We should have waited for the Phase-III trials of Covaxin

India has begun the world's largest immunisation drive with the government, also distributing homegrown vaccine to other countries as a part of its vaccine diplomacy and support programme. Dr K Srinath Reddy, President, Public Health Foundation of India, spoke to Bizz Buzz on what awaits next for the healthcare system in the country and the transformation the healthcare is already witnessing through private manufacturers

On the indemnification, I believe that ideally, as far as the vaccine is concerned, if the regulator has done the job well of examining the evidence very thoroughly and making sure that the vaccine has met the standards of safety efficacy, then there is a shared responsibility between the manufacturer and the government

Basically, we need a lot more investment and financing at a much larger level to do lots of front-end spending in order to improve the infrastructure and also the health workforce. Just providing the health infrastructure and building equipment is not enough if you do not have multi-layered multi-health workforce

India's tryst with mass immunisation drives such as measles and polio have been a leading example to the world. What awaits next for India with Covid vaccination drive?

This is one of the largest adult vaccination programmes anywhere in the world and each country has a challenge for itself. India, because of its very large population and vast geography, certainly face challenges. However, we've had some experiences in the past with large scale universal immunisation programmes for children and women and we have had sporadic adult immunisation programmes as per the need on occasions.The issues that we need to consider are availability of vaccine, the actual supply chain logistics, availability of personnel for administering the vaccine, and also looking at what the vaccination receptivity is in terms of vaccine confidence or hesitancy.

Covaxin has been surrounded by controversies, with its efficiency and ethical trials. Your thoughts on the accountability of vaccine manufacturers in India and indemnification of vaccine makers.

Under ideal circumstances, we should have waited for the Phase-III trials to be completed and demonstrated, but there were questions or rather concerns about the mutant form rising in different parts of the world. The British mutant had already entered India. There was a question whether the vaccines that were directed at the targeted proteins would be very effective if the spike protein affects a lot of structural change in the mutation.

Whereas, an inactive vaccine on theoretical grounds offers additional antigen for immune response and therefore having the possibility of having second vaccine at hand was what considered important health system preparedness measure. We should hope that the trial will be completed, and the results will be available by March which will validate the clearance that has been given mainly on the immunogenicity and the safety data.

On the indemnification, I believe that ideally, as far as the vaccine is concerned, if the regulator has done the job well of examining the evidence very thoroughly and making sure that the vaccine has met the standards of safety efficacy, then there is a shared responsibility between the manufacturer and the government. Both the government and manufacturer are responsible for safety issue. There can't be indemnity for either.

How do you rate the governments' handling of Covid-19 pandemic? Which States will stand out on this?

It is not just a single government. There are multiple stakeholders, including Central and State governments. It is also true that no health system in the world was prepared for such an occurrence. The decisions were taken first and then learnings came later. I can't perform a post-mortem on the government's performance right now since the response is still active. All this can be debated later on.

As far as the State governments are concerned, the challenges have been different. For western or southern Indian State or even the national capital, where there is a lot more urbanisation, crowd density, more mobility, travellers coming in and going out, challenges of containment are very different in rural areas or less developed States like Jharkhand, Chhattisgarh or eastern UP or Bihar. It depends upon the level of transmission also. I won't judge on the basis of case counts; I'll judge only on the basis of how much States have managed to contain death and in general most states have seemed to do well on that.

Chief Economic Advisor has advised a regulator for private hospitals and doctors. What kind of reforms or policies can be introduced to stop negligence at the private player's end?

Yes, even the Finance Commission has advocated that. We do need to bring the private sector into much greater participation as well as much greater accountability. So, I would say what we need in India, given the state of our health system, is a more responsive public sector, a responsible private sector and a resourceful voluntary sector.

Has the government made sufficient allocations for the healthcare sector in the recent Union Budget? What about upgrading technology of medical equipment in rural areas at PHC and CHCs?

Basically, we need a lot more investment and financing at a much larger level to do lots of front-end spending in order to improve the infrastructure and also the health workforce. Just providing the health infrastructure and building equipment is not enough if you do not have multi-layered multi-health workforce, which we can utilise well from primary health care to colleges and hospitals. So yes, the sector needs more monetary investments and you need to improve the capacity of the healthcare system to absorb that money.

There is a shortage of doctors in India when compared to standards in developed countries. What should the government do to correct this?

Again, we are commenting on the Union Budget. Much of the allocations and hiring of workforce happens at the State level in medical college and hospitals. Most of the medical and nursing colleges have been sort of congregated in the southern Indian States. Central and North Indian colleges do not have many medical educational institutions. We must change the situation and strengthen the districts hospitals and turn them into training centres in places where there are no medical colleges. You cannot have concentrations in a few States. We also need to focus on doubling the number of ASHAs, mid-wives, and train more frontline health workers.

Let us hope that the new Medical Commission of India work towards building a better system, which will be in tune with the health system needs of India. You cannot have salary deductions in places where 90 per cent of the workforce is in the informal sector and a large number are still under the poverty line or close to it.

There have been controversies in the past regarding Ayushman Bharat. With Covid-19 vaccine drive ongoing, what health insurance plans can be launched?

I am not in favour of a contributory health insurance scheme. I am in favour of tax-funded health care financing and that is what most economists are recommending. Those which can be supplemented by employer provided insurance, there will be small segment of the population who will purchase private insurance. If you can actually merge this with the State and Central health financing schemes and then we will be able to provide a larger service package.

We do need to spend more in insuring both primary healthcare and hospitalised care are backed with additional public financing. Otherwise depending only on contributory health insurance will not be going to work in India.