Before COVID-19, more than 2 million children lived on the streets of India, which is the final frontier for the most destitute and vulnerable. Since the pandemic, these numbers have only increased. This crisis resulted in thousands of people losing their lives. Millions more have lost their meagre livelihoods without any social protection measure, resulting in further impoverishment.

India’s health system with all its inequities, gaps and weaknesses, has been brought to its knees. Children from the most vulnerable communities have been among the worst hit.

The second wave of the Covid-19 pandemic has caused havoc for India’s fragile health system, especially as infection rates surged in rural areas where the health system is the weakest. Inequities within India’s health system have been highlighted like never before. Lack of hospital beds including in intensive care, shortage of oxygen and lifesaving medicines, a badly rolled out vaccination plan, and serious shortages of critical commodities and infrastructure at the subnational level all contributed to extremely high mortality rates.

Will a Third Wave be even more Dangerous for Children?

Experts in India are predicting a possible COVID-19 third wave that could hit India later this year – and are calling for pre-emptive measures.

The Prime Minister has requested state and district officials to collect data on the infection transmission and severity among youth and children. Dr VK Paul, health adviser to Niti Aayog, the public policy think tank of the government of India, has reiterated that, while current data shows low numbers of children admitted to hospitals, the government should be fully prepared to counter children being infected during the third wave.

Vaccine Rollout

Only 13% of the Indian adult population has been vaccinated and just 3.3% have received both doses. Current vaccine rollout plans are proving to be ineffective both in supply and demand. Uptake is low. At the same time, with states struggling with vaccine supply issues, many people who have received the first dose are unclear if they will receive their second in time, if at all. India needs to urgently escalate its vaccination efforts. And to counter vaccine hesitancy through sharing effective information with communities about the importance of getting vaccinated.

Late in the day, in an effort to improve uptake and rollout, the Prime Minister has finally announced that the COVID-19 vaccine will be free for all adults in India – this had not been the case until now. Hopefully this will kickstart procurement and supply systems that will make possible the comprehensive rollout of the vaccine, dramatically improve coverage, and lead to operational guidelines that recognise children may need to be vaccinated.

Third Wave Preparedness

Nearly half of the 2021–22 health budget is allocated for the procurement of the COVID-19 vaccine, with very little new money for plugging the other huge gaps in the health system. India spent as little as 1.2% of its gross domestic product (GDP) on health in the lead up to the pandemic. Requests and recommendations to increase this allocation to at least 2.5% of GDP have been ignored despite almost 350,000 deaths to date due to COVID-19 alone. India’s current health spend remains low at just 1.9% of GDP. Unless there is a serious influx of resources to address deep systemic weakness – such as the severe lack of health workers, facilities, medicines and commodities at all levels of the health system – it is unlikely that India will be prepared in any way to address the challenges of a COVID-19 third wave. Or the even greater challenge if the COVID-19 virus mutates and becomes even more infectious.

To be prepared, the government and states need to immediately increase health allocations to strengthen inpatient care, including for children. That includes strengthening intensive care units, with assured availability of oxygen and all essential lifesaving equipment both at the national and subnational levels.

The only way to be prepared for a third wave is to strengthen the entire health system by allocating much needed resources now. Action is needed now. Any delays in prioritising health, will only lead to further unnecessary deaths of adults, and real danger for children who may become ill with COVID-19.

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