Tackling COVID-19: Public Health and Socio-Economic Strategies - Diginar 2

Key Takeaways:

• Despite the commonality of the Covid-19 pandemic, countries have adopted a wide-ranging set of public health and socioeconomic strategies to deal with the multidimensional challenges of the pandemic. As such, the webinar focused on three questions – 1) what have been the key public health and socioeconomic strategies adopted by countries to tackle the pandemic? 2) how have responses to the pandemic evolved with the unfolding evidence? 3) what are the lessons for as well as from developing countries like India in this regard?
• Tackling the Covid-19 pandemic has proved to be a major challenge even for rich countries with well-developed health systems. Is it that modern science still has some way to go in learning how to deal with such pandemics and prevent high levels of mortality?
• The high mortality caused by the Spanish Flu was not entirely on account of the limitations of the extant public health infrastructure, but also due to large-scale troop movements arising from the First World War. With the increasing density of air transport worldwide, pathogens can spread globally within few days. This is what appears to have happened with Covid-19, as governments across the world scrambled to close borders in a manner which had a devastating impact on economies and livelihoods. It is a matter of time before a similar pandemic visits us again. What kind of protocols need to be put in place in dealing with pandemics which are least disruptive for increasingly interconnected trade and economies?
• The Covid-19 pandemic has highlighted the systemic risk posed by global health crises, their potential for disruption of routine operations of health systems, and their wide-ranging impact on socioeconomic outcomes. Globally, 181 million confirmed cases and 3.9 million Covid-related deaths had been reported to the WHO until 28th June 2021, 11:30 hours CEST. Of 3.9 million deaths, 3.1 million were reported from the Americas (1.9 million) and Europe (1.2 million) alone. Asia and Africa seem to have done much better vis-à-vis the developed world in this regard. At the same time, we also know that several countries in Asia and Africa also have weak health information systems, and it is possible that many deaths were missed from the official counts.
• Sometimes, we forget that behind these deaths, there are real people, lives, hopes, aspirations. As a German journalist once cynically remarked, ‘if only one person dies, it is a tragedy; 1 million die, it is only statistics’.
• One of the panelists during our previous webinar remarked that we tend not to learn from the past. The German philosopher Hegel once remarked – the only thing we learn from history is that we learn nothing from history. But what we have witnessed over the past few months in particular inspires us to learn from history as well as from each other’s experiences as we can no longer, politically or morally, justify leaving our health care workers alone on the frontiers of this pandemic.
• India imposed, perhaps, the world’s most stringent and extended nationwide lockdown. The measures undertaken to deal with Covid-19 pandemic have had significant socioeconomic implications in India. India faces an unprecedented negative economic growth for the first time since independence.
• Lockdowns in states during the second wave equally disrupted non-Covid-19 services. Yet, it underscored India’s vulnerabilities as migrant workers had to trek hundreds of kilometres to reach home, while a sizeable share of informal workers lost their jobs and wages.
• Evidence from Government-funded health insurance schemes during Covid-19 shows that health care utilization declined by 61% during the early phase of the lockdown and by 46% during its later stages.
• There was a significant decline in general immunization coverage as well as rise in home-based child births.
• The second wave caught us unawares and the response from the government was too little and too late. Governments abdicated responsibility, did very poor planning – thanks to our deep belief in market-based health care system, which wreaked havoc, especially given our regulatory failure.
• Though 900 million people in India are now covered with some form of health insurance, effective coverage is only about 20 to 25%.
• In terms of service coverage, ESIS and CGHS are more comprehensive than the PMJAY and private insurance that largely cover hospitalization. Only 1.7 million Covid-19 tests and 0.6 million Covid-19 hospitalization cases were covered by PMJAY until June 2021.
• Drug shortage was problematic and led to price hike. Voluntary licensing is just a suboptimal solution: it does not provide good competition. The Government of India should invoke Section 92 of Indian Patent Act for compulsory licensing so that critical, patented drugs could be produced in such circumstances.
• India should –

- Adopt compulsory licensing (CL) in the case of Covishield vaccine. CL is not required for Covaxin as it was developed with public money (R&D) and scientific knowledge from ICMR. PSUs should also manufacture it. The financing and procurement of vaccines should be the responsibility of the central government and distribution that of the states / UTs;

- Scale up health care spending to a minimum of 2.5% to 3% of GDP (tax funds complimented by wage contributions from employer employees); o Integrate a fragmented health financing and insurance system for scale economies, cost minimization and larger coverage;

- Increase production of specialists and focus on distribution – larger focus should be on nurses – changing incentive structure necessary to bring back clinical specialists;

- Enhance spending on medicines – improve drug procurement & supply chain (pooled procurement); strengthen drug regulation and dispensing to avoid an antibiotic-resistance crisis; make use of TRIPS provisions to ensure access and affordability of key medicines;

- Implement the Clinical Establishment Act and Rules to regulate private sector (for quality and price);

- Improve quality of government health services to improve confidence in people and access;

- Deepen universal health coverage, with special focus on preventive and promotive care, delivered largely by the public health system.

• Covid-19 pandemic is multidimensional; is heightening fragilities, exacerbating inequalities and deepening vulnerabilities in system of all kinds.
• Inequality is the determining factor explaining why the Covid-19 pandemic has had such differential impacts on peoples’ lives and livelihoods.
• We need to tailor our actions to meet the needs of the most vulnerable. We are obliged to use multi-pronged approaches to address challenges around food, social protection, gender inequality, governance and a range of societal issues.
• Improving the quality, coverage and resilience of health systems is of primary importance if we wish to sustain long-term socioeconomic progress, promoting shared prosperity and driving sustainable and inclusive growth.
• At least half of world population does not have full coverage of essential health services. Nearly 12% of world population spends at least 10% of its household budget on health care. If we are going to build forward differently, we will need stronger and more resilient health systems.
• The global focus has now shifted to vaccines, their availability, rollout and take up. Significant inequalities are associated with who gets the vaccine, where and why. In UK, vaccine rollout is progressing rapidly, by and large successfully due to the NHS, coupled with massive outreach, using a whole-of-society approach.
• The idea of vaccine passports as a road to return to some kind of normality also raises concern about existing inequalities. We also need more evidence about whether people who are fully vaccinated can still spread the virus.
• We also need to help people to be better prepared for the future, and be able to address new and different shocks, which are inevitable.
• Despite several constraints – close proximity to China, high proportion of aged population, high urban density, crowded public transport, lack of constitutional provision for a forced lockdown, complexity of vaccine approval, etc. – number of infections and deaths were relatively controlled in Japan. Its Covid-19 cases were 800,305, of which 766,540 had recovered and 14,730 died (1 July 2021).
• Vaccines could not be approved in Japan until they were tested on the locals. Therefore, vaccine approval took some time.
• By 24 June 2021, 37 million vaccine doses had been administered, and 9.23% of the Japanese population was fully vaccinated, with more than 30% receiving their first dose.
• The “infodemic” was challenged through science-based governance. When the first Covid-19 death was reported, a high-level Expert Group (EG) of experts in infectious diseases, public health, virology as well as lawyers was formed as per a cabinet decision. The EG was supported by a working group of data scientists, logistic experts, AI specialists and others.
• Simulation exercises with big data analysis and future scenarios were regularly developed and discussed.
• Regular press briefings were jointly held by the Health Minister and EG Head, and periodically jointly by the Prime Minister and EG Head. EG’s advice helped in government’s decision-making, even as the joint press briefings were helpful in generating people’s confidence in the shared information.
• Citizens will comply with guidelines if right information is given at the right time and they have trust in the given information.
• People’s attitudes, behaviors and basic hygiene habits were helpful. Wearing masks and hand-washing education in elementary schools were very helpful.
• Japan’s border control measures during initial stages really helped in lowering the peak and giving the health system more time to prepare themselves.
• Covid-19 wards were created in hospitals; hotels were booked by local governments for people who needed isolation, but not hospitalization. • Japan asked people to avoid the 3 Cs – closed spaces, crowded places, closecontact settings. The concept has now been expanded to 3C+, which includes behaviors such as talking loudly and singing.
• Public attention to the changing severity of Covid-19 cases in terms of numbers was drawn through color-coded displays in landmarks.
• Japan could mobilize resources because they already had three major national programs – Society 5.0, National Resilience Plan and Local SDGs. Fiscal support was injected into these three development programs.
• Japan has an excellent basic health care system, in both urban and rural areas, with good CT scan availability, which helped.
• Japan’s Covid-19 challenges included fewer PCR tests and tug-of-war between medical professionals and business lobbies, unemployment, employment loss, extension of Olympic, less use of emerging technology compared to other east Asian countries like China or Korea.
• 6 key factors helped in the initial flattening of the curve in Japan – government response, health care system, culture, sanitation, food habits, immune system.
• India lacks credible data systems, particularly at smaller geographical levels, to help us understand what is actually happening on the ground.
• During the second Covid-19 wave, the impact was felt across both developed and underdeveloped states in India, vis-à-vis Covid-19 cases as well as deaths.
• Nevertheless, there persist substantial heterogeneities in the burden of Covid19 pandemic across states and UTs in the country. • The first and second waves show different magnitudes of spatial concentration and severity.
• States with disproportionate socioeconomic and epidemiological vulnerabilities exhibited limited institutional capacities to mitigate the pandemic.
• Covid-19 cases were significantly associated with the proportion of households with poor sanitation and hygiene, incidence of poverty, food insecurity, level of urban population, inter-state migration, comorbidities, etc.
• Covid-19 death was significantly associated with poor housing quality, hygiene, sanitation, food insecurity, slums, urban places, inter-state migration, etc.
• Greater investment is needed in public health institutes to tackle the pandemic.
• Specific focus is needed on socioeconomically weaker population groups that would also help reduce the widening gap between the ‘haves’ and ‘have-nots’.
• State-specific multisectoral programs are needed to strengthen preventive and curative arms of health systems dealing with the Covid-19 pandemic.
• Universal vaccination is the need of the hour to reduce the menace of potential third wave.
• Children, elderly, adolescents, unemployed men and women, people with comorbidities, etc. need policy support for securing regular life, peace and wellbeing.
• The Government of India has taken the responsibility of providing free vaccines to all 18+ citizens. Hopefully, this initiative will enhance the pace of vaccination, reduce the speed of infections in the country and mitigate the socioeconomic challenges arising out of infections as well as lockdowns.