Centre stalls demands of protective-gear manufacturers; HLL retains procurement monopoly amid COVID pandemic

Emergency procurement of personal protective equipment—or PPE—such as masks, gloves and respirators for healthcare workers, remain stalled. PPE manufacturers are opposing the Indian government’s decision to centralise procurement through HLL Lifecare Limited, a government-owned company that has been granted the monopoly over the procurement of PPE kits. Officials from the ministry of health, the ministry of textiles, and representatives of HLL met twice on 23 March to iron out problems caused by the monopoly, the delays in supply of PPE kits, as well as lockdown. Yet, there does not appear to be any resolution so far.

According to PPE manufacturers, the process of procurement laid out by the Indian government requires every PPE manufacturer to send the PPE kit to HLL, which will then assemble it and send it forward to the different state and central hospitals treating COVID patients. This unwieldy process has created a bottleneck of medical equipment that is urgently needed by India’s healthcare workers.

“They want us to supply coveralls to HLL, to be assembled and sent it back to different states,” Sanjiiiv Kumar, the chairman of the Preventive Wear Manufacturers Association of India, said. “We are getting frantic calls from doctors who need the kits now. Do you think we have the time for this process? Everything is under lockdown and we can barely move our material. We cannot supply to HLL and perpetuate the centralisation of procurement. We are not here to do business as people die.”

“There are many anomalies in the procurement process,” Malini Aisola, the co-convenor of the All India Drug Action Network, a health-sector watchdog, said. “The subsequent failure to obtain stock makes that amply clear. HLL and the coordinating government agencies have gambled with the safety of health workers. They have already jeopardised India’s COVID-19 response.” Aisola was unequivocal in stating that “HLL must be removed as the monopoly agency to supply PPE.” She added, “The health ministry must take charge in recommending minimum specifications and prices, issuing guidance to state governments which can also be utilised by private hospitals. It should also set up a central monitoring mechanism to rapidly respond to requirements, and shortages from different parts of the country.”

On 22 March, The Caravan reported that India had failed to create stockpiles of PPE required for healthcare workers despite the World Health Organisation issuing guidelines to do so as early as 27 February. Making matters worse, the government did not ban the export of raw material used to make PPE kits until 19 March, triggering massive shortages in the market, as manufacturers continued to export the material to other nations that were stockpiling.

During a press briefing on the day after The Caravan published the report, Lav Agarwal, the joint secretary in the health ministry, said that he was not aware that WHO had issued such guidelines. “Where is this WHO report where India was advised to take these steps?” Agarwal asked. Pertinently, The Caravan’s report did not claim that the WHO had issued guidelines specifically to India. But the guidelines, titled “Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19)” were issued by the WHO on 27 February, and are available on its website. But Agarwal continued in the press briefing, “We have not received any such advisory. This is rumour mongering and fake news.” Agarwal did not answer a follow-up question about the insufficient number of PPE kits in India.

The day after The Caravan’s article, the textile ministry also issued a statement noting that “certain sections of the media are spreading misinformation on the efforts of the Government in augmenting the supplies” of PPE. The ministry stated that it had spent the last 45 days “attempting to locate adequate number of sources who can produce and supply the requirement of Body Coveralls for the government.” The ministry claimed that the coveralls were a “specialized protective suit” with “stringent technical requirements as prescribed by Ministry of Health & Family Welfare.”

However, the WHO’s guidelines on PPE, issued on 27 February, specifically emphasised that “coveralls (sometimes called Ebola PPE) are not required when managing COVID-19 patients.” It noted that COVID-19, unlike Ebola, was a respiratory disease and as such had different requirements from the protective equipment needed for Ebola. As a result, the “stringent technical requirements” followed by India appear unnecessary, and needlessly resulting in shortages.

According to Kumar, the health ministry has also insisted on unnecessarily technical requirements for the gowns. Due to growing shortages, Kumar explained, most countries are using PPE kits with single-use gowns, which is not fluid resistant. He added that countries have now started using an additional water-proof apron over the gown, in order to combat the risk of droplet infections that can travel through respiratory transmission. In its 27 February guidelines, the WHO, too, recommended that “aprons should also be used if gowns are not fluid resistant.” Meanwhile, the specifications published by the HLL on its website demanded fabric testing of the PPE gowns, for synthetic blood penetration, which has effectively limited India’s capacity to meet the current shortage of protective equipment.

The textile ministry also emphasised that “the export ban on Body Coveralls and N-95 Masks has been in force since 31st January 2020, a fact in contravention to the misleading information published in the media.” The Caravan’s article did not claim that the export ban on these two products had been removed. In fact, it specifically stated that the government’s “notification banned the export of specific PPE, but not prevent the export of raw material used to make the PPE.” The textile ministry’s response does not address why manufacturers were permitted to export raw material to other countries that were stockpiling PPE during the pandemic, instead of doing the same for India’s healthcare workers.

Meanwhile, the HLL’s monopoly now threatens supplies to India’s premier medical institutions such as the All India Institute of Medical Sciences. On 6 March, Jitendra Arora, a director in the health ministry, wrote to every AIIMS in the country—in Bathinda, Bhubaneswar, Jodhpur, Raipur, Rishikesh, Nagpur, Raebareli, and Bhopal—informing them about HLL’s role in procurement.  “HLL will be the procuring agency for emergency procurements concerning nCorona virus management / treatment for next three months w.e.f. from 20.02.2020 or till further order, whichever is earlier,” Arora wrote.

Ten days later, Adarsh Pratap Singh, the president of the AIIMS Resident Doctors Association, wrote to the institute’s director, Randeep Guleria, expressing concern over the shortage of PPE in the country’s premier hospital. Singh wrote that “RDA executives inspected various wards to check the supply of PPE” at around 11 pm on 15 March, and found that “most of the wards do not have adequate universal precaution components.”

Evidently, the crisis of shortage is still continuing. “The supplies to institutions such as eight AIIMS hangs in balance because HLL has been selected as the procurement agency for next three months, with effect from 20.02.2020,” Aisola told me. “The need of the hour is to ramp up production of PPE kits and components on a war footing.” As of 8 pm on 23 March, the number of COVID-19 cases in India had risen to 471.