Health and Healthcare Systems

How India can show leadership in addressing COVID-19

Police officers in protective suits arrive in a residential area to check on people under home quarantine, during a 21-day nationwide lockdown to limit the spreading of coronavirus disease (COVID-19), in Ahmedabad, India, March 25, 2020. REUTERS/Amit Dave - RC2YQF9PGQ3I

Police officers in protective suits check on people under home quarantine, during a 21-day nationwide COVID-19 lockdown in India, March 25, 2020. Image: REUTERS/Amit Dave

Aditi Vyas
Head of Business Engagement, India and South Asia, World Economic Forum
Sriram Gutta
Head, India and Deputy Head, South Asia, World Economic Forum
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With close to 400,000 people infected and more than 16,000 deaths around the world, as well as a global economic slowdown, COVID-19 is creating a challenging test for humanity. India has seen over 400 cases and 10 deaths so far, as it goes into a 21-day lockdown imposed by the Narendra Modi government Tuesday.

How will a country of 1.3 billion people with a high density of population, millions of habitants in rural villages and urban slums avoid a large-scale community spread of coronavirus?

Tackling this unprecedented challenge requires a systems approach and the mobilization of all stakeholders to respond. Here’s how the Indian government, the private sector and common people in their individual capacity can contribute.


What is the World Economic Forum doing about the coronavirus outbreak?

How the government can ramp up its efforts

The Indian government has so far followed a step-by-step model and been on the front foot with early screening at airports from mid-January onwards, initiating travel restrictions and in collaboration with states, applying restrictions on events and on places of social gathering including restaurants, theatres and gyms. Such a response ensured that there was no panic among the citizens and avoided inconvenience to the extent possible. The Indian government has also evacuated more than 1400 of its citizens and those of its neighbours from high-risk countries, including China, Japan, Iran and Italy. This is not the first time that India has evacuated its citizens and those of other countries during such crises to ensure their safety and security.

Equally noteworthy are the various public awareness campaigns. Prime Minister Modi has shown leadership in mobilizing the heads of government of the South Asian Association for Regional Cooperation (SAARC) and that of the G20 to share reliable information, best practices and support each other in fighting this pandemic.

Yet there is still much more to be done to improve health response systems and boost the economy.

Currently, India has completed among the lowest tests per million population. The limited testing capability in India for COVID-19, led primarily by the apex laboratory at the National Institute of Virology at Pune, has now been extended to 52 viral research and diagnostic laboratories spread across the country. The Indian Council of Medical Research (ICMR) only recently allowed private labs to test, but it is unclear whether even 48 hours after such an order, private labs began testing. The government should also facilitate the regulatory environment to empower Indian firms to produce test kits. South Korea has been an example, with companies producing test kits in a little over two weeks compared to months.

The government will need to take steps to protect those most vulnerable to COVID-19, such as those with prior conditions or without insurance. Italy’s National Health Authority this week stated that more than 99 percent of Italy’s coronavirus fatalities were people who suffered from previous medical conditions: more than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease. The scope of Ayushman Bharat, India’s flagship insurance/assurance scheme launched with the vision of universal healthcare and leaving no one behind, should be expanded to include the 40% ‘missing middle’ who are neither covered by private insurance nor by the government, so that any COVID-19-related expenses are covered by the government.

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There is also a pressing need for economic measures to stabilize and stimulate the economy and protect people’s jobs and livelihoods. According to the International Labour Organization, COVID-19 could render 25 million people unemployed and many more underemployed by virtue of reduced wages and working hours. This is especially critical in India where a large part of the population is either self-employed or dependent on daily wages for their subsistence.

Given India’s infrastructure around direct benefits transfer (DBT), the Modi government could consider depositing cash on a monthly basis for the foreseeable future. This would ensure the poor can take care of their basic needs and help stimulate demand in the Indian economy. Many countries, including Canada and the United States, have announced economic measures for individuals and businesses, and India could take inspiration from those. This is especially true for the urban poor and here the Jan Dhan accounts could be a good opportunity to transfer cash. With over 150 million beneficiaries with accounts in urban bank branches, such a transfer can reach a large segment of this population. Equally, the government currently has over 430 schemes that use DBT and can be targeted to reach specific groups such as pensioners, bereaved and unemployed, among others.

An important consideration is the harvest season for the Rabi crops due in the next 2-5 weeks. This is a sensitive population given the already distressed farmers. The government will need to balance the economic impact of any potential curb in farming and the heath and societal impact of a spread of the coronavirus pandemic.

This unique situation also presents a case for stronger alignment between India’s monetary and fiscal policy. As has been the case with other G-20 economies such as Australia, the government can use this opportunity to work closely with the Reserve Bank of India (RBI) to ensure that the necessary fiscal stimulus is supported by further loosening of monetary policy. This can provide necessary bandwidth to both corporate India as well as retail borrowers.

The government must also continue to ensure constant, consistent and credible communication to provide necessary public health guidance and to allay any fears and panic among the populace. A good example of such a communication is in the state of Kerala, which successfully managed the Nipah virus in 2018. Here the Chief Minister Pinarayi Vijayan and Health Minister K.K. Shailaja have been giving a press conference every day at 7 pm to update and educate the state’s citizens. In many ways, Kerala is a benchmark in pandemic preparedness and action and other states can emulate its successful ways.

Global spread of COVID-19.
Global spread of COVID-19. Image: World Economic Forum

One such example of real-time and dynamic updates on India's response to COVID-19 is Invest India's Business Immunity Platform. This unified platform can bring together the public and private sector to fight this pandemic.

This pandemic will likely highlight our state capacity or the gaps in it. From trained medical professionals to managing the scale of COVID-19 to the ability of the state to manage a crisis through a multi-ministry/department in an integrated way.

How the private sector can mobilize

“The Indian private sector must proactively address the COVID-19 pandemic,” said Sanjiv Bajaj, Managing Director, Bajaj Finserv. “Temperature scans and improving personal and office hygiene are important. Also, we must assist in social and office distancing by practising work from home, creating adequate space between those employees that are at work for critical activities, and ensuring proper care for our colleagues who may get infected. Equally important is to continue to thoughtfully serve our partners and customers and support the economy in these trying times.”

ICMR has given the private sector its nod to support testing efforts and issued guidelines to cap the price. The most significant contribution from the private sector in this area will be to support testing at zero cost to the poor. The utilization of CSR funds to fuel these efforts will help scale a very significant stage in the containment of the pandemic.

Equally, personal protective gear, including hazmat suits and N95 respirator face masks, are in short supply and this will only be exacerbated if and when large number of citizens are infected. Businesses that have relevant manufacturing capabilities can repurpose their manufacturing plants to contribute to the supply chain of critical medical products the way French multinational and conglomerate LVMH has for sanitizers and Zara has for face masks. Here in India, Reliance Industries has built a 100-bed hospital in just two weeks dedicated to supporting COVID-19 cases and many business leaders including Anand Mahindra have pledged support in multiple ways.

Small businesses will be significantly impacted through this pandemic. This is where businesses, philanthropists and investors can support coordinated efforts to provide funding and mentorship to bring these companies back on their feet.

The private sector can also provide technological solutions to gather and use data on travel patterns and health symptoms, and to leverage the smartphone penetration in India to build contact tracing. For example, Singapore’s community-driven contact tracing app “TraceTogether” reduces dependence on memory and identifies people who have been in close proximity within two metres for at least 30 minutes. The private sector can also support virtual medicine efforts to offload hospitals and use telemedicine for remote monitoring of low- or mid- risk patients.

“Technology-enabled digital tools like virtual consulting will enable continuity of care especially in cases of non-communicable diseases at times such as these when patients cannot visit their doctors for follow-ups,” explained Shobhana Kamineni, Executive Vice Chairperson of Apollo Hospitals Enterprise Limited. “As of this week all our consultants are available via tele consults. This crisis has catapulted the adoption of the digital in every sphere and will make the difference between life and death and our capability to overcome this pandemic.”

A view of nearly deserted wholesale market is seen during lockdown by the authorities to limit the spreading of coronavirus disease (COVID-19), in the old quarters of Delhi, India, March 24, 2020.
A view of nearly deserted wholesale market in the old quarters of Delhi, India, March 24, 2020. Image: REUTERS/Anushree Fadnavis

Businesses have a responsibility towards their employees. Those employees who are not on any permanent contract often become the first casualty of cost-cutting measures and are the most vulnerable. It will be critical for businesses to ensure all such employees continue to get paid and that companies can partner with the government to ensure their health coverage.

Businesses should use this opportunity to invest in their digital capability and trainings that allow for easier and efficient ways for their staff to work from home. In the short term and in a scenario where we may not have the necessary healthcare infrastructure, businesses can then offer their office space and facilities to the health and healthcare community at the national, regional, local and hyperlocal level.

In addition, it is important that banks, although under severe duress even before COVID-19, consider measures especially for the most-hard-hit sectors, including aviation, travel and tourism. A moratorium on debt for such companies and for micro, small and medium enterprises would be very helpful.

Businesses and business leaders on social media also have a unique role to play in quelling misinformation and providing clear and coordinated messaging from verified sources including the World Health Organization (WHO). One such example that has been lauded by Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO, is Indian mobile networks playing a 30-second coronavirus information alert before the start of every phone call.

It will be increasingly important over the next days and weeks to convert intent to action and support the fight against COVID-19 in a synchronized way. To bring the business community together with other stakeholders, the World Economic Forum has launched the COVID Action Platform to galvanize the private sector for collective action, protect people’s livelihoods and facilitate business continuity, and mobilize cooperation and business support for the COVID-19 response.

How individuals can do their part

With 75 COVID-19-hit districts across India under complete lockdown until March 31st, Prime Minister Modi’s appeal to the nation has been to seek their solidarity in social distancing. It is, however, eventually up to each individual to continue following this to reduce the spread of the virus. It is possible that asymptomatic people can spread the virus, which could put in harm’s way the elderly and those with pre-existing medical conditions. A rapid transmission will also place additional burden on the healthcare system and frontline healthcare workers.

Millions of Indians don’t have the privilege of working from home and the call for social distancing may seem to ignore the reality of much of our population, including maids, drivers, caregivers and others. For those of us who can afford to, we can support their own need for social distancing and continue to pay them their salaries.

As we fight this pandemic together, governments, businesses, civil society and citizens require great resilience and adaptability. With an approach that includes the whole society, together we can and will fight this coronavirus pandemic.

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