Knowledge is power. This is especially true when we are faced with a new threat like SARS-Cov-2. The more we learn about it, the better able we are to develop solutions and policies to deal with it.
Yet whether it is the government, the population or even doctors to some extent, India’s response to the Covid-19 pandemic does not appear to have been based on solid knowledge and evidence time and time again.
As far as government is concerned, the lack of an evidence-based approach is hardly surprising, given that even under historically minimal public spending on health, the budget allocation to the Department of Ministry of Health and Family Welfare (MoHFW) health research accounted for only about 3% of the MoHFW budget. An article published in 2019 on NITI Aayog’s Development Monitoring and Evaluation Office (DMEO) website argues quite widely – and rightly so – that, “even as the world shifts to evidence, our country has yet to adopt the practice of regularly evaluating government policies and charting the future direction of policies accordingly. ”Two years later, in the context of the Covid-19 pandemic, the government doesn’t even allow / reveal reliable evidence.The government, even in a state like Kerala, is also guilty of this accusation – forget about the BIMARU states.
When it comes to people, health literacy levels continue to be quite low. An example of this is the high levels of stunting among children, even among the educated and wealthy nationwide – 31% among children of parents with a high school education or higher, 22% among children of parents in the quintile. highest wealth (National Family Health Survey 2015-16). Faced with the novel coronavirus, people have stored / consumed all kinds of unproven drugs and immunity-boosting products, driving up shortages and prices in the market.
As for physicians, many of them have been infected, passed away, overloaded with the workload – with little time to relax, let alone review and bring emerging evidence to their practice. Perhaps to avoid hospitalizations / deaths in the context of the collapsing healthcare system, antibiotics like Doxycycline have been prescribed even for asymptomatic cases, despite the threat of antibiotic resistance, the WHO consistently advises against the use of antibiotics for viral infection such as Covid-19, and MoHFW’s “Guidelines for the management of co-infection of COVID-19 with other seasonal epidemic diseases” also advise that “antibiotics should not be prescribed routinely unless there is a clinical suspicion of bacterial infection ”.
Going forward, we need to consider the following evidence-based strategies:
Strengthen surveillance. As David Nabarro, WHO Special Envoy on Covid-19, argued, surveillance, rather than vaccination, should be our main strategy to exit the pandemic. This is especially relevant for a country like India, which struggles to keep its citizens – as well as its vaccination campaign – alive.
Support research and reviews. Research as well as ongoing, systematic and rapid reviews of the evolving evidence – what works, when and how – should be funded by government, conducted by experts, and regularly shared with policy makers as well as physicians.
Disseminate. Emerging evidence and guidelines based on it should be regularly disseminated among communities in accessible formats. Governments urgently need to engage with communities to work together against the pandemic.
Vaccinate. Prioritize people at risk of death from Covid-19 based on our own evidence. The second wave in the country showed that even the very young are at risk, and not just the elderly and those with metabolic risk factors.
Dr Ali Mehdi leads the Health Policy Initiative at ICRIER.
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