3.
COVID
INDIAN VARIANT — B1.617
COVID HAS PHENOMENALLY INCREASED THE
INNOVATION IN OUR SOCIETY — science to social
Remember — for Hospitals, Vaccine developers, medicine
companies — due to COVID the demand has shot up so high
that they can recover the cost and make profit but charging
less … learning to even out profits. See, in non-covid world,
the hospital occupancy used to be 60-70% … now its
>100% … so balance
The K curve that Rohit told about — missed out vs. capitalised upon
Over 11 crore returned migrant labourers found job under
MGNREGA in 2020-21 safety net!
Re-infection — its an open scientific debate — there have been some
cases of it happening | the conclusive understanding is important here.
MPLAD and MLALAD funds for COVID | O2 | Charter air India | O2
concentrator can only be procured in large number … aise ek ek ni aa payega
Vaccine Related
Generally it takes 10-15 years for any effective vaccine to be developed …
Covid vaccine was done at historic pace. But still the process is quite complex
and specialised.
65 million/month (May 2021) — 5 from Covaxin and 60 from Covidshield
(SII)
2 ways to work — 1. Increase the immune response 2. Decrease the change of
catching the pathogen itself
Vaccine development — uses Electron Microscope, years of research,
sophisticated scientific models, they make actual |
Scientists have actually modelled the ’spike’ structure (quite imp across all
types of Corona virus family) and separated it and then based the vaccine on
that structure alone.
Importance of Science — the scientists in US and other places were able to
make these vaccines so fast because they had been studying the Corona virus
family from the times of SARS (2002) and in this 18 years of deep study….
They knew much about this new kind of Corona virus and thus able to rightly
identify the cure. All this happened because the research was promoted in
these countries.
Research → Animal Testing (preclinical) → Clinical Trials → (
Phase 1 → Phase 2 → Phase 3) → Approval → Factories and
infra → Manufacturing
Phase 1 — few dozens humans volunteers (healthy) — find the right
amount to be used in the dose
Phase 2 — focus on efficacy | few 100 volunteers … of same demography
Phase 3 — 1000s of individuals | side effects, did they get covid-19? How
severe was it if they got it? | months to years !!!
Why vaccine shortage?
1. Huge demand …. 7 billion people want it and 2 doses (14 billion doses)
and only a handful of manufacturers
2. Developed vs. Developing divide — developed nations have pre-ordered
major chunk of the production, in fact most of the producers are from
these countries … this resulted into a condition where even the WHO-
led effort COVAX failed and merely 1% of the African population has
received thus far.
3. Approvals are not been made to many vaccines due to some kind of
hesitancy over its efficacy or some factors.
4. The developed world is not giving IP waiver to the developing world to
increase the production.
5. Vaccine manufacturing itself is a tedious task and India being a vaccine
hub, is dependent on the raw material from the West. Moreover many
of the raw material, biological in origin, takes time to develop and
highly sophisticated machinery, which cannot be quickened, just like
that. Even if you have funds, it will take time to actually make these
vaccines.
6. Even if license is given to all the vaccine manufacturers, the production
will take several months of preparation to kick-off. For quick
vaccination, importing them seems the only immediate solution.
Why did we export vaccine?
We had 3 main agendas for doing that — showing commitment towards
humanitarian assistance to our friends in trouble | show our commitment
towards global community and since we’re trying to emerge as global leaders,
such commitment is important to gain goodwill and trust | harness long term
diplomatic goals and establish deep relationship, as we helped them in the
time of crisis, as this is explicitly said by French Prez Macron who thanked
India’s role … even WHO commended our work
Indian Vaccine — Covidshield, Covaxin (BharatBiotech) (covaxin is an
inactivated vaccine and takes much longer time to make)
COVAX (WHO) GAVI Alliance — Covidshield-AstraZeneca pact | India has
benefitted under it and also exported to others
US Vaccine — Pfizer, Moderna, Johnson & Johnson | Sputnik-V (Russia) |
Sinovax, Sinopharma (China) | Astra Zeneca (Oxford)
Decentralised Model
Union Govt had allocated Rs. 35,000 crore for vaccine procurement in UB21.
Starting from May 1, states are free to procure their own vaccines directly
from the companies — this has led to problems : 1. Logistical infra of UIP
(centre) is not available now so there is problem, 2. The quantity of order is
now lower and fragmented, thus reduces the state’s bargaining power,
3. Difference in the price of vaccines across states, due to differential
procurement.
Surely we do need decentralised model for lockdowns, identifying
red/containment zones etc .. but for Vaccine procurement, it has to be
centralised to ensure uniformity and higher bargaining power against the
companies. Now States are floating Global Tenders to get vaccines, at their
level.
SC has also raised this issue of inter-state disparity in vaccine prices.
Compulsory Licensing
Compulsory licensing refers to the use of a patent without the authorisation
of the patent holder. This is generally given in times of crisis (mostly health)
and after due deliberation with the original patent holder (time taking
process). The Covid-19 conditions do not allow such luxury on time.
Compulsory licences need to be issued fast for enabling Indian companies to
make patented vaccines and critical drugs.
The WTO’s rules allow countries to issue compulsory licences to
domestic producers for manufacturing patented drugs and other
products. This is allowed under situations of serious public health
concern.
India’s Patents Act of 2005 provides for issue of compulsory licences in
public health emergency. In past India had used this to make some
Kidney cancer cure drug which was originally patented by German
company.
The Supreme Court has asked the government to explore the possibility
of issuing compulsory licences under the Patents Act of 2005 for locally
producing critical drugs like Remdesivir and Tocilizumab for treating
Covid-19 patients. Various High Courts have also asked to look out its
prospects.
Indian Patents Act 2005 is WTO compliant with reference to
Compulsory Licensing
Why isn’t India adopting CL? — As of now this CL under Patent’s Act can
only be applicable to Covaxin of Bharat Biotech and NOT to Covidshield as
its patent is with Oxford and AsteraZeneca of UK. Further, as Covaxin is an
inactivated vaccine, it takes a long time to make it …see only 5 million out of
monthly 65 million vaccines are Covaxin … so even if CL is used now, it
won’t be able too much of a difference. This is also why we along with South
Africa are pushing for IP waiver from WTO.
Honestly I don’t know this but I believe there has to be some strong reasons in
the fine lines of this process which is holding us back. Now that SC/HC have
asked, GoI should seriously look for its prospects.
COVAX
Under the COVAX program, over 2 billion doses of COVID-19 vaccines are
expected to be delivered by the end of 2021.
COVAX program led by — GAVI, WHO in collaboration with UNICEF and
World Bank — Aim : equitable distribution of COVID vaccines globally |
vaccinate 20% population in low-middle income country, not able to afford
(GNI <$4000)
Funding Target — around $7 billion || 2021 aim — vaccinate around 550
million people
GAVI — Global Alliance for Vaccination and Immunisation | 2000
Vaccine Alliance, helps vaccinate almost half the world’s children against
deadly and debilitating infectious diseases.
Dr. Harsha Vardhan nominated as member of GAVI Board
Brings public and private sector | Bill and Melinda Gates Foundation
One Health Concept
Its a inter-disciplinary collaboration of looking at health from integrated
aspects of Humans, animals and environment. It identified zootonic diseases,
AMR, food security and health threats are interrelated. This concept is used
by FAO + WHO.
Covid has shown how zootonic diseases can escalate into pandemic. Due to
land-use pattern change, climate change etc disruption of habitats and passing
of new diseases to animals happen. As population is increasing, more and
more people are living in close proximity and also close to animals, often on
their land — thus more opportunities for disease to transfer both ways.
Furthermore due to easy cross-border travel, international trade and
commerce, the disease from one place can rapidly spread out to far out places
and thus eventually escalate to a pandemic, as happened in COVID.
India’s priorities in post-COVID world —
multidimensional
Domestic
1. Significantly upgrade the healthcare infrastructure and system …
increase spending and open more seats in colleges
2. Look out for options to revive the economy, focussing on MSME revival,
job creation, agri support
3. To revive the animal spirits in the market and attract more investment
give series of incentives, tax benefits …. Reducing the direct tax rates
can also be looked for.
4. Look out for innovative ways to make up for the loss of education to the
students, esp from underprivileged sections … give some relaxation in
promotion, restructure the curriculum to ensure critical knowledge is
provided, which was lost in covid. Prospects of Digital education should
be looked upon …. All this could be done under NEP 2020
5. Women empowerment programs … incentivise their participation, mass
awareness and financial empowerment … as covid had a
disproportionate adverse impact on women.
International
1. Strengthen our diplomatic reach out programmes under Vaccine Maitri
and otherwise to earn massive goodwill.
2. Push for favourable FTAs, both with the West and the East … FTA with
UK and a parallel mechanism to RCEP can be looked into
3. Push for multilateralism and reforms in the working of international
agencies, esp after when we saw the poor response of WHO towards
Covid.
4. Focus on One Health Framework — data sharing, collaboration, IPR
5. Increase our role in the global issues like fight against Climate Change,
Big Tech regulation, Geopolitics
COVID-19 RELATED
Remdesivir Issue
Its not being available at many places, including hospitals …. Following which
a massive black marketing, fake drugs, hoarding has resulted in massive upshot
of the prices … adding to the woes of the covid patients
Bombay HC has asked the state to include Remdesivir under Scheduled List
Drugs and regulate its prices — hearing a PIL
Liberal interpretation of Drugs and Cosmetics Act 1940 allows this —
restriction or regulation of prices of a drug that’s essential during a
natural calamity or epidemic. Even the Drugs Control Act, 1950 allows
this regulation.
Both these acts allow the Central govt to issue a notification to fix rates
of essential drugs during an epidemic.
Doing this will — stop black marketing, hoarding, put stop to extortion
of money from covid patients.
HC also asked the Centre to use the powers under Disaster Management Act
2005 and Epidemics Act 1897 — to centralise all the purchasing of covid
related medication at an appropriate price and DO AWAY with the time
consuming tender process — “if the state doesn’t rise to the occasion of this
disaster, then it would be falling in its duty to protect human life”.
Disaster Management Act 2005 and Covid-19
Constitution is silent over ‘Disaster’ … the legal basis of DM Act is
Entry 23, 29 of Concurrent List
All the lockdowns at pan-India level are done using this Act.
PM is the Chairman of NDMA
National DM Plan 2019 extensively dealt with Biological disaster and
Health Emergency.
Section 6 of the DM Act provides extensive powers to the Centre
Center can issue ANY direction to ANY authority ANYwhere in
India to facilitate disaster management. Thus Centre can issue
direction even on the State list subject.
Moreover any direction by the Centre HAS to be followed by
State Govt.
Thus using DM Act, Center can virtually direct States to do anything it
thinks that is necessary for DM.
The
Divide!!
Procurement and logistical
issues as govt cannot use UIP infra (cold chains) now
Covid at rural areas — need local leaders, community leaders, religious
figures to come up and appeal to masses
MUMBAI BMC MODEL TO TACKLE 2ND WAVE
Worked upon the infra and systems from the 1st wave and upgraded
them … Jumbo Centres with O2 facility.
Collaborated with the GoI to get the O2, as the crisis kicked in, from
Jamnagar (regular overnight supply) and then went on to build more
and more O2 plants …. Now moving towards self sufficiency
O2 management issues —
dedicated supply management with clear marking of the people
responsible for tanker movement, custody
ask civic bodies not to pressurise the hospital to suddenly increase
beds as there is no steady O2 supply to these hospitals for
additional beds … rather, follow Mumbai model, and only
increase the beds in the Jumbo Centres which already have high
O2 supply
Focus on building more Jumbo centres with in-house O2 plants
like in Mumbai .. more than 70% new bed are O2 beds.
O2 that is available should be optimally used and leakages have to
be reduced … eg. Mumbai after consulting the docs have focussed
to maintain the spo2 level at 94 and not 97-98 … thus saving O2
… moreover high-flow nasal oxygen is a guzzler .. don’t give it to
everyone just because you have O2 … use more optimised
methods
O2 containers CANNOT be airlifted … they might explode due to
Pressure change
Model to call the corporate houses, housing societies, offices to sign
MOU with the hospitals so that these offices provide the space to
conduct the vaccination drive easily….. hospital will provide the
personnels and vaccine vials. eg. Bombay HC using this model got its
1100 people vaccinated in a day.
There has to be sharing of experience and successful models among
each other …. Mostly at the bureaucratic level … so that people learn
to tackle this pandemic, collectively. Its new for everyone … we have to
learn as we tackle …so info sharing becomes imp. eg. Karnataka took
advice from BMC about ward war rooms, jumbo centres, ambulance
management etc and now implementing.
GST complete exemption on COVID products can be
counterproductive — if GST is removed then the companies won’t be able to
take benefit of Input-tax credit and pass on to the customers, thereby
increasing the costs. So a minimal token 5% GST is levied on the Covid
products. Moreover custom duties, health cess etc are already removed from
these products.
Taiwan Model to tackle COVID-19
Their model came out to be one of the most successful in tackling
COVID-19 despite being in such close proximity with China
Their experience with the 2003 SARS outbreak came out very handy
Post 2003 experience they made nationwide infections disease
healthcare network, which provides the legal authority for
transferring patients with highly contagious disease to designated
facilities. This allowed to protect healthcare system and health
professionals from being overwhelmed and allowed the non-
COVID health services to continue. This time in 2020 with the
identification of early first cases of COVID, the govt came in swift
action and was very very serious about it.
Public Trust in the govt, balance between people privacy and
people’s right to know, focus on reasonable response focussed on
minimum damage, containment zone from beginning to balance
quarantine and normal functioning, upheld the principle of
fairness and specialised attention to the disadvantaged groups,
including migrants.
Taiwan also through this sends out a message to the world and WHO in
particular to acknowledge its success story and its willingness to help out
others. It has to include Taiwan in the WHO and its meetings …world
need to support Taiwan to get into the world affairs. Taiwan is quite
interested in contributing as equal member to international community
for achieving the UNSDG.
Dr. Randeep Guleria — AIIMS Chief on COVID
surge 2021
Vaccination is just one of the strategy to tackle COVID — given the
kind of society we have here, we need to have 2-3 parallel strategy
running simultaneously — because preventing people crowding,
without complete lockdown, is very very difficult. — people seem to
be oblivious to covid-appropriate behaviour.
The 2nd wave is much more steeper than the 1st one and as of now
its assumed that mortality rate will be lower. Moreover more such
waves are to come again and again … covid isn’t going away soon.
We need to learn to live with it — change our lifestyle, include
wearing masks, washing hands etc — soon covid will lose its
pandemic nature and will become an annual endemic … like a
seasonal flu … but it is to around for a while.
On Re-infections — there is lots of speculations and hypothesis on
this without much empirical data to conclusive tell. Its a question of
study that whether the antibodies formed within covid-recovered
people stay for lifetime to just for few months.
There is a lot of vaccine-hesitancy among healthcare workers —
since they always remain in contact with covid patients, the believe
that they already had got asymptotic covid and have developed
antibodies … so no need to get vaccine. Moreover many also get to
see the debate around vaccine quite closely and read up information,
which again push them away.
Bihar Paradox — how a full fledged election in Bihar with next to
zero covid appropriate behaviour by people, failed to translate into
any significant covid surge. There were appropriate number of tests
also happening … its just that people didn’t get it. Some say that
because of massive return of migrant labourers, people already
developed herd-immunity. But this is a question of paradox.
RBI’s Prediction — GDP to contract by (-)9.5% with risk to
downside.
India and Post-COVID World
First such after 1930s Great Depression and WW2
The BARBELL STRATEGY (Economic)
Two central problem — uncertainty and paucity of information
Hedge first for the worst-possible outcome while progressing step-
by-step as more and more clarity comes in.
Initial Pan-India Lockdown = hedging against worst possible
outcome — gave time to arrange medical equipments, masks,
testing facilities etc
Then slowly unlocking kicked in, step-by-step, in a phased manner
— info and medical capacity increased
In economic response also Barbell strategy — cushion to the most
vulnerable segment of society and MSMEs
Cash transfers to PMJDY, free ration, loan moratorium, govt
guaranteed loans to small enterprises etc
Now with complete unlocking of economy — focus on
Infrastructure investment — monetary and fiscal space exist for
this push — carefully calibrated monetisation is required
Adapting to Post-covid world
There will be new — geopolitics, supply chains, tech innovation,
world order, corporate structures
Two main focus area now — FLEXIBILITY AND RESIDENCE
— since we still don’t know much about the future … so avoid
rigidity
Agri reforms — no more labelled as hoarders — freedom to
stock
Central labour laws — more accommodative and pro-
business
Emphasis on resilience — Atmanirbhar Bharat
Open up more for FDI — engage more on GVC
Institutional and infra reforms — build self-resiliences
Persuing national interest unapologetically and boldly … eg.
RCEP
Leverage internal strengths
Administrative Structure and Legal Reforms — digitisation of
records | reformed and faster judiciary | arbitration
ECONOMIC REVIVAL
Pre covid — slowdown phase 4.1% (lowest in over a decade) | FRBM’s
‘escape clause’ was invoked 2 consecutive years | First Quarter of 2020-
2021 registered -23.9% (decline) | ONLY Agri sector showed a 3.4%
growth in the period (saviour)
Actions Taken
1. RBI — policy rate cuts | pumped liquidity | Loan Moratorium |
Ways and Means Advances to State Govt | Credit Guarantee
Schemes
2. Govt — Rs. 20 lakh crore stimulus package — large scale
structural reforms | Atmanirbhar Bharat Package | Downside is
that its just 1.5 % of GDP … can be more
1. Manufacturing Hub — 4 Ls - Land, Labour, Liquidity, Laws
reforms
2. 5 Pillars — Economy, Infra, System, Demography and
Demand
3. MSME schemes, KCC, MGNREGA
4. MSME definition updated — Micro (I = 1cr | T = 5cr) |
Small (10,50) |Medium (50, 250)
5. Product Linked Incentive
6. Make in India 2.0 — 15 Champion Sectors like FPI, Textile
7. National Infra Pipeline of Rs. 100 lakh crore
3. Recovery — Govt predict it to be V shaped but many economists
put this as “smoking pipe” shaped recovery — sharp decline and a
prolonged recovery at later stage| GST collections are now back
at pre-covid levels which suggest signs of recovery
Post COVID Industrial Policy
1. Make in India for the World — reduce dependence for API |
consumer and defence goods | employment
2. Quality — competitive at world
3. Infrastructure augmentation and reducing logistics costs —
competitive
4. EoDB reforms — collaboration |faster GRM and DRM |
competitive
5. IR 4.0 capitalise | tech innovation revolution | Digital India |
Data Protection
6. Labour Reforms — pro-business | respect to wealth generators |
No to stigmatised capitalism
Agriculture Sector
1. Unprecedented reverse migration — rise in disguised employment
| land fragmentation
2. PM KISAN — Rs. 2000x3
3. NREGA wage rate revised
4. PM Gareeb Kalyan Yojana — vulnerable people in distress period
— cash and food assistance in informal sector under PM CARES
fund
5. NABARD extended additional Rs. 30,000 crore for crop loan
requirement
6. 25 lakh new KCC
7. PM Gareeb Kalyan Rozgar Yojana — to provide employment to
returned migrant labourers
8. Interest subvention | Loan moratorium
ETHICAL ISSUES WRT COVID
1. Public service vs. Private safety — Doctors | IAS/IPS
2. Election duty during Covid | esp police
3. At hospitals — whom to give the bed | to go to duty into the COVID
ward knowing that you may also catch it and even die on duty
4. Vaccination priority — whom to give first?
5. Vaccine nationalism — rich vs. poor divide among countries
6. Political ethics — centre vs. states — no misuse of power
7. Domestic — laying off your maids/helpers after years of service
8. Businesses — laying off old employees as business has stopped now
9. Cremation of dead bodies
UP Response to COVID
1. WHO lauded UP Govt’s response to COVID
2. Contact tracing was done efficiently
3. In January-March 2020 itself UP Govt planned to set-up 10-bed
isolation ward in every distt. Hospital and increased vigilance at
airports and Indo-Nepal Border.
4. By March a strict quarantine rule was mandated for any foreign
travellers and closed public places to prevent public gathering.
5. Welfare work — paid leaves to workers under Epidemic Act 1897 |
free ration for sometime to around 1.65 crore workers and daily wage
workers | Cash transfer to about 40 lakh construction workers and
street vendors.
6. Lockdown — very strict personnel presence and implementation |
multi-levelled management committees and constant feedback to
tweak the policies based on on-ground evidences
7. Funding — UP Covid Care Fund | 30% salary deduction in
ministers/MLA/MLC | Developmental work was cut down to save
1500 crore | doubled the Contingency Fund to 1200 crore
8. Demarcation of areas — Zones | Hotspots | strict surveillance
9. Essential services — display the price list | limited quantity can be
bought | PDS was made universal w/o Aadhar/Ration card for
some time
10. Migrant management — provided basis necessities at home | register
them, keep a look, quarantine | Nodal officers from Admin and
Police were put in place as POC
