Author: Dr. Joseph M. Chalil, MD, MBA, FACHE

UNDER MODI GOVT, India beats the world in medical infrastructure

Dr. Joseph M. Chalil, MD, MBA, FACHEOpinion 0

Medical colleges grew by 78% in India compared to 9% in the US and 0% in Canada since 2014, while the MBBS seats increased by 105% in India, outpacing growth in the US and Canada. AIIMS grew by 186%. Is this time for ‘One India, One Healthcare?’

With the term of Prime Minister Narendra Modi entering its 9th year, the effect of his government’s healthcare policies has been scrutinized, particularly analyzing its response to the pandemic that swept the globe. Covid exposed many weaknesses in healthcare systems worldwide, from manufacturing critical vaccines to a shortage of medical personnel, facilities, and equipment. India uncovered several areas that needed attention, but also plenty to celebrate. Although India has only been independent for 75 years, it has managed to build a significant infrastructure meant to care for its citizens, which quickly adapted to meet the demand for manufacturing and production in the face of the worldwide health crisis. During the nine years of the Modi government, several changes have been made in the healthcare sector that made this possible. Here are some of the highlights:

Ayushman Bharat: One of the significant healthcare initiatives of the Modi government is the Ayushman Bharat scheme, which aims to provide health coverage to over 500 million people from economically weaker sections of society. The scheme provides cashless health insurance coverage of up to Rs 5 lakh per family per year for secondary and tertiary care hospitalization and prescriptions after a hospital stay for up to a year. As a result, India has made significant strides in providing coverage of what could otherwise be catastrophic healthcare costs. But now the focus needs to shift towards covering annual physical exams and prescription drugs for chronic disease management like diabetes and heart disease to prevent those hospitalizations while maximizing the health of Indians, regardless of income status.

Digital Health Mission: The government launched the National Digital Health Mission (NDHM) in August 2020, which aims to create a digital health ecosystem that will provide universal health coverage, including access to health records and other healthcare services for all citizens. Millions have transitioned to telehealth consultations during Covid-19, allowing them to receive care without extensive travel costs while minimizing the spread of illness.

Infrastructure Development: The government has invested significantly in improving healthcare infrastructure, including building new medical colleges, upgrading existing healthcare facilities, and expanding the number of hospital beds. Many of these programs have succeeded, mainly as India established 302 new medical colleges in the past nine years, outpacing countries worldwide. Today, India can boast an over 78% growth in its number of medical schools, opening the doors for more doctors and medical personnel to be trained, thus addressing an ever-increasing need for these professionals globally. While more medical professionals are needed, India is increasing the educational opportunities available. The next stage in its development is maintaining the highest standards within each new medical school as it comes online. In addition, a recommendation will be to mandate NABH accreditation for all medical colleges and hospitals, including government hospitals.

Covid-19 Response: The government took several steps to combat the pandemic, including setting up Covid-19 hospitals and increasing the number of testing facilities. They also increased the production of vaccines and could vaccinate nearly their entire population, which was a target few other countries achieved.

Despite these initiatives, several challenges still need to be addressed in the healthcare sector. Here are just a few suggestions to continue to build upon the progress that has already been made:

ONE INDIA, ONE HEALTHCARE

Healthcare delivery in India is decentralized and varies from state to state as it’s currently a state subject. Various factors like low levels of education, lack of environmental sanitation and safe drinking water, under-nutrition, poor housing conditions, tobacco consumption, poverty, unemployment, unhealthy lifestyle, etc., impact health.

The allocation of funds to the health sector inter-alia depends on the government’s overall resource availability, competing sectoral priorities, and the system’s absorptive capacity. With the advancement in technology and telemedicine and labour migration leading to interstate commerce, one could argue it is time for a constitutional amendment to guarantee access to primary healthcare to every citizen as a fundamental right and change healthcare to a Central subject. The Covid-19 pandemic also showed us that state borders are irrelevant regarding disease prevention and healthcare delivery. It’s time for “One India, One Healthcare.”

PUBLIC HEALTHCARE CIVIL SERVANTS

Government hospitals are managed by doctors promoted based on their seniority rather than their training in hospital management, while professional hospital managers manage private hospitals. Managing a public health system for the largest population in the world takes work, even for the best doctor with decades of experience in patient care.

Indian civil services select and train senior bureaucrats who lead the Indian government. India currently has several IAS and IFS officers with MBBS training. I propose that the Government of India create an Indian Health Service (IHS) branch. India will need 742 “IHS” officers, one per district, who are ranked equal to the IAS officers to coordinate the public health system of the district. By creating a civil service branch to manage healthcare centres and increasing medical and nursing colleges to one per district, a large workforce could be made available to staff these facilities adequately.

Work in rural areas could also be mandated, allowing communities and villages to receive quality care. For instance, part of a doctor’s training could include a year or more of service in a rural village working in a primary care centre. Other options include incentives to reduce educational costs in exchange for time served in a primary healthcare center.

FOCUS ON PRIMARY AND PREVENTIVE HEALTHCARE

While the Ayushman Bharat scheme focuses on secondary and tertiary healthcare, more future emphasis should be given to preventing fraud using the DRG payment system and covering primary healthcare, including chronic disease management and community health. With all its progress, India still struggles with the rapidly growing burden of chronic diseases and the demands on its healthcare system. Chronic conditions like diabetes only worsen, resulting in complications and hospitalizations without proper and consistent treatment.

How can these issues be addressed? First, by mandating wellness exams yearly and prioritizing primary and preventive care for all citizens. Identifying and managing chronic diseases early is more effective and less costly than managing and treating their complications. Like countries around the globe, India faces geographic variations in the quality of healthcare services and providers, reflecting the need for consistent processes and standards throughout the country.

Second, in determining the best path forward, the process of delivering healthcare services needs to be improved by differences in the funding and availability of healthcare options within each state. To move to a universal healthcare system, India needs to be willing to step away from the current state model that does not evenly address the needs of all Indian citizens. Instead, we must embrace a “One India, One Healthcare” for all citizens. Private-public partnerships in primary healthcare delivery should be encouraged.

With a long history of rising to the challenge, India can continue to lead the world in tackling healthcare issues for all, particularly by elevating the value of primary care, annual physical exams, and continued investment in environmental policies that can positively impact all Indians. With the largest population in the world, India could lead the world in providing quality healthcare to all its citizens.

The biggest democracy in the world needs urgent investment in the health of all its citizens and reform the public healthcare system while maintaining the current rate of infrastructure growth.

Prof (Dr.) Joseph M. Chalil is an Adjunct Professor & Chair of the Complex Health Systems advisory board at Nova Southeastern University’s School of Business, the Chief Medical Officer at Novo Integrated Sciences, Inc, and the Chief Strategy Officer of the American Association of Physicians of Indian Origin (AAPI). He recently published a best-seller book, “Beyond the Covid-19 Pandemic: Envisioning a Better World by Transforming the Future of Healthcare.”

Under India’s Leadership, G20 Can Help Solve Global Healthcare Crisis

Dr. Joseph M. Chalil, MD, MBA, FACHEEditorial/Opinion, Health, World 0
Dr. Joseph M. Chalil, MD, MBA, FACHE

According to a new study published in the Lancet, an estimated 6.4 million physicians are needed to meet global universal health coverage (UHC) goals. America is also experiencing a significant physician shortage, and it’s only expected to get worse, a concerning situation that could lead to poorer health outcomes for many patients. Data published in 2020 by the Association of American Medical Colleges estimates that the US could see a shortage of 54,100 to 139,000 physicians by 2033.

Europe is not in any better spot. More than three years into the pandemic that decimated personnel, healthcare managers and governments are scrambling to cobble together a semblance of a workforce in European countries. Europe’s healthcare worker shortfall—around 2 million—is acutely felt across the Continent.

In Greece, first responders sound the alarm over longer emergency response times due to a shortage of personnel. England lacks tens of thousands of nurses, reporting a record number of vacancies. Nurses top the list of all occupations experiencing shortages in Finland. Maternity wards in Portugal are struggling to stay open due to a lack of doctors. Some 50,000 healthcare workers in Europe have died due to Covid-19, and health worker absences in the European Region increased by 62% during the first wave of the pandemic in 2020, according to WHO.

The pandemic also took a severe toll on the workers’ mental health. In some countries, over 80% of nurses reported psychological distress caused by the pandemic, and 9 out of 10 nurses planned to quit their jobs.

G20, under the leadership of India and Prime Minister Narendra Modi, could offer bold solutions to this impending global healthcare crisis. While the recommendations to establish a G20 Health Preparedness Taskforce are excellent, addressing the global health workforce shortage must be a key priority in national development agendas. India can help solve the expected global physician shortage in G20 nations by investing in healthcare infrastructure and training programs. This could involve increasing funding for medical schools and postgraduate programs and improving the quality of medical education.

Additionally, India can help by expanding its role in providing medical services to underserved populations in G20 countries. This could include establishing telemedicine programs, allowing Indian doctors to provide medical care remotely. India can also work with governments in G20 nations to develop more streamlined pathways for Indian doctors to practice in those countries. Finally, India could use its public health and health systems expertise to help G20 countries develop and implement effective healthcare policies.

Here are the practical steps that G20 may take under Indian leadership:

  1. STRENGTHEN THE MEDICAL EDUCATION FRAMEWORK

Setting up common minimum standards in the medical education of physicians, nurses, health administrators, and other allied healthcare workers among G20 nations could create a G20 medical corps that can be mobilized in the invent of emergencies due to pandemics, war, or other natural calamities. Promoting private-public partnerships and investing in new international medical schools should also be considered. We have examples of Indian universities like Manipal offering American equivalent medical education from Antigua. We also have several thousand Indian students currently completing medical education in European countries. Let G20 help execute formal agreements between G20 governments and India that define the conditions and requirements for Indian doctors to practice in those countries.

Revamping the existing guidelines for setting up medical schools and teaching methods as per future methodologies will require significant investment in e-learning tools, including remote learning, virtual classrooms, etc.

Indian medical education system is evolving and striving to reach international standards. Setting up new international medical colleges in addition to current colleges training MBBS and PG students may be considered initially. There are examples of parallel pathways in primary and secondary education in India currently offered via State syllabus in addition to ICSE or CBSE schools.

  1. STANDARDIZING GLOBAL MEDICAL LICENSING SYSTEMS AND VISA REQUIREMENTS

Developing an online database and platform that lists the qualifications and experience of Indian doctors interested in pursuing opportunities in G20 countries would be a good start. In addition, let us work with G20 nations to create more flexible visa and work permit requirements for Indian doctors.

Furthermore, establishing a mutual recognition agreement between G20 countries and India would enable Indian doctors to practice in those countries without additional licensing exams and create standard international medical licensing guidelines. Working with G20 governments to develop and implement standardized, streamlined credentialing and licensing processes for Indian doctors and the reciprocity of national medical licenses and international clinical rotations for medical students among G20 countries should also be considered.

Facilitating and supporting the mobility of Indian doctors within the G20 countries should be promoted. We will also need to create more opportunities for G20 nations and India to collaborate on research and development initiatives.

  1. HARNESSING TECHNOLOGY

The healthcare industry is fast-tracking the use of e-health and e-learning techniques, AI, VR simulation, and the internet of things to train, upskill and empower health workers. Telemedicine and remote patient monitoring should be encouraged among and within G20 nations involving the G20 Medical Corps, as mentioned above. The scaling-up is rapid, based on big data and analytics. These emerging technologies will also generate more demand for new skills, increasing the potential to employ more in digital healthcare delivery. Let G20 leadership help develop programs that allow G20 countries to benefit from the expertise of Indian doctors through telemedicine and other remote care services.

  1. REBALANCING HEALTHCARE TASKS AND MANUFACTURING

As per an OECD global survey, 79% of nurses and 76% of doctors were found to be performing tasks for which they were over-qualified. Given the worldwide evidence of the poor distribution of skills, we must rationally re-organize our workforce for effective management of high-burden diseases, particularly NCDs, which are responsible for 71% of the global mortality and, unless addressed, could cost the world $30 trillion by 2030. G20 nations should also increase manufacturing and procurement of essential medical supplies domestically. Depending on China for most of your medical supplies has exposed the vulnerabilities of G20 healthcare systems during the Covid-19 Pandemic.

  1. BRIDGING LANGUAGE BARRIER AMONG HEALTHCARE WORKERS

The newly proposed international medical and nursing students should be encouraged to be fluent in at least one or two foreign languages, which will help them bridge the language divide. For instance, several countries have similar course curriculums for nursing; however, cultural aspects sometimes need fixing. For example, Sweden and India have identical nursing curricula, and there is great potential to encourage the exchange of nurses. Still, the potential for exchange is restricted due to linguistic barriers. However, this can be easily overcome, and more conducive arrangements can be implemented to facilitate the exchange of healthcare workers.

  1. CREATING A SUSTAINABLE AND GENDER-BALANCED WORKFORCE

Evidence points towards gender imbalance and disparities in health employment and the medical education system. According to the WHO, globally, only 30% of doctors are females, and more than 70% of nurses are females. A similar trend is seen in India, where most nursing workforce comprises women, but only 16.8% of allopathic doctors are females. As per ILO data, gender wage gaps are also a cause for concern. Therefore, we need proactive steps to create a balanced healthcare workforce that addresses the issue of gender inequity and ensures equal pay for work of equal value, a favorable working environment, and targets investments towards training the female workforce.

G20 member states under India’s leadership must increase the in-built flexibility of their health systems, showing the capacity to guarantee everyday quality healthcare for all citizens, refugees, and displaced populations. Significant investment in the future of healthcare of G20 nations is the need of this hour. The abundance of young Indian talents could help the world to minimize the expected healthcare human resource shortfall with proper training and investment. G20 countries represent two-thirds of the world’s population and four-fifths of the global gross domestic product but also a significant proportion of people left behind socially, economically, and in terms of health. Let India propose bold steps and offer solutions in healthcare to secure the future of the G20 nations.

(This story was published in The Sunday Guardian on February 11, 2023)

(Prof (Dr) Joseph M. Chalil, MD, MBA, FACHE, is an Adjunct Professor & Chair of the Complex Health Systems advisory board at Nova Southeastern University’s School of Business, Chief Strategic Officer of the American Association of Physicians of Indian Origin (AAPI), and the publisher of The Universal News Network. He recently published a best-seller book, “Beyond the Covid-19 Pandemic: Envisioning a Better World by Transforming the Future of Healthcare”.)

Treatments For Covid-19

Dr. Joseph M. Chalil, MD, MBA, FACHEEducation, Health, Science 0

The world remains in turmoil over SARS-CoV-2. But, ground-breaking progress in global vaccination has been made in India through Covishield and Covaxin.

Multiple scientific advances in the 21st century have given us a lifeline in nature’s arms race. The world, however, remains in turmoil over SARS-CoV-2, which is continuing to plague even our largest economies, with India being no exception. Ground-breaking progress in global vaccination has been made in India through Covishield and Covaxin. Despite this progress, the country now has the highest per-day rate of positive cases in the world. Furthermore, it is unlikely that vaccines will reach most of the population necessary to stop the spread of the virus. Another major problem in India is for the critically ill with Covid-19, who require mechanical ventilation, as ventilators and trained operators are in short supply in India’s overtaxed hospital system. Beyond this, the mortality rate with invasive mechanical ventilation is at 70%. Both grim facts highlight the overwhelming need to avoid invasive mechanical ventilation. What can India do to combat this? The answer lies within a diversified approach to target treatment of Covid-19 rather than solely addressing infection prevention.

WHAT TOOLS DO WE HAVE TO TREAT COVID-19?
The repurposing of previously used drugs is of great value to patients within our suffocating healthcare systems. Remdesivir, an antiviral treatment previously used for SARS and MERS, has been applied to Covid-19 patients. The efficacy of remdesivir’s five- to ten-day treatment course in hospitalized Covid-19 patients has been globally debated by leading international health care organizations and scientists. The drug demonstrated improvement in recovery in a randomized, double-blind clinical trial versus a placebo group. The US Food and Drug Administration granted the drug emergency use authorization in October 2020 for Covid-19 patients requiring hospitalization. Marketed as Veklury™, remdesivir has recently been approved in India. Manufacture and distributions have been significantly accelerated by scaling up batch sizes, contracting local manufacturers, and adding production facilities. The opportunity exists to curb the damage of SARS-CoV-2 if the region is willing to adapt its current practices to the rapidly changing needs.

Dexamethasone, an inexpensive corticosteroid, is an older drug that has been found most beneficial in hospitalized patients who require invasive mechanical ventilation. Yet, when given too early in Covid-19, for example, when supplemental oxygen is not required, dexamethasone may be detrimental. Dexamethasone may also be inappropriate for use in patients that have co-morbidities such as obesity and diabetes. Dexamethasone has been used to reduce cellular immune responses and treat patients with acute respiratory distress syndrome (ARDS). It is now repurposed to combat severe symptoms of Covid-19 and is one tool in the Covid-19 treatment armamentarium.

With the crisis pushing us to innovate, we are learning about newer drugs that can fight the virus’ effects. One such promising medication is lenzilumab, a drug created by Humanigen, based in the United States. Lenzilumab targets the initiation of “cytokine storm,” the hyper inflammation consequent to SARS-Cov-2 infection that leads to critical illness in many patients. In the LIVE-AIR phase 3 clinical trial, lenzilumab improved the likelihood of survival and/or ventilation by 54%, over and above remdesivir and dexamethasone, in newly hospitalized Covid-19 patients, who required supplemental oxygen but had not yet progressed to invasive mechanical ventilation. The effect of this one-day treatment was most beneficial in patients who were less than 85 years old and had a biomarker of early hyperinflammatory response; in which lenzilumab improved the likelihood of survival and/or ventilation by nearly three-fold.
Other innovative treatments include tocilizumab (Regeneron) and otilimab (Glaxo Smith Kline). Tocilizumab works on a downstream mediator in the cytokine storm. The open-label RECOVERY study showed that tocilizumab improved survival and other clinical outcomes in hospitalized Covid-19 patients who required respiratory support. However, results from other trials are conflicting, including one that found no benefit in clinical status or survival. Otilimab, like lenzilumab, also targets the early steps in cytokine storm. Otilimab failed to achieve its primary endpoint in a clinical trial, but an exploratory analysis found that it provided benefit in hospitalized, ventilated Covid-19 patients who were over 70 years of age—an effect that is being explored in an additional clinical trial.

WHAT CAN BE DONE?
To date, more than 20 million confirmed cases of coronavirus are reported in India, with an exponential increase in cases over the past month. More than 222,408 people have died, but survivors, funeral directors, and scientists say the actual numbers of infections and deaths in India may be many times more than the reported figures. Therapies, which are quick and easy to administer, can help countries struggling to contain SARS-CoV-2. A new urgency to investigate alternative treatments for Covid-19 is imperative, as this pandemic is suspected of remaining present for several years.
Lessons are to be learned from the case of Hepatitis C. While vaccines for Hepatitis A and B are available and frequently used, the Hepatitis C virus constantly mutates and has escaped the development of an effective vaccine. However, Hepatitis C treatment has been successfully developed. So why should approaches to Covid-19 be different?

WHAT IS THERE TO OVERCOME?
A big consideration for our political leaders is the size of the problem. India’s mammoth population is its biggest resource and one of its greatest challenges. The vaccination process is slow and tedious. With our limited understanding of the virus, it will not be long before we see newer mutations arise, which would require boosters to mediate. Once vaccinated, populations will require following up and, given the geographical challenges, will push back recovery many years.
Another significant challenge the country faces is the daily mortality figures. Symptoms of Covid have an uncanny resemblance to that of many common tropical diseases. It is not the system’s failure but the success of a virus that has been baffling epidemiologists at every corner. Our reality may be far worse than what we perceive it to be. Unaccounted deaths from people dying at home, on the way to hospitals, and the streets remain unaccounted in the national statistics as many are untested for Covid due to test shortages. If there is a drug accessible at local pharmacies, it can reduce these unaccounted deaths—these precious lives.

THE WAY FORWARD
Locking down India for Covid-19 is an untenable answer, as this approach previously almost collapsed the economy. Therefore, prevention and treatments are required and need to be delivered to hospitals and the populace. Inefficiencies in the logistical process of drug and oxygen manufacture and distribution should be at the top of the government’s plan.
It is time to reform the Drugs and Cosmetics Act of 1940 and Rules 1945. Covid-19 drugs, especially those showing efficacy in phase 3 of trials, under reliable international health authorities, should be given conditional approval in India immediately by the Drug Controller General of India (DCGI). Data needs to be collected as done with the NIH in the US and NHS in the UK, and drug efficacy and side effects reported publicly. Manufacturers such as Regeneron, Humanigen, Pfizer, and GSK should be encouraged to produce in India for the local population. We should end this over-reliance on vaccines and focus on treatments. Such open-minded approval processes will decrease dependency on a single solution, give our system more breathing room and drive down prices for life-saving medications.
The biggest democracy in the world needs just as many options when the matter is of saving its own citizens’ lives.

Prof (Dr) Joseph M. Chalil is an Adjunct Professor & Chair of the Complex Health Systems advisory board at Nova Southeastern University’s School of Business; Chairman of the Indo-American Press Club, and The Universal News Network publisher. He recently published a best seller book, “Beyond the Covid-19 Pandemic: Envisioning a Better World by Transforming the Future of Healthcare”.

Let this be the Last Medical Oxygen Crisis in India

Dr. Joseph M. Chalil, MD, MBA, FACHECommunity, Education, Health 0

The problem is not a shortage of medical oxygen but the supply chain of delivering it to the patient bedside in a hospital. A routine site at all major Indian hospitals is the large oxygen cylinders delivering oxygen to patients at the bedside, says Dr. Joseph Chalil.

International media is filled with headlines such as “Indian COVID-19 Patients Die as Ventilators Run Out of Oxygen” and showing images of people with empty oxygen cylinders crowding refilling facilities in Uttar Pradesh for their relatives in hospitals. The last such news was from Pakistan in December 2020 when six COVID-19 patients died in Khyber teaching hospital in Peshawar.

India has a daily production capacity of at least 7,100 tons of oxygen, including for industrial use, which appears to be more than enough to meet current demand. The problem is not a shortage of medical oxygen but the supply chain of delivering it to the patient bedside in a hospital. A routine site at all major Indian hospitals is the large oxygen cylinders delivering oxygen to patients at the bedside. Yet this is something you never see in a western hospital. All American hospitals have central piping, which delivers oxygen to the patient bedside from a Pressure Swing Adsorption (PSA) Oxygen Plant attached to each hospital. This is one of the building permit requirements for a new hospital in the USA. Medical oxygen can easily be manufactured from surrounding air.

Among the most significant challenges early in the COVID-19 Pandemic was the shortage of essential supplies like personal protective equipment (PPE) and ventilators. These products are tied to supply chains that stretch worldwide, and the Pandemic highlighted their fragility and susceptibility to significant disruptions. As China, a leading global exporter, dealt with the Pandemic in its early days, it was forced to shut down manufacturing, leaving the rest of the world scrambling to address its rapidly shifting supply needs.

Prime Minister Narendra Modi has also given a call for self-reliance – an ‘Aatmanirbhar Bharat’ where he talks of integrating India with the world moving away from isolation but from a position of internal strength. The aim is to make India and its citizens independent and self-reliant in all senses. Mr. Modi further outlined five pillars of Aatma Nirbhar Bharat – Economy, Infrastructure, System, Vibrant Demography, and Demand. India demonstrated its ability to go from producing zero PPE kits pre- COVID to producing millions of kits and exporting them today as a result of the COVID-19 Pandemic. Let us also make our hospitals self-reliant in Medical Oxygen production.

A vision for the future of health-conscious manufacturing

A supply chain that depends on domestic manufacturing is part of our strategic healthcare plan for the future. In the book *Beyond the COVID-19 Pandemic*, we outline a 33-33-33 Buy Local Policy, which involves increased purchases of local products while allowing purchasers flexibility to tap into the global marketplace. In the plan, healthcare systems would be required to buy 33% of their products locally within their region, 33% of their products within the country, and 33% from outside. This policy aims to create a flexible supply chain that could be ramped up to deal with emergencies.

Self-reliance has always been an Indian (The Swadeshi Movement) virtue and the key to India’s success and development. Suppose one supply chain is cut off due to war, natural disaster, or bioterrorism; there are other options to maintain and sustain supply chains. This will also ensure that the dependency on one particular source for anything essential is minimized. Domestic manufacturing is vital for job creation and a strong economy, and it’s also essential for national security.

AirSep Corporation of New York has installed PSA Medical Oxygen Systems in more than 4,500 hospitals in nearly 50 countries worldwide, including several hospitals in India, to meet their central pipeline and other oxygen needs. These generators and plants operate automatically to supply patient, surgical, and critical care units in medical facilities, military field hospitals, on-site emergency preparedness centers, and disaster-relief efforts. There are several other manufacturers with similar technologies.

Supply chain policy does not have to be an all-or-nothing proposition. That is to say, we should neither import everything nor should we import nothing. Currently, however, we are too reliant on imports in some areas, which hurt us during the early days of this Pandemic. More steps must be taken to create reserves of supplies and manufacturing capacity, similar to the U.S. strategic oil reserves or the Indian strategic food reserves.

India should invest in mobile containerized, turnkey packaged oxygen systems that are ideal for locations where a compressed air supply is limited or unavailable. These units can be truck mounted and moved to areas of shortage or pandemic hot spots. Containerized units can also be used for military applications as well. The oxygen generator within a containerized unit produces oxygen from an air compressor that is included in the package. These rugged systems can perform in extreme temperatures, high humidity conditions, and at high elevations.

Let this be the Last Medical Oxygen Crisis in India. Let us not scramble our resources; purchasing compressed liquid oxygen from Russia or China, which at best is a temporary fix but will arrive too late for our patients’ bedside in Delhi. Let us retrofit our hospitals with central oxygen piping
and support installing hospital oxygen plants and backup systems. Domestic production policies of all medical supplies will lead to job creation and positively impact the environment, reducing the distance oxygen and other supplies must travel from manufacturer to end-user. Local production is also a necessary part of national defense in a world where bioterrorism is an ever-present possibility—the military, for its part, has demonstrated the importance of not centralizing any aspect of its supply chain to one region or country.

India can lead the way globally by building supply chains that incorporate local manufacturing that can be ramped up to address critical needs. This goal recognizes that global supply chains can be broken, and alternatives need to be in place. When countries take these lessons and models to heart and use them to craft policy, their citizens can benefit from a common-sense approach that empowers us to mitigate challenges—everything from a natural disaster or political upheaval to a once-in-a-100-year pandemic.

(Prof. (Dr.) Joseph M. Chalil is an Adjunct Professor & Chair of the Complex Health Systems advisory board at Nova Southeastern University’s School of Business; Chairman of the Indo-American Press Club, and The Universal News Network publisher. He recently published a Best Seller Book – “Beyond the COVID-19 Pandemic: Envisioning a Better World by Transforming the Future of Healthcare.”)

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