India’s COVID-19 response: The power of collaboration, science & pragmatic leadership

As I write this column, India is on the verge of crossing the daunting threshold of 50,000 cases.  Given the initial trends that emerged and situations that evolved in New York and the Milan region, I would have anticipated that Mumbai, a city I once called home, would emerge as the epicenter in India.  While Maharashtra does lead the tally with over 15,000 cases, the last 40 days have been fraught with surprises from across the country.  Indore in Madhya Pradesh captured headlines on some of the days while Tamil Nadu, Andhra Pradesh and Gujarat did so on others. Chennai’s Koyambedu vegetable market is now a cause of concern and Gujarat has overtaken Delhi with more than 6000 cases.  This enemy has been one that is hard to understand or hard to predict.  Uncertainty has been the order of this game, and most developed countries have been struggling to play catch up.

Global lessons: the importance of testing, contact tracing, multi-stakeholder efforts

Globally, COVID-19 has now claimed more than 250,000 lives based on officially recorded numbers.  The reality has been harshest in geographic pockets where the undue spike in critical cases was beyond what the health system was capable of handling.  Rationing of ICU capacity and makeshift morgues from Milan and New York will remain in our memories for another generation.  At the other end, there are also impressive examples of countries that have been able to tame the enemy and avert a crisis at such scale.  Germany and South Korea continue to impress with their statistics and ongoing efforts.  South Korea snubbed the curve upfront and has less than 11,000 cases and 300 deaths as on date.  While Germany is one of the top five globally on caseloads, it has been able to contain mortality at about 4% of reported cases (compared to 15% in UK, 14% in Italy, and 11% in Spain).  The agile and determined response has been at the heart of their efforts. More importantly, timely interventions were combined with transparent and coherent communication that helped gain strong public engagement and behavioral participation in response measures.  Also very notable in South Korea is the effective testing, contract tracing, and isolation policy is driven by extensive use of diagnostics.

The Indian context

Indian response so far has been commendable despite the expanse of challenges in a country that is as large and socio-economically complex.  Agility, unified scientific power, and pragmatic capacity enhancement in the health system stand out as elements we can take great pride in.

Scientific engagement at the forefront

India’s Health Ministry and Indian Council for Medical Research (ICMR) have been at the forefront of shaping response measures and enhancing preparedness. Reasoned and scientifically backed decision making has marked all communication on diagnostics and therapeutic protocols.  ICMR’s communication has been clear and specific; and has provided much needed clarity on use of various testing options for both screening and diagnostic purposes.

Scientific bandwidth in the country across private sector and all institutional networks such as DBT, CSIR, ICMR and DST has been effectively pooled with urgency and scientific rigor being the common thread.  This has been critical for all three measures – creating multiple options on indigenous diagnostics, rapidly exploring both repurposed and novel therapeutic (antibody solutions) and fuelling the critical quest for a vaccine.  Genome sequencing has been simultaneously stepped up and we can be confident that mutations will be well understood and will inform the vaccine development effort in an active manner. DBT’s antibody consortium, NBM’s accelerated funding program for vaccines and diagnostics, NIV’s constant championing of various activities including diagnostic test kit validation, SCTIMST’s Lamp diagnostic assay, CSIR’s contribution to genome sequencing and the CRISPR-Cas9 based paper diagnostic test from IGIB are all flagbearers of the country’s strong scientific force that is at the forefront of this battle.  With more than 6 vaccines in the private sector under active development, a sustainable solution that will be produced at scale is a highly likely reality.  Empanelment of hospitals for the ICMR coordinated PLACID trial for Convalescent Plasma therapy to limit associated complications has also been done in a timely and transparent manner with active participation of hospitals from across the country.

Pragmatic capacity enhancement in the health system

No country in the world was prepared for this onslaught.  Strengthening of the health system is the foundation of the response measures.  There is no other way to brace ourselves for what might be ahead other than doing this on a war footing.  For the most part, this has been done very well.

Foremost, creating diagnostic capacity is important to ensure active measures can be instituted around isolation, tracking and tracing.  Now, the same diagnostic tests (as pooled tests) are serving as tools for community surveillance and determination of additional response measures.  We have graduated from imported test kits to domestic kits with a clear vision to be self sufficient for testing kits by end of May.  The 12.7 lakh tests done till date have been possible due to the active focus on expansion of the testing network.  At record pace, private labs were rapidly onboarded and the public research institutions were also included in the network.  In total, we now have 445 public and private labs across the country serving the testing need for molecular tests.  All this with high transparency and dissemination of information through the ICMR website.

In India, we have an additional complexity of health being a state subject.  Creation of quarantine facilities and healthcare delivery capacity to handle a surge in critical care is far from easy.  Some of the states have done incredibly well on this count.  For instance, Telengana has converted a sports complex into a 1500 bed special hospital for COVID-19.  An ideal situation to work towards, is to target a similar capacity creation effort across all states and union territories.  The other parts to the capacity building puzzle have been medical devices (primarily ventilators for critical care) and PPE. PPE shortage has been most difficult for countries across the world to bridge; and is a continuing challenge that will need to be addressed with greater vigour.  The import dependent medical devices industry is far from mature and the Make-in-India potential has remained an aspiration.  While the segment dynamics remain, it is impressive to note we have pooled capacity from various corners to create a local backbone for manufacturing ventilators.  Contribution of the corporate world, especially industrial groups with no business interest in healthcare, in creating this makeshift ventilator capacity on war footing is again worth celebrating.

Alert, unified and agile throughout the marathon

With only a few exceptions, the response measures have been largely immune to political leanings and have reinforced the belief that India can stand tall as one unified force.  With a common goal, pluralism and federalism have co-existed well.  The agility has been pervasive; and alertness has also been high all through this marathon.  The record timeline on which the $1bn World Bank support was formalized is beyond impressive.  The clinical community have been the commanders on the field and their spirit remains undaunted.

Remaining resolute and realizing the collective power of our democracy

We have taken difficult decisions early on and have the curb the severity of this public health crisis.  It was prudent to shut the country’s borders and implement hard measures for distancing in a timely manner.  However, the course of the pandemic is hard to predict. We could have new threats to address as this battle advances.  While we enhance our preparedness, we have to embrace reality and looming risks.  The most important arsenal as we do so is our unified strength.  Meandering lines in front of liquor stores across states on the 4^th and 5^th of May were harsh realities glaring at us.  It was a strong reminder that the sensitization of the population needs to be more pervasive and bottom-up.   We have to remind ourselves that the battle is far from won.  The resolute and steadfast intent to beat this enemy has to be true of every citizen.  If each of us realizes the implications of our action, the collective power of our democracy can turn this battle around.  As we step out of Lockdown 2.0, we need to step up our broad population engagement to take this war to the individual level.

About Author: Ms Pushpa Vijayaraghavan is the Director and Practice Lead, Healthcare and Lifesciences Advisory at Sathguru Management Consultants. Pushpa advises companies on emerging market growth strategies, M&A opportunities, portfolio optimization, innovation access and strategic partnerships. In addition to close to a decade at Sathguru, Pushpa’s experience includes technology transfer at University of Michigan and investment banking/advisory at PwC and E&Y.  She can be reached at lifesciences@sathguru.com or pushpa@sathguru.com

*The views expressed by the author are her own.