Looking ahead to 2022

The contextual scenario between the first two waves is different today when a majority of the population is vaccinated and has developed natural immunity due to Covid infection. Yet, cases are multiplying, even among those with double vaccination and a previous history of viral infection, albeit with reduced virulence and strength. In other words, while Omicron is causing infections, its impact is weaker, leading to the belief that the strength of the virus is getting depleted. With life disrupted and fear and uncertainty gripping every one’s mind, we would like to believe that we are perhaps seeing the end of this tunnel.

With viral onslaughts expected to return, perhaps in a more aggressive form, it is time to step back and consider what next. India has never paid attention to the health and well-being of the people, believing that with incomes, individuals will consume nutritious food and make choices that will make them healthy. That is not the case and state interventions through intelligent policy is critical. While India has over the past two decades made progress on key indicators like maternal, infant and child mortality, yet, the rising disease burden on account of non-communicable diseases like diabetes, hypertension, mental health, vascular diseases and cancers, and some communicable diseases, namely, TB is a cause for concern. And over the past two years, due to the sole preoccupation with Covid, diagnosis and treatment of non-Covid diseases has taken a heavy toll of life due to delay and denial of service. Data needs to be analyzed to assess the damage that Covid has left behind in its trail on the lives of those affected and unaffected by it.

What clearly emerges from the disastrous experience of the Covid pandemic, when an estimated 3 million people have died, is that India can no longer ignore health and continue to assume that healthy well-being will sort itself out. Government has to intervene and it is hoped that in 2022, it will take a comprehensive stock of our current status and draw up a vision for the next decade.

My list of must-do for the government is as under:

• Increase in real terms health budgets to strengthen the primary and secondary healthcare system with the three critical inputs of capital infrastructure, human resources, and diagnostics.
• Pay attention to public health by decentralization of disease surveillance to community levels. Our surveillance system is weak and unable to cope with the tracing, tracking, and communicating to communities vital information required to arrest and cope with infectious diseases. Much more needs to be done to collect, collate, integrate, and interpret data for communities to be alert and take preventive action. This is key to building resilient communities – not panic reaction of stalling all economic and social life in terms of lockdowns.
• Prioritize investment on public laboratories and bring all public and private laboratories up to given standards and networked, weeding out at the same time unviable and poor-quality labs. Such capacity strengthening is critical. It may be recalled how we lost crucial months in getting such a decent network set up for scaling up testing, including genomic sequencing. We also need upgradation of laboratories to keep pace with the needs of the increasing complexity of the disease burden. We have also been overly dependent on imports for testing kits or vital components for manufacture of vaccines. It is important that the government invests in research, and aim to become a manufacturing hub for medical diagnostic and laboratory testing devices as well as kits.
• Even as we scale up investment in strengthening the research and service delivery infrastructure, there is equal need to work toward institutional reforms. It is time for the CDSCO, the NCDC to be made autonomous and strengthened technically to play an independent role. There is also a need to constitute a full-fledged Department of Public Health so as to ensure focus, policy attention, and resources to the rapid development of the public health capacity in the country at all levels of governance – epidemiologists, biostatisticians, virologists, microbiologists, cytologists, etc. Their inadequate presence has clearly impacted the manner in which India handled the pandemic.

Since the virus is here to stay and another pandemic can be a real possibility, there is need to focus on public health, and a department dedicated to this issue will enable building the required networks between public, private, and academic institutions, drive scientific research unalloyed with politics and in collaboration with related departments, and have the much needed broader and holistic perspective to health and well-being by focusing on behavior change, prevention and promotive health. For designing such transformative changes, government would be well advised to constitute a Commission to come up with appropriate recommendations.

The bottom line is to ensure that India does not suffer ever again and go through the trauma that was witnessed in 2021. We certainly have the knowledge and capacity to do better.