India is in a state of biological war against an invisible enemy (coronavirus), which has imposed unprecedented health emergency of this century. While the magnitude of cases and sudden spike, in second wave, has pushed many countries into unsurmountable shortages, but it does put a question mark on handling of the pandemic this time, in comparison to much better handling of pandemic last year during first wave by India. While specialists may cite many reasons for such hike, from double mutation to casualness by all, including election rallies, religious gatherings, and slowing down of momentum in capacity building for forthcoming second wave; hence, revisiting existing management responses, in context of indigenous best practices/structures is necessary to improve the situation.

Centralised Versus Decentralised Control

An unending spike in current Covid-19 infections with almost 4 lakh people getting affected daily, adding close to approximately 1 lakh cases and 4,000 deaths per day, for over a week, despite recoveries, has put the entire Covid-19 management system in India out of gear. While every agency in the country is struggling to make up shortages and develop capacities, a large number of friendly foreign countries have also dispatched health appliances and material, which have been/are being distributed.

During first wave last year India was grossly unprepared, but the control of Covid-19 management system was central. The centralized lockdown and management helped India to control the spread and generate requisite capacity to handle the case load during the process of unlocking. It did save many lives and the response was well appreciated globally, giving a hope that India could be the savior of the world in managing the pandemic. Unfortunately, in a democracy, the credit seeking politics echoed the voice of health being State subject, need to decentralise, together with problems of migrant labor, forced the country to adopt decentralised management system, as India unlocked.

It is understandable that the unlocking was essential for livelihood and getting the economy back on track, but stretching it to heavy crowding for events like elections was gross casualness, which coronavirus was in no mood to pardon. It also brought a weakness in response with Centre and State governments waiting for other to take actions and blaming each other for shortages and follies, along-with the reasons mentioned earlier. Today a common man is suffering from shortages of Oxygen, hospital beds, ventilators, and other appliances besides inadequate number of vaccines. Cases of hoarding/black-marketing of health appliances, Oxygen, and hospital beds, indicate leakages and inadequacy of system of management of this crisis.

Despite increase in national availability, shortages at the level of common patient raises question mark on efficiency and transparency of existing logistics system. Currently every agency is working hard, but in silos without visible central co-ordination putting the desired output to sub-optimal level. A case in point is people dying because of shortage/over hiked prices of ambulances in Delhi, which has innumerable flatbed vehicles with movers and packers, which can be made into makeshift ambulances by putting few mattresses and oxygen cylinders inside, provided the RTOs are tasked for it by appropriate authorities.

How can India Manage it Better?

With third wave of pandemic on the horizon India needs to acknowledge it as warlike situation and everyone has to respond accordingly. Currently a large number of agencies are working hard for Covid-19 management at national as well as state level in silos, without a centalised strategic plan, with little coordination, resulting in leakages, inadequacies and non-availability of resource to patient requiring it most. The fact that Honorable Supreme Court of India appointed National Task Forces to control allocation and distribution of Oxygen, justifies need for centralized control of scarce resource. There is a need to declare it as �National Health Emergency' and activate the existing system and infrastructure of National Disaster Management Authority (NDMA) under Prime Minister, suitably modified for handling coronavirus pandemic, with minimum turbulence in ongoing effort.

It is necessary to have this central agency activated with state representatives for collective strategic decision making at two levels; firstly, at strategic level with CCS (Health Minister included) to co-ordinate work of various ministries to improve capacity building, medical resource generation and policy guidelines; secondly at operational level National Crisis Management Committee under Cabinet Secretary with senior representative of all stake holders including Centre (Health, Home, Defence Ministries and Intelligence agencies) and States (Nominated secretaries), expert professionals from various fields, doctors, public and private players, manufacturers and Defence Services, involved in Covid-19 management to issue implementable instructions for similar set up at state levels. It needs to be understood that pandemic management, besides medical care requires sound logistics management and information management.

There is a need to activate NDMA Resource Centre (suitably modified for pandemic) in New Delhi, with every possible information on smartboards regarding patient load, availability of hospital facilities, progress of vaccination, production of vaccines, health appliances, purchases, aids and every information to make a viable strategic and operational, implementable plans, through a process of collective decision making, nominating the agency to execute, which should be held accountable. It must have a media outlet to keep the nation informed of policy guidelines and allocations, as inadequate information leads to rumors, panic and related actions like hoarding. If allotments are done through digitized models using latest management techniques (like transportation model) by participative decision making, then the centre-state blame game can be reduced to a level that it doesn't obstruct response mechanism and makes last man delivery faster. All purchases and delivery must be on digital transaction mode to reduce leakages.

How can Defence Forces Help?

Currently Defence Forces are assisting the national effort in fight against Covid-19 pandemic. Air Force and Navy is extensively involved in transportation of health-related equipment from abroad and within the country. Indian Army has opened many additional make shift covid hospitals, besides opening the existing ones to civil patients. Efforts are also underway to recall some of the retired medical personal to join in and add on to the effort. There is also a scope to incorporate logistics expertise of services during crisis management in improving the supply chain management during such criticalities. The engineering resources of Railways and Defence Forces can be utilized for diverting manufacturing assembly lines of other gases to Oxygen in the country to tide over shortages. For better synergy of efforts with civil authorities, it is necessary to keep defence services in information and decision-making loop. Currently out of 11 empowered groups, none had any representative from military, despite some states wanting Army to step in. While defence forces must support national effort, but unlike some other disasters, it's not recommended that a state or district be handed over to military for covid management.

Conclusion

The second wave of coronavirus as has established that health security is inseparable part of national security and the pandemic will have to be fought like a war, on a mission mode, with each agency playing its part in a coordinated manner to economise on efforts and resources. Health workers and most agencies are contributing to the best of their capabilities, but there is a need for better coordination to minimize shortages, leakages, and improve overall efficiency to minimize wastages, as lot of reserve resources will be required for third wave as well. Centralised planning, coordination, digitized allocation of meagre resources and decentalised execution at State level, is the need of the hour. The security agencies and courts have to be ruthless in punishing hoarders/black marketers with fast-track trials. Foreign help is welcomed, but the future case load demands self-reliance in capacity building to defeat the pandemic, at an unprecedented speed.

(Major General S.B. Asthana is a strategic and security analyst, a veteran Infantry General. He is the Chief Instructor, United Service Institution of India. The views expressed are personal)