The second wave of the COVID pandemic in India has revealed one important thing that was missed; long term scenario planning.
All the government departments, think tanks and research institutions failed to develop a future scenario of the pandemic and its impact on the nation. We, as a nation, are now in a reactive mode. Avoiding such a situation requires us to have a look at future scenarios.
In 2014, the British government came up with a futures toolkit for the civil service to use. The avowed objective was to provide the bureaucrats a well developed toolkit to look at the factors likely to impact future and develop scenarios. This would enable strategic decisions that can prepare the country in advance.
I have used the same toolkit to look at the emerging pandemic from an Indian perspective. Note that the scenario planning is not based on data but is usually an exercise of predicting extremes. As such there are no numbers in the exercise and its quite possible that you can have scenarios that are between the extremes predicted here.
Firstly let us look at the factors that will impact the pandemic evolution
1. Virus mutation: Very clearly, the virus will continue to mutate. However, none is certain how the mutations will evolve. This leaves us with two extremes to consider;
a. The virus will mutate and become weak
b. The virus will mutate to a more virulent strain
2. Social distancing: Social distancing will be a very big challenge in a country such as India. We can’t afford extended lockdowns for economic reasons. This will mean that markets and factories will continue to be super spreader locations. More worryingly, social events such as marriages, elections and festivals are unavoidable and these will continue to be super spreader events as well. A clear conclusion is that social distancing as a tool for preventing virus spread will never take off.
3. Health care infrastructure: It is now an accepted fact that our health care infrastructure is completely insufficient. Private medical care, despite its contribution, has failed and the evidence of that is profiteering that is seen. In the health care space we need to consider several situations
a. We will be reliant on temporary infrastructure during crisis
b. Critical resources such as liquid oxygen will be locally available
4. Vaccination: Vaccination will play a key role in the management of the pandemic. It is also likely that we need booster shots every year. Importantly, vaccination is going to be a long drawn process and fairly expensive for the government to manage. A clear conclusion is that a nation vaccination program will probably be in place for a long time.
5. Other medical solutions: Development of other medical solutions could be potential game changer in managing and tackling the virus. There are many experiments that are underway that could help mankind. There are efforts at developing oral medications that will speed up recovery or reduce complications.
There are efforts to develop nasal sprays that will prevent infections or limit infections to mild forms.
There are efforts to develop UV based solution that will neutralize the virus.
This forces us to consider a few situations to consider;
a. There will be medical solutions to treat the infection safely and reliably with minimal impact on healthcare infrastructure
b. There will be medical solutions to prevent the infection
c. There will be medical solutions that eliminate the virus
What does all this mean for our future? Future scenarios are a result of interaction of various factors such as those detailed above. I believe that we need to prepare for the following scenarios
Scenario 1: The virus weakens to a mild variant over the next few years. There are no effective solutions beyond vaccines.
Scenario 2: The virus continues to virulently mutate in waves and continues to ravage the world. Medical solutions to treat and eventually neutralize it are developed over the next 2 to 5 years.
Scenario 1 for India
Under this scenario India will likely have atleast one or two waves as well take another 18 to 24 months vaccinate the country. It is likely that we will find better cures during the third or 4th wave that reduces complications and need for ventilators and oxygen support.
1. Vaccination Program
A national taskforce that develops a detailed vaccination program. This should include vaccine financing, supply planning, distribution planning and vaccine administration. The government has to launch a vaccine passport as this may become a key need for global movement of people.
While the existing program has probably made a decent start, its weak regarding financing and sourcing. These need to be fixed for universal vaccination. While it should be free for everyone, the government should offer to exempt vaccination cost for both individuals and business, where they choose to pay for it, though ensuring that those who pay don’t get any priorities.
Vaccination pricing must be transparent, with manufacturers being made to comply under RTI provisions.
As an emergency action, the government should offer vaccine production facilities, both private and government owned, on a 12 to 18 month lease to vaccine owners so that vaccine capacity can be ramped up.
2. Field hospital program
The government must put together a program that prepares all state governments to create temporary field hospitals. Technologies are already available and must be tapped to enhance the capacity to quickly react to capacity constraints.
A regulation must be passed to commander wedding halls for this purpose.
Hotel industry must be prepared to convert hotels into field hospitals (may be government must commander them during waves)
3. Medical oxygen supplies
Centralized oxygen production and transportation through tankers of liquid oxygen is a non-viable proposition. Its prone to delays and excessive cost, with serious consequences. As a minimum, a hub and spoke model has to be created.
Over the next 3 months, every hospital must be made to setup captive oxygen plants on a war footing or atleast centralized liquid oxygen storage and distribution system .
All municipal corporations must be mandated to maintain liquid oxygen stocks that are dictated by population and lead time for transportation.
The reliance on small cylinder oxygen supply should be stopped and cost of oxygen provision at hospitals must be controlled.
4. Avoiding social gathering
Its not possible to enforce social distancing or masking behaviour in the general public. Behaviour change will take time.
During the time it takes to achieve effective control over the virus (and it may take 18 to 24 months), the government should ban all large gathering; no political rallies and religious congregation. Weddings and parties must be with limited participants and organizers must be mandated to take healthcare liability for the attending people.
Allow sports events but mandate that if spectators are infected, the organizers must pay for treatment.
Don’t allow liability to be transferred to individuals by any organizer. This should be extended to large shops which tend to be super spreaders.
Scenario 2 for India
We have a more dangerous scenario of the virus continuing to mutate as more virulent strain and continuing to challenge the health care system over a longer period. In this scenario, solution is only likely through the development of more effective medical solutions such as newer vaccines that are effective against newer strains, medicines / sprays that neutralizes the virus or treatments that work to reduce impact of infection. The medical battle will continue for many years, while waves keep appearing from time to time.
In addition to the strategic actions highlighted for scenario 1, there are a few more initiatives that need to be taken
5. Invest in medical innovation
The nation requires an urgent medical innovation program. Such a program needs to define the direction for medical innovation on multiple fronts. In the short term, we need a program to focus on covid pandemic. This must be an open innovation program and incentives for corporate participation clearly articulated. IPR created must be open source and mustn’t rely on government discretion of licensing.
A longer term program has to be put in place for medical innovation that builds national competencies for fast response. The nation needs to develop, not just engineer medicines based on expired or overseas IPR, but should actively create new IP in the area of medicines and devices.
6. Acquisition of overseas medical technologies
There are significant global research efforts on developing solutions for tackling the virus. The government must make strategic investments in such programs and acquire domestic rights for promising solutions. A team of medical professionals must be created to scan and evaluate all such programs and make these investment decisions within the next 100 days. This will secure the advanced medical solutions at a significantly lower cost than to acquire them once they are fully developed.
I am hopeful that there are thinktanks within our country that can significantly refine these scenarios and recommendations to come up with even more robust recommendations. This is the time for the best minds in the country to help overcome the challenge it faces, not engage in criticism or politically motivated dialogue.
This pandemic also shows the need for a India futures toolkit. The finishing school for civil services must consider establishing a futures toolkit and futures cell. Officers could be trained on this methodology and required to write one or two scenario papers an year and the institution can be the central consolidator and publisher of scenarios for the government to consider.
Krishnan is a leading innovation consultant and focuses on helping people and organizations innovate and build capabilities for innovation. He brings over 25 years of experience in the industry and consulting. You can reach him by phone / WhatsApp: +919791033967 or email: firstname.lastname@example.org