How Do We Get Out Of Covid Hell?
When put together with innumerable tales of death and suffering amid a collapsed healthcare system that just cannot cope with the Covid caseload, photographs of fires in overloaded cremation sites offer a heart-wrenching metaphor for the hell that India is in right now. How do we get out of here? And to address that question, it is natural to ask how we got here in the first place.
There is sufficient evidence that the current government bears great responsibility for this tragedy:
- Every epidemiologist worth her salt will tell you that a pandemic never has a single wave and second and third waves will occur, with the second wave often more severe than the first. In the Covid pandemic, before the end of 2020, we have seen these second waves erupt in many countries. Yet, toward the end of the first wave in India, the government was blind to this basic fact of science. On 28 January 2021, Prime Minister Modi addressed the Davos Summit of the World Economic Forum, proudly claiming that India had prevailed over dire predictions of doom and had defeated the coronavirus. On 21 February 2021, the Bharatiya Janata Party passed a resolution congratulating the Prime Minister stating that it can be “said with pride that India not only defeated Covid under the able, sensitive, committed and visionary leadership of Prime Minister Shri Narendra Modi, but also infused in all its citizens the confidence to build an ‘Atmanirbhar Bharat’.”
- By late February, the second wave moved from being a science-based prediction to an observable reality, and all Covid numbers which had been declining in India began to rise. By end February, the numbers left no doubt that a second wave had begun. By the first week of March, the government had received scientific advice that we were well into a second wave whose peak would not come until mid-May. Yet, denial by the Government continued, shadowed by prevailing political exigencies.
- On 7 March 2021, the Union Health Minister (a qualified medical practitioner who should know better) claimed that we were in the “endgame” of the Covid-19 pandemic in India.
- The Kumbh Mela — a religious festival where millions were to gather — continued as planned in Haridwar, in the state of Uttarakhand. The Kumbh, which is held every twelve years, was scheduled to be held in 2022, a time where one could hold greater hope that we were past the worst of the pandemic. But, biased by the impulse to appease its Hindutva vote base, the government supported advancing it by a year for ‘astrological reasons’, moving one of the largest mass gatherings in the world forward squarely into pandemic times.When questioned about this, eschewing whatever modern science would have told him, the Chief Minister of the state proclaimed that the flow of the sacred Ganges river would prevent infections by the virus. On 21 March 2021, full page advertisements, bearing photographs of the Prime Minister and the Uttarakhand Chief Minister, appeared in many newspapers, propagandising the Kumbh Mela, asserting it was safe to attend.
- On 18 April 2021, a day when the daily count of new cases had been above 200,000 and rising for three days and daily fatalities had entered the four-figure range, the Prime Minister, campaigning for his party in the state elections in West Bengal, addressed an election rally in Asansol where he spoke without a mask and expressed elation over the huge crowds that had turned up for the event.
- It was clear, right from the start of the pandemic in early 2020, that the only long-term resolution would be to vaccinate a majority of the population. While the numbers in India are huge, these numbers were always known, and advance scenario planning could have been done to evaluate how best to scale up production to meet need as soon as a tested vaccine was released for use. While most other countries would struggle to do that, India has the luxury of being one of the largest vaccine producers in the world. Now it appears that such planning was not implemented, orders for sufficient quantities were not placed, and now the government is scrambling to revise export commitments and raise domestic production capacity. Given that change cannot happen overnight, it could take till the middle of the year before we see impact of the new arrangements. There is little disclosure on what the government’s plans are, what the expected production capacity is, or how quickly the population can be vaccinated.
- Similarly, advance planning could have been done to build capacity for supply of medical oxygen, yet the effort toward capacity enhancement showed little sense of urgency, and fell far short by the time the second wave hit.
- There is clear and widespread evidence, demonstrated by media coverage as well as an overwhelming abundance of anecdotal sources, that there is a severe shortage of vaccines due to poor planning as well as a crisis in oxygen supply where Covid patients are dying because they are unable to get oxygen treatment. Yet the government continued to deny reality and the Union Health Minister continued to assert that there is no shortage of vaccines, there is no dearth of oxygen, and the country is well placed to deal with the second wave of the pandemic.
- It is clear that centralised vaccine procurement is best positioned to balance priorities and negotiate prices. Yet, the central government has abdicated its responsibility to the 500+ million adult citizens between the ages of 18 and 45, passing the buck to states and private hospitals, who will now compete against each other to procure vaccines. Strict regulatory controls on pricing have been relaxed, which is likely to produce vaccine inequity where the affluent will corner available vaccines, and the poor, who have borne the brunt of the impact of the pandemic, will suffer. Moreover, the financial capacity of the states is far below that of the central government, so shifting burden to the states is likely to lead to greater inefficiencies in vaccine procurement.
- Seeing no assistance from a healthcare system that cannot cope, people have resorted to social media to appeal for oxygen or hospital beds. Rather than empathising with the pain in these pleas, there are incidents of a state government aligned with the ruling party seeking to suppress this publicity that puts them in a bad light and resorting to intimidation and threat of prosecution to suppress social media appeals.
- Similarly, a state government aligned with the ruling party has sought to suppress the perception of systemic failures by reducing actual fatality counts, releasing data that does not match with the ground conditions found at cemeteries and burial grounds.
- Mobilisation of expertise to tackle the crisis was very slow off the ground. Although the emergence of a second wave was clear by February, and numbers were beginning to exponentially rise in March, the country’s national scientific task force formed to deal with the Covid crisis did not meet through all of March, and held their first meeting on the second wave only on April 15 2021.
Reactions to how the central government has handled this second wave of the pandemic have ranged from accusations of crimes against humanity and demands for resignations, on one hand to demands for transparency and expertise on the other. But a significant section of the population seeks to stay loyal to the current dispensation and refuses to engage with such criticism. In his weekly YouTube webcast of 28 April 2021, Parakala Prabhakar comments on the reactions he has received to his criticism of the way the central government has mismanaged the situation (I am likely to get people pointing out that he is the spouse of the incumbent Union Finance Minister, but while that leads to some interesting speculation over the conversations in their home, it is not really relevant). Prabhakar mentions the following reactions from those who reject his criticism:
- This is from an anti-Modi camp who will malign him whatever happens.
- This crisis calls for unity rather than criticism, so we should all rally behind the government in support.
- It is easy to criticise; tell me what you will do, or what you think should be done.
- Constructive action only looks forward, never backward.
Prabhakar rejects these critiques as sanctimonious attempts to claim a purported moral high ground from which accountability for mismanaging the pandemic can be effectively evaded. Beyond this, a failure to concretely recognise and correct current failures, lays the ground for them to continue and consequently prolong the crisis and multiply suffering of the citizenry.
Still, let us take this critique to heart and concentrate on looking forward on what should be done. I list below some key expectations on what should be done:
- The effort should be science-based, and science should trump politics. The best possible expertise should be roped in to bear on the problem, at central and state levels, whether from the government or the private sector. Frequent public briefings to the press by these experts should form a key component of the government’s messaging on the pandemic.
- There should be openness on the data of all aspects of the pandemic, not just in case counts and fatality rates, but also on supply chains and shortages on hospital beds, oxygen, vaccines, needed medicines. Even if the data picture is difficult and troubling, it should be transparent, for only then will citizens have trust in public action being taken. A regime that seeks to claim there is no shortage of oxygen or vaccines when multitudes of people are suffering while facing such shortages, a regime that seeks to intimidate those who desperately plead for help on social media, a regime that manipulates fatality rates to make the situation appear less serious than it is, all these will come across as heartless and self-centred to a public who can see from evidence in front of their eyes that what the regime claims is far from reality on the ground. Only openness can build the public trust and cooperation so badly needed today.
- Where severe shortages exist, there should be transparency on the extent of the shortage, action being taken to tackle these shortages, along with projections on the timing of improvements we can expect to see. Even if progress is not as fast as we would like it to be, clarity will offer concrete goals to look forward to, whereas visible shortages amidst suffering, with no clarity on the future, breeds a disheartened helplessness. Clarity on progress is the foundation of hope.
- While ultimate action on the ground has to be decentralised to state and local governments, the centre should play a key coordinating role. Firstly, data aggregation at the central level can guide policy in many fundamental aspects. Second, the central government has far greater financial resources and political clout to play an effective role in procurement of vaccines, oxygen plants, and other resources to fight the pandemic. Third, centralised procurement avoids the inefficiency of states and private players competitively bidding against each other for scarce resources. Fourth, the harnessing of resources, such as supply chains of the military or foreign aid, to alleviate suffering can only be done by the centre. But this is not just a coordinating role, it should involve ownership of the problem and accountability for all actions that have to be taken.
- Public trust and cooperation are crucial, and for this there should be an openness on all fronts. It is not just data transparency, there should be an openness and sense of responsibility visibly demonstrated by the government to field questions from the public, including difficult questions. This should happen in press conferences as well as through social media outreach. This should manifest itself at all levels of government, starting at the top. On this count, it is demoralising to note that Narendra Modi is the only Prime Minister of independent India, and practically the only leader of a democracy, who has never held an unscripted press conference where he is open to fielding challenging questions from the press. It is also demoralising that government press briefings on the pandemic have been irregular, led by politicians and bureaucrats more than experts in epidemiology and medicine, and have left little time for questions
- Given that good practices to resist spreading infection are poorly understood by large sections of the population, there should be incessant messaging on wearing of masks in the proper manner, avoiding large gatherings, and (for those who have the luxury of affording it) social distancing and frequent sanitising of hands. Masks should be subsidised for the poor. Messaging is not enough; leadership should offer role models, demonstrate by example, accompanied by visible messaging within government institutions and political parties. There should be consequent disciplinary action for non-compliance. On this count, the performance of political leadership has been extremely poor.
- The centralisation of power in the current regime is one that India has not seen since the days of Indira Gandhi. An overly centralised regime is inefficient in handling most situations in a country of India’s size and complexity, especially a serious one like a pandemic. Over-centralized power structures seek to foreground one or two leaders over broad-based expertise; hamper decision making to tackle complex and urgent issues by overly depending on one or two key individuals, and people outside the elite inner circle suppress their expertise knowing their future depends on kowtowing to leaders. We need political and bureaucratic leadership, at multiple scales, that is fully empowered to speak its mind and take independent decisions within the umbrella of an overall strategy that is shaped by the best of relevant expertise rather than political exigency.
- When we are overwhelmed with our heads so far below the water, we must take all the possible help available and must not prioritise saving face over effectiveness in tackling the crisis. The refusal to avail an opportunity to use the vast global logistics and supply chain of the United Nations does not make sense, and it appears that this decision was influenced by the fear that taking this help would make the government appear out of its depth.
- With the pandemic affecting the economy badly, economic relief packages from the government are crucial. Such packages should clearly identify their intended recipients, with an emphasis on the poor and vulnerable sections of society. They should spell out the delivery mechanisms by which aid will be delivered, along with the timing of delivery. The package should also define how its effective implementation will be tracked, and data from this tracking should be open to the public domain. The package should be transparent on the extent of relief being offered solely due to the pandemic and should not use sleight-of-hand public relations measures where old schemes are repackaged as new relief to mislead the public on the size of the economic aid package being offered.
- The government must articulate a clear set of priorities, holding the pandemic as a fundamental crisis that must be awarded top priority, assessing all possibilities where funding that is not very urgent or essential can be diverted toward tackling this crisis. This evaluation must be transparently shared with the public. In this light, many citizens are perplexed and shocked that the Central Vista Redevelopment in New Delhi has been declared an essential service so that its construction can proceed through the lockdowns imposed to fight the pandemic. This one project alone, with a reported cost of Rs. 20,000 crores, holds a value that is a substantial portion of the cost of vaccinating the entire adult population of India.
- Leadership must hold itself accountable for doing all that is possible to tackle the pandemic. This does not amount to an expectation that they can make it go away in a hurray — citizens will recognise that this is a complex and difficult challenge that cannot be easily controlled. But we must be unforgiving to both incompetence and wilful disregard to essentials. A leader who disregards data, side-lines expertise, puts political benefit to self and party above public welfare, or repeatedly promotes events and/or behaviour that is likely to enhance the spread of infection, must either resign or be removed. This signal must come from the very top.
This is not too much to ask. It is a list that springs from common sense rather than specialised expertise. It is revealing that what we see is so far removed from this common-sense list; the gap revealing the fundamental failures of governance in India, where rather than a professional system-driven approach, we place undue emphasis on personal charisma, pursue the uneven patronage that springs from caste or community loyalties, and accept the opacity over performance and accountability that ensues. Worst of all, the inertia of this distorted system prevails even when we the people are torn apart by the suffering and angst of a raging pandemic.
History has shown that positive fundamental change is very rarely offered by political power, it occurs only when it is demanded and claimed by ordinary people as their right. The failures of our governance acquire a painful acuity in the midst of a crisis like the Covid pandemic, and the faint silver lining in this dark cloud is that this acuity can provoke us into mass action that demands change: a nonviolent citizens’ movement that asserts, “Enough is enough! We cannot take it anymore!”