Estimating vulnerability to COVID-19 in India
Authors: Saurav Basu
Journal: The Lancet Global Health (2020)

Rajib Acharya and Akash Porwal1Acharya R Porwal A A vulnerability index for the management of and response to the COVID-19 epidemic in India: an ecological study.Lancet Glob Health. 2020; 8: e1142-e1151Summary Full Text Full Text PDF PubMed Scopus (122) Google Scholar calculate a composite COVID-19 community vulnerability index at the state and district level in India. The index is based on a set of 15 indicators across five domains that contribute to vulnerability or the consequences of COVID-19 disease in the population. Data for 13 of the 15 indicators used for constructing the index were obtained from a large, nationally representative cross-sectional survey, the National Family Health Survey-4 (NFHS-4), data for which were collected between Jan 20, 2015, and Dec 4, 2016.2International Institute for Population SciencesNational family health survey (NFHS-4), 2015–16. International Institute for Population Sciences, MumbaiDecember, 2017http://rchiips.org/nfhs/NFHS-4Reports/India.pdfDate accessed: July 20, 2020Google Scholar In the case of at least three indicators, data from the NFHS-4 are unlikely to be representative of the present situation. First, households with no toilet facility. According to the NFHS-4, 48% of Indian households use an improved, non-shared toilet facility, 9·1% use an improved but shared toilet facility, and 39% practised open defecation.2International Institute for Population SciencesNational family health survey (NFHS-4), 2015–16. International Institute for Population Sciences, MumbaiDecember, 2017http://rchiips.org/nfhs/NFHS-4Reports/India.pdfDate accessed: July 20, 2020Google Scholar However, the Swaccha Bharat Mission launched in 2014 by the Union Government of India, to date, has contributed to the construction of more than 100 million individual-household-level toilets.3Government of IndiaMinistry of Drinking Water and Sanitation. Swachh Bharat mission (Grameen).https://sbm.gov.in/sbmdashboard/Date accessed: July 21, 2020Google Scholar As per the findings of the National Annual Rural Sanitation Survey (2018–19) based on a nationwide survey of 92 040 households in 6136 villages across India, 706 of the 740 districts of the country have attained open-defecation-free status.4Independent Verification AgencyNational annual rural sanitation survey.https://jalshakti-ddws.gov.in/sites/default/files/NARSS-2018-19.pdfDate: 2018–19Date accessed: July 20, 2020Google Scholar Second, households with health insurance. As per the NFHS-4, only 28·7% of Indian households have any usual member covered by a health scheme or health insurance.2International Institute for Population SciencesNational family health survey (NFHS-4), 2015–16. International Institute for Population Sciences, MumbaiDecember, 2017http://rchiips.org/nfhs/NFHS-4Reports/India.pdfDate accessed: July 20, 2020Google Scholar However, in September, 2018, the Government launched the Ayushman Bharat—Pradhan Mantri Jan Arogya Yojana (PMJAY), the largest health-care scheme in the world. The PMJAY targets the provision of health insurance coverage to 500 million Indian citizens belonging to the most socioeconomically disadvantaged populations, with the maximum hospitalisation coverage amounting to half a million Indian rupees for each family per year. To date, more than 125 million e-cards for potential beneficiaries have been issued, 10 899 888 hospital admissions have occurred, and 6 551 993 claims have already been paid under this scheme.5Government of India National Health AuthorityAyushman Bharat-Pradhan Mantri Jan Arogya Yojana. PM-JAY Dashboard.https://pmjay.gov.in/Date accessed: July 20, 2020Google Scholar Third, overcrowding (people per room). According to the NFHS-4 data, nearly half (49%) of Indian households are overcrowded, with three or more people sleeping in the same room. To combat the situation and to improve living standards, the Government of India launched the Pradhan Mantri Awaas Yojana in November, 2016, to provide assistance to promote affordable housing for economically disadvantaged parts of society. To date, more than 8·7 million houses have been constructed under the scheme in rural areas.6Government of IndiaMinistry of Rural Development. Pradhan Mantri Awaas Yojana – Gramin completes three years.https://rural.nic.in/press-release/pradhan-mantri-awaas-yojana-%E2%80%93-gramin-completes-three-years-union-minister-ruralDate: Nov 20, 2019Date accessed: July 20, 2020Google Scholar Consequently, the overall vulnerability of the various states and districts are likely to be significantly lower than the current estimates. Nevertheless, additional sources of vulnerability that were not considered in the index by the authors might include the challenges of food and economic insecurity based on employment profile of the local population, local road connectivity, and transport availability, especially in rural areas for patient transport, and existing primary-care preparedness for the management of moderate to severe cases of COVID-19. I declare no competing interests. Estimating vulnerability to COVID-19 in IndiaIn their ecological study, Rajib Acharya and Akash Porwal1 measure the vulnerability of India to COVID-19 in five main areas: socioeconomic, demographic, housing and hygiene, availability of health care, and epidemiological conditions. The authors examined the five dimensions and 15 indicators of vulnerability for all the districts and states of India separately, which can contribute to mitigating the ongoing pandemic. However, the study has some shortcomings. Full-Text PDF Open AccessEstimating vulnerability to COVID-19 in India – Authors' replyWe express our sincere thanks to several colleagues who took interest in our Article on a vulnerability index for management of COVID-19 in India1 and provided valuable feedback. We will address the comments in a collective way, not individually. Full-Text PDF Open AccessA vulnerability index for the management of and response to the COVID-19 epidemic in India: an ecological studyThe vulnerability index presented in this paper identified a number of vulnerable districts in India, which currently do not have large numbers of COVID-19 cases but could be strongly impacted by the epidemic. Our index aims to help planners and policy makers effectively prioritise regions for resource allocation and adopt risk mitigation strategies for better preparedness and responses to the COVID-19 epidemic. Full-Text PDF Open AccessEstimating vulnerability to COVID-19 in IndiaIn the ongoing COVID-19 pandemic, timely and best available data surveillance is crucial to guide policy decisions. Rajib Acharya and Akash Porwal (September, 2020)1 exemplify this by developing a vulnerability index based on socioeconomic, demographic, housing and hygiene, epidemiological, and health system characteristics across states and districts in India. Such exercises can help decision makers identify priority areas for the purpose of resource allocation and designing containment and mitigation strategies. Full-Text PDF Open Access