Why Covid-2 is a manmade disaster PART I: A blow by blow account of a pandemic in progress

India’s total healthcare spending is a mere 3.5% of GDP, far lower than in countries ranging from the world’s wealthiest countries.: PTI

Ujjwal K Chowdhury   |  TT   |   08.05.21  : When the ongoing COVID mayhem in India hopefully ends, the questions that will remain: Was it largely a manmade disaster? Could this be avoided or its impact lessened? In tracing the course of the pandemic in India, this piece (in two parts) tries to answer these questions for the sake of our collective memory.

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 infections 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 caseload has crossed 2.1 crores, active cases are above 35 lakh, and deaths have crossed 2.3 lakh in total, as per government figures.

Since testing is very low _ in many states like UP private laboratories have been ordered not to conduct tests _ and many test reports are not coming in even after five days, one never knows the actual number of infections. Again, 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 the first week of April,  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, 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 therewith 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 the central government and NDMA are extensive. The Centre, irrespective of any law in force (including overriding powers), can issue any direction to any authority anywhere in India to facilitate or assist in disaster management. Importantly, any such directions issued by Centre and NDMA must necessarily be followed by 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.

Graphic: The Telegraph Online

Undoubtedly, India’s large population poses an administrative challenge to deal 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 close administrative and political coordination, led by the Centre and followed by state governments. Issues like movement of migrant labourers, availability of food, arranging livelihood for 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 Centre was empowered by the DM Act.

Secondly, as per the mandate of DM Act, a concerted effort was required to ensure that state disaster management bodies were administratively, politically and financially empowered, on which several lacunae have been pointed out by the 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

In 2020, the hurried national lockdown with 4-hours of notice was seriously flawed. This was not a demonetisation type of an issue. The short window brought trains, buses, trucks to a halt midway. Lakhs of migrant labourers with families, left in the lurch by their employers and governments, had to walk back to their hometowns. Some got run over, many died. All of them suffered. 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 zones, limited operations, occasional and localized curfews over the last one year, the Prime Minister, who in March 2020 had ordered the hasty all-out lockdown, in April 2021 appealed to state governments to consider lockdowns as the last resort when cases (total and daily) are several times higher than the last year.

In this scenario, a lockdown should be considered as a measure of 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.

Hospital infrastructure, 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. Citizens are rushing to buy drugs with prices surging, while labs struggle to process the growing backlog of COVID-19 tests. There is an urgent need to expand the healthcare infrastructure by transforming stadia, large halls, worship places, educational institutes into temporary COVID care hospitals, the process of which has started, spearheaded primarily by civil society. Some 151 recognized journalists and at least 330 health workers have died while on job due to the virus. It is heartening to see that Sikhs in Delhi are running Oxygen langars and have opened up gurudwaras for patients. Maharashtra chief minister Uddhav Thackeray has gone on record thanking the Muslims of Mumbai for opening up mosques, donating plasma and blood and providing oxygen to the needy. To that extent, the 5-crore membership strong Rashtriya Swayam Sevak seems to be missing in action.

India has started airlifting oxygen generators and other supplies from abroad with countries like 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 the key to curbing the second wave.

Vaccine production, availability and pricing

Modi’s insistence on Atmanirbhar Bharat, the principle of self-reliance, made India slow to approve and purchase foreign vaccines, including Pfizer-BoiNTech'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 crore 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 the backfoot and opened up to using foreign vaccines, these companies have no capacity to take immediate orders to supply to India. Only the Russian vaccine Sputnik is being taken up by Reddy’s Labs for production in India.

While most nations have given advances to pharma companies to conduct research and produce vaccines, India did not support Serum Institute and Bharat Biotech initially with funds. Serum (SII) invested Rs 2,000 crore by itself and got Rs 2,200 crore from the Bill & Melinda Gates Foundation. While the US had invested Rs 44,700 crore in vaccines by Moderna, Pfizer, Johnson & Johnson, etc, as early as August 2020, India only on April 19, 2021, gave an advance of Rs 4,500 crore to vaccine makers in India. Our current monthly vaccine requirement is around 180 million doses, while production capacity is at best 80 million. 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 accurate data, and that too quickly.

Graphic: The Telegraph Online

The Supreme Court took note of the price difference of  Covid-19 vaccines for the Centre, states and the private hospitals and asked the Union government to explain the “rationale and basis” behind such a pricing policy. Covishield available to the Centre at Rs 150 per unit, is being offered to states at Rs 300 and to 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 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 Centre 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 Union 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 SmallPox 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 was facing shortage of supplies in many of its own states. Why was such large scale vaccine diplomacy being carried out in a time of national public health crisis in the middle of a second wave? Is the vaccine diplomacy being carried out to skirt questions over the efficacies of the two indigenously manufactured vaccines? Are the vaccines being distributed for the purpose of image building of the prime Minister  whose government is on the backfoot on multiple issues that have come under international attention, like farmers’ protests and suppression of dissent?

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 was 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, donations to PM CARES Fund will qualify as corporate social responsibility (CSR) expenditure under the Companies Act, 2013. The PM CARES Fund has also got exemption under the FCRA and a separate account for receiving foreign donations has been opened.

Opposition leaders, especially Trinamool MP Mohua Moitra, has raised questions as to why there is no accountability of the PM Cares Fund. She had also noted the unfair treatment of identical contributions to state relief funds was against public interest, against public policy, and completely disincentivised corporate contributions which state governments otherwise would have got. Some 38 leading public sector units have donated more than Rs 2,100 crore to the PM CARES, 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 the 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 crore allotted for oxygen plants hasn’t been spent yet.

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 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 it 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 released a report 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 the 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 warnings have  either been ignored by the government or at least not properly acted upon. 

Hence, there is 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.

Tomorrow: Covid-2: compounding a manmade disaster

The writer is an educationist, columnist and television panelist; he is currently pro vice chancellor of a Calcutta-based university. Views are his own.