In March, India started to witness a second run of rising COVID-19 cases. By April, the country had recorded 100,000 new cases in a day for the first time since the pandemic began. Daily case rates would continue to grow explosively, and, in May, reach a record-breaking pace of more than 400,000 cases a day.
The irony of the situation is that India, responsible for more than half of the world’s daily COVID-19 cases at the time, is also one of the world’s leading vaccine manufacturers.
High-income countries were able to purchase enough vaccine doses to inoculate their populations multiple times over. But delays in domestic production and lack of access to foreign supplies meant that India wasn’t able to protect itself from the outbreaks that killed hundreds of thousands, and potentially even millions, of citizens.
At the time of the deadly surge, only 3% of India’s population had been fully vaccinated, providing ample opportunity for the virus to spread. Now, the Delta variant — first discovered in India during the country’s second wave — remains the dominant strain worldwide.
“Vaccine inequity has been a major challenge in global public health and certainly has undermined the speed and efficiency of our collective response in this pandemic,” said K. Srinath Reddy, president of the Public Health Foundation of India (PHFI). “If you have some areas with high levels of vaccination, but many areas with extremely low access to and availability of vaccines, then you have a very imbalanced world.”
Professor K. Srinath Reddy prepares for a keynote speech at his office in Gurugram on December 8, 2021.
Throughout the pandemic, PHFI has been advocating for vaccine equity in India. The organization is pushing forward policy that aims to increase health care access for those who lack it.
PHFI is not directly involved with vaccine distribution and administration, but it has been assisting in other ways. It has been providing technical support to the government, developing health technologies, training primary care physicians and health care workers, and using social media to increase awareness of the virus.
Reddy, who helped found PHFI, was serving as head of the Department of Cardiology at All India Institute of Medical Sciences when he was approached with the idea of starting an organization that focuses on improving public health in India.
“I still had about 10 years of service left in cardiology, but when this concept was being floated around and I was asked to take the leadership position, I had no hesitation,” he said. “I wanted to see this come true.”
Since its creation in 2006, PHFI has established six locations in India and trained more than 26,000 primary care physicians.
For Reddy, working in public health was an opportunity to focus on the equity aspect of health care. He first realized that not everyone can afford good health through the experiences of his mother, an obstetrics and gynecology doctor. She had treated a large number of poor patients who regularly struggled with accessing care.
Professor K. Srinath Reddy
Professor K. Srinath Reddy, interacts with first year MPH students at the Public Health Foundation of India (PHFI) office in Gurugram on December 8, 2021.
Professor K. Srinath Reddy
Students attend an interactive session by Professor K. Srinath Reddy at the Public Health Foundation of India (PHFI) office in Gurugram on December 8, 2021.
Later, as a medical student and then a cardiologist, Reddy’s own experiences expanded his awareness of the social dimensions of health.
“I saw how the poor had much greater risk of acquiring disease, of being unable to afford the kind of care required, or being pushed into poverty by the kind of expenses that the care entailed,” he said. “Even as a cardiologist when I was practicing in the biggest hospital in India, it was very clear that many people came too late with very advanced diseases because they had poor facilities for early detection or could not afford to travel until the situation became dire.”
When Reddy conducted field research in epidemiology, he realized that poverty is also associated with inadequate health literacy, unhealthier diets, and fewer health checkups — all of which further drive up risk factors.
With this knowledge, Reddy became an advocate for many intersectional health issues. He now advocates for tobacco control, nutrition, human rights, and universal health coverage, which he believes is key to solving the equity problem. PHFI became the means through which he hopes to achieve these goals.
“India was selling itself short by not investing adequately in public health,” he said. “The whole idea was not just to come up with a problem diagnostic and write papers in prestigious journals, but to make sure there is actually a difference being made on the ground. That’s how my commitment to public health inequity translated into institution building and capacity building.”
As India grappled with the world's biggest and deadliest COVID-19 outbreak, Reddy used his expertise to lead PHFI in the fight for vaccine equity within his country.
Professor K. Srinath Reddy, President works on his computer as he prepars to deliver a keynote lecture for a webinar at the Health Leadership for Positive Change Program.
The organization has advocated for the vaccine to be free of cost to everyone. It has also supported the creation of walk-in centers to address barriers created by the online vaccine registration systems. This is especially important for people who do not have smartphones or who aren’t familiar with technology.
When the government required people under age 45 with comorbidities to provide medical certificates to get vaccinated, PHFI argued against it. The organization said that many people either do not have the required records or have not yet recognized their illness due to lack of health services in rural areas.
PHFI has also been working with private hospital groups to address difficulties they face in procuring vaccines for smaller towns and hospitals.
Since the peak of the second wave, the situation in India has improved dramatically — daily cases and deaths have decreased, and 38% of the population is now fully vaccinated. Yet the majority of Indians are still vulnerable, leaving plenty of room for another surge.
Most countries, especially in the developing world, have struggled to access COVID-19 vaccines. This limits the speed at which they can protect their populations from deadly surges. At the same time it increases the chance for more variants to develop.
COVAX aims to deliver 2 million doses to low- and middle-income countries by the end of 2021, but a stark disparity continues to exist between the haves and have nots. Wealthier countries are opting to prioritize booster shots for their own populations rather than spread the resources to lower-income countries. Reversing this would help ensure that every country has vaccinated at least 10% of its population, a goal that the World Health Organization had hoped to meet by September 2021.
Professor K. Srinath Reddy, President, Public Health Foundation of India (PHFI), photographed at his office in Gurugram on December 8, 2021.
As the threat of a third wave looms over India, with the Omicron variant sparking new concerns, PHFI continues to work with the public and private sectors to ensure broader and more equitable vaccine access within the country.
“We have had some challenges, definitely, because things do not always come easy,” Reddy said. “But the fact that we are making headway in actually getting public health anchored very firmly into the policy making arena — that has been a success. It was happening even before the pandemic struck, but now, everyone recognizes the importance of public health.”
Disclosure: This story was made possible with funding from the Bill and Melinda Gates Foundation. It was produced with full editorial independence.