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Uniting divergent strands

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As India moves closer to the festival season, vaccines are our hope of averting a catastrophic COVID endgame. No government – state or center – is going to have the political will to announce or enforce hard lockdowns like the one in March 2020. Especially as enforcement is leaky to say the least. They are right to protect lives and livelihoods, but we need a stronger and wider vaccine net to face the consequences of crowded beaches and weekend getaways.

Vaccine makers are willing to ramp up supplies to meet this demand. But is the data good enough to warrant regulatory compliance? Yes, India is building a trove of data on Covisheild and Covaxin vaccinations, but the regulators must be allowed to take their time for due diligence of each vaccine candidate and not be pressured into hasty emergency approvals. These two COVID vaccines must set the bar high enough for the jabs and nasal sprays, etc that will follow. Vaccine security is now a reality and the bedrock of health security.

Unfortunately, experts like Soumya Swaminathan, WHO have cautioned that SARS-CoV-2 shows signs of becoming an endemic infection in India and some regions of the world where total vaccine coverage is taking time. So, can we learn from the strategies used to combat other endemic infections?

Take polio for instance. All of us are familiar with the annual polio drops campaign. Thanks to Amitabh Bachchan’s baritone, millions of babies and children in India got their polio drops on time, year after year. This was to ensure that their immune systems were boosted each year, to ensure that any surviving strains of wild poliomyelitis virus did not break through the immune shield.

Will COVID shots become as routine as polio drops? If so, when will we have enough data to make this conclusion? And is it ethical that some parts of the population receive boosters while others wait for their first dose?

Of course, certain populations like healthcare staff need booster shots as they are exposed to higher levels of infection. Some hospital chains in India and overseas have already reportedly given their staff booster doses, as this was the logical way to protect them as they faced abnormally high levels of viral loads from the patients they are treating. The US has reportedly also started giving booster doses to immune-compromised individuals.

So far, academics and our public health policymakers are very rightly reserving judgement. ‘Show us the data’ is the right refrain, but it also means that while we wait for more data, we need to figure out other aspects like the funding of such booster shots, their storage, administration strategy etc, should the data indeed show that they are needed.

Luckily, there are signs that the country’s vaccine production seems to be finally picking up. The last few days of August saw the country’s daily vaccination count cross one crore doses on two days. This is also an indication that administration infrastructure too has kept pace with vaccine production and delivery.

A key cog in the COVID-19 vaccine roll out and preparing for the third and future waves is the ramp up of healthcare infrastructure in non-metros. Like vaccine production, this ramp up too cannot happen overnight and has a gestation period. Again, the government has stepped up efforts to get this in place. Finance Minister Nirmala Sitharaman recently reiterated that the Rs 50,000-crore Loan Guarantee Scheme for COVID Affected Sectors (LGSCAS) launched this June, would help in building healthcare infrastructure and related capacity in tier 2, tier 3 towns and municipalities to help deal with a possible third wave.

In a letter addressed to Nirmala Sitharaman, Rajiv Nath on behalf of the Indian medical device industry has cautioned that in order that these loans do not become NPA’s and to ensure med device projects become financially profitable, more supporting policy enablers are required. He mentions a  list of six suggestions, like a predictable nominal tariff structure matching the mobile phone industry to protect investors, protecting consumers by monitoring MRP (Maximum Retail Price) of importers in bills of entry as data to enable capping of 2 to 4 times over 1st point of sale (when GST is charged 1st time), giving price preference based on QCI’s Quality Certification in Public Healthcare Procurement as permissible under GFR 153, seeking customs to enforce restrictions on imports of pre- owned equipment over 3 years and Labeling (MRP, Country of Origin and Manufacturers & Importers name and address), phasing out export restrictions and various duty exemption notifications on medical devices as announced in this year’s Budget and lastly, reducing GST on certain medical devices from 18 per cent to a nominal 12 per cent

The Government is closely tracking the policies of other jurisdictions as evident from the Commerce and Industry Minister Piyush Goyal recently asking the industry to give feedback on non-tariff barriers in other countries so that the government can take appropriate measures. Pavan Choudary, Chairman & Director General, Medical Technology Association of India (MTaI), which represents global medtech companies, makes the point that the “geo-political churn is forming new groups and forging new alliances among nations”, with trading moving from “random off-shoring” to “friend-shoring”, choosing countries with “similar political dispensations, market systems and shared histories of peace.”

His suggestion that new trade barriers can be considered “with countries that India is not aligned geo-politically” while mutually reducing trade barriers with friendly nations which “will strengthen the supply chains and keep them competitive” should also be analysed in the context of making India’s medtech sector more resilient to future shocks.

India’s government will have to balance the aspirations of all segments of med device companies, as also corporate hospitals, diagnostic chains etc. Uniting these sometimes divergent strands of the sector is essential to jointly conquer COVID-19. (Link to digital edition:https://www.expresshealthcare.in/digital-issue/express-healthcare-september-2021/430967/)

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