Centralised vaccine procurement, transparency: Lancet panel makes eight recommendations to Centre for COVID-19 management

With an aim to curtail the loss of life and suffering caused by the second wave of rise in COVID-19 cases across India, a panel of experts made eight crucial recommendations, including proposing a central system for procurement of free vaccines, transparent pricing policy and cash transfer by states to workers in the informal sector. “We call on the central and state governments to act with urgency and in solidarity with each other and across sectors to address one of the greatest humanitarian crises facing the country since its independence,” the authors wrote, saying that there is still time to stem the haemorrhage of life and the suffering caused by COVID-19 in India. The panel which included 21 experts, including noted virologist Gagandeep Kang and Narayana Hrudalaya chairperson Devi Shetty, made the recommendations in an  article published in the British medical journal Lancet. The Lancet Citizens’ Commission on Reimagining India’s Health System was launched in December last year to map the pathway to achieving universal health coverage (UHC) in India in the coming decade through a participatory, solutions-driven approach, PTI reported. Besides Kang, who is professor at the Christian Medical College (CMC) in Vellore, and Shetty, the panel also includes Vikram Patel, professor, Harvard TH. Chan School of Public Health, Kiran Mazumdar-Shaw, executive chairperson and founder of Biocon Limited and Yamini Aiyar, chief executive of the Centre for Policy Research in New Delhi. Aiyar is also the lead author of the article. The experts made the following eight recommendations: 1. Central system to procure vaccines free of cost Among the key points is the establishment of central systems to procure and distribute COVID-19 vaccines free of cost, a departure from the current policy of decentralised procurement through state governments. “Such an approach would optimise prices and minimise cross-state inequities that may result from differential fiscal and capacity contexts,” the 21 authors wrote in the article. 2. Decentralise organisation of essential health services The commission recommended that district-level working groups should have the autonomy to respond to rapidly changing local situations and must be empowered to receive funds and resources to coordinate efforts across all sectors of the health system, from front-line workers to tertiary care. “A one-size-fits-all approach is untenable since the numbers of COVID-19 cases and health services differ substantially from district to district,” the authors said in the article. The panel also recommended use of appropriate technologies in streamlining the management of resources and supplies, such as hospital beds, oxygen, ambulances, and funeral resources, adding that several states and districts have successfully used such decentralised systems for quarantine, triage through front-line workers, and community-based primary service delivery. 3. Transparent national pricing policy, cap on essential health services. Given the pandemic situation, the expert panel also recommened a transparent national pricing policy and caps on the prices of all essential health services such as ambulances, oxygen, essential medicines, and hospital care. It also said that “hospital care should not require any out-of-pocket expenditure and costs should be covered by existing health insurance schemes for all people, as has been done in some states”. Besides, local governments must be allocated their grants as recommended by the 15th Finance Commission to ensure they have the resources to augment COVID-19-related health services in their jurisdictions, the article added. 4. Evidence-based information on management of COVID-19 Given the indiscriminate use of experimental therapies and drugs, the expert panel recommended a wide dissemination of evidence-based information on the management of COVID-19. The guidance, the panel said, should include suitably adapted international guidelines for home care and treatment, primary care, and district hospital care in local languages that incorporate local circumstances and clinical practice, as well as emphasise on what not to do. “It should also provide information to help prevent increasingly concerning reports of other impacts of COVID-19, including secondary infections such as mucormycosis,” the panel recommended. 5. Marshal resources across sectors The panel also recommended that the State marshal all available human resources across sectors of the health system, including the private sector, for effective response to the disease. The panel supported the govt’s decision to deploy final-year medical students and AYUSH (ayurveda, yoga, naturopathy, unani, siddha, and homoeopathy) students in the COVID-19 response, however, it suggested that the policy be extended to nursing and paramedical students as well. 6. Active cooperation betweem govt, NGOs Besides, the panel proposed active collaboration between government and civil society organisations to create and disseminate accurate information, enabling home-based care, emphasising prevention, helping navigate access to life-saving treatment, and promoting vaccination. And to achieve that, it recommended that the government immediately withdraw the restrictions on NGOs access foreign or domestic CSR funds. 7. Transparency in COVID-19 data collection Another recommendation is transparency in government data collection and modelling to enable districts to proactively prepare for likely caseloads in the coming weeks. 8. Cash transfers by state to workers in informal sector Finally, the commission recommended minimising the profound suffering and risk to health caused by loss of livelihoods by making provisions for cash transfers by the state to workers in India’s vast informal economy who have lost their jobs. With inputs from PTI