India did not stockpile COVID protective equipment for health workers despite clear WHO guidelines

22 March 2020
The India government took till three weeks after the World Health Organisation issued guidelines about a disruption in the supply of personal protective equipment for healthcare workers before it completely prohibited its export.
Rafiq Maqbool/AP Photo
The India government took till three weeks after the World Health Organisation issued guidelines about a disruption in the supply of personal protective equipment for healthcare workers before it completely prohibited its export.
Rafiq Maqbool/AP Photo

On 22 March, as 1.3 billion Indians imposed a curfew on themselves, at the request of Prime Minister Narendra Modi, health workers continued to struggle with the slow-rising horror that India had failed to create stockpiles of personal protective equipment, or PPE, such as masks, gowns, and gloves in the past two months. Modi had called upon the nation to impose the “janata curfew” on 18 March, urging them to make noise from their balconies to support India’s health workers. But it was only the next day that the Indian government issued a notification prohibiting the export of domestically manufactured PPE, three weeks after the World Health Organisation issued guidelines informing countries to expect a disruption in the supply of PPE.

As early as 27 February, the WHO had issued the guidelines, noting, “The current global stockpile of PPE is insufficient, particularly for medical masks and respirators; the supply of gowns and goggles is soon expected to be insufficient also. Surging global demand − driven not only by the number of COVID-19 cases but also by misinformation, panic buying and stockpiling − will result in further shortages of PPE globally.” As described in the WHO guidelines, PPE includes gloves, medical masks, gowns or coveralls, and respirators, such as  the N95 masks. Yet, the Indian government waited till 19 March to issue a notification prohibiting the export of domestically manufactured PPEs and the raw material for the same.

Perhaps the most disturbing aspects of the government’s decision-making process has been the bizarre progression of developments with respect to PPE, as they watched the pandemic approach. On 31 January, one day after India reported its first COVID-19 case, the government’s directorate general of foreign trade issued a notification prohibiting the export of all PPE. But in just over a week, on 8 February, the government amended that order, permitting the export of surgical masks and all gloves. On 25 February, by which point Italy had reported 11 deaths to the virus and over two hundred cases, the government further relaxed the restrictions, allowing eight new items for export. It is inexplicably clear that the Indian government did not make the necessary attempts to forecast the demand for PPE kits, as had been recommended by the WHO. As a result, India’s doctors and nurses have paid the price and will continue to do so, as they walk into this public-health nightmare without adequate gear to keep them safe.

Decisions taken by health ministry, the textile ministry and a government-owned company called HLL Lifecare Limited in the past two months have alarmed health activists and health care workers alike. Several manufacturers have told me that the Indian government has granted HLL a monopoly over procurement of PPE, which has since been selling the equipment at inflated prices. The decision made little sense amid the growing public-health crisis, given that HLL is currently not manufacturing PPEs. As a result, by awarding the company with a monopoly during this crisis, HLL has effectively been given free reign to assemble PPE kits from other suppliers, which it has then been selling at Rs 1,000 per kit. Meanwhile, manufacturers of the same PPE kits told me that they could supply the same at costs between Rs 400–500 if permitted by the government. Moreover, the assembly of kits causes further delays. 

The price gouging has alarmed health activists. Malini Aisola, the co-convener of a non-profit industry watchdog called the All India Drug Action Network, told me that the AIDAN would be writing to the prime minister on 23 March demanding that the HLL be immediately removed as the nodal agency for the centralised procurement of PPE.

Vidya Krishnan is a health journalist based in Goa. Her first book, on the rise of antibiotic resistance and the threat to global health security, is slated to be published in 2020.

Keywords: COVID-19 healthcare Narendra Modi public health
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