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A plea for reform and transparency

In their words, “It is unrealistic to expect that Covid-19 pandemic can be eliminated at this stage given that community transmission is already well-established across large sections or sub-populations in the country.

Bharat Dogra | New Delhi |

In the recent debates on Covid-19 in several countries (such as Germany, Norway and the USA) several senior scientists have questioned establishment views and sought important policy reforms. Some associations and networks of scientists and doctors have also taken important initiatives for this. In the process, important areas of policy reform and change have opened up. It is good that this process has also started in India.

Professional associations of scientists and doctors have started coming forward to present independent assessments of the situation, pointing out lapses and suggesting important reforms. An effort along these lines that has been receiving attention recently has seen the coming together of three important associations.

A Joint Task Force of eminent public health experts of India was constituted by Indian Public Health Association (IPHA) and Indian Association of Preventive and Social Medicine (IAPSM) in April 2020 to help the Government of India for containment of Covid-19 in the country. Subsequently, the Indian Association of Epidemiologists (IAE) also joined the Task Force.

This Task Force released an important statement on May 25. This statement has pointed out that India’s efforts could not achieve the desired success as the best available expertise on the subject were not utilized adequately. The statement says, “India’s nationwide ‘lockdown’ from March 25, 2020 till May 30, 2020 has been one of the most stringent; and yet Covid cases have increased exponentially through this phase, from 606 cases on March 25 to 138,845 on May 24.

This draconian lockdown is presumably in response to a modeling exercise from an influential institution which was a ‘worst-case simulation’. The model had come up with an estimated 2.2 million deaths globally. Subsequent events have proved that the predictions of this model were way off the mark. Had the Government of India consulted epidemiologists who had better grasp of disease transmission dynamics compared to modelers, it would have perhaps been better served.”

Further the statement says, “From the limited information available in the public domain, it seems that the government was primarily advised by clinicians and academic epidemiologists with limited field training and skills. Policy makers apparently relied overwhelmingly on general administrative bureaucrats. The engagement with expert technocrats in the areas of epidemiology, public health, preventive medicine and social scientists was limited. India is paying a heavy price both in terms of humanitarian crisis and disease spread.”

In a sharp critique of the existing approach, this statement of senior scientists and doctors says: “The incoherent and often rapidly shifting strategies and policies especially at the national level are more a reflection of ‘afterthought’ and ‘catching up’ phenomenon on part of the policy makers rather than a well thought cogent strategy with an epidemiologic basis.”

An important point made in this statement is that the cost of lookdown in terms of the denial of health care to other patients and worsening of unemployment has been very heavy.

The statement says, “as the mortality attributable to the lockdown itself (primarily because of total shutdown of routine health services and livelihood disruption of nearly the entire bottom half of the Indian population) may overtake lives saved due to lockdown-mediated slowing of Covid-19 progression… Ample evidence has emerged that the human cost of disruption of routine health services specially for terminally ill patients, those with life threatening catastrophic health events like myocardial infractions, stroke, chronic infectious disease like TB and preventable measures like immunization have far outweighed the deaths due to Covid-19.

The brunt of disruption of health services may even be higher in days to come.” On the basis of this observation this statement recommends strongly that all serious patients should start getting proper treatment immediately. Another important aspect of this statement is that it has placed great emphasis on transparency.

More specifically its recommendations state, “All data including test results should be made available in public domain (unlinked anonymous) for the research community (clinical, laboratory, public health and social sciences) to access, analyze and provide real-time context-specific solutions to control the pandemic. A Public Health Commission with task-specific Working Groups may be urgently constituted to provide real-time technical inputs to the government.

The opaqueness maintained by the Government of India as well as state governments in the context of data so far has been a serious impediment to independent research and appropriate response to the pandemic.” These associations of scientists and doctors have emphasized that overall much higher resources have to be made available for public health.

Their recommendations say, “The historic and systematic neglect of public health as a discipline and non-involvement of public health experts in policy making and strategy formulation has cost the nation enormously especially in the current pandemic. Rapid scaling up of public health (including medical care) – both services and research – should be done on a war footing with an allocation of 5 per cent of GDP to health expenditure at Centre and state level.”

This recommendation has a strong immediate context also as these scientists say that the present situation is an extremely serious one. In their words, “It is unrealistic to expect that Covid-19 pandemic can be eliminated at this stage given that community transmission is already well-established across large sections or sub-populations in the country. No vaccine or effective treatment is currently available or seems to be available in near future (there are a few promising candidates though).”

These scientists offer a wider vision of how the overall outlook of humanity needs to change. These observations also deserve our attention. The statement says, “Nature has once again reminded us of our tenuous situation in the wider universe. It is high time that humankind takes note of the warning signals and undertakes midcourse corrections urgently and now.

The “One World One Health” approach should be central in ensuring optimal harmony amongst all humans and animals of the world based on principle of “Vasudhaiva Kutumbakam” (The entire world is one family). Being respectful and mindful of all animate and inanimate beings of this planet is the way forward in the post-Covid-19 world.” The writer is a freelance journalist who has been involved with various social movements.