10 questions on COVID-19 management that the Narendra Modi government must answer

Prime Minister Narendra Modi at parliament for the first day of the budget session on 28 January 2021. Sonu Mehta / Hindustan Times
28 May, 2021

While the Indian government has been addressing media briefings three times a week, it has not released enough information for scientists, journalists, as well as citizens to protect themselves from the viral apocalypse we are in. Instead, the Modi administration has been engaged in a performance of numbers in which they refer to people in percentages and families broken in mortality rates.

These are 10 questions that the administration must answer:

1. Why is Covaxin, the Bharat Biotech vaccine funded by Indian taxpayers and developed at National Institute of Virology, Pune, not available to citizens for free?

On 25 April, Bharat Biotech announced that it was increasing the price of Covaxin, its COVID-19 vaccine, to Rs 600 per dose for state governments and to Rs 1,200 per dose for the private sector. Meanwhile, the company would continue to sell the vaccine at Rs 150 to the central government, which would be distributed to states for free. A few days later, the company said it would supply the vaccine to states for Rs 400 instead of Rs 200. 

The Indian Council for Medical Research has helped Bharat Biotech in developing Covaxin and has co-funded its research. The National Institute of Virology, which is an ICMR laboratory, performed the critical task of isolating the SARS-CoV2 strain used in developing the vaccine. Yet, the company has claimed in the past that it never took any money from the government and has justified its prices as necessary to cover the costs of development and production. Even if the company has incurred costs, like using an expensive Biosafety Level 3 to make the inactivated virus vaccine, the government should absorb the costs in the middle of one of the worst outbreaks of the pandemic to make sure that price is not a deterrent to getting people vaccinated. 

2. Why did the government delay in making the Pfizer, Moderna and Johnson & Johnson vaccines available in India?

 In the five months since India first started vaccinating people against COVID-19, it has used only two vaccines—Covishield produced by the Serum Institute for India and Bharat Biotech’s Covaxin.  The government then focussed on vaccine diplomacy and exporting these indigenous vaccines rather than make deals to allow the supply of more vaccines to India. The result has been that the vaccine market in India has been under a duopoly despite shortages as infections and deaths have skyrocketed. 

The government has only recently approved the use and is importing a third vaccine—Sputnik V, which was developed in Russia’s Gamaleya Institute and is being distributed by Dr Reddy’s Laboratories in India. The government dragged its feet on approvals for other vaccines. Pfizer had expressed an interest in supplying to India and even applied for emergency use authorisation in December. However, it withdrew its application after the government asked for bridging trials in India as a condition for approval. The government has agreed to do away with this requirement in light of the surge in cases but is now mulling Pfizer’s demand for conditional indemnity. The vaccine may be available in July, according to news reports.  Earlier, the government said that it was in formal talks with Pfizer, Moderna and Johnson & Johnson to supply vaccines to India but that discussions are likely to take place only after August. 

3. Why is the government not using the Rs 35,000 crore budget allocation for vaccination to ensure free COVID-19 vaccines for all?

In February, Nirmala Sitharaman, the finance minister announced Rs 35,000 crore in the budget for  the year 2021-2022 for vaccination alone. Experts have estimated that this amount is enough to procure COVID-19 vaccines and distribute it free of cost to all. Still, the government has opted to deregulate the COVID-19 vaccine market and allow private hospitals to charge as much as Rs 2,000 per dose, leading to vaccine inequity in the middle of vaccine shortages. On 13 May, the Financial Express reported that the centre had spent Rs 4,400 crore of this budget on COVID-19 vaccination. 

4. Why has the centre not capped treatment prices for COVID-19 and nationalised healthcare?

Since the beginning of the first wave last year, prices of hospital beds, medicines and equipment such as PPE kits have risen dramatically. The central government left it to states to cap prices. Several state governments did so and offered free treatment at public hospitals. Prices at private hospitals, which comprise more than 70% of the healthcare sector in India, continued to be too expensive for most people despite price caps. The government could have taken measures under the Disaster Management Act to regulate prices across the country and even declared medical devices like pulse oximeters and oxygen concentrators essential commodities. It could have made treatment uniformly accessible by nationalising the healthcare sector for the duration of the pandemic. 

5. Why has the government not issued compulsory licenses for COVID-19 treatments?

India has seen shortages of drugs to treat COVID-19, such as fabiflu, with every local or national spike in cases over the past year. Yet the central government has refrained from issuing compulsory licenses that can boost production of these drugs and make them more widely available. The Trade Related Aspects of Intellectual Property of TRIPS regulation of the World Trade Organisation allow countries to issue compulsory licences to generic drug manufacturers to make drugs under patent in emergencies. Health experts have been asking the government to invoke these provisions for many months. Even the Supreme Court has asked the central government why it did not consider compulsory licencing. The Indian Drug Manufacturers Association wrote to the government on 12 May to issue compulsory licences for essential COVID-19 drugs. 

6. Will the BJP government relax FCRA restrictions given that the Prime Minister has asked for help from civil society?

On 30 April, Prime Minister Narendra Modi asked government officials to explore involving civil society volunteers in helping the healthcare sector manage the COVID-19 surge. Modi reportedly asked whether NGOs could undertake “non-specialised tasks” to take the pressure off health workers. However, just eight months before this meeting, the government severely constrained the functioning of NGOs by amending the Foreign Contribution Regulation Act, which regulates the use of foreign donations to NGOs in the country. The amendments included disallowing sub-grants from large NGOs to small NGOs and cutting the limit for administrative expenses from foreign contributions from 50% to 20%.   

7. Why did India delay deploying foreign aid?

India began receiving medical aid from foreign countries to help with the 2021 surge in cases from 25 April. However, as various news reports have shown delays in allocating and distributing the material  quickly and effectively. Aid from foreign countries included oxygen cylinders, oxygen concentrators and remdesivir injections. The government, in fact, rejected the United Nations’ offer to use its integrated supply chain that would help with logistics, saying that it already had a robust system to deal with it. 

8. Will the health ministry release actual figures of COVID-19 deaths to the Supreme Court's task force?

India has been recording between 3,000 and 4,000 excess deaths a day during the second COVID-19 wave that began in mid-March. These figures do not account for how the health system has been overwhelmed and for how crematoriums and cemeteries have been overburdened. Reports from across the country have shown undercounting of deaths by various means. This underreporting has caused concern about global pandemic response being derailed. The Supreme Court has set up a 12-member task force to improve the COVID-19 response. The court has asked the central and state governments and other agencies to provide complete real-time data to the task force. More than 200 scientists have also written to the ICMR asking for access to more granular data so that they can work on measures to combat the pandemic. 

9. Why is the Central Vista construction “essential work”?

While the country and the national capital reel under the second wave with devastating numbers of infections and deaths, the government declared the construction of the central vista as “essential work”. Even though Delhi has allowed no construction at this time, unless workers live on site, 180 vehicles have been given permission to ferry workers to the Central Vista site. A petition filed at the Delhi High Court seeking to stop work on the Central Vista has pointed out that the project does not have any features of an essential service.

10. Why does the government continue to list unproven treatments in its COVID-19 protocols?

On 17 May 2020, the ICMR dropped plasma therapy from its COVID-19 treatment guidelines after almost a year of recommending its use in early treatment  of the disease. Trials in different parts of the world had shown that plasma therapy showed little benefit to COVID-19 patients. The guidelines continue to suggest the “off label use” of remdesivir and tocilizumb even though evidence for them is very limited. The ICMR’s guidelines continue to list ivermectin and hydroxychloroquine as “may dos”. There is little data to show that either drug has any effect against COVID-19 and the World Health Organisation has recommended against the use of both. As health experts have pointed out, the use of unproven therapies are not harmless and have potential side-effects, reactions with other medications and cause families of patients anxiety and financial damage.