India’s Near Flawless Management of Pandemic: Dr Amit Thadhani

Dr Peter Hotez, Dean National School of Tropical Medicine, at Baylor College of Medicine in Housten, has recently said India’s huge efforts in combating the global pandemic is a story that is not really getting out in the world. A physician-scientist, internationally renowned in the field of vaccination, he says that the Vaccine is India’s gift to the world. So far 38.9 Million COVID-19 vaccine doses have been administered till Day 62 of the world’s largest vaccine drive.

Dr Amit Thadhani, a consulting general and laparoscopic surgeon practising in Mumbai and Navi Mumbai, has been at the frontline of the Indian pandemic situation. His home state has been the most badly affected by the virus. Dr Thadani strikes an optimistic note about the way India has dealt with the situation.

He writes: As the nation’s COVID vaccination program takes off in earnest, a most striking feature has been the near-flawless conduction of the program at government hospitals as well as outsourced COVID facilities. The government’s rollout has received a staggeringly high 97% positive rating by healthcare workers, who were the first to receive the vaccines in the country. This kind of positive feedback for a public healthcare program is unprecedented in our country. (Even) Film personalities have also been spotted availing vaccination at government facilities.

It is known that Indian is a much favoured destination for treatment for countries where patients have a long waiting time for medical attention. Writes Dr Thadhani: “This is probably the first time that paying patients are opting to take treatment at free government facilities by choice on a mass scale. In India this is unusual, but in other countries such as UK, this has been the norm. Treatment at NHS hospitals in UK is free, but waiting lists are long. As 70-90% of consultants are in the private sector in India, the problem of long waiting lists for treatment at government facilities too can be eliminated by bringing in a pay per patient policy of outsourcing.”

Here are excerpts from an interview with CSP:

As a doctor who has watched this tragedy unfold, what hope does the vaccine hold out?

The mass vaccination program is needed to prevent mortality and the morbidity of severe disease. As 15-20% of patients need hospitalisation and treatment and many of them suffer prolonged symptoms (“Long COVID”), this burden is considerable. I would have liked to be sure that it would also prevent transmission, but there is no clear evidence as of now in this regard.

 

Have you heard of such a quick turnaround in the history of science?

This has been the first rapidly spreading pandemic of the digital age. We have not turned around yet. India is staring at the second wave rising across several states. France has declared that it is facing a third wave. That said, the spread of information as well as misinformation during this pandemic has been tremendous. Global collaborative efforts ensured that protocols for treatment were created and updated almost instantaneously across countries. We have also seen that vaccine development and deployment has been done globally much faster than at any point in history, and that it is quite safe to do so.

Why is there a distinction made that when India gives vaccine its termed vaccine diplomacy but when the West does it’s called aid? 

The “saviour complex” of the West is very real. The so-called developed world has yet to come to terms with the fact that it needs a poor third-world country’s assistance to overcome a pandemic. Smaller, not so prosperous nations such as those in the West Indies, have been quite gracious and grateful for the vaccines they received as aid from India.

Did you believe that India would find the vaccine given its huge expertise in vaccine production. How does previous expertise help?

India has been the world’s largest low-cost vaccine manufacturer and biggest supplier to the WHO since a few decades. But what is lesser known is that Indian vaccine manufacturers have also been selling their own research vaccines apart from mass manufacturing those created by other companies. So much is already known about virus families that creating a new vaccine has become a relatively straightforward affair. A number of original research-based vaccines are under development, such as the nasal spray COVID vaccine of Bharat Biotech. Previous expertise is being put to good use and taken to the next level.

Are perceptions changing in the global scientific community about India's medical contributions?

In many fields, Indian scientists are making cutting-edge contributions. Indian doctors are now prominently recognised and invited as faculty in many international conferences. Indian researchers and doctors are organising international conferences where foreign speakers are invited. The number of publications by Indian researchers in indexed and reputed journals has been steadily rising. We are increasingly getting noticed and respected. But there is still a very long way to go to reach a dominant position and overcome subtle discrimination. Media distortion also tends to influence the global scientific community’s opinions. India’s daily vaccination rate, for example, is next only to the USA in terms of absolute numbers but the reportage in the Western media is overwhelmingly negative. The tenor of reportage with regard to India having done much better in managing the pandemic than the rich, so-called civilised West has by and large been one of condescending disbelief than genuine examination and appreciation.

What are your thoughts about Indian society at large in responding to the pandemic? Have we as a society shown greater scientific maturity and responsibility? 

I think we have done quite well. The messaging from the leadership was consistent and clear, and most people have indeed complied to their ability and understanding. People suffered economic hardship due to the prolonged lockdowns, but there was no social unrest. The Indian people, more inured to hardships, took things in their stride and moved on. There was no rush at stores, no hoarding for groceries or consumables, no sense of panic – all of which was disturbingly seen in so-called developed and civilised nations.

What does this pandemic mean to the Indian Public Health care System, going forward?

Several positives have emerged from the way states and central government, barring a few exceptions, have conducted themselves. Contrary to public posturing, the collaboration has been working quite well. We saw the emergence of a successful pay-per-patient treatment model of Private Public Partnership in the form of large “jumbo COVID care centres” that offered excellent quality treatment and were not saddled with any of the traditional liabilities of the government and municipal hospitals such as labour unions, poor maintenance and service, overcrowding etc. Going ahead, this can be a workable solution to decongest public hospitals.

We have also seen how India went from being a zero in PPE kit manufacturing to becoming the world’s second largest manufacturer within just a few months, with some handholding from the central government. We had just one lab for virus testing (NIV, Pune) and now we have over 2000 and they are manufacturing millions of test kits every month. Several innovative test kits for COVID have emerged, although for some reason they have not hit the market in any large number. We are producing massive quantities of vaccines, both for our regular immunisation programs as well as for COVID. The capacity upgrade will do us good for future. There is an increased budgetary allocation for healthcare, but it is mainly directed at water and sanitation. This needs to change. The vacancies of specialist doctors in government and municipal hospitals are to the tune of 65-90%. These need to be filled out at the earliest instead of forcing MBBS students to rural areas for three years. Successful models for filling out rural vacancies of doctors, such as that adopted by Tamil Nadu, should be studied and implemented across the country.