Appeal for Free Testing and Free Treatment for COVID-19: Letter to PM Modi

Taking a serious note of the Government of India’s efforts to tackle COVID-19, a group of organizations and experts have appreciated the efforts and urged the government to avail access to free testing and treatment for COVID-19.

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A group of organizations, Jan Swasthya Abhiyan (JSA), All India Drug Action Network (AIDAN) and All India Peoples Science Network (AIPSN), have appealed to Prime Minister Narendra Modi to enable access to free testing and free treatment for all citizens in order to suppress the COVID-19 pandemic. The letter dated 25 March makes several pertinent points with regards to our national response, preparedness and lack of adequate healthcare infrastructure. It also suggests measures to ensure that timely prevention and treatment efforts can be implemented to address the pandemic.

Taking cue from the experiences of other high burden countries, the undersigned organizations emphasize that there is a correlation between extensive screening and control of the epidemic, and even of mortality. Presently, we have only 119 government laboratories that are either operational or in the process of operationalization, they suggest that testing will be crucial to help identify ‘hot spots’, where concentrated and timely action can be directed to curb the spread of COVID-19. Notably, the Indian Council of Medical Research (ICMR) has already started the process of validating private medical labs for carrying these tests, and has successfully approved 26 labs in 7 different states till now.

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While the eligibility criteria for COVID-19 diagnostic test was recently expanded to include patients suffering from Severe Acute Respiratory Illness (SARS), symptomatic healthcare workers, and those who have come in direct contact and are thus at high-risk, the letter suggests a further broadening of criteria. Amongst other recommendations that address Influenza patients, the demand for population-wide research with an adequate sampling method at different selected sentinel sites must be given due consideration to better understand and censure the spread of the virus.

COVID-19 Pandemic and Health System

At present, COVID-19 tests are being conducted through home-brew kits in government laboratories but this is a time-consuming and expensive method. Arguably, commercial test kits can produce faster results at a significantly lower cost. A fast-track mechanism for validation of non-US FDA/CE has been approved as commercial test kits at ICMR NIV, Pune. It is inevitable that more private sector hospitals and laboratories will be pressed into action if the infection spreads, and particularly, at the stage of community spread.Therefore, the ICMR has developed a fast-track process for the validation of commercial test kits, which can help reach a greater number of people and enable broad-base cheaper testing. A much-needed step, but the letter has also appealed for more research to ensure the validity and efficiency of these kits before approval for public testing.

The letter also raises serious concerns regarding the financial burden of getting a COVID-19 test, which is roughly around INR 4,500 at a private lab. In a country where most families earn less than INR 5,000 per month, this pricing approach can only be termed grotesque. Before it elevates into a monumental government failure and the welfare state, the union government must take strong and urgent action to lower the costs and increase access to testing and treatment for every citizen to ensure that the fight against COVID-19 is not marked by class discrimination. The letter firmly advocates that regardless of whether an individual is tested in a government or a private lab, the cost must be borne by the government.

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The JSA, AIDAN and AIPSN have expressed serious concerns regarding the payment cap of up to INR 4,500 for testing in private labs.

They have pointed out that this would negate the public health response to the pandemic and create inequitable access to testing for people who meet the testing criteria. It is not so much about lowering the expense, it highlights, but removing it altogether so it doesn’t act as a barrier to testing. On a positive note, the union government has already directed related expenses for COVID-19 to be covered under the government-sponsored insurance schemes such as Ayushman Bharat. Still, how the government intends to cover those who are outside the purview of such schemes is a matter that requires further deliberating.

While the letter emphasizes the need to follow a free test and free treatment policy regime in dealing with such a grave public health emergency, the health networks have urged the government to bear the cost of COVID-19 testing kits to be made available at private labs. Along with this, they have demanded that the GoI should provide full disclosure of prices at which test kits are being supplied by each manufacturer as well as the costs of testing in public and private laboratories. The demand for the acceleration of the evaluation process of pending applications of PCR test kits for COVID-19 has also been put forward. Bringing attention to reagents and other physical components such as swabs which are used in testing, the networks have demanded that the local production and secure supplies of raw material for reagents.

Raising the concerns of spreading the coronavirus in the country and calling the immediate action from the government, the public health networks sent the letter to various line departments and authorities including the Prime Minister, Narendra Modi, Union Health Minister, NITI Aayog, ICMR and Drugs Controller General of India among others.