Well Done India

When the history of the Covid Pandemic is written and hopefully it should be history fairly soon, there should be a special place for India. In overall terms, our country has handled this grave crisis in a mature and effective manner. There have been missteps, things that we could have done better but in overall terms we have done well. I, along with a small group of friends have been following the progress of the pandemic with keen interest and we are familiar with the numbers and statistics not only in India but abroad. I would like to highlight the following:

1. The first lockdown in March 2020 was draconian and sudden. It impacted the livelihoods of migrant workers in a rather harsh fashion. However, it did serve to make the Indian public aware of the grave crisis that Covid represents and what are the tools (social distancing, masking, hand hygiene etc) to combat it. Such a huge behavioural impact is very hard to achieve in a country like India especially as many of these practices are quite alien to most Indians. We are a gregarious, expressive people and the change required was almost a polar opposite. Given what we had to go through later, in hindsight, this was a painful but necessary education. We have seen that masking has generally been followed and vaccine hesitancy has hardly been there. The govt should be commended for a massive publicity blitz for constantly exhorting people in this area.
2. Initially, we faced shortages of masks, PPE, sanitizers etc. However, this was rapidly overcome and India started exporting these items. 
3. India's reporting of the numbers and statistics has been widely criticized in Western Media. It is true that the level of testing per million was low and hence real figures of infections are much higher that what was reported. The same is true for fatalities with figures being underreported by 4 - 10 times depending on whose model you choose to believe. Having said that, to get daily information at a district level, compile it, and disseminate it without fail for the entire period of the pandemic in a complex country like ours is highly commendable. Despite the limitations, researchers were able to use the data productively and the authorities were able to come up with fairly balanced and well thought through policies. It is also worth mentioning that the Sero Positivity Surveys that were carried out frequently were also useful in planning for vaccination and epidemic control.
4. The Delta Variant wave of April/May 2021 was truly catastrophic. Despite a focused effort to augment medical facilities in the major towns, the impact on the country was traumatic. An oxygen shortage and poor logistics contributed to the trauma. Deaths were significantly underreported and the sero positive surveys carried out later indicated the extent to which the virus had impacted the population. India, and soon afterwards the world, was just not ready for the devastating impact that Delta had. In retrospect, there was little we could have done differently. Perhaps we could have started vaccination a little earlier but in overall terms it was unlikely to have made a significant difference on the outcome. India is a poor country and decades of neglect of the healthcare sector cannot be transformed in a jiffy. Hopefully the pandemic will help to focus attention back on this critical area. Western countries who had better vaccination rates were able to stave off the worst impact of Delta but were hit by Omicron almost in parallel. However, at this point, India is better off than most of Europe and USA. It is possible that countries that were harder hit by Delta such as South Africa and India have been better protected by natural immunity than others.
5. The process of vaccination has been a deeply satisfying achievement by India. There were a few missteps and delays in the initial stages but these were overcome. The data capture, security and user friendliness of the Cowin application has been outstanding. The scale of vaccination is also unprecedented and the supply chain from both manufacturers especially SII has been effective. India has taken its own decisions in this whole area right from the beginning. It is heartening that a local vaccine, Covaxin, has proved to be effective as well. The drive is widening now as younger people are also being covered. All in all, this has been a significant achievement by India. In retrospect, the most important lesson is that having a local supplier for critical items is the only way forward. This is equally true for pharma especially APIs. 
6. The govt has by and large exhibited a great deal of empathy for its citizens. Right from the time that Air India flew to Wuhan to evacuate Indian citizens, the Vande Bharat flights have been operating to help Indians get home. Not insisting on hospitalisation but allowing home quarantine after we gained some familiarity with the disease, free testing and vaccines etc, India has behaved in a manner befitting the world's largest democracy. There have been missteps as in the case of the migrant workers but by and large we have managed the situation as well as could be expected. Economic support packages have been measured. Economic hardship is undeniable but it is also true that the economy has bounced back and that recovery has been faster than most other countries. We are a relatively poor country and fiscal profligacy may have been a disaster in the medium term. 

What of the future? Opinion is divided amongst experts on what surprises Covid may yet spring on us. However, some important directions have clearly emerged:

1. Reliance on any one country for supplies of critical items is untenable. Alternates must be found for Pharma, APIs, Semi conductors, solar panels and such like on a war footing. India is a big enough market and our costs and pricing are becoming more competitive. We must develop our own manufacturing.
2. Healthcare needs a massive boost in terms of spending and focus. Our healthcare workers have performed wonders during the pandemic. They deserve our heartfelt admiration and gratitude. However, a lot needs to be done.
3. It is possible that Covid may become endemic in the near future. What will that entail is still not clear. Perhaps regular booster doses and containment of local outbreaks. What it means is that we cannot afford to drop our vigilance. 

As of now we can say with some justification that the govt, institutions like ICMR, Vaccine manufacturers, ancillary product manufacturers, health care workers, data compilation, analysis and modelling groups, the administration and all those involved in the fight against Covid deserve our praise and thanks. Let us hope for a Covid free future.

Well done India.