At the latest edition of Express Adda, Union Health Minister Mansukh Mandaviya spoke on behind-the-scenes of India’s mammoth vaccine drive, preventive health modules and how the digital health mission can make treatment both accessible and affordable
I don’t see the success only through the prism of vaccine administration. India’s story is built on vaccine research, developing of indigenous resources, manufacturing, administration and delivery. In short, it defines Atmanirbhar Bharat. When over 2.5 crore doses were administered by midnight on September 17, making it the highest single-day vaccination, it was a personal milestone.
I’m from a village, where to hear of a vaccine was itself a big deal. Getting vaccinated was a mammoth challenge. Today, vaccines are available in villages. About 73 per cent of the rural population has been vaccinated.
That is the USP of PM Narendra Modi. When the Covid crisis began, people had apprehensions about the quality of a home-grown vaccine, whether we’d be able to vaccinate the entire population within given timelines. But Mr Modi told us to fight the crisis in mission mode, in the spirit of sewa, and not be blinded by political fights. Our goals were specific and single-minded: speedy vaccination of citizens, scaling up vaccine manufacturing and financially supporting manufacturing companies. I was the Minister of State for Chemicals and Fertilisers then and the Department of Pharmaceutical was part of my portfolio. I visited each plant and personally documented their strengths, weaknesses, requirements and worked out ways to escalate production. Many companies had the scientists and capacity to produce in bulk but no facilities. So we linked them with companies that had them. We sourced raw material and our production volumes increased to three times. Today, 98 per cent of the population (18 and above), have been administered the first dose while 91 per cent have received both doses. The precaution dose is ongoing. We’ve also exported vaccines and supported other countries. Indian manufacturers didn’t think of profit. Rather, we supplied quality medicines at affordable prices. Vaccines, which cost $20-25 globally, were provided for $4-5. The kind of fear and deaths during the second wave, were seen in the third wave, too, in many countries. But we had already carried out the vaccinations, so we got saved. At around 1,50,000 vaccination centres per day, there were enough vaccinators, syringes. Our drive was an example of best-management practices. That’s why the world praised us. Bill Gates congratulated our Covid management efforts at the World Economic Forum. When Covid began, the PM assessed that we didn’t have a dearth of brainpower and manpower but lack of faith in our scientists. We trusted them.
We didn’t stop anyone from coming into the country. We just asked them to get the registration done in India to sell their vaccines but they had reservations. There was a clause to remove indemnity and sovereign guarantees but we insisted on compliance with local rules and regulations. Besides, by then Indian companies had begun mass-scale production, so they won the race.
We take decisions only after consulting experts. Once, after a discussion on a survey in New York, which studied 200 people to assess the effects of a vaccine, we discussed if a modern app like CoWIN, which has data on dosage in every Indian city and the vaccinator, could be used by the Indian Council of Medical Research (ICMR) to issue a similar report. ICMR came out with its study that was globally recognised. Similarly, for COVID, our experts guide us. At present, various sub-variants of are causing infections. Our team says that when a variant has a sub-variant, its effects are less severe. So, the virus will stay and become like influenza, afflicting people once or twice every year. But in India, it is under control.
Screening is crucial to make healthcare accessible and affordable apart from strengthening public health. Modiji decided to start 1,50,000 health and wellness centres. Out of these, 1,20,000 have already come up and can conduct tests for 13 diseases. India is the only country where besides primary, secondary and tertiary healthcare, we also have the ASHA (Accredited Social Health Activists) behen. The role of these workers in managing women’s health is significant. Keeping this data set in mind, we should focus on a national awareness campaign on screening.
We are adopting a Western lifestyle but how do we balance it? In a country like Switzerland, there are more cycles than people. It’s the same in Denmark. Every country has a different climate, soil and resources which influence their food. Our country is extremely diverse. Every state has its own unique food. Besides eating the food we have grown up with, we also need to exercise. Simple tweaks like using a cycle for short distances and reserving the car for longer journeys are helpful. When I was staying at North Avenue, I’d cycle to the Parliament. Health has to be seen as a key index of development. The idea to make healthcare affordable and accessible led to the Ayushman Bharat Yojana, the ECRP-II package, the Ayushman Bharat Health Infrastructure Mission and the expansion of the National Health Mission.
A person living in the remotest area should feel that there is public concern about his/her well-being. A poor villager with a heart condition often avoids surgical intervention because he cannot arrange the Rs 1.5-2 lakh without help from a moneylender. And he does not want to pass on the burden to repay the loan on to his family. I’ve seen many such incidents in my own village. Ayushman Bharat emerged from this gap between accessibility and affordability. In the last few years, 3.5 crore people have had surgeries and their lives have been saved.
Once we strengthen Ayushman Bharat, we will look at expanding health infrastructure by setting up 22 AIIMS centres. Healthcare is free in government hospitals and the poor are covered under some or the other scheme. But schemes don’t work in a straitjacketed manner. With time, we will need improvements. No poor person should die in this country for lack of treatment.
What is the last-mile effect of the decisions that I am taking inside my office? Till you don’t see it, you won’t understand. And it’s not just me, the entire Cabinet is doing so to see that beneficiaries are not cheated and implementation of schemes is fair. When I visit cities, I survey various hospitals and Jan Aushadhi Kendras. It is satisfying to see a person buying medicines comfortably. So, when we sit down to make decisions, our morale is higher.
Even today, the faith and respect that people have for doctors in India is much better than in other countries. Our citizens often consider doctors demi-Gods. Stressed patients may express themselves aggressively. That should not happen. We are also doing orientation courses with doctors. In many countries, doctors, nurses and paramedic staff stopped coming to hospitals during the Covid crisis but medical personnel in our country risked their own lives and reported for duty.
We are working on two things aggressively. One is affordable and quality healthcare for which a lot of medical tourism is happening. How do we encash that? The other is our health workforce which is in demand all over the world. Can India contribute to global healthcare?
If we want to change medical education, we will have to assess the country’s requirements, the kind of medical education that is being followed globally and the need to future-proof ourselves. We’ll need to have conversations with our scientists, hospital staff and bureaucrats. Only after we’ve taken suggestions and opinions of all stakeholders can we draw up actionable plans and move forward. The government’s vision for the health sector is not short-term. We are planning for ‘Amrit Kaal’, when the country celebrates 100 years of freedom. Governments keep changing but when you plan like this, the country’s holistic growth can happen.
From the beginning, Modiji has focussed on a digital India. Jan-Dhan accounts have helped people get direct cash transfers during Covid-stressed times. Similarly, under ABDM, a significant element is the digital account or the Ayushman Bharat Health Account (ABHA). This is important because my attending doctor can access all my health information and history on a digital platform and only an OTP can activate it. There is data privacy too. My account cannot be re-opened until a new OTP is generated. This is going to be a game changer as more than 20 crore people have opened an ABHA account. It’s a huge campaign and could be a global first. I request people to join hands with the mission.
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We are the pharmacy of the world and a huge exporter of generic medicines. For muscular dystrophy, one injection costs Rs 16 crore. Imagine if we can make this cost-effective. We’ve linked industry and academia and are strengthening the National Institute of Pharmaceutical Education and Research (NIPER). We will soon be bringing in a policy for the pharma sector.
During COVID, many institutes started teleconsultations and received up to 200 distress calls every day. Every state should have a teleconsultation centre. We’ve also started a programme of training doctors to address mental health issues in hospitals. We want people to also use the eSanjeevani app to get a teleconsultation with a specialist to avoid stigma. We have started mental health programmes in districts and trained doctors.
Dr Naresh Trehan
Chairman & MD, Medanta – The Medicity
In healthcare, what is your vision for the next 10-25 years for private and public hospitals, and NGOs? What will be your role in this? There is a struggle that goes on, where some tax increases or there is demand for concession. In two years, the infrastructure cost has become 150 per cent. We should know with clarity whether one should invest in the coming years? What should be one’s role as nation builders?
If someone invests, then they’d want to know what the future holds for them. They wouldn’t want to invest and get stuck. A partnership is necessary between private and government sectors. When we show you the vision for 25 years, you’ll see the solutions and that vision will be formed with all the stakeholders’ contributions in the coming future.
DR Bishnu Panigrahi
Group Head, Medical strategy & Operations, Fortis Healthcare
If there were a common database, it would be good for health economics and disease prevalence in public and private sector. Talking of non-communicable diseases, cancer is spreading but health screening is not happening. How should we do that? Like TB, can cancer become a notifiable disease too? This way, it’ll be picked up early.
Health screening is done by a lot of states from their primary schools. The best way to register cancer is through screening. When cancer is detected in the first stage, survival chances increase. Primary health and wellness centres help in screening for breast cancers, cervical cancers, oral cancers – which are more in number. It is important to give them financial support through the government. Teleconsultations should be enabled through eSanjeevani app.
Dr Karan Thakur
VP, Projects & Public Affairs, Apollo Hospitals group
CoWIN was a game changer. Is there any policy in the future like the CoWIN app that everyone can use?
I want to bring universal vaccines into the CoWIN app. It is getting more popular in the world.
Founder Director, Steadfast Nutrition
Life expectancy is improving at 0.33% in India. How can we improve our quality of life?
Quality of life has a huge purview. Someone in a poor village and a rich mansion will have different criteria for quality of life. NFHS-5 (National Family Health Survey) says that the quality of life is already improving. Even in the furthest villages, their houses and toilets and electricity are assured. Their primary requirements are getting met.
Dr Anoop Misra
Executive Chairman, Fortis C-DOC Hospital for Diabetes & Allied Sciences
We had a lot of national control programmes for diabetes but there’s no decrease in the cases. In fact there’s an explosion. The entire economy is getting impaired because of this. It’s easy to say it’s an individual problem, but until there are legal and policy changes, there may not be a change. Do we need to think out of the box?
We do need to think out of the box. This issue cannot be completely turned around. So we need to take this step by step.
Director and Former Chairman, Dalmia Group
There are many obstacles in starting medical colleges. Then children study medicine abroad. Upon returning, their degree isn’t recognised. Your thoughts? Also, shouldn’t we teach our children about exercise and food habits in primary school?
In the country, the 48,000 MBBS seats have increased to 97,000. There are more than 612 medical colleges. We need more. Abroad, through middlemen, kids end up studying in any random college and their government doesn’t give them permission to practise. We decided with NMC if a child wants to study abroad, he/she should clear an exam to practise here. Under the new education policy, children will become more health-conscious.
DR Suneet Marwah
Chief Project officer, Indian spinal injuries centre
The government wants to add a five per cent GST on room rent. Won’t this affect affordable health? Is there a way that hospitals can be given some benefit which they can pass on to the patients?
There are two kinds of healthcare. One way is where a patient gets treatment at a private hospital. The other is by using government hospitals and schemes. In the case of the latter, the idea is that there should be no inconvenience.
CEO, Save the children
The frontline warriors, which included some NGOs, were working very hard in the pandemic. In the future, how will the government work with the NGOs?
All the NGOs, individuals and government resources together tackled the pandemic. So nobody in the country had to sleep hungry. NGOs are a significant part of our culture. We have a databank of all NGOs in NITI AYOG as well.