View: As Covid crisis worsens, one wonders: Where is India’s Dr Fauci?
Last fortnight, India lost two prominent Covid warriors. One to death — cardiologist and former president of the Indian Medical Association (IMA) Dr K K Aggarwal. The second to politics — former Kerala health minister K K Shailaja, who, despite her sterling work in Covid mitigation during the first wave of the Covid crisis, was dropped from the new state government. As the country faces its gravest health crisis amid a piling number of dead, it is only natural to ask: where is India’s Dr Anthony Fauci?
Fauci has been the face of America’s fight against the Covid crisis, and justifiably so. As a physician working with some of the premier government institutions involved in public health research, he has served the US public health sector for over half a century, and has acted as an adviser to every US president since Ronald Reagan. He stood his ground against the insinuations from Donald Trump.
India, unfortunately, never cultivated a Dr Fauci.
It is not that India does not have experts to tackle the pandemic. In April last year, a 21-member national Covid-19 taskforce was constituted as a technical expert body to advise GoI on the pandemic. The functioning of the taskforce, however, has been chequered — marred with opaqueness, lack of independence, policy flip-flops, failure to flag off the second wave and the recent resignation of a member.
The challenge is not just of having an expert, or a body of experts, but also of following the expert’s advice even when it is not in line with the popular opinion within the system or outside it. The advisers — eminent experts in their fields — need the autonomy to provide independent and unbiased advice in handling a crisis supported by a culture of evidence-based policymaking. Such an ecosystem pre-empts collecting the right public data and making it available to the experts for effective decision-making.
The pandemic has made it evident that public health in India has been a neglected priority for decades, and the country is paying a heavy price today for this neglect. India has had a history of handling its health crisis at a leisurely pace — be it polio eradication or tackling the AIDS epidemic. Unfortunately, the coronavirus is spreading fast in more fatal variant forms that demand immediate corrective action on a war-footing, an aspect that has rarely ever been seen in Indian healthcare at a national level.
Missing in Inaction
And it’s not just Fauci. India also does not have a Centers for Disease Control and Prevention (CDC)-like institution. The Atlanta-based CDC has emerged as a global beacon on Covid-related care and precaution with its timely guidelines and prescriptions. The Delhi-based National Centre for Disease Control (NCDC, formerly National Institute of Communicable Diseases) was designed on the lines of CDC. But it has remained a poor, toothless body with no powers and capacity. It is not an independent body and is housed under the ministry of health and family affairs. Instead, institutions such as the Indian Council of Medical Research (ICMR) and Aiims (All India Institute of Medical Sciences) continue to brief on similar issues.
Constituting a taskforce seems to be the stop-gap arrangement being favoured. Over the past one year, several task groups have been set up — National Expert Group on Vaccine Administration for Covid-19 (NEGVAC), Indian Sars-CoV-2 Genomics Consortium (INSACOG) with different objectives, etc. However, their effectiveness has been limited.
Earlier this month, the Supreme Court constituted a 12-member national taskforce of top medical experts to formulate a methodology for allocation of oxygen to states and Union territories, and to facilitate a public health response to the pandemic.
Astrong NCDC could well have been a single focal agency framing the Covid testing advisory and treatment protocol, issuing guidelines to the public, and updating it to suit the changing conditions, recommending the gap between two doses, laying down standards on the nature and duration of lockdowns, when needed.
Incidentally, controversial repurposed drugs such as remdesivir, ivermectin and therapies like plasma donation could have been promptly accepted or revoked by NCDC, based on the studied evidence. The institution could have also served as a national voice of authority to follow against the cacophony of unsubstantiated recommendations available in public domain.
Cerebral Policy
If there is any good to come out of this pandemic for India’s health system, it could be a spate of reforms to fix the country’s healthcare delivery.
It may involve investing in primary health services, honouring health to be a fundamental right, reimagining Ayushman Bharat, forging publicprivate initiatives and undertaking civil service reforms to better harness the medical community’s talent in public administration.
Viruses like Covid may well become a more frequent affair as India becomes an even more integrated part of a globalised world. The country may soon have to start tracking a clear flu season like many other countries, having a regular vaccination programme to safeguard against Covid and its future strains. But will a pandemic of this calamitous proportion be enough to shake policymakers out of their inertia?
Views are personal
Last fortnight, India lost two prominent Covid warriors. One to death — cardiologist and former president of the Indian Medical Association (IMA) Dr K K Aggarwal. The second to politics — former Kerala health minister K K Shailaja, who, despite her sterling work in Covid mitigation during the first wave of the Covid crisis, was dropped from the new state government. As the country faces its gravest health crisis amid a piling number of dead, it is only natural to ask: where is India’s Dr Anthony Fauci?
Fauci has been the face of America’s fight against the Covid crisis, and justifiably so. As a physician working with some of the premier government institutions involved in public health research, he has served the US public health sector for over half a century, and has acted as an adviser to every US president since Ronald Reagan. He stood his ground against the insinuations from Donald Trump.
India, unfortunately, never cultivated a Dr Fauci.
It is not that India does not have experts to tackle the pandemic. In April last year, a 21-member national Covid-19 taskforce was constituted as a technical expert body to advise GoI on the pandemic. The functioning of the taskforce, however, has been chequered — marred with opaqueness, lack of independence, policy flip-flops, failure to flag off the second wave and the recent resignation of a member.
The challenge is not just of having an expert, or a body of experts, but also of following the expert’s advice even when it is not in line with the popular opinion within the system or outside it. The advisers — eminent experts in their fields — need the autonomy to provide independent and unbiased advice in handling a crisis supported by a culture of evidence-based policymaking. Such an ecosystem pre-empts collecting the right public data and making it available to the experts for effective decision-making.
The pandemic has made it evident that public health in India has been a neglected priority for decades, and the country is paying a heavy price today for this neglect. India has had a history of handling its health crisis at a leisurely pace — be it polio eradication or tackling the AIDS epidemic. Unfortunately, the coronavirus is spreading fast in more fatal variant forms that demand immediate corrective action on a war-footing, an aspect that has rarely ever been seen in Indian healthcare at a national level.
Missing in Inaction
And it’s not just Fauci. India also does not have a Centers for Disease Control and Prevention (CDC)-like institution. The Atlanta-based CDC has emerged as a global beacon on Covid-related care and precaution with its timely guidelines and prescriptions. The Delhi-based National Centre for Disease Control (NCDC, formerly National Institute of Communicable Diseases) was designed on the lines of CDC. But it has remained a poor, toothless body with no powers and capacity. It is not an independent body and is housed under the ministry of health and family affairs. Instead, institutions such as the Indian Council of Medical Research (ICMR) and Aiims (All India Institute of Medical Sciences) continue to brief on similar issues.
Constituting a taskforce seems to be the stop-gap arrangement being favoured. Over the past one year, several task groups have been set up — National Expert Group on Vaccine Administration for Covid-19 (NEGVAC), Indian Sars-CoV-2 Genomics Consortium (INSACOG) with different objectives, etc. However, their effectiveness has been limited.
Earlier this month, the Supreme Court constituted a 12-member national taskforce of top medical experts to formulate a methodology for allocation of oxygen to states and Union territories, and to facilitate a public health response to the pandemic.
Astrong NCDC could well have been a single focal agency framing the Covid testing advisory and treatment protocol, issuing guidelines to the public, and updating it to suit the changing conditions, recommending the gap between two doses, laying down standards on the nature and duration of lockdowns, when needed.
Incidentally, controversial repurposed drugs such as remdesivir, ivermectin and therapies like plasma donation could have been promptly accepted or revoked by NCDC, based on the studied evidence. The institution could have also served as a national voice of authority to follow against the cacophony of unsubstantiated recommendations available in public domain.
Cerebral Policy
If there is any good to come out of this pandemic for India’s health system, it could be a spate of reforms to fix the country’s healthcare delivery.
It may involve investing in primary health services, honouring health to be a fundamental right, reimagining Ayushman Bharat, forging publicprivate initiatives and undertaking civil service reforms to better harness the medical community’s talent in public administration.
Viruses like Covid may well become a more frequent affair as India becomes an even more integrated part of a globalised world. The country may soon have to start tracking a clear flu season like many other countries, having a regular vaccination programme to safeguard against Covid and its future strains. But will a pandemic of this calamitous proportion be enough to shake policymakers out of their inertia?
Views are personal
