,” said Piyush Goyal, a senior official in India’s interior ministry.
Indeed, it is the hospitals which must “ensure a judicious use of the oxygen according to the directives”, continued Mr. Goyal, leaving the doctors perplexed.
But experts say the oxygen shortage is just one of the problems that show the Indian government has been “caught sleeping at the wheel”, not having done enough to stop or minimize the damage from the air. second wave.
Warnings have indeed been issued on several occasions, in particular:
Despite this, on March 8, the country’s health minister announced that India was in the “final phase of the pandemic”.
So where did it go so wrong?
In January and February, the national number of daily cases fell to less than 20,000 from peaks of around 90,000 in September last year. Prime Minister Narendra Modi has declared Covid beaten and all places of public gathering have been opened.
And soon, people were not adhering to Covid’s security protocols, in part because of confusing messages from above.
While Mr. Modi asked people to wear masks and follow social distancing in his public messages, he addressed large crowds unmasked during his election campaigns in five states. A number of his ministers were also seen addressing large public gatherings without wearing masks. The Kumbh Mela, a Hindu festival – which attracts millions of people – has also been allowed to take place.
“There was a total disconnect between what they practiced and what they preached,” says Dr Chandrakant Lahariya, public policy and health systems specialist.
Prominent virologist Dr Shahid Jameel says “the government just didn’t see the second wave coming and started celebrating too soon.”
But there is more to the story: The devastation also exposed the underfunding and neglect of India’s public healthcare system.
The heartbreaking scenes that have been observed outside hospitals – of people dying without seeking treatment – show the grim reality of India’s healthcare infrastructure.
As one expert puts it, “India’s public health infrastructure has always been broken, the rich and the middle class are just finding out.” Those who could afford it have always relied on private hospitals for treatment, while the poor struggle to even get a doctor’s appointment.
Recent programs, like health insurance and subsidized drugs for the poor, are not helping because very little has been done in decades to increase the number of medical staff or hospitals.
India’s health spending, private and public, has accounted for around 3.6% of GDP over the past six years, the lowest percentage of the five Brics countries: Brazil spent the most at 9.2% , followed by South Africa with 8.1%, Russia with 5.3% and China at 5% in 2018.
Developed countries spend a much higher share of their GDP on health with, for example, the spending of the United States in 2018 at 16.9% and that of Germany at 11.2%. Even the smallest countries like Sri Lanka (3.76%) and Thailand (3.79%) spend more than India.
Several “empowered committees” were reviewing the preparations needed to deal with the next wave of coronavirus last year, so experts are bewildered by the shortages of oxygen, beds and medicine.
“When the first wave died down, that’s when they should have prepared for a second wave and assumed the worst. They should have taken an oxygen inventory and [the drug] remdesivir and then increased manufacturing capacity, ”Mahesh Zagade, former health secretary of Maharashtra state, told the BBC.
Officials say India is producing enough oxygen to meet rising demand, but transportation was the problem – although this is questioned by experts.
The government is now operating special trains carrying oxygen from one state to another and stopping the use of oxygen in industries – but only after the death of many patients due to lack of oxygen.
“The result has been desperate family members spending thousands of rupees securing an oxygen cylinder on the black market and then waiting in line for hours to get it refilled,” says Dr Lahariya.
Meanwhile, those who can afford it are also paying large sums for drugs like remdesivir and tocilizumab.
An executive at a pharmaceutical company that makes remdesivir said “demand dried up” in January and February. “If the government had placed an order, we would have built up stocks and there would have been no shortage. We have increased production but demand has increased dramatically,” he said.
In contrast, the southern state of Kerala planned the push ahead. Dr A Fathahudeen, who is part of the state’s Covid task force, says there was no shortage of oxygen in the state as the necessary measures were taken in October last year .
“We have also purchased a sufficient stock of remdesivir and tocilizumab and other drugs well in advance. We have also put in place a ramp-up plan to deal with any exponential increase in numbers in the coming weeks. “he said.
According to Mr. Zagade, other states should also have taken similar measures “to avoid suffering”.
“Learning means someone else has done it and you can do it now, but it means it will take time,” Maharashtra’s former health secretary said.
But time is running out as the second wave is now spreading to villages where health systems are not equipped to cope with the outbreak.
Sequencing the virus genome is an important step in identifying new variants that could be more infectious and fatal. The Indian SARS-CoV-2 Genomics Consortia (INSACOG) were set up last year and brought together 10 laboratories across the country.
But the group would have struggled to secure funding initially. Virologist Dr Jameel said India started to seriously examine mutations quite late, with sequencing efforts “getting off to a good start” only in mid-February 2021.
India was currently sequencing just over 1% of all samples. “By comparison, the UK was sequencing at 5-6% at the height of the pandemic. But you can’t build such capacity overnight,” he said.
However, India’s main hope has always been vaccination.
“Any public health specialist will tell you that there is no practical way to strengthen an already broken public health system in a matter of months,” a woman, whose family runs a large private hospital in a few months, told the BBC. Delhi.
“The best and most effective alternative to combat Covid was to vaccinate the population as quickly as possible so that the majority did not need hospital care and therefore did not overload the health system.
India initially wanted 300 million people to be vaccinated by July, “but it appears the government has not planned enough to secure the vaccine supply to run the program,” says Dr Lahariya.
“On top of that, he opened the vaccination for all adults without securing the vaccine supply.”
So far, only about 26 million people have been fully vaccinated out of a population of 1.4 billion, and about 124 million have received a single dose. India has millions of more doses on order, but still a long way from what it really needs.
The government also canceled exports, reneging on international commitments.
The government has tapped other companies such as Biological E and the state-run Haffkine Institute to produce vaccines. It has also given a loan of $ 609 million to the Serum Institute of India, which produces the Oxford-AstraZeneca jab which is made in India under the name Covishield, to speed up production.
But that funding should have come sooner, says Dr Lahariya, saving precious lives. Experts say it’s ironic that India is known as the world’s pharmacy and now faces a shortage of vaccines and drugs.
All of this, says Dr Lahariya, should serve as a warning to federal and state governments, which should invest more in the health sector because “this is certainly not the last pandemic we will have to fight against.”
“The future pandemic could come sooner than any model can predict,” he says.
Data analysis and graphs by Shadab Nazmi