The health crisis in India

May 29, 2021

by Yanis Iqbal

India is in the throes of the second wave of the COVID-19 pandemic. There are horrific scenes of people dying due to the lack of medical oxygen, hospital beds and so on. There is neither enough space for the dead in the crematoriums and graveyards, nor enough wood for the pyres. The bodies of more than 100 people have been dumped into the river Ganges.

Since late April, 2021, India has consistently recorded more than 300,000 COVID-19 cases daily, with an average death toll of 2,000-3,000. These statistics don’t fully convey the gravity of the situation. Medical experts say that the actual deaths and infections could be ten times the official numbers. Britain’s Financial Times published an authoritative estimate of deaths and infections being eight times the official figure. An article written by four medical experts states that “only 6% of India’s COVID-19 infections are reported.”

Graphic by: Shanze1

While the corpses of poor citizens kept piling up, the wealthiest were able to fly in private jets to Europe and other places to secure themselves. The people who fled were the same who in 2020 lobbied the government to ease curfews and restrictions. Manufacturing, construction, shopping malls and many other sectors were permitted to resume without any serious measures to ensure the safety of workers. And the wealth of India’s bourgeoisie has increased astronomically since the pandemic, while ordinary working people struggle with inadequate medical facilities.


The first reason behind the Indian health crisis is a chaotic vaccination campaign. As of mid-May, only 141.60 million people have received at least one vaccine dose, which is about 10% of India’s population of 1.35 billion, according to health ministry data. The country has fully vaccinated just over 40 million people or 2.9% of its population. If India moves at this speed, it will not be able to effectively tackle the pandemic.

To cover its entire adult population, India needs 1.9 billion doses of vaccines. If these vaccines were to be administered over the next 12 months, India would need 5.4 million doses each day. Currently, India produces only about 2.5 million doses per day. At the present rate, India would be able to cover only 30% of its population by early 2022. Only by 2023 would it be able to administer the shot to everyone older than 18.

What is behind the slowdown in vaccination? One immediate factor is the government’s decision to plan the vaccine rollout over the internet, asking the residents to create an account on the government’s “CoWin” website, and then register for an appointment. But half the population doesn’t have internet access. Apart from this, the structural dynamics behind the vaccination failure are located in the initiation of market liberalization.

In April 2021, the central government deregulated vaccine price, directing manufacturers to supply 50% of vaccines to the central government at the set price of Rs 150 ($2) per dose, and to distribute the remainder to states and private hospitals at whatever cost they wish. Accordingly, the two vaccine producers in India—Serum Institute of India (SII) and Bharat Biotech International (BBI)—raised the prices of vaccines by two to six times in just a week. The center transferred the job of vaccination to the states, without providing any funding—in fact making them pay higher prices. It has set up a pricing system whereby state governments, already desperately short of finances and facing budgetary constraints, have to pay up to four times what the central government pays for the same vaccines.

While state governments are buying vaccine doses at a high price and competing against each other for the limited number of vaccines made available through SII and BBI, private vaccination centers—where two thirds of Indians receive their healthcare—are buying at an even higher level and are charging exorbitant prices to the people. The vaccine prices are now so unaffordable that informal workers are forced to spend about half of the household’s monthly salary on vaccinating all its adult members. No wonder Adar Poonawalla, CEO of SII, increased his personal wealth by 85% during the pandemic.


While vaccines at government hospitals are free for healthcare and frontline workers, and those aged over 45, shortages have not allowed for continued and rapid vaccination. These imbalances could be eliminated if India’s public sector vaccine factories—which are sitting idle—were utilized properly. Even though India has about 20 licensed manufacturing facilities for vaccines and 30 biologic manufacturers, all of which could have been harnessed for vaccine manufacturing, only two companies are currently producing vaccines.

The central government has also refrained from taking out a compulsory license—an involuntary contract between an unwilling seller (patentee) and a willing buyer (licensee), which is enforced by the State—on Covaxin, which is developed within the country and with government funding. Instead, it has allowed BBI to be a monopoly producer of this vaccine and has even supplied public money to this private company (Rs 1,500 crore or $205 million) to expand capacity so that it can strengthen its monopoly position. It has similarly given Rs 3,000 crore ($410 million) to SII to expand capacity while keeping its monopoly position as the producer of Covishield intact.

Rather than confronting the national vaccine shortage, the government has chosen to cover it up. In the first phase of the vaccination process, the second shot of the Covishield vaccine was to be administered 4-6 weeks after the first. This was first increased to 6-8 weeks and then to 12-16 weeks. While some scientific evidence exists that the efficacy rate of the Oxford-AstraZeneca vaccine can be increased by administering the second dose at a gap of 12 weeks, there is absolutely no evidence in favor of administering the second dose after 16 weeks. This has been done in a knee-jerk manner in response to bottlenecks in vaccine supply.


The second reason behind the COVID-19 catastrophe in India pertains to the augmentation of neoliberal healthcare over the last few decades. Contemporary capitalism has subjected the health sector, its institutions, systems and services to a severe process of erosion. Funding for the public health sector in India, among the lowest in the world, has neither taken into account a growing population, the wide-ranging and complex health burdens, nor even considered the right to good health to be a fundamental right. The discourse on a public medical education system has fallen by the wayside as health entrepreneurs are openly authorized to cultivate a shady nexus between private medical colleges and a “health industry.”

The Indian government spends only 1.3% of its Gross Domestic Product on the healthcare system, while it has the world’s third largest military budget—$73 billion per year—amounting to more than double all public expenditure on healthcare. In late 2020, the Indian government stated that it has 0.8 medical doctors for every 1,000 Indians, 1.7 nurses for every 1,000 Indians, 5.3 beds for every 10,000 people, 2.3 critical care beds for 100,000 people and a mere 48,000 ventilators. Indians pay exorbitant amounts of their income in out-of-pocket healthcare expenses because of this destruction of public healthcare, the growth of for-profit hospitals and the underdevelopment of medical insurance schemes.

In a 1966 speech to the Medical Committee for Human Rights, Martin Luther King Jr. declared: “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” Indeed, this is most visible in India today, where innumerable people are dying due to a system torn apart by murderous, profit-making impulses. It is high time that we recognize the deleterious impact of neoliberal rationality on the health sector of India. If this is not done, the country will keep reeling under the impact of the pandemic.

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