When the ongoing COVID mayhem in India hopefully ends, the questions will remain: Was it largely a manmade disaster? Could this be avoided or impact lessened?
On May 7, India’s coronavirus cases hit a grim global record with 4,12,262 fresh infections in the last 24 hours. And 3,919 deaths were reported. India recorded over 4 lakh cases for the first time on May 1, after reporting 3 lakh daily infection for nine straight days. The country – hit by a deadly second wave – logged 1 lakh cases in a day for the first time about three weeks ago. While the total case-load has crossed 2.1 crores, the active cases are above 35 lacs, and deaths have crossed 2.3 lacs in total, as per government figures.
Since the testing is very low, in many states like UP private laboratories are ordered not to conduct tests, and many test reports are not coming even after five days, one never knows the actual number of infections. Then, since many cases are not reported but deaths are happening, in rural India reporting of deaths is even lower, and many COVID induced deaths have been passed off as deaths due to some co-morbidity, the death figures are highly under-reported.
The entire scenario rapidly deteriorated since April first week, May first week being the worst so far. It is now being reported that the deaths and suffering are more due to lack of ICU beds, oxygen and some critical drugs than the disease itself. And we need to look at the reasons for the same.
National disaster law and centre-state mistrust
The Disaster Management Act, 2005, extends to the whole of India and provides for “the effective management of disasters and for matters connected there with or incidental thereto.” The Act calls for the establishment of National Disaster Management Authority (NDMA), with the Prime Minister of India as chairperson. Under section 6 of the Act it is responsible for laying “down guidelines to be followed by the State Authorities in drawing up the State Plans”.
Power bestowed by DM Act on Central Government and NDMA are extensive. The Central Government, irrespective of any law in force (including over-riding powers) can issue any directions to any authority anywhere in India to facilitate or assist in the disaster management. Importantly, any such directions issued by Central Government and NDMA must necessarily be followed the Union Ministries, State Governments and State Disaster Management Authorities. In order to achieve all these, the prime minister can exercise all powers of NDMA.
The March 2020 national lockdown was imposed under DM Act as per the order of NDMA ‘to take measures for ensuring social distancing so as to prevent the spread of COVID 19’. Hence, the responsibility of arresting the pandemic lies squarely and primarily with the central government.
Undoubtedly, India’s large population poses an administrative challenge in dealing with any disaster, especially a pandemic such as COVID-19. However, overall management could have been strengthened through three possible ways, on which the government has failed.
Firstly, biological disaster of a national magnitude necessitates a close administrative and political coordination, led by Centre and followed by State governments. Issues like movement of migrant labourers, availability of food, arranging livelihoods to daily wagers, relief camps, entitlement of statutory minimum relief, movement of essential drugs and oxygen, availability of additional beds, ventilators and health-workers, all of which affecting millions in the country needed special attention and advanced planning, for which the Central government was empowered by the DM Act.
Secondly, as per mandate of DM Act, a concerted effort was required to ensure that the state disaster management bodies were administratively, politically and financially empowered, on which several lacunae have been pointed out by media and political circles.
Third and finally, in times such as these, constitutional courts must play its role. There are complaints of discrimination, police excesses, starvation, lack of medical aid, non-availability of drugs, oxygen and beds from various corners of the country. Pertinently, there is a bar on jurisdiction of courts and there is no grievance redressal mechanism under DM Act. Good to see that the Supreme Court and several High Courts only recently have taken up issues arising out of the failure of disaster management by the Centre and several State governments.
Lockdown, curfew & containment policy
In 2020, the hurried national lockdown with 4-hours of notice was seriously flawed. This was not demonetization type of an issue. The short window brought trains, buses, trucks stop midway. Lakhs of migrant labourers with families, left in the lurch by their employers and governments, had to walk back, dying, being beaten, being run over and suffering on the way. Wherever lockdowns were announced in the world, there were prior preparations, no dramatic measures taken and time was given to all to help implement the mass quarantine.
While many nations have taken resort to localized containment zone, limited operations, occasional and localized curfews over the last one year, the PM who in March 2020 had ordered the hasty all-out lockdown, in April 2021 now appeals to state governments to consider lockdowns as the last resort when the cases (total and daily) are several times higher than the last year.
Yes, in this scenario, lockdown should be considered as a measure of the last resort to be used when no other steps work, to contain the spread of the virus, keeping also in consideration the abysmal state of the economy. Even if it is resorted to, it should be short (within two weeks duration), and at least half the population will need to be fed during the lockdown period. Top US epidemiologist Anthony Fauci has also suggested a complete lockdown as an immediate step.
Beds and hospital infrastructure, plight of frontline workers
India’s total healthcare spending is a mere 3.5% of GDP, far lower than in countries ranging from the world’s wealthiest like France (11.3%) and the U.K. (10%) to other emerging economies like Brazil (9.5%) and South Africa (8.3%). And only a third of India’s health care spending comes from the government, with the rest mostly coming out of citizens’ pockets.
Understandably today, India’s health system is on the brink of collapse. Hospitals across the country are running out of oxygen supplies, ventilators and beds. Indians are rushing to buy drugs with prices surging, while labs struggle to process growing backlogs of COVID-19 tests. There is an urgent need to expand healthcare infra-structure by transforming all stadia, large halls, worship places, educational institutes into temporary COVID care hospitals, the process of which has started, spearheaded more by the civil society. Some 151 recognized journalists and at least 330 health-workers have died while on job due to Corona. It is heartening to see that the Sikhs in Delhi are running Oxygen Langar and opened up Gurudwaras for patients. Maharashtra Chief Minister Uddhav Thackeray has gone on record thanking the Muslims of Mumbai for their yeomen service in opening up mosques, donating plasma and blood, and providing oxygen to the needy. To that extent, 5-crores membership strong Rashtriya Swayam Sevak (backing BJP) is missing in action today.
India has started airlifting oxygen generators and other supplies from abroad, with countries including Australia, the U.K., Germany, China, UAE and even Pakistan & Kuwait offering support. The US is sending ventilators, test kits, PPE and oxygen concentrators to Delhi, and has overturned a ban on the export of raw materials India needs to ramp up vaccine production.
In the short term, this emergency disaster relief—along with lockdowns in hot spots and a national mask mandate—is key to curbing the second wave.
Vaccination production, availability and pricing, export of vaccines and oxygen
Modi’s insistence on Atmanirbhar Bharat, the principle of self-reliance, made India slow to approve and purchase foreign vaccines, including Pfizer-BioNTech’s, in favor of its own Covishield and Covaxin. In the meantime, the government was keen to wield its image as the “pharmacy of the world,” exporting 6.5 crores of doses even as it vaccinated only 0.2% of its population per day (only 16 crores of 101 crores adults are vaccinated till date). Today while the Modi government has gone on back foot and opened up for foreign vaccines, they have no capacity to take immediate orders to supply to India. Only Russian vaccine Sputnik is being taken up by Reddy’s Labs to produce in India.
While most nations have given advances to pharma companies to research on and produce vaccines, India did not support Serum Institute and Bharat Biotech initially with any funds. Serum (SII) invested Rs.2000 crores by itself and got Rs.2200 crores from Bill & Melinda Gates Foundation. While US had invested Rs.44,700 crores in vaccines by Moderna, Pfizer, Johnson & Johnson, etc, as early as August 2020, India only on April 19, 2021, gave an advance of Rs.4500 crores to vaccine makers in India. Our current monthly vaccine doses need is around 180 million, while production capacity is at best 80 million! Less than half. India placed its first order of vaccines in January 2021 and only for 16 million doses!
In the longer term, vaccinations are desperately needed to prevent a third wave. With limited vaccine supply, and less than 15% being vaccinated with the first dose, the most effective way to reduce transmission may be to target hot-spot areas and higher-risk people—which means India needs better data, and fast, and not the rampant data-fudging as is done today.
The Supreme Court took note of different prices of COVID-19 vaccines for Centre, states and the private hospitals and asked the Central Government to explain to it the “rationale and basis” behind such a pricing policy. Covishield available to the Centre at Rs.150 per unit, is being offered to the states at Rs.300 and to the private hospitals at Rs.600 per unit. The top court, hearing a suo motu case related to “distribution of essential supplies and services during pandemic”, also asked the Centre as to how it was going to meet the sudden surge in demand of vaccines now in May when vaccination for all above 18 years of age has started, to which no viable plan has been placed yet.
The Kerala High Court issued a notice to the Central Government on two pleas challenging its “discriminatory COVID-19 vaccination policy”. By virtue of the new policy, dual pricing of vaccines has been allowed and states are forced to contend with private players to purchase the vaccines in the open market, whilst the Central Government procures them at a discounted/ subsidised rate. Also, the Centre should adhere to the National Vaccination Policy when it comes to procurement of vaccines. Polio and Small Pox vaccination drives earlier were free and universal, without any discrimination.
Earlier, as part of vaccine diplomacy, India has supplied around 65 million doses of vaccines to around 70 countries. It is perplexing that India was carrying out vaccine diplomacy till March 2021 at such a large scale when it is facing shortage of supplies in many of its own states. For what purpose such a large-scale of vaccine diplomacy was being implemented in such a time of national public health crisis in the middle of a second wave? Is the vaccine diplomacy being carried out to skirt away the questions over the efficacies of the two indigenously manufactured vaccines? And are the vaccines are being distributed just for the purpose of image building of Modi whose government is on a back foot in multiple issues which have come under international attention; farmers’ protests and suppression of dissent being some examples?
PM Cares & Disaster Relief Funds
Prime Minister’s Citizen Assistance and Relief in Emergency Situations Fund (PM-CARES) was set up after the first scourge of COVID in 2020. The Government of India had denied that the PM CARES Fund is a public fund for the purposes of transparency laws such as the Right to Information Act 2005, even though the Fund uses government infrastructure and the national emblem of the Government of India. But, strangely, it was also told that donations to PM CARES Fund will also qualify to be counted as Corporate Social Responsibility (CSR) expenditure under the Companies Act, 2013. PM CARES Fund has also got exemption under the FCRA and a separate account for receiving foreign donations has been opened.
The opposition leaders, especially Trinamool MP Mohua Moitra, has raised question as to why there is no accountability of the PM Cares Fund. She had also noted the unfair treatment of identical contributions to the state relief funds is against public interest, against public policy, completely disincentivises corporate contributions which the state governments otherwise would have got. Some 38 leading Public Sector Units have donated more than Rs 2,100 crore to the Fund, which is above 70% share of the fund. Yet PMCares is not subject to auditing by the State! In effect, the PM Cares Fund diverts funds from local communities into this dark hole where not even a speck of light can enter.
Further, critics have asked why PM Cares fund was not used to fund the return of the migrant labourers many of whom were charged for their movements in extreme duress. The Rs.200 crores allotted for the oxygen plants are not spent yet.
Then there are questions on the need to set up a fund similar to Prime Minister’s National Relief Fund already existing and which is a public fund, subject to auditing and RTI transparency.
Celebrations too soon
Cases peaked around 93,000 per day in September, 2020—less than a fourth of the daily tallies India is reporting in May 2021—and then the curve began to flatten. A narrative emerged that India may have quietly achieved herd immunity, thanks to its comparatively young population—the median age is 27, and just 6.4% of Indians are over 65—and the fact that 66% of its population live in rural areas, spending most of their time outdoors. This optimism was ill founded. The optimistic account has since been complicated by two facts: cases are now hitting the young, and also surging in poor, rural states like Bihar and Uttar Pradesh.
Experts say the current crisis could have been avoided if the government had acted earlier. But it did not being steeped in incompetency and complacency. Also, many Indians who took strict precautions last year abandoned their masks and gathered indoors when the broader public messaging implied that India had conquered the virus.
The RBI in its bulletin of January 21, 2021, said, “Soon the winter of our discontent will be made glorious summer.” The next day, Prime Minister Narendra Modi heralded the spirit of Atmanirbhar Bharat (self-reliant India), claiming that had helped India secure victories in two major battles: on the cricket field against Australia and in the pandemic. “A positive mindset always leads to positive results,” he declared. On February 21 this year, Modi’s ruling Bharatiya Janata Party passed a resolution unequivocally hailing the “visionary leadership of Prime Minister Modi” in turning India into a “victorious nation in the fight against COVID.” Crucially, the public complacency was encouraged by the government’s “mission-accomplished mentality.”
Recently Reuters had released a story about how a consortium of national laboratories tasked with genome sequencing, Indian SARS-CoV-2 Genome Sequencing Consortia (INSACOG), had forewarned the government in early March that they have high concerns about variant strains of coronavirus that were particularly contagious and were in danger of taking over the country. Dr Rakesh Mishra and other members of INSACOG have so far claimed that these warning has either been ignored by the government or at least not properly acted upon. India’s leaders ignored warning signs in the data and the news of variants circulating in other countries.
There is hence a pressing need to set up a formal judicial commission of inquiry with at least three sitting Supreme Court judges to take a 360-degree look at how India’s COVID-19 management system collapsed and came to this sorry pass. This is the very least we owe to those whose lives were lost due to the sheer callousness of the decisions taken or not taken by the government and its leadership. There are more to this on the failure of the powers that be, and we take them up in part two of this research piece.
The author is an educationist, columnist and television panellist, and is currently working as the Pro Vice Chancellor of Adamas University, Kolkata.
COVID 2 & Governance Deficit
Prof Ujjwal K Chowdhury
While the second surge of COVID is ravaging India, it is important to dwell upon the reasons of its lethality, for posterity and delineate good governance in public health, hopefully in future. Carrying forward from the first part on this theme, we look into the other issues compounding the crisis.
Oxygen & essential drugs, their black-marketing
For six weeks now, the entire nation has been reporting lack of oxygen, essential drugs like Remdisivir and ICU beds, with acute situations in Delhi, several cities of UP, Ahmedabad, Pune, Mumbai and Indore. Several media have graphically shown that failure to act, refusing to act, or acting far too late are behind these crises across the nation. The citizens’ voluntary COVID helplines are proving to be more active in this hour of crisis in reaching out to the masses in distress, while even politicians in Maharashtra and Gujarat have been seen hoarding essential drugs and oxygen to sell to the chosen few and at any costs available, which is illegal.
Many in this second COVID surge are dying more due to the lack of oxygen than due to the virus per se. So far, only in Delhi hospitals, more than a hundred have died due to lack of oxygen, including two doctors. Many more outside the hospitals. The Delhi High Court virtually threatened coercive action on central officers to ensure 700 tonnes of oxygen supply to Delhi gasping for breath. Worse situation in many other cities.
In October 2020, quite late in the day, Modi government announced 162 oxygen producing units in 150 district hospitals across India, with around Rs.200 crores from the PMCares fund. But six months later, today, only 33 have been installed. These were to be procured by a central medical supplies process which acted too late too little, whereas in many cases the hospitals and the governments of the states where they are located have been sitting ready with allocation of space and resources.
Till date, Essential Commodities Act has not been invoked against hoarding or black marketing of essential drugs or oxygen etc by the states or the central governments and predatory business is on the rise, including charging abnormally by ambulance services for even short distance travel with patients or corpses. These are quick low hanging steps that could have been taken early in the crisis. Only the Chief Ministers of Delhi and Andhra have fixed rates of even private services.
Poor genomic research
The scale of the current crisis may have been driven by more-transmissible variants, though data are limited because of a lack of widespread genomic sequencing. The virus moves quickly through the multigenerational households that account for 4 in 10 Indian homes. Chronic underfunding of the health system over decades has also left hospitals ill-equipped to deal with the surge.
B.1.167, the Indian origin double mutant strain of nCOVID19, is believed to be behind the current COVID surge. It was detected on October 5, 2020. No immediate genome sequencing was resorted to by the government and its funded bodies to understand the strain better and modify Indian vaccines to counter this deadly strain. But, as late as in January 2021, a Covid Genomic Consortium, INSACOG, network of 10 labs, was set up to speed up genome sequencing with a budget of Rs.115 crores, which was not allocated by the central government and the biotech department of the government had to find money on its own to which it could manage some 80 crores as late as March-April, 2021. Precious time was lost due to a policy paralysis and lack of political will at the highest level.
India has a history of successful, large-scale immunization programs for diseases like polio and tetanus, first-rate scientists, highly trained doctors and powerful networks of community health workers. What has been lacking, experts say, is the political will to get ahead of the crisis—and to use data and science to its advantage.
A team of the Council for Scientific and Industrial Research – Centre for Cellular and Molecular Biology scientists published a paper on their findings – “SARS-CoV-2 genomics: An Indian perspective on sequencing viral variants”. The Hyderabad-based Institute has been studying the evolution of the virus, its mutations and strains ever since the pandemic hit the country. The paper stated, “India has so far not been sequencing SARSCoV-2 isolates to full capacity, having deposited only about 6,400 genomes of the over 10.4 million recorded cases (0.06 percent).”
Large religious congregations
Rather than intensifying public-health messaging and ramping up interventions like banning mass gatherings and encouraging mask wearing, PM Modi and his government did the opposite. They and other regional parties held mass rallies ahead of elections in Bengal, Tamil Nadu, Kerala and Assam, and promoted the Kumbh Mela, a Hindu pilgrimage that drew millions of worshippers to a single town, which had anything between 40 to 50 lacs of visitors, and has emerged to be one of the biggest super-spreaders in the world. Two chief Mahants of the leading Akharas have died due to COVID, and hundreds of sadhus at Kumbha are infected, many dying with every passing day. Even the former King and Queen of Nepal, who were at Kumbh Mela, returned COVID infected. Earlier in March, the widespread Holi celebrations by the Indians was also misplaced and allowed unhindered by the governments.
On April 17, after India had overtaken Brazil to become the second worst-hit country in the world, Modi gloated in a rally in West Bengal that he was “elated” to see such a large crowd (most of whom in close proximity and without masks). Only five days later, he was forced to suspend all physical rallies due to the surge, Madras High Court admonition of the Election Commission, and widespread media criticisms.
Misplaced priorities in big ticket spending
Some of the big ticket spending by the central government include the following, and their timing during the pandemic has been rightly questioned.
Two B777 VVIP planes with state-of-the-art missile defence systems called Large Aircraft Infrared Counter-measures (LAIRCM) and Self Protection Suites (SPS) costing Rs.8400 crores were finalized by the central government during this pandemic for the protected use of President, Prime Minister and Vice President. One of them has been delivered on October 1, 2020.
Then there is the Central Vista Redevelopment Project. It refers to the ongoing redevelopment to revamp the Central Vista. Scheduled between 2020 and 2024, the project first aims to revamp a three kilometre Rajpath between Rashtrapati Bhavan and India Gate, convert North and South Blocks to publicly accessible museums by creating a new common Central Secretariat to house all ministries, a new Parliament building near the present one with increased seating capacity for future expansion, new residence and office for the Vice President and the Prime Minister, and convert some of the older structures into museums. The project began with ceremonial laying of the foundation stone of the new Parliament building in December 2020. The government stated that the entire project costs ₹20,000 crore, and the parliament building alone costs ₹971 crore.
Ironically, the total cost of vaccinating 101 crores of adult population of India with the current Covishield cost to the central government being at Rs.150 per jab, it is less than Rs.16,000 crores! Opposition parties and former civil servants have questioned the need to spend money on the project during a pandemic, even if independent India is turning 75 years in 2022.
Information war & Infodemic
Many say the government has lost sight of its priorities. As cases soared to record highs in April, the government ordered Twitter and Facebook to remove posts critical of the authorities. Independent journalists have scrambled to identify the massive discrepancies between official figures and actual deaths. The UP government ordered attaching properties of those “who spread rumour” in social media on the crisis, and the police arrested a young boy desperately pleading all in social media to get oxygen for his out-of-breath grandfather who finally passed away. On the other hand, a series of false narratives have been built in the last two months by the IT Cell of the ruling party to save the face of the government. The Chief Minister of UP had openly and falsely claimed that there was no crisis of beds, drugs and oxygen even when thousands were suffering, and his government was being pulled up by the Allahabad High Court.
To the relief of the aggrieved citizens and journalists at work, a Special Bench of Justices D.Y. Chandrachud, L. Nageswara Rao and S. Ravindra Bhat of the Supreme Court recently said on record that any move by any State to punish citizens who take to the social media to seek help for oxygen cylinders, COVID-19 drugs, beds, hospitalisation, etc, amid a rampaging second wave would attract contempt of court action.
Rightly observes the Lancet, “India squandered its early successes in controlling COVID-19. India must now restructure its response while the crisis rages. The success of that effort will depend on the government owning up to its mistakes, providing responsible leadership and transparency, and implementing a public health response that has science at its heart.”
What we now need is not managing perceptions, but managing the actual crisis by coordinating all possible government and non-governmental resources, domestic and foreign support, and correcting the past mistakes noted above, apart from severe restrictions in affected areas for two weeks, while the capacities at every level are enhanced. Rather than wallowing in fault-finding, which for accountability is important, we need to move forward with managing oxygen, drugs and beds on one side, and massive national universal free vaccination on the other.
The writer is an educationist, a regular columnist, television panellist, and working currently as the Pro Vice Chancellor of a Kolkata based university.