Has India Learned Its COVID Lessons? 'Disease X' Will Be A Tough Test

What if such an incident becomes a real one? Going by the World Health Organization (WHO) there is a high probability of another pandemic coming soon. Better known as Disease X, it is a concept floated by the WHO. Much like what one witnesses in Kaala Pani, Disease X has a high fatality rate matching that of Ebola and is as infectious as measles.

It is to be noted COVID-19 killed 6.9 million people, and that for Disease X, the fatality rate can be much higher. Presently, there are 8 families of viruses in the WHO priority list, each one mutating in unknown ways and becoming more virulent because of climate change, which may lead to the occurrence of Disease X. WHO floated this concept, to understand the future readiness of any country to fight the pandemic. It underscores the importance of vigilance, research, and preparedness in the face of emerging infectious diseases that may.

How prepared is India?

In a counterfactual setting, we identified factors that led to a broken supply chain when the second COVID-19 wave hit India. Back then, COVID-19 was more like Disease X, a pandemic that tested India’s preparedness to fight it. There was a shortage of hospital beds and doctors. Disruption in the medical supply chain impacted the availability of medicines, vaccines, PPE suits, and medical equipment such as ventilators.

Need For Policy Reforms

In a paper released in August, Need for Policy Reforms in the Aftermath of COVID-19, we took a detailed look at all possible factors that led to disruption in the supply chain during COVID-19. Importantly, through factor loading analysis we are able to rank these factors, the higher the weights the more disruptive are these factors impacting the vaccine supply chain. The results can serve as a policy toolkit next time there is a call for a mass vaccination drive and delivering the doses on time.

These factors are clubbed into operational, financial, and logistic issues. A stratified sampling approach is followed. The sample comprised of medical doctors (300 in numbers) and pharmaceutical corporate executives (100 in numbers). The medical doctors and pharmaceutical corporate executives in the sample were selected from the National Capital Region (NCR) of Delhi.

Given India’s supply chain exposure to China on active pharmaceutical ingredients (APIs), all the pharmaceutical companies selected in the survey either import APIs from China and use them for manufacturing medicines and vaccines or import medicinal equipment from China. Some firms are also dependent on imports from the USA for certain critical inputs used for vaccine manufacturing. The stratified nature of the sample (random sampling without replacement) suggests that the results hold true pan-India.

A Logistics Nightmare

The empirical results on supply chain challenges in India reveal that logistic issues are quite important. For instance, people were unwilling to take vaccines due to fear emanating from a lack of trust, side-effects, and concern regarding the efficacy of vaccines. Interestingly, ‘religious belief’ as a reason to opt out of vaccines was not found to be significant.

In addition to these demand-side factors, there are also supply-side issues. For instance, RT-PCR testing facilities are seldom available in Primary Healthcare Centres (PHCs), particularly in rural India. During the peak of the second wave of COVID-19 during the months of April, May, and June 2021, there were inadequate RT-PCR testing centres in urban areas also. This led to patient inconvenience, delay in getting test results, resulting in hesitancy on the part of the people to get the testing done.

Among operational issues, lack of cooperation and collaboration among multiple stakeholders including public health officials, government agencies, pharmaceutical manufacturers, and distributors among others gets a higher weight. Public health is a state subject in India. However, it is the Government of India (GoI) that is responsible for designing health policies and vaccine delivery mechanisms. There was a mismatch between the number of vaccines available for distribution and the demand for vaccines.

India’s pandemic response suffered because of a lack of policy clarity, transparency, and accountability between the GoI, state governments, and manufacturers of vaccines. Initially, there were problems associated with the online registration portal not working once the government opened up registration for vaccination to Indian citizens (above 18 years of age group) on 28 April 2021. Thereafter, there was difficulty in booking an online slot for vaccination, once the government portal started functioning starting early May 2021. At a firm level, there was also a problem to scale-up production, particularly with respect to getting access to skilled labours and critical inputs needed for vaccine production.

Among the financial issues, although tariffs resulted in an increase in the price of medicines and vaccines, it is the non-tariff measures (NTMs) that got higher weights, implying that they play a bigger role in supply chain disruption. Interestingly, the US embargo on exporting COVID-19 raw materials for vaccines has a lower weight.

Trade data show that India’s imports of COVID-19 raw materials from the USA increased between October 2020 and March 2021. However, the higher price of Chinese APIs was negatively impacting the supply. The extent of price-led disruptions becomes clear from the fact that Chinese suppliers of APIs and para amino phenol (used for manufacturing paracetamol) increased prices by 20 percent and 27 percent in comparison to the pre-COVID days.

Rightly so, the Indian government's decision to initiate the Production Linked Incentive (PLI) scheme for Pharmaceutical products. India is dependent on APIs and we are not that competitive vis-à-vis China with respect to many pharmaceutical products. There is a need to build domestic capability and competitiveness in the API segment.

Also, to ease the supply chain issues in the event of the next pandemic, there is a need to form an independent task force comprising specialists such as doctors, economists, pharmaceutical corporate executives, engineers, etc. This group will take inputs Integrated Health Information Platform, which is web-enabled near-real-time electronic information system tracking viral outbreaks. All the state governments should be made equal participants in such government initiatives, with their inputs considered for policymaking. Once in a while, this task force can engage in mock viral outbreak scenarios to identify the problems and ensure how to make the system work better.

(The Author is Professor, Mahindra University, Hyderabad).