A decentralized approach could help turn the tide against covid

As the second wave of the coronavirus pandemic continues to ravage India, the inadequacies of our health and medical care systems are exposed and we are paying a horrifying price in lives and livelihoods lost. We need to respond with speed and agility to turn the tide. To ensure that, decentralization is a must.

Giving local governance structures the freedom to craft their own strategies is key because they have the advantage of ‘on ground’ information, monitoring and immediate action when it comes to tackling a public health emergency like the covid outbreak.

Decentralization encourages ownership and sharing of responsibility, while a centralized command-and-control approach leads to passing the buck for crisis decisions to alternative sources of authority.

Community participation is key: To counter the second wave, the government is advocating covid-appropriate behaviour and vaccinations. If these measures are to be effectively enforced, it will need the active participation of everyone at the community level across the country.

The impact of community participation in effectively dealing with such outbreaks is best demonstrated by the example of a 17th-century English village, Eyam, which became one of the most remarkable cases of self-quarantine in history. During the bubonic plague of 1665-66, Eyam’s inhabitants quarantined themselves to prevent the spread of the plague. People from the village would come to place money in six holes drilled into the top of a boundary stone to pay for food and medicine left by their neighbours. More than a quarter of the village’s population of almost 1,000 had died by the end of the outbreak. But thanks to their self-sacrifice, the plague was contained.

As the historical example of Eyam shows, local communities can rally together to enforce covid-appropriate behaviour. They can also organize covid vaccination drives in apartment complexes, just as several resident welfare associations (RWAs) have been doing in Bengaluru, with the help of the Bruhat Bengaluru Mahanagara Palike (BBMP), and other cities.

In addition to planning vaccination camps in collaboration with local bodies, community involvement can also play a key role in identifying vulnerable households, supporting the elderly and those in quarantine, and also in contact tracing. They can also come together to order medical supplies such as oxygen concentrators, oxygen cylinders and medicines in bulk for community use or for replenishing the stocks of the local hospital or medical centre frequented by members of the community.

Lessons from success stories: It is now clear that district-level covid management works best. During the first covid wave, the central government had given broad guidelines to support the states in tackling this crisis holistically, which led to unique district level response strategies, tailored to local needs. This decentralized approach had led to the creation of success stories such as the ‘Kerala model’, the ‘Bhilwara model’, the ‘Dharavi model’ or the ‘Karnataka model.’

Many of these decentralized, district-level models have fallen by the wayside during the second wave, which has been characterized by too much centralized coordination both at the Centre and within states. Centralized covid task forces and war rooms sound reassuring, but are not effective in delivering real-time rapid responses.

Learning from the success of others has never been more important than now. At a time when supply shortages of medical oxygen has left states like Delhi and Uttar Pradesh gasping, Kerala has a surplus of it. A state that was dependent on neighbouring Tamil Nadu and Karnataka has enhanced oxygen production capacity over the past one year through concerted efforts to set up new plants and maintain existing ones. The ‘Kerala model’ of oxygen self-sufficiency needs to be emulated by other Indian states.

Tiered vaccine pricing: The perils of centralized planning is evident from the slow pace of vaccination in the country. The government was right in changing over from a centralized immunization drive to allowing states to expand the scope of vaccinations. Provided there is adequate supply of vaccines, state governments should be able to very rapidly work out effective strategies to immunize their populations.

The government has also suggested a vaccine sharing model of 50% for the Centre and 50% for state governments and private hospitals/private sector. However, the Union government’s attempt to create multiple price points for three different categories of vaccine buyers has led to confusion. We cannot have a situation where the Centre procures vaccine doses at one price, states at another, and private sector buyers at yet another. This could slow the pace of vaccine procurement because there will be multiple buyers negotiating with manufacturers on purchase quantities, supply logistics and payment plans. Vaccines need to be offered to the Central and state governments at a uniform price. The private sector, which includes private hospitals and the corporate sector, may be provided price flexibility based on the volumes procured.

In the next few days, industry associations, corporate entities, self-help groups, RWAs, traders’ associations and political parties will have to join forces and act locally down to the ward, district and panchayat levels if we are to win the battle against the virus at the national level.

Kiran Mazumdar-Shaw is executive chairperson, Biocon, and co-chair, Lancet Citizens’ Commission for ‘Reimagining India’s Health System’.