With more than 4,789 active cases and 124 deaths from the novel coronavirus as of 8 April, India is gearing up for its toughest challenge yet as cases continue to multiply rapidly. The country is no exception to the overwhelming challenges being faced by world powers as they struggle to balance globalization, international trade, and the devastating effects of the pandemic. In addition to major lack of testing, reporting, and contact tracing raising doubts about India’s suspiciously low number of cases and deaths, medical practitioners and essential services workers at the frontlines of the situation have raised concerns regarding the alarmingly low availability of medical resources like Personal Protective Equipment (PPEs), testing kits, and ventilators.
On 31 January, shortly after the country recorded its first case in Kerala, the Indian government issued a notification banning the export of PPEs and the materials used in their production. However, they lifted the ban on 8 February to allow for the free export of disposable surgical masks and certain gloves, sending a major consignment to China, whose infection rate was skyrocketing at the time. Simultaneously, Indian authorities ignored guidelines laid out by the World Health Organization on 27 February to begin stockpiling these essential protective gear as the situation around the globe was worsening.
It was only on 19 March that the government overturned its 25 February notification allowing the free export of protective medical gear, imposing a full ban on the export of PPEs and ventilators. On 4 April, it restricted the export of locally-produced diagnostic kits. In the middle of all this, however, the country also sent a 90-ton consignment of ‘restricted’–but not ‘prohibited’–items like surgical gloves to Serbia, which the Central health ministry initially claimed to know nothing about, sparking controversy among the political opposition and medical community.
Ironically, India is now looking to import millions of surgical masks from China as these drastic policy changes, made against the backdrop of a highly restrictive complete nationwide lockdown, have impeded the country’s efforts to produce and distribute PPEs. The limits placed on the number of workers in factories, the restrictions on interstate transportation services, and the rampant red-tapism and favouritism in innovation approval processes have negatively disrupted the country’s medical supply chain, leaving professionals and caregivers frustrated and vulnerable as they brace for a surge in cases and deaths once testing increases.
Further, India had banned the export of all active pharmaceutical ingredients (APIs) following a major setback in supply from China after Beijing closed its borders in January. As a leading world supplier of APIs and pharmaceuticals, this move by India left the country’s neighbours and leaders in the US and Europe stunned and concerned as their medical industries are heavily reliant on exports from India and China, even for basic drugs like paracetamol. Of all the drugs and APIs exported by India, hydroxychloroquine (HCQ), a medicine usually used for the treatment of malaria and certain autoimmune diseases like lupus, has emerged as a popular alternative to treat COVID-19 among select medical professionals and nurses. Although the efficacy of the drug in killing the coronavirus is unconfirmed, countries have advocated its use and have been pressuring India, the world’s largest exporter of HCQ, to relax restrictions on its export. The pressure was particularly strong from the US, which currently leads the global charts for the highest number of reported cases and deaths from the coronavirus.
Following a distasteful threat of sanctions from US President Donald Trump, the Centre, on 6 April, changed its policy to allow the selective export of HCQ to countries in need on a case-by-case basis, just two days after it had issued a notification banning the export of the drug without any exception. While the Opposition was quick to criticize this move, it is worth noting that India has a sufficient supply of the drug to meet its domestic demand, which has been corroborated by both governmental and independent medical authorities. Moreover, HCQ has not yet been determined as an essential drug to combat the COVID-19 and India’s export of it to nations will definitely work in its favour diplomatically. In fact, India has also eased restrictions on the export of an additional 24 drugs and APIs, such as paracetamol, vitamins, and antibiotics to try and fill the void that its export ban created in reliant countries. India Today's Ankit Kumar has also argued that the easing of restrictions can provide relief to India's pharmacy sector and that its medical diplomacy can ensure early access to vaccines and other innovations from key countries.
What is concerning about this whole HCQ export debacle, however, is not India’s decision to export the drug and provide medical supplies to countries in need, but the ease with which it gave up its protectionist policies under pressure from the US. This raises major red flags about the current government’s ability to protect itself from a sanctions-ridden world economy and maintain its carefully manufactured global image, especially in the aftermath of a global pandemic. It is also worth noting that during the course of this crisis, Prime Minister Narendra Modi acknowledged requests from Israel, Iran, and other countries in need of medical supplies, while also promising to lead the SAARC nations through this pandemic. New Delhi did not follow through on Tel Aviv and Tehran's requests; to its neighbours, it sent around $1 million worth of emergency medical supplies but can no longer afford to sustain that commitment owing to its own shortages. Such inconsistencies can compromise India's image as a regional leader and global medical power. Modi has already come under the scanner for his administration's inability to take effective preemptive action to combat the spread of the virus and the disastrous migrant crisis that followed the announcement of the nationwide lockdown.
To better deal with the issue locally, India needs a strong economic policy that diverts more funds to its public health spending, which is currently among the lowest in the world. While the current export restriction on N-95 masks, PPEs and ventilators is a welcome and necessary move, perhaps its introduction came in too late for a system already saddled with poor infrastructure and far fewer intensive care professionals and resources than required. The constant flux of export rules has also shocked the domestic supply chain, with medical workers facing the brunt of the burden, physically and otherwise. There have been also reports of medical staff facing backlash from authorities and civilians for speaking out about the lack of available resources.
For a more holistic long-term gain, protectionist pharmaceutical trade policies must be complemented by equally robust efforts on the ground to strengthen medical infrastructure and make it self-sustaining and affordable to more people. The approach needs to be inwards-looking with the aim of empowering local workers and aggressively pushing for the safe production and innovation of crucial resources. For this, the Centre and affected states need to urgently allocate more funds towards public healthcare spending. At the same time, especially during a lockdown, there needs to be a more sustainable manner of easing export restrictions with ample warning given to producers to ensure minimal shocks in the domestic market. India's role in the international pharmaceutical sector is undeniably large and it is unrealistic to expect it to ban all exports completely, especially during a humanitarian crisis. But in what Foreign Policy has described as a ‘Sisyphean quest’ to maintain his global image and foster multilateral and regional cooperation, Modi’s knee-jerk reactions will continue to have drastic consequences on the country’s domestic medical capabilities unless his government addresses the concerns of medical workers as swiftly as it responded to Trump's threat.
Image Source: Quartz
Can India Afford to Ease Exports on Medical Supplies During the COVID-19 Pandemic?
April 8, 2020
