COVID-19 – Impact assessment and outlook of PPE in India

PPE are the protective gears designed to minimize the risk of exposure to hazards/ infections capable of transmission. These generally include a wide range of products like face masks, N-95 respirator masks, face shields, sterile & non- sterile gloves, coverall/gowns, head caps, shoe covers etc. PPE are largely used by frontline healthcare workers, who are in close contact of patients in critical care areas, areas with infective and immuno-compromised patients who possess possible risk of human to human transmission of infections.

Before the COVID-19 outbreak, the procurement of PPE was never a challenge for any healthcare organization as the demand and supply was adequately met globally, but with the prevailing pandemic situation, like the rest of the world, India too is facing a shortage of PPE. This acute shortage of PPE arose because facemasks and hand sanitizers, whose consumption was largely limited to hospitals/healthcare workers, have suddenly emerged as essential commodities for the community as a whole with all 130 billion in the race to procure them to keep themselves safe. As PPE and its raw material was largely imported from other counties, the cessation of imports is the other critical factor leading to its shortage in India.

As soon as the spread of infection widened, the unethical marketers started parallel black marketing by over stocking of PPEs and hand sanitizers, which led to an artificial shortage in the market; thus the sale price knew no boundaries. A comparison of the price points in pre-COVID and post COVID era is illustrated in the table below.

Taking this as an opportunity for cashing on in the name of virus terror, some unorganized manufacturers jumped into the market and started production of PPE gears. But with the lack of guidelines or standards set by the government for manufacturing PPE, there was an explosion of complaints about low quality and sterilization issues. The doctors claim that the locally manufactured PPEs, sold at exorbitant prices, are of little or no use.

Concerned with the scenario, the Association of Indian Medical Device Industry (AIMED) sought the intervention of NPPA (National Pharmaceutical Pricing Authority), for capping the price and ensuring the quality – with its ramifications on consumers, healthcare workers, and industry alike. Therefore, NPPA vide its order dated March 13, 2020, has directed all the state/UT governments to ensure sufficient availability of surgical and protective masks, hand sanitizers, and gloves at prices not exceeding the MRP printed on the pack size, and to monitor the production and distribution of the above items to ensure that hoarding, black marketing, and profiteering may not happen. It also capped the retail prices of hand sanitizers at Rs 100 per bottle of 200 mL, 2-ply and 3-ply surgical face mask at Rs 8 per piece and Rs 10 per piece, respectively, till June 2020.

The acute shortage of PPE has affected hospitals badly, with the footfalls and occupancy levels going down, the spend on these gears has gone multifold, with hospital pharmacies procuring the PPE at 5x–10x cost and hospital consumption going up to 3x–5x of the pre-COVID times. It is estimated that for a 100-bedded hospital, which was previously spending Rs 1.5 lakh to Rs 2 lakh monthly with a credit period of 60–90 days on the procurement of PPE gears, their current spend has gone up to Rs 8 lakh to Rs 10 lakh on a monthly basis with immediate cash payment.

To ensure there is no shortage of PPE in the coming months, the Central government has ramped up domestic manufacturing of coveralls, and it is expected to go up to 15,000 coveralls per day by the end of May. Also, the DRDO has decided to collaborate with local manufactures to produce 20,000 N-99 masks per day. Some domestic producers have started manufacturing and supplying 50,000 N-95 masks on a daily basis. Indian Railways has also started large-scale PPE manufacturing as a relief initiative, along with the organizations like the Indian Red Cross Society, many MNCs, famous personalities, etc., who have come forward and are actively involved in donating and arranging the PPEs to cope with the current requirement of the country.