Indrani Gupta is a Professor and Head of the Health Policy Research Unit (HPRU) at the Institute of Economic Growth, Delhi. Professor Gupta’s work experience includes working at positions including the World Bank, the Government of India, and more. Her areas of interest cover a wide range of topics in the domain of health economics and policy, including demand for health and health care, health insurance, and financing, poverty and health, costing and cost-effectiveness, the economics of diseases, and international agreements.
Q1. We can see the second wave hitting India with a large number of cases. What would you say would be the impact on the economy as we are still recovering and coming out of the effects of the first wave?
Prof. Indrani Gupta: The first lockdown was very severe and it impacted the economy very badly. If there is a lockdown, again, even if it's partial, it will hurt the economy very adversely. So, lockdown is clearly not the answer at this point, maybe it wasn't even at the first instance because all you do is delay the impact. Right now, India has been trying to put the economy back together, but it's still very tentative. So, because we are reeling under the previous lockdown impact, and unemployment is at an all-time high, growth rates have been very low and poverty must have increased all over the country because many people went under the poverty line during the COVID period. I'm sure that if there is another lockdown, it's going to only increase all these severe impacts on livelihoods. I would say that to come out of the second wave, we should stick to our public health measures and not shut down the economy.
Q2. What learnings can be drawn from the pandemic to improve our primary healthcare system and now, post-pandemic, how do you see the health infrastructure being rebuilt?
Prof. Indrani Gupta: Our healthcare system is a very elaborate one, but it's in a bad shape. Much of our existing infrastructure falls short of what we require and what we had planned for. We have a shortage of doctors, nurses and technicians et cetera. When the pandemic had hit us last year, we must have lost a lot of lives because our health system was just not prepared to handle a pandemic of this magnitude. Much of this work has to fall on the states because health is a state subject. The central government has not been able to increase core funding for the health ministry and it is not clear whether states will be able to, given that their GSDP has shrunk.
So, it is not only rebuilding but putting in place what is at the minimum, what is required. We need to fill the infrastructure personnel and the supply gaps that currently exist. And if you remember last year, when we had the pandemic, we didn't have hospital beds, we didn't have gloves or personal protective equipment. The government had to do all this in real-time. So, your healthcare system has to be prepared for a pandemic and not troubleshoot in real-time, which is what we had to do last year. We were importing all our medical supplies at that point. Now in this one year, the government has been able to crank up production. And now we apparently have a surplus in things like PPE kits, but it wasn't the case last year. But we still don't have enough doctors and other medical personnel. So I think at the very least if this pandemic has taught us a lesson, it is about how investment in the health sector is critical and how we need to strengthen the health system to prepare for a calamity like the COVID pandemic.
Q3. Talking about the health expenditure and allocation, we know about how this year, there was so much anticipation around the budget and health allocation, and we have seen a 137% increase. So, do you think this is sufficient?
Prof. Indrani Gupta: Actually, the 137% increase is not real in the sense that when you talk about health sector investment, you talk about the core health sectors, Ministry of Health and Family Welfare, and how much money is going to them in terms of outlay. Now, if you look at the budget closely and what comprises the 137% increase, it includes things like water, sanitation, nutrition, and, vaccination - COVID-19 vaccine, etc. Finance commission transfers have also been included in the 137% calculation. Adding water, nutrition, and vaccine makes the number look high. This way of measuring the changes in health allocations is unprecedented: when you measure that increase in every budget, you only measure the main health allocation, which is the Ministry of Health and Family Welfare and Ministry of AYUSH, together. Now, if you look at these two allocations, there has been a decline in the budget estimates over the previous year’s revised estimates. That is not to say that water, sanitation, and nutrition are not important. They impact health directly. So, these are good investments, but cannot replace investments in making the health system a functional one. You need to invest in the core health functions of the government, which is the Ministry of Health and Family Welfare, etc. and that has not happened. So as far as the health budget is concerned, it has been a disappointment.
Q4. Recently, everyone's been fighting over vaccines. So, what would you comment about the vaccine diplomacy of India, there have been rumors around the shortages of the vaccines, like the COVISHIELD after there's been a change in the period between the two doses from four to six weeks to four to eight weeks? So, how do you perceive this change? Is this a cause of worry in any form?
Prof. Indrani Gupta: So, these are two questions, one is vaccine diplomacy and shortages and the other is the extension of the period. Now, we are manufacturing a lot of vaccines and right now, there is no shortage as such, but if everybody gets vaccinated in the coming months, of course, we will have a shortage. We are also exporting vaccines as you know and that has given us a lot of mileage in terms of goodwill and all of that. Yes, that is important, but actually, it's also important to get our people vaccinated as well. But, I think, there is an equity angle to it because if we give the vaccine to the poor people of the rest of the world, that's one point, but if the vaccine is going to people who are not so vulnerable, then that may not be the best approach. So, I think there is a lot to be said about both things as we need to ensure adequate supplies for our population and we would also possibly have to continue some of the exports - we are a part of the global community as it’s a pandemic and you have to be very mindful of the global needs as well. So, there is tension, there is a challenge, but we are stepping up and there are a lot more other vaccine candidates in the pipeline as you know, these are not the only two options that we would have.
We are going to be coming up with more vaccines, different kinds of vaccines, very soon. So hopefully there will not be a shortage. There has been some wastage of the vaccine in some of the states, people are not coming forward to get the vaccine and there has been some vaccine hesitancy as they call it. Hopefully, that will get over as well. It is important to think of other possibilities like vaccinating those who go to work every day. It is good that now 45 and above are being vaccinated. More and more people need to be vaccinated and there is no need to wait for this.
Now, the other question is about the extension of the vaccination period by two weeks of COVISHIELD to eight weeks, which has been taken at the highest level. There is a national technical advisory group on immunization and the group decides based on evidence. So, the evidence seems to suggest that a slightly longer window period is more efficacious than a shorter one. So, based on that, this decision has been taken and it is all right. So, if you take it into the fourth week, versus if we take it into the six weeks, the efficacy of the vaccine is supposed to be greater if you take it in six weeks. So, I think that decision is fine.
Interviewer- Nicole Srishti Basile and Sara Bhasin
Image Source- Institute of Economic Growth