There is much to learn from the Indian experience with the virus.
Any government must have a body that is paranoid and focuses on what could go wrong.
There needs to be a healthy and constructive balance between the optimists and the prudent ones inside the government.
I just happened to come across the article in Financial Times (FT) by Ramachandra Guha (‘The unmaking of India’, 30 April 2021). The comments in the article by Guha reflect the widespread anger and resentment at the deaths and the personal sufferings that many have experienced directly or indirectly.
They are also an expression of revulsion at the embarrassment that India has faced. According to many, it was avoidable and the responsibility for not avoiding it is the Prime Minister’s to shoulder. That is the simple narrative.
A few things are important to note. One, in any distress, the first human reaction is reluctance to recognise the problem, to seek to externalise it next. Only over time, humans seek to understand and accept the problems and work towards their resolution. With commentators, the first thing is to find someone to blame. It is usually the government. Especially if it happens to be a government led by someone whom you loathe otherwise, the task becomes that much easier. One can avoid further intellectual rigour to analyse the situation.
The second thing is to conflate issues and include many things that have no bearing on the situation being analysed. The third thing is to avoid asking the counterfactual question. The fourth thing that goes with it is to engage in hindsight wisdom, whereas decisions are made in real time. The critic has that luxury while decision-makers don’t.
The first question to ask is if any scientist or expert inside or outside the government in India, inside or outside the country, warned the government – when it was celebrating the end of the first wave and the vanquishing of the virus in India between October 2020 and January 2021 – of the second wave of such a magnitude, speed and spread. I searched for them but in vain.
Recently, reports have surfaced that some experts sent warnings to the government in March. Perhaps, they should have been heeded. If they were heeded, maybe, some of the damage could have been averted. But, it is difficult to conclude, based on publicly available information, that it was PM Modi who did not make the necessary calls to up the ‘cautionary’ ante. In reality, the explosive phase of the second wave of infections almost sneaked upon the country, burst suddenly and caught everyone by surprise.
Since the usual refrain is to listen to science or scientists, let us turn to them. From an article published in Nature (Nature 591, 512-513 (2021)) in March 2021:
“In India, for example, an as-yet-unpublished nationwide survey of more than 28,000 people in late December and early January estimated that 22% of those aged 10 and older had already been infected. That figure exceeds 40% in megacities such as New Delhi and Mumbai, says Manoj Murhekar, an epidemiologist and director of the National Institute of Epidemiology in Chennai who is one of the researchers behind the work. He thinks this means that India probably won’t return to the peak of about 100,000 new daily cases, seen in September.”
The same article goes on to cite another study published in the Lancet:
“For example, a meta-analysis of antibody studies, published in The Lancet Global Health on 8 March, found that India had one of the highest percentages of antibody prevalence in the general population of any country included in the analysis — with about 20% of people testing positive for antibodies against SARS-CoV-2.”
Even Ramanan Lakshminarayanan, who was rather pessimistic about India during the first wave is quoted in the article as being optimistic that the pandemic peaked in January.
Right now, scientists are puzzled about the ferocity of India’s second wave but critics seem to know exactly which one or two people are responsible for it.
The second question concerns the holding of elections in India. One of the things that might have entered into the calculus of the government in Delhi and the Election Commission of India was that the holding of the elections in Bihar did not lead to any surge in infections. That might have been a factor. Further, the elections were being held in April, well after the winter season got over. Most rallies take place in the open. So, they might have thought that the balance of risks was in favour of going ahead with the elections and not postponing them.
We should not forget too that postponing state elections in India is not easy. In his LinkedIn post, author and analyst Anirudha Dutta reminds us of the near-impossibility of doing so: “Assembly term cannot be extended unless an Emergency has been proclaimed (imagine the reaction to that). Without an emergency you can either have the President’s rule or caretaker CM without any assembly. If President’s rule was imposed, what would have been the reaction of the same people who are questioning the need for an election now?” The truth is that no political party sounded the warning and pleaded for postponement of elections.
In fact, while Modi is now criticised for holding rallies and canvassing amidst large crowds, an article published by two analysts at the Centre for Policy Research in October 2020 expressed the ‘apprehension’ that recourse to digital and social media campaigning would confer an undue advantage on the Bharatiya Janata Party (BJP).
Data show that the steep rise in active infections in India occurred in several states – Rajasthan, Karnataka, Bihar, Uttar Pradesh, Odisha and Gujarat – that did not have elections and associated rallies in February-April 2021. Second, if super-spreader events were to be criticised, one cannot selectively pick out election rallies alone. The so-called farmers’ rallies and protests and congregations were, from this angle, potential risk events.
The news is that other countries in Asia are seeing a massive surge in infections and citizens in Thailand are angry about lack of hospital beds. They did not have elections or rallies as in India. A sudden and big outbreak of infections is like a tsunami can engulf even advanced nations as happened in Italy and in America last year and now in other parts of Asia.
While PM Modi comes under attack for continuing with ‘business as usual’ while infections were rising, last year, when he imposed a nationwide lockdown in March, he was accused of being callous. Yes, he announced the commencement of the lockdown in four hours from the time of his speech. One view is that he was insensitive and incompetent. But, an alternative perspective is possible, if we try.
Any notice of 48-72 hours given to the public to adjust, given the sheer population numbers in India, might have nullified all the aims of the lockdown policy – which was to arrest the spread of infection and minimize deaths. The public would have freely moved across state borders spreading infection. Many migrant workers, losing jobs in cities and trudging hundreds and thousands of kilometres, endured and experienced enormous pain and suffering in the process. Both the Union and State Governments responded to their plight. Again, from the point of view of Modi’s critics, the situation called for an emotional response and they rose to the occasion. To be objective and constructive in such situations is hard work.
A paper that Dr. Bibek Debroy wrote in November 2020 (‘Seven governance issues raised by Covid’, Indian Public Policy Review 2020, 1(2), pp 16-25) is very useful to understand these issues: migrant labour, public health and even recording of deaths.
“The Inter-State Migrant Workmen (Regulation of Employment and Conditions of Service) Act has acted since 1979. Among other things, this specified the responsibility of the contractor…. Under the Seventh Schedule, the responsibility is with the Union government, but implementation and enforcement vests with the States. Had the intent of the legislation been enforced, there would have been a register of migrant workers, with portability of welfare benefits for returning migrants. Nevertheless, the statute was not enforced.”
Public health is squarely in the state list as per the seventh schedule of the Indian constitution that has three lists: Union, State and Concurrent. Most subjects concerning public health are the responsibility of the states except a few which includes prevention of the extension from one State to another of infectious and contagious diseases. Similarly, the Epidemic Diseases Act of 1897 restricts the role of the Union Government only to actions taken at the border (seaports and airports).
It goes into the complexities of health care and the recording of deaths. “Physicians and medical workers who certify the cause of death are not necessarily familiar with the 14,000 codes for various diseases under ICD. For example, in the 2018 report, 13.1% of total medically certified deaths were classified as “symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified”. The eighth highest cause of death in India is something that cannot be pinned down.” ICD stands for International Classification of Diseases.
Indian GDP statistics came under fire from critics of the government for overstating economic growth. Again, in their view, it was all Modi’s machinations. But, the same omnipotent PM could not stop the statistical agencies from reporting a 26% (y/y) contraction in India’s real GDP between April and June 2020. His critics fell silent because the magnitude of the contraction was a big enough stick for them to beat the government with for ignoring the economy and for locking down the country in utter disregard for the consequences of the lockdown on livelihoods.
This time around, the Prime Minister exhorted the states to use targeted and localised lockdowns that many had advocated at that time as an alternative which he eschewed. But, now, he is a target of criticism for not locking down the country and for putting the economy and economic growth ahead of health and lives!
Journalist Shankkar Aiyar wrote ‘The Gated Republic’, a book that documents, in depressing detail, India’s failures in water, power, education, health and law and order. Both at the systemic level and at the personal level, the second wave that caught India unawares – in terms of speed, magnitude and impact – was a case of an acute attack in a chronically weak body.
In a recent column, ‘The price of inaction’, he wrote:
“There has been a blitzkrieg of criticism of the Centre’s handling of the crisis. This column in previous weeks has commented on the ‘Politics of Not Leading by Example’ and the ‘Epidemic of Wilful Blindness’. However, there is no disputing the systemic sloth afflicting governance. The March 2021 report of the Parliamentary Standing Committee examines a litany of issues. One factoid is illustrative. The Department of Health Research deals with epidemics and outbreaks. Of the 42 sanctioned posts 24 are vacant…..
…… The Union government has much to explain but that cannot be an alibi for ineffectual record of state governments. The aggravating factor in the magnitude of the surge of the second wave has much to do with the failure of state governments in getting their act together. Delhi, Maharashtra, Uttar Pradesh and Madhya Pradesh which went through oxygen shortages in the previous wave were just as unprepared this time. In fact the Centre’s initiative to expand oxygen capacity with grants is pending in most states.” [Emphasis mine].
Mr. Guha mentions crony capitalism as a feature of the Modi government. Cronyism is an enduring feature globally. Critics are right to keep it at the front and centre of their criticisms. However, it is also a fact that the government’s taxation policies, de-criminalising of company law offences, bankruptcy law and production linked incentive schemes benefit many businessmen and not just a few.
In hindsight, it is clear that the Government declared victory over the virus prematurely. Given the experience in other countries, the need was to ask, with persistence, as to how India could hope to be exempt from and cope with future waves. But, in this matter, all the three sectors of the economy – households, businesses and the government – reinforced each other in believing that India has seen the end of the pandemic. Even experts, as cited earlier, were singing the same refrain.
There is much to learn from the Indian experience with the virus and to set right. Any government must have a body that is paranoid and focuses on what could go wrong. There needs to be a healthy and constructive balance between the optimists and the prudent ones inside the government. Such voices would be muted and feeble in an environment that is quick to declare victory and celebrate successes disproportionately. Secure leaders encourage voices to speak up and speak out even on celebratory occasions. Leaders at all levels – in the government and in the private sector – must imbibe this spirit.
Second, Dr Debroy’s article, referred to earlier, spells out the areas that need clarity and attention. Public health infrastructure remains the responsibility of states. They need to step up to the plate. Third and more immediately, the Indian government must procure the vaccines centrally and distribute them to states. Competition between the states in vaccine procurement will be counterproductive and will cause delays. That is important to avoid, if India were to withstand a third wave, should it come.
Third, in his co-authored article in Indian Express, Professor Milind Sohoni wrote that the real problem all along has been an outdated administrative system, and a knowledge elite who have soaked up prestige, but not delivered the facts. The administrative system, a colonial era relic, is not set up to make India an economic success story. Prime Minister Modi has to dedicate himself to that task now.
Finally, the most important point is that in the unseemly haste to pin Modi down, critics are failing to focus on finding the truth behind the origins of the pandemic itself. Far more attention and a sustained one at that is needed to be trained on that big question, given the rather unpredictable behaviour of the virus elsewhere in the world except in the place of its origin.
The letter that Hamish de Bretton-Gordon, Director of ‘Doctors under Fire’ and author of ‘Chemical Warrior’ wrote to ‘The Telegraph’ is worth reading and reflecting upon:
“What concerns me about this virus is that it is almost “too perfect” a pathogen: highly transmissible, deadly and ever evolving. If this was the result of a zoonotic transfer, why now? People in China have been eating bats and pangolin for millennia. The question is too important to drop. We must get to patient zero and find out what really went on in the Wuhan lab to ensure that it doesn’t happen again.”
A final word for critics to think about: unleashing one’s vitriol indeed may leave us with the satisfaction of preaching to the choir but from a public welfare angle, it achieves very little. Criticisms that are disproportionate and misplaced turn their targets into victims deserving of sympathy and support and help shift focus away from the issues of importance to polemics and polarisation. In doing so, the critic and his target meld into one, indistinguishable from the other.
This article first appeared in The Gold Standard and has been republished here with permission.
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