VIDYA KRISHNAN15 April 2020
The Narendra Modi administration did not consult a national task force of scientists and experts on key decisions relating to India’s health policy on COVID-19, including the decision to allow private testing for the virus, the price cap on such tests and the decision to extend the lockdown, according to members of the task force. T NARAYAN / BLOOMBERG / GETTY IMAGES
A national task force on COVID-19, comprising 21 leading scientists from across the country, which was supposed to advise the Narendra Modi government on its response to the pandemic, did not meet even once in the week preceding the announcement to extend the nationwide lockdown, according to four members of the group of experts. In a national broadcast on 14 April, Modi announced the decision to extend the lockdown till 3 May. The government did not consult the team of experts before taking the decision. “The committee has not met all of last week,” a member who spoke to me on 14 April, on the condition of anonymity fearing retribution from government, said. In that time, India’s COVID numbers rose from 4,421 confirmed cases and 114 deaths, as of 7 April, to 10,363 cases and 339 deaths, on 14 April.
“It seems like they created a committee to say they were consulting the scientists,” the member said. The member pointed to an example that supported his statement. On 4 April, the Indian Council of Medical Research, the nodal body framing India’s COVID-19 policy, submitted to the Supreme Court that the decision to allow private laboratories to conduct COVID-19 tests was taken after “extensive deliberations” with the task force. But according to the member, there was no such discussion. The member added that as of 14 April, the task force had not been given the minutes of any of the meetings. A second member of the task force, also speaking on the condition of anonymity, said that the minutes of the meetings were sent only to the cabinet secretary, and not shared even with other members of the task force.
On 18 March, Balram Bhargava, the director general of the ICMR, wrote to Lav Agrawal, a joint secretary in the health ministry, informing him of the constitution of the task force, under the chairmanship of Vinod Paul, a member of the Niti Aayog. Bhargava wrote that a “high-level technical committee of Public Health Experts for COVID-19” had been established to “guide the prevention and control activities in the country.” It then listed the 21 members of the task force, which includes doctors from the All India Institute of Medical Sciences in Delhi, members of the ICMR, and both current and former government officials, among others.
The terms of reference for the task force were to identify research priorities, review evidence, align research with the level of outbreak and response, identify and create protocol, develop concept notes and identify partners for implementation. Yet, multiple members of this task force said that they had not even met before crucial decisions pertaining to COVID-19 were taken, not least guide the country’s response, as was its mandate.
The decisions taken by the task force have not been transparent, and this was starkly reflected in the circumstances surrounding private testing for COVID-19. On 21 March, three days after the task force was constituted, the health ministry had notified guidelines issued by the ICMR to allow private clinics to test for the novel coronavirus, and fixed a cap of Rs 4,500 for the tests. Shashank Deo Sudhi, a lawyer, had challenged this decision in a public-interest litigation, seeking directions from the court to direct private clinics to conduct free testing. On 8 April, the Supreme Court allowed the petition and ordered that testing should be free at both government and private laboratories.
Two days later, Dr Kaushal Kant Mishra, an orthopaedic surgeon attached with Primus Hospital in Delhi, filed an intervention application seeking the modification of the order, noting that the court had stated that the question of reimbursement of the private clinics would be determined later. Mishra argued that this could result in the private labs refusing to test patients. His application sought the court’s directions that private labs may be allowed to charge upto Rs 4,500 for the general public, and must conduct free tests only for individuals falling in the economically weaker sections category. On 11 April, Mishra tweeted, quoting an ANI tweet about his application, “It’s just an attempt to help the every citizen and government!!! … It should be considered as donations to PM fund, as you are not preventing yourself alone but society also!!”
On 12 April, the ICMR made its submission to the Supreme Court supporting the application for modification. R Lakshminaryanan, an assistant director general in the ICMR, filed an affidavit on behalf of the ICMR and stated that the court’s order directing free testing “may work to the detriment of the cause the country is fighting.” Lakshminarayanan wrote, “I state and submit that the Government of India has constituted a National Task Force on Covid-19 to effectively and scientifically deal with the global challenge posed by this pandemic to save maximum lives by taking scientific decisions based upon expert advice and keeping in mind the fact that the resources are not unlimited. The National Task Force which takes these decisions consists of experts from various walks of life.” (The affidavit listed only 17 members as part of the task force, but the members I spoke to said that all 21 experts were still a part of it.)
According to Lakshminarayanan’s affidavit, as of 9 April, government labs conducted 87.28 percent of the COVID-19 tests, and only 12.72 percent were conducted by the private clinics. The assistant director general then added, “I state and submit that the Government took the decision to involve private laboratories in the process of testing … after extensive deliberations with the National Task Force on all aspects.” The assistant director general further stated that “after elaborate and extensive discussions and deliberations with subject experts from various fields,” the centre “took an administrative decision to allow private laboratories while imposing price cap for them to ensure that they do not charge more and cannot exploit the citizens.” But the members of the task force contradicted Lakshminarayanan’s claims, noting that the centre did not hold any discussions with the task force regarding private testing.
In the affidavit, the ICMR concluded that “it may be prudent to leave such decision making to the executive when the decision is shown to have been taken after taking into consideration all relevant and germane factors and is not demonstrated to be either discriminatory or so manifestly arbitrary which needs substitution of the view of this Hon’ble Court for the view taken by the statutory authorities.” In essence, the ICMR submitted that the court should not intervene in the policy because the centre had arrived at the decision after considering all relevant issues. But the disclosure by multiple members of the task force that the government did not discuss the policy with the team of experts raises grave questions about the centre’s decision-making process.
The central government supported the modification of the order. During the hearing, Tushar Mehta, the solicitor general, pointed to the “limited resources” of the state and highlighted that the fight against COVID-19 may go on for months. Accordingly, on 12 April, the court modified its order to state that free testing would be limited to persons covered under the centre’s flagship Ayushman Bharat insurance scheme. The court added that “the Government may consider as to whether any other categories of the society can be extended benefit of free testing of COVID-19,” without issuing any specific instructions in this regard. The court also noted, “We are conscious that framing of the scheme and its implementation are in the Government domain, who are the best experts in such matters.” The government, on the other hand, seems to have decided not to consult the team of best experts that it constituted. As a result, the private sector will receive the windfall from this pandemic, with the court allowing them to charge individuals for testing and effectively upholding the ICMR’s cap of Rs 4,500 per test.
Activists who followed the developments in the court maintained that the decision to allow private laboratories to charge has been riddled with conflicts of interest. Malini Aisola, a co-convenor of the All India Drug Action Network, a health-sector watchdog, said that private-sector players in the health industry played a crucial role in the government’s decision to allow private clinics to test for the virus. “A committee that included Kiran Mazumdar-Shaw and other private-sector players was instrumental in deciding the modalities for private lab testing, as well as settling on the price cap of Rs 4,500,” Aisola said.
Mazumdar-Shaw is the chairperson and managing director of Biocon Limited, India’s leading biopharmaceutical company. In an interview to CNBC-TV18 following the government’s decision to allow private testing, she congratulated the ICMR for taking the decision “very expeditiously.” She continued, “I was involved with this, it was a very very strong public-private partnership, even in terms of the process, and it was done in a record time of less than a week.”
“This price cap is unjustifiably high and bears no relation to true costs of testing,” Aisola said, adding that scientists whom AIDAN is in touch with estimated that the tests could cost as low as Rs 500. “Why were private labs allowed such hefty margins, even accounting for different cost structures in private testing? More curiously, why did ICMR fail to mention the committee headed by the private sector to the court? It has not been transparent about how decisions were taken on fixing the cap.”
Meanwhile, the government does not appear to have implemented the recommendations of the task force. On 6 April, the ICMR published a document noting that the task force had recommended establishing a “India COVID-19 Clinical Research Collaborative Network” as an immediate priority. The document noted, “The goal of this network is to enhance the clinical understanding of COVID-19 in the country so as to develop specific clinical management protocols.” Yet, according to two members I spoke to, this has not been done yet. “To the best of my knowledge, this has not been discussed,” the first member who requested anonymity said. “However, they seem to be taking decisions and passing it on to us, so I’m not sure if this decision has been taken elsewhere, and we will be credited for it.”
I did not receive responses to multiple emails and messages to Paul, the chairperson of the task force, and Bhargava, the ICMR director general. This story will be updated as and when they respond
courtesy the Caravan