Modi regime lost its credibility amid COVID-19 Crises, Indian Civil Society writes Open Letter to 74th World Health Assembly

DND Thought Centre Report

The Indian Civil Society has lambasted the Narendra Modi-led New Delhi regime for its criminal negligence amidst the COVID-19 pandemic, arguing that the Indian government has lost its credibility to represent the people of India, and called for strong global political commitment to address the challenges in public health care.

In an Open Letter to the 74th World Health Assembly which is discussing the agenda prepared by the World Health Organization’s Executive Board virtually from May 24 to June 1, the concerned Indian citizens belonging to various organizations and movements have mentioned that at a time when COVID-19 is wreaking havoc in India, there is a growing sense of people having lost faith in the current Indian government– which continues to exhibit its apathetic attitude towards its citizens.

The Indian Civil Society ought the global support towards systemic changes in India and the rest of the world committed to public health, social equity and justice in the times of COVID-19

The following is the full text of the Open Letter by the Civil Society from India to the 74th World Health Assembly:

As the country delegations gather to discuss the agenda prepared by the World Health Organization’s Executive Board at the 74th World Health Assembly (WHA), we, concerned citizens of India belonging to organizations and movements committed to health, rights and justice as well as members from the medical fraternity would like to draw global attention to unimaginable scale, and critical issues arising from the COVID-19 pandemic in India. A number of world leaders have called for a ‘Pandemic Treaty’, which will govern the future global approach to pandemic preparedness and response. But the language used is that of health securitisation and the mandate of the treaty is being seen through the lens of International Health Security Regulations alone.

It is pertinent to state that we are concerned about the lives of people and their well-being. There is a growing sense of people having lost faith in the current government of India – which continues to exhibit its apathetic attitude towards its citizens. The government confronted the first wave of the pandemic with a hastily imposed lockdown that left millions hungry and to fend for themselves. It also perpetrated one of the largest migrations of its own citizens. When the government should have been spending its time on building up medical, social and logistical support for its citizens to handle the pandemic and economic crisis, it was busying itself priding on the illusory victory over COVID-19. During the massive and fatal second wave, it was not only callously unprepared, and under-prepared, but, also criminally negligent in the implementation of internationally developed scientific protocol for the treatment of the viral attack and its secondaries. With utmost disdain towards people’s lives, it abandoned the patients and families at a crucial juncture when people required governance mechanisms to prevent blatant profiteering and black marketing of life-saving drugs and oxygen. India’s high mortality rate is a direct result of this negligence and apathy, clubbed with irrelevant & over-medication, and unscientific treatment meted out to hapless people.

No other country in the world may have witnessed widespread prescription medicines being sold over-the-counter. As evidence suggests, heavy and multiple dosages of irrelevant antibiotics and anti-parasitic medicines have wreaked havoc with people’s health – leading to even asymptomatic persons having to shift to life support and worse, lose their lives. The government shamelessly allowed experimentation on people of India by the pharma lobbies, yoga gurus, private hospitals, a few doctors and quacks alike treating them as guinea pigs, who are now exposed to the additional threat of the deadly Mucormycosis fungal infection that is seeing unprecedented escalation.

We, the citizens of India, are uncertain about the government’s position at the WHA, however, we do know that it has lost its credibility to represent the people of India. We seek to gather global support for systemic changes in India and elsewhere, while at the same time, calling for a commitment to strengthening public health systems globally by honoring ‘Health as a Universal Right’ through all means possible – Increased resource allocation for the public health sector in national budgets, increased investment in R&D, and providing equitable access to quality public health services, especially for the most marginalized sections of our societies. In spite of long known studies and predictions of real possibilities of novel pathogen borne pandemics, the global community failed to respond to COVID-19 in earnest, and often succumbed to narrow private economic interests in the initial stage, allowing the disease to become a pandemic. With our invasion of ecologically isolated niches and Climate Change threatening to unleash more novel pathogens into human environments, we must learn hard lessons and prepare before the next such threat strikes.

Institutional Failure Responsible for Loss of Countless Lives

The complacency of the Indian government after the first wave thoroughly exposed its lack of preparedness for the second wave. The already critical situation was further exacerbated (as widely reported by internationally media) by a series of missteps overwhelming the public health infrastructure that has been systemically weakened over the last few decades by policies and disinvestment.

Subsequently, the government of India ignored the potential second wave warnings from doctors, health experts and its own committees. A Parliamentary Committee in November 2020 pointed out the ‘glaring lapses’ in emergency supplies, including oxygen. Another expert group of scientists formed by the government warned of a more contagious variant of Corona-Virus in early March of 2021. The government’s endorsement of local-bodies’ and state-level elections, and allowing massive congregations at religious festivals only aggravated the already critical situation. As the world is well aware, the severe lack of preparedness from the state led to the chaos that unfurled, with hospitals and doctors taking to social media sending distress calls for oxygen replenishment and upgrading medical infrastructure.

The urban and rural healthcare infrastructure in India was grossly insufficient and did not have the necessary infrastructural capacity to take care of the surge in the number of patients. This is a result of the chronic underinvestment in healthcare, and shift towards privatization of essential health services, especially in rural pockets of the country. Moreover, sub-optimal rollout of vaccines has created panic, confusion and chaos, which has further impacted the lives of the people.

Prioritizing Superstition over Science

When the primary focus of the Government, health departments and medical fraternity should have been to spread scientific temperament and establish proven treatment protocols, the people were constantly fed quasi-scientific and superstitious beliefs. Even when India was clocking a record number of infections and deaths due to COVID-19, a constant barrage of misinformation found its way into the public domain, many of which were acknowledged and promoted by authorities in the government and the Ayush Ministry. Alternative medical/medicinal approaches were blindly promoted without rigorous scientific and clinical testing of their efficacy and safety, which – if proven, could have added to our collective knowledge and repertoire towards an effective response to COVID-19. The government literally allowed the overriding of medical sciences with mythological invocations.

Reckless Overmedication and Serious Consequences

Due to the failure of Indian medical authorities to issue and implement a clearly articulated scientific treatment protocol for COVID-19, many a medical practitioners were in breach of WHO and Indian Council of Medical Research (ICMR) protocols and guidelines in their reckless and untimely use of drugs that have drawn no conclusive evidence of fighting the infection and has resulted in a deadly impact, like

–           Ivermectin, Fabiflu, Tocilizumab, Remdesivir, Convalescent Plasma, all of which have not shown any significant effect in any of the clinical trials and were not in the WHO protocols were prescribed recklessly, thereby severely compromising the natural immunity of patients, and creating unnecessary vulnerabilities to a myriad of secondary infections. Some of the state governments had announced dosage of Ivermectine as a prophylaxis, for anyone above 18 years. Remdesivir, despite its very limited effect, was made to look like a magic drug, creating a rush and panic among patients to procure spending tens of thousands of rupees (upto over 1000 USD)!

–           Broad spectrum antibiotics like Doxycycline and Azithromycin were prescribed in the first week to symptomatic and asymptomatic patients alike, and even promoted as preventive drugs, hindering body’s ability to fight the virus subsequently. Similarly, corticosteroids were randomly prescribed in higher dosages (Dexamethasone over 12mg) in many cases without accounting for risk factors, such as diabetes – while the globally recognized protocols clearly prescribed 6mg dosage of the same.

–           Despite Convalescent Plasma being another experimental treatment that had not been accepted by the WHO or any leading government medical hospitals; countless big and small private hospitals prescribed and profiteered by promoting and administering Plasma as therapy. It took an acute shortage of plasma and countless deaths and a strong campaign by certain sections of the civil society and medical fraternity, for the government to finally remove It from the treatment protocol.

–           At this moment, India is facing a dangerous spike in cases of Black Fungus (Mucormycosis) amongst COVID-19 and post-COVID-19 patients, that is speculated to be a direct result of rendering patients severely immunocompromised due to the faulty medications and high doses of steroids. It is also linked to forcing people to desperately buy and use industrial-grade oxygen in the face of a dire shortage of medical-grade Oxygen.

Corporate Loot in Time of COVID-19 Crisis:

While it is yet to be empirically confirmed, there is need for a serious investigation into the link/s between alarming death rates in India and the reckless medication, which have suddenly gained a huge market share in India. Most crucially, the government of India, stood and watched as people paid the price and companies profited.

It is an irony of our times in India, that the Union Government that seeks to centralise power in so many ways, has now created a multi-tier pricing policy for vaccines revealing its commitment to corporate profit rather than its citizens. The new policy earmarks that the Centre and states will have to negotiate independently with companies, as though vaccines are a luxury good in a so-called free market, instead of a basic service that the state should guarantee for its people.

Public Health Crisis Handled as Disaster Management:

The Indian government has been tackling the pandemic through a disaster management strategy and legality of the Disaster Management Act, rather than treating it as a public health crisis.

Passing authoritarian strictures that further compromised the health and immunity of the people of India, allowing states to implement cruel measures on migrant workers – men, women and children – such as spraying them with disinfectant chemicals, using the law and order apparatus to ruthlessly ‘control’ movement, instead of pressing into service measures that aided the people at large, the deeply over-stretched medical and care fraternities has only increased the peril and fragility of peoples’ lives and health – both physical and emotional.

Another serious implication of the pandemic being seen and handled as a disaster rather than a public health crisis is the fact that all decisions on medical protocols and advisories are being made and issued by civil bureaucrats, rather than the scientific and medical fraternity, public health specialists, etc. The government is deliberately obfuscating the data pertinent to incidence of infections and mortality. Anyone trying to unearth these discrepancies is denounced by the State and also liable to inviting severe reprisals by the State.

Health as a Right of People is Severely Undervalued:

India’s public spending on health care has remained an abysmally low of around 1.6% of GDP, one of the lowest even among developing countries.  With citizens forced to bear huge expenses for health care, this pushes out the poor to the brink of health care access. A very tiny portion of even this amount is actually spent on public health infrastructure or investments. The second wave is not only a health, economic and livelihood crisis, but, a crisis of humanity. Today, not only scores of Indians have been brutally snatched from their loved ones, many young children have been orphaned, and those who have survived are heavily indebted and made poor by a system dictated by greed of private capital – hospitals, pharma companies and insurance alike. Equating health care and health coverage misses the point of public health investment in favor of indemnifying health, and is thus an indicator of shallow proportions.

We call upon the World Health Assembly to not limit its responsibilities to a short-term and piecemeal ‘pandemic treaty’, but rather focus on public health care investment and infrastructure.

Our Appeal to the WHA

We, call for a strong global political commitment to address the challenges in public health care, by having instantiated the case for India. Health should be seen as an investment in human capital, which is essential for social and economic development of a country. Therefore, the governments should take a primary ownership role in ensuring people-centric and equitable delivery of health care to all its citizens. But, this role is not being fulfilled by most governments, especially those in Low-Middle Income Countries (LMICs). As World Health Organization’s Global Health Expenditure database shows, there is a wide variation between the High-Income Countries (HICs) and LMICs on the Current Health Expenditure as a proportion of Gross Domestic Product (GDP). In many countries, the General Government Health Expenditure as a percentage of Current Health Expenditure has also been shrinking over time. This reveals a dangerous trend that the governments are slowly withdrawing its responsibilities of ensuring health of its citizens.

We, the undersigned, draw the attention of the Assembly through the Office of India’s Permanent Mission at Geneva to the following:

• Underinvestment in health care sector by national governments and demand a publicly funded Universal Health Care.
• Need for an international ring-fenced fund for renewal of health care infrastructure in LMICs
• Supply chains for products required for essential and emergency medical care during the time of an international healthcare crises. This also encompasses easing of restrictions on exports and imports of raw-materials and components for vaccine manufacturing, by possibly waiving off TRIPS Agreement as subscribed to by the WTO
• Pooled procurement and public manufacturing of products required for essential and emergency medical care during the time of an international health care crises
• Accountability of national governments to its citizens and the international community, on health and health-care delivery. We also demand accountability and transparency on data pertaining to vaccine and vaccination status as well as efficacy of vaccines and other medical drugs as regards their lines of treatment
• Transparency in reporting of morbidity and mortality statistics, by national governments to its citizens and the international community.
• International health governance processes should be initiated during the time of an international health care crises and the Office of the World Health Organization should honored
• Emerging concerns like Antimicrobial Resistance and Neglected Tropical Diseases and challenges posed by HIV/AIDS, Tuberculosis and Malaria should also be addressed in priorities
• We demand provisions to be made and strictly adhered to by national governments for those who need regular medical treatment and hospices. They mustn’t be barred from accessing their critical and follow-up medical services
• Keeping in mind the state of overcrowding in prisons and consequent risk of infection, we demand the authorities to uphold human rights and liberties of those incarcerated, and those wrongly held without conviction

Though we are yet to enter into a formal phase of negotiations for the treaty, the emphasis given on surveillance, whereby individual rights are controlled & curtailed by the state; and vaccines in the discussion about the treaty shows a very narrow approach taken by the high-level stakeholders. At a time when the political capital available for increasing public expenditure on health is high, the pandemic should be seen as a wake-up call for revamping the global health care system, and restructuring it for the larger good in consonance with democratic principles.

The Letter was endorsed by: