India at the Centre of Fight Against COVID-19

Medan, November 29, 2020 — As countries across the globe battle the raging COVID-19 virus with various strategies, it has invited comparative analysis of how different countries acted and reacted to this virus and to what extent they succeeded and at what cost. India, indeed, is at the centre of the global fight against Covid-19. India has become the country with the second largest reported infections in the world and the highest in Asia. A lot has been written about India’s predicament but at the same time evoked intrigue about its relative success in handling the virus. But when someone asks how various countries have fared against the pandemic, all one needs to do is to look at the total number of cases reported by each country.

India – Putting Up a Better Fight than Most

Is India doing better than the rest? Let’s look at some figures. To put into context, a true measure of a country’s performance is the number of cases per million and number of deaths per million. As of end November 2020, India has 6,731 cases per million. In comparison, the USA has 40,000 cases per million, UK has 23,361, France has 33,424, Brazil has 29,129 while Italy has 25,456.Most of these countries have about 4-5 times the number of cases than India, on a per million basis.

When it comes to the number of deaths per million, India reported 98 deaths per million. Every life is precious, not even a single death is acceptable, but this is just to compare how effective countries have been in saving lives from the pandemic. While India saw 98 deaths per million, USA saw 813, Brazil saw 805, France saw 780, Spain saw 955, United Kingdom saw 846 and Italy 888. Almost all these countries have about 8-9 times more deaths than India on a per million basis. This is despite the fact that many of these countries are reputed to better healthcare systems than India.

Currently, India’s curve is showing a downward trend. From the peak of almost 97,894 daily cases in mid-September, it has halved by end November to 43,174 cases. It appears that India seems to have bent the curve (as of end November) when one considers the daily cases with a 7-day moving average.

How was this possible?

India was among the quickest to react at the government and institutional level. When China notified the world on 7 January, 2020 about the virus, the very next day, India had a mission meeting. India started screening passengers from 17 January, among the first countries in the world to do so. The first case in India was detected on 30 January and aggressive containment and screening measures were instituted then and there.

On the other end of the spectrum, India was among the first to introduce Rapid Antigen Tests along with RT-PCR tests. India was criticised initially for this strategy but later the WHO itself has adopted this model.

It was in March first week itself that Prime Minister Modi announced that he would not join any Holi festival based on scientific advice to stay away from mass  gatherings. It was among the earliest examples among world leaders to send a message to the country. When PM Modi sent this message of staying away from mass gatherings to millions of countrymen, India did not even have 50 cases!

As early as April, lndia stated that wearing of masks was mandatory, while the WHO waited till June before recommending it the world over. It is clear that this early lockdown proved critical to contain exponential spread.

When the Prime Minister announced complete lockdown on 24 March, India had just about 500 cases. India could have waited or delayed imposing a lockdown and risked going down the European or USA trajectory. But India’s growth rate of new cases had increased from 10.9% to 19.6% in just one week and the doubling time was just over 3 days. That is when Prime Minister Narendra Modi took the decision to impose a national lockdown, which till then no other country had taken so early.

This one decision changed India’s trajectory. It helped not just to contain the virus during this crucial phase, but also avoided deaths and filling up of hospital beds at an early stage. Moreover, this was a crucial period for the government to build up infrastructure to treat the pandemic.

The lockdown period enabled the Government to create 15,362 dedicated COVID-19 health facilities, 15.40 lakh isolation beds, 2.70 lakh oxygen supported beds and 78,000 ICU beds. It also delivered 32,400 ventilators to government hospitals across the country. It also provided 3.70 crore N95 Masks and 1.60 crore PPEs to State Governments. It also provided 3.70 crore N95 Masks and 1.60 crore PPEs to State Governments.

Economic Impact of the Pandemic

India’s GDP growth numbers naturally went down, given the disruption due to the pandemic. However, GDP for Q2 of FY20 contracted by (-) 7.5%, much smaller when compared to the contraction of (-)23.9% reported for Q1 of FY20. Between these two quarters, already a huge improvement could be seen in private consumption expenditure. Agriculture reported a growth of 3.4% in Q2, the same as in Q1. Manufacturing has grown by 0.6% in Q2 as compared to a contraction of (-) 39.3% in Q1. 

For a better perspective, here is a comparison with other economies globally which shows India’s position is better

Table: GDP Growth (%) Across Prominent G20 Economies

India, first to lockdown and first to unlock

But one must remember that India went into lockdown early, but also unlocked the economy much earlier than other countries. The impact of this could be seen in most high frequency indicators seeing an uptick!

For example, Manufacturing Purchasing Managers’ Index (PMI) rose from 56.8 in September to 58.9 in October 2020, registering the highest figure in over a decade. PMI Services index also rose to 54.1 in October, ending the seven-month sequence of contraction, signalling improved market conditions. Power consumption clocked double digit YoY growth of 12.1 per cent in October and 4.5 per cent in the first 24 days of November, reflecting a post-recovery rebound and even in growth economic activity across all spheres – agriculture, industry and services.

Passenger vehicle sales reported 2% growth in October 2020, while total domestic sales of two-wheelers increased 16.8%, auguring well for consumption demand. Domestic tractor sales posted a 7% YoY growth in October, auguring well for rural demand and signaling an early indicator of the transformation arising from agricultural reforms introduced under ‘Aatmanirbhar Bharat package’. Railway freight grew YoY at 15.4% in October and 13.6% in November. Cargo traffic volumes in October reached 7% of previous year levels, registering a 1.23 % YoY growth.

While India was fighting the pandemic, the Government was mindful of the need to initiate social and poverty alleviation programmes. Through the Pradhan Mantri Garib Kalyan Package (PMGKP), the Government announced free food grains and cash payment to women and poor senior citizens and farmers. Around 420 million poor people received financial assistance of US$ 15 billion, which is a mind-boggling number. Similarly another US$10 billion were transferred to farmers, vendors, constructor workers etc through schemes like the PM-KISAN Jan Dhan and Garib Kalyan Anna Yojana.

The Oxford University COVID-19 Government Response Stringency Index

Despite these favourable figures, India detractors prefer to look at sheer numbers in isolation and continue to question the effectiveness of Governmental response. So let’s look at the findings of an independent entity, the Oxford University COVID-19 Government Response Stringency Index, which shows how proactively and decisively a country’s government has acted against the spread of the pandemic.

According to its rating, here is how different countries achieved their highest score on their index:

• On 21 March, when the USA first achieved its highest score (72.69), it had 16.24 daily confirmed COVID cases per million. On 26 March UK (75.93) already had 21.39 daily confirmed COVID cases per million, 2.74 daily deaths per million and 10.22 total COVID deaths per million.
• Similarly, on 12th April, Italy (93.52) already had 77.64 daily confirmed COVID cases per million, 10 daily deaths per million and 322 total COVID deaths per million.
• In contrast to all these examples, when India first achieved its highest score (100%) on the Stringency Index on 25 March, it had only 0.04 daily confirmed COVID cases per million, 0 daily deaths per million and less than 0.01 total COVID deaths per million.

It is quite clear that proactive and quick decisions taken by the Indian leadership was critical and instrumental in avoiding a major health disaster in the country.

India’s Vaccine efforts – When will the vaccine come?

Despite all kinds of national COVID strategies, it is crystal clear that only a vaccine could arrest this pandemic. Recent developments in the possible manufacture of the much anticipated and needed vaccine have raised hopes of world governments for restoration of some kind of ‘normalcy’ as the world knew it before.

As the world’s largest supplier of drugs and producer of 60% of the world’s vaccines, India is at the centre of global efforts to produce a COVID vaccine.

India is at various stages of talks with at least half-a-dozen companies to manufacture and procure vaccines for a population of 1.3 billion people. India is pinning its hopes on five vaccines that were in advanced stages of development — four of them in Phase II/III studies and one in Phase I.  

Serum Institute of India (SII), the world’s largest vaccine manufacturer by volume, and Indian Council of Medical Research (ICMR), the apex body in India for biomedical research recently announced completion of enrolment of phase 3 clinical trials for COVISHIELD developed by AstraZeneca and Oxford University.

At present, SII and ICMR are conducting Phase 2/3 clinical trials of COVISHIELD at 15 different centres, across the country. It has completed the enrolment of all 1600 participants on 31 Oct 2020. COVISHIELD has been developed at the SII Pune laboratory with a master seed from Oxford University/Astra Zeneca. COVISHIELD is by far the most advanced vaccine in human testing in India. Based on the Phase 2/3 trial results, SII with the help of ICMR will pursue the early availability of this product for India.

ICMR and SII have further collaborated for clinical development of COVOVAX (Novavax) developed by Novavax, USA and upscaled by SII.

At the trial III stage, Bharat Biotech Vaccine, in collaboration with ICMR, is testing the first indigenous vaccine of India, COVAXIN, on volunteers selected from  Peoples’ Medical University in the State of Madhya Pradesh.

Biological E. Limited (BE), a Hyderabad-based vaccines company (in partnership with Dynavax Technologies Corporation, USA and Baylor College of Medicine, Houston) has initiated a Phase II clinical trial of its COVID-19 subunit vaccine candidate in India.

India also has a deal with Russia’s Gamaleya Research Institute for production of Sputnik V Vaccine in India. Similarly Novavax of UK and the Serum Institute of India entered into an agreement in September to make up to 2 billion doses a year. Novavax is currently under human trials in UK.

Indian Government has acted with alacrity to ensure that the National Expert Group on Vaccine Administration for Covid-19, in consultation with states and all relevant stakeholders, accelerated the efforts towards vaccination of priority groups in the first phase. A digital platform for vaccine administration and distribution has been prepared, and test runs are underway in partnership with state and district-level stakeholders.

Prime Minister of India is personally reviewing the progress of the COVID vaccines and has leant heavily on scientific advice and evidence. India has already declared that it is its duty, as the world’s largest pharmaceutical and vaccine producer, to assist other countries, including the nations in its neighbourhood, in the collective fight against the virus.

Writer: Raghu Gururaj, Consul General of India to Sumatra 
Writer can be contacted at: rgururaj@yahoo.com