Can COVID-19 finally bring Public Health to the Centre of Policy Discourse in India?

COVID-19, the Pandemic. Source: www.gcn.com

It was refreshing to watch a half an hour statement by the Union Health Minister Dr. Harsh Vardhan (a medical doctor himself) in the Rajya Sabha earlier this week, invoking a message of preparedness in the tone of ‘Don’t Be Scared, Rather Be Vigilant’ regarding COVID-19. There are signs regarding disease awareness everywhere, from my apartment block in an urban village on the outskirts of Pune by the Municipal Corporation, with preventive measures in Marathi in a poster to the Ministry of Health and Family Welfare landing website, which has been turned in to a single window for health data in with regard to the virus. These are all exemplary measures towards building disease awareness. 

With newer cases reported every single hour, reliable access to health information is often the first step towards safeguarding ourselves, families and communities around us. Reliable is the critical syntax here, as in the age of googling away to glory, the fine line between hearsay and scientifically credible information is often blurred. This is the ‘Post-Truth’ and ‘Fake News’ era after all, where the dynamics of information consumption, either paralyses decision making or spurs us on to take more concrete action, in the batting of an eye lid.

There is an enormous corpus of ready COVID-19 health communication material available on the World Health Organisation (WHO) portals, which are being translated into regional languages by state governments. New Delhi is the regional health office for WHO (SEARO) South East Asia Regional Office as well. India has over the years worked successfully in eradicating communicable diseases such as Polio with WHO assistance and has close cooperation as many Indian bureaucrats are seconded to WHO positions globally as well, including Dr Soumya Swaminathan, the chief scientist at the WHO

Multicultural Singapore has excellent research-based health communication material as well, which India can tap given the close people and government-based linkages. It will be particularly applicable to Tamil Nadu, where Tamil is one of the four national languages in Singapore, and collaboration saves time in a pandemic. The virus does not discriminate against nationalities when it infests us, it attacks humanity and hence these are global moments in which borders should dissolve to foster a cohesive and cogent response, standing together as a species. 

COVID-19 is a global black swan event with 100,000 infections from Australia to the UK. ‘Connectography’ (Dr. Parag Khanna’s book title) entails that globalisation of infrastructure is a boon for business, it however amplifies our vulnerability as complex systems crash when the weakest link in the system gets hit, as Charles Perrow has written in his seminal work named ‘Normal Accidents’. Pandemics such as COVID-19 are the Fukushima and Chernobyl of this decade, only much more dissipated and harder to manage due to the expanded scope, beyond a geography. 

China with its Command and Control system has put Wuhan under a total lockdown which is near impossible and unprecedented in a democratic environment. The stifling information environment in Communist China also contributed to the outbreak as neighbouring democratic Taiwan with an open information culture has managed the outbreak better with such fewer infections. 

Singapore has been praised as the model for tackling the COVID-19 outbreak by the WHO. There is a rationale for this success as Singapore has one of the best funded public health systems in Asia and had cut its teeth during the SARS crisis in 2003. Singapore has a national stockpile of masks for these pandemic situations. 

Each household in Singapore has been given four masks as a measure to calm nerves as an indication that the Government is in control at the steering wheel as there were incidents of panic buying for essentials at supermarkets, and rampant reselling of masks on online platforms at a substantial mark up. Scarcities breed black market profiteering, that is basic economics 101 at play. There are reports of overcharging for masks and paracetamols in India, even though we have not been impacted severely with 56 reported cases as of the time of writing this article. 

The country under Modi ji’s New India vision, has focused on targeted welfare schemes for the poor, where graft and pilferage is curtailed through technology and systemic change in culture, with the ‘Na Khaoonga, Na Khane Doonga’ (I will not accept money, nor I will allow anyone else to accept money) mindset. This approach towards performance-based welfare has a distinct health care focus with building a ‘Modicare’ for India. 

This is a masterstroke for healthcare governance in India. Never has healthcare become a policy mainstay in the country as today. The mix of programs such as ‘Ayushman Bharat’ and ‘Jan Aushadhi Yojna’ are stitching together a vision for affordable healthcare access in India. Universal Healthcare Coverage is a work in progress where myriad characters need to work on the same page. 

The sheer fact that a poor man can get a specialist operation done in a super speciality hospital at no cost, is a moral victory. 

The so-called socialists at the centre also could not achieve this milestone but however a cultural nationalist government achieved this development. Political will is the cornerstone towards delivering better public goods than meaningless rhetoric. 

India has many different typologies of public health systems as a concurrent list subject (federal and state) as public healthcare assets and private hospitals, nursing homes and clinics along with traditional medicine practitioners all configure the highly decentralised and diverse healthcare governance architecture. 

The Kerala Model for Public Health Governance is highly feted as they have exemplarily performed during the earlier well managed Nipah virus outbreak as well. Kerala mandates a 28-day quarantine instead of a national standard of 14 days as a Chandigarh based Community Medicine Expert Dr. Tanweer Rahman MD informed during an interview. Kerala with its social justice centric politics, borrowing a page out of the Cuban system has over the decades has invested heavily in its social infrastructure including a good public health system that pays dividends during emergencies. Higher literacy levels and gendered emancipation all translate to a greater social resilience, which are unquantifiable metrics. 

There needs to be a national health information database where Aadhar and PAN Card databases need to be linked with hospital meta data for quicker response in contact tracing in an infectious disease outbreak. These capacity building measures are long term programs as structural muscle is painstakingly developed in multi-stakeholder environments.

These are capital intensive initiatives, where along with paying salaries and regular operational expenditure, capital needs to be allocated for new pandemic research centres in addition to the National Institute of Virology in Pune as well as training new public health physicians  in a multidisciplinary knowledge systems including Data Analytics, GIS Mapping and Health Communication along with the usual clinical diet for tackling new strains of pandemics. 

A crisis is an opportunity disguised as a blessing for the pivot in thinking and practice towards transformation. The real time response to pandemics often is a result of generational efforts in training for the response. Doctors are not the only community of practitioners who are responsible for managing this crisis. There needs to be private sector involvement as well in financing next generation technology for detection and pandemic linked healthcare infrastructure in a PPP model. 

The media needs to cover healthcare in greater, broader terms apart from the crisis events hogging the headline ticker. Schools need to teach information literacy to kids as the new civics for a digital present. Historians and Sociologists need to understand and write the politics of medicine to prepare effective commentaries for public servants. Computer Scientists are the stars of any pandemic response as their social network mapping, helps detect hotspots to create openings for clinicians to intervene. The SARS outbreak in 2003 created the context for China and any other countries in Asia to prepare better for the next big outbreak. Let COVID-19 be the trigger for India.

Manishankar Prasad

Manishankar Prasad is an environmental engineer, sociologist, researcher and writer. He has studied at the National University of Singapore and Nanyang Technological University, Singapore. He has published across numerous national and international platforms such as the New Indian Express and the Huffington Post, been a panellist on Al Jazeera International and BBC World, and has been interviewed by Forbes and The Guardian.

The views and opinions expressed in the article are those of the authors and do not necessarily reflect the official policy or position of The Tilak Chronicle and TTC Media Pvt Ltd.

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