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When 2021 began, there was an air of buoyancy as covid numbers had plummeted to such a low that travel, business, elections, religious congregations and social gatherings resumed without restraint. Faulty forecasts were made that India would not experience a second wave and proffered explanations extended from magical herd immunity to a mystical mantle of genetic protection against covid. Plans for vaccine production, procurement, prioritized administration and export were predicated on a calendar that would be covid-free.

Alas, that was not to be. Even as the Alpha variant sneaked in and started exhibiting higher infectivity, the stage was being prepared for a more dangerous Delta variant to emerge and launch a ferocious attack. After India steadied itself in the second half of 2021, it appeared that the year would end with confident strides into a 2022 that would not be dominated by the virus. That might well have been, if it was only the familiar but ageing Delta that was still the lead actor. However, the arrival of a new variant that had far greater infectivity placed the spotlight on young Omicron.

India’s experience with covid in both the first and second waves focused on the need to strengthen our inadequately resourced health system. While emergency provisions made during the first wave and the Fifteenth Finance Commission accorded special attention to health infra and workforce, commitment to revamp the health system was clearly conveyed in the 2021 budget. The Digital Health Mission and Health Infrastructure Mission followed, under the umbrella of Ayushman Bharat. They aim to strengthen rural and urban primary healthcare, expand critical care hospital capacity and establish robust surveillance systems for infectious diseases, ranging from block level labs to regionally distributed National Institutes of Virology. District hospitals will be strengthened, new medical colleges established and allied health workers will be trained in large numbers.

If designed and implemented well, the digital transformation of India’s health services would advance tele-health in diagnostics and treatment, while enabling health information systems to gather and analyse data in a more representative, timely and accurate manner.

The performance of the health system too would become more efficient, with improved supply chain management of drugs, vaccines and equipment, while streamlining health insurance programmes.

Investments in health infrastructure will take time to demonstrate impact. While digital transformation can improve system efficiency earlier, the greatest area of need is primary healthcare. Apart from creating or upgrading infrastructure, training and deployment of technology-enabled non-physician health workers will add strength to primary care even in a relatively short time. People participation will add strength to the health system.

India will see Omicron numbers rising in the New Year. It appears to be a milder form than Delta but its higher infectivity and vaccine evasion pose a threat of many new, recurrent and ‘breakthrough’ infections. They can overwhelm the health system with the drill of testing, tracing and treatment. Again, many non-covid health services will be compromised.

To avoid that, we need to slow down the spread of Omicron by ensuring that people protect themselves with masks, good ventilation and avoid crowded places. We also need to protect people, especially the vulnerable groups, against severe disease by speedily completing the double vaccination schedule. Boosters for high-risk groups can follow later if vaccine supply is limited, or run in parallel if adequate supplies are assured. Homecare will be the main support for the mostly mild cases, while oxygen equipped beds will be needed by a small fraction.

Domestic capacity for development, testing and manufacturing of vaccines grew in 2021. India’s role as a global supplier of vaccines will be amplified in 2022, as covid is calling for boosters of current vaccines, development and manufacture of new vaccines, which can counter variants and provide mucosal immunity. Approval of new antiviral pills will generate high demand for pre-hospital use, with Indian firms called upon to produce large quantities at low cost. While India’s health sector will pursue its mission of self-reliance, the dynamics of the pandemic will require it to play a larger role in the global response.

The New Year calls for a renewed resolve to build an efficient, equitable and empathetic health system that can build on the hopes and promised programmes of 2021 and dispel the oppressive anxiety that the virus heaps on us with its every new edition.

K. Srinath Reddy is a cardiologist and epidemiologist, and president, Public Health Foundation of India. Views are personal.

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