In the third week of April, faced with a worryingly high and rising COVID-19 caseload – staying at over 3 lakh new cases a day, concerns over vaccine and oxygen shortages, the Indian government announced a flurry of measures – from expanding the age group of people eligible to take the vaccine, declaring an intent to release funds to Serum Institute of India (SII) and Bharat Biotech to ramp up their vaccine production capacities, getting Indian railways to run Oxygen Express trains to even tapping the services of the Airforce to reduce travel time in supply of oxygen. Well-meaning measures but then, some experts who have been seeing the trends in the caseload, feel it is rather late in the day with not much clarity on the execution plans. Especially one that can facilitate a transition from a run-with-a-central diktat model to an environment where states have to take greater ownership and responsibility.
The vaccine challenge
The first major policy announcement has been around expanding the age eligibility for vaccination. Starting May 1, all citizens above 18 years old are eligible for vaccination. This is a welcome measure aimed at checking transmission since the focus, experts say, is on young, who tend to get exposed more and therefore carriers. But then, there is little clarity on how it is to be practically executed given the relatively limited kitty of vaccines – the two vaccine makers – Serum Institute and Bharat Biotech – today make around 75 to 80 million doses in all in a month (the bulk of it, about 60 million doses, from SII alone) with no clear plans as yet on imports and supplies of the newly cleared Sputnik V vaccine. Though, both SII and Bharat Biotech intend to ramp up supplies, it cannot happen overnight and even when production is ready, batches do fail and there could be delays. SII, for instance, is attempting to make 100 million doses a month from June.
Dr Gagandeep Kang, India’s top vaccine scientist and professor at the Christian Medical College Vellore, while welcoming the move to take vaccination to a larger pool of people, is not sure how it can be implemented with limited doses of vaccines that are currently available as is also unclear on the need arising for a differential pricing approach. As per the policy announcement, 50 per cent of the total supplies from the vaccine manufacturers is to go to the central government and of the rest to state governments or in the open markets. The apparent question, therefore, is how are the companies to decide? Will there be a bidding war? Or how is a differentiated pricing policy (between Centre and states) to be executed?
The next bit of news that many expect in due course from the centre is its announcement that it has concluded the coverage of citizens aged 45 years and above but what is still not clear is the cut off yardstick that the centre wants for this. Will it be at 40 or 50 per cent or 90 per cent of those in the age bracket of 45 years and above, is yet not known. On differentiated prices, Dr Kang for instance seems to find it a bit odd as it seems to put the centre above the state “on something that is a public good as under the national programme on vaccines, the vaccines are provided free of charge).”
Other experts who have looked at the vaccinations, feel there should be an option that can attract more suppliers while also ensuring transparency. Some for example are in favour of creating a sort of exchange or a clearing house format wherein all suppliers and buyers engage with procurements happening and pricing in a transparent manner – the equivalent of the Power Trading Corporation (or PTC India) in the vaccine space.
Role for Oxygen Concentrators
At a time when those who are involved with mathematical modelling of the COVID situation and giving projections of the likely peak that India can expect in May, there is a view that a lot could be done to save the situation. Nachiket Mor, visiting scientist the Banyan Academy of Leadership in Mental Health and one who has been involved with and writing on public health, feels while we focus our energies to save the sick, it is equally important to remember that there are many who are not sick and we need to ensure they do not fall sick and those that are moderately ill are not allowed to deteriorate and end up in tertiary care hospitals.
One way, to check the sliding of the moderately sick into serious illness is by focusing on the role that oxygen concentrators or mini oxygen generators can play. These concentrate the oxygen from the ambient air and deliver oxygen in a controlled manner. These come in two formats – 5 litres a minute and 10 litres a minute and cost around Rs 40,000 apiece. There are enough local producers and enough suppliers globally and roughly 2 to 3 lakh such units costing a total of around Rs 1,000 crore or less to stock up all the primary healthcare centres or the covid-care centres of the government.
Take a deep breath
Typically, 80 per cent of the COVID patients will recover without any problem and it is only about 80 per cent of the balance 20 per cent who may need these interventions and need not end up in hospitals if handled well in time. In fact, Dr Kang also feels, “there are a lot of things that can be done to keep people out of need to be in the hospitals,” she says and explains: “Patients get on to oxygen because certain simple things that they could be doing are not done. Teaching people to do deep breathing exercises early on in infection has gone a long way to help.” It sure is worth a try, as is sticking religiously to the pandemic-related safety measures of using properly fitted face masks, sanitising and keeping to the physical distancing requirements.