The current situation in India- call it a nightmare, a challenge, a mayhem, a carnage, or an apocalypse- will end some day after wrecking millions of lives and livelihoods. And questions are and shall rightly be raised: Was it largely a manmade disaster? Could this be avoided or impact lessened? This piece answers these questions for the sake of history and our collective memory.
On May 1, India’s coronavirus cases hit a grim global record with 4,01,993 fresh infections in the last 24 hours. And 3,523 deaths were reported. The third phase of the world’s largest vaccination drive has also started on May 1 amidst chaos as several states flag shortage. India recorded over 4 lakh cases for the first time 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 crores, the active cases are above 20 lacs, and deaths have crossed 2 lacs in total, as per government figures.
Now, the challenge of these figures is that even die-hard pro-government people also do not believe in these 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. Newspapers in Gujarat, UP and MP specially have given death figures from crematoria, hospitals and government records to show wide discrepancy.
Journalists and health-workers have noted that infections can be two to three times of what is reported, and deaths can be as high as three to four times, differing from state to state. So, these are anyone’s guess.
The entire deterioration of the scenario has happened rapidly in April, last week being the worst. 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.
First, 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”. The act has been criticized for marginalizing Non-governmental organizations (NGOs), elected local representatives, local communities and civic group; and for fostering a hierarchical, bureaucratic, command and control, ‘top down’, approach that gives the central authorities sweeping powers, which it can share with the states.
NDMA so far formulated 30 Guidelines on various disasters. The 2019 National Disaster Management Plan deals extensively with Biological Disaster and Health Emergency. This is the broad legal framework within which activities to contain COVID-19 are being carried out by the Union and State governments. 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. This ensures that there is adequate political and constitutional heft behind the decisions made.
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’. Additional guidelines were issued on the same day by the Ministry of Home Affairs, being the Ministry having administrative control of disaster management. 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 disasters, 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, Disaster Management Authorities, and other stakeholders. 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.
Secondly, success of effective implementation of the national and state decisions under the DM Act is dependent on its ground level implementation; district administration and local self-government institutions remains the best bet. As per mandate of DM Act, a concerted effort was required to ensure that these bodies are 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. Having assumed the role of sentinel on the qui vive, it is obligatory on all the constitutional courts in the country to suomotu register PILs and closely monitor the implementation of 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.
Second, oxygen& essential drugs, their black-marketing
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 (like the stories in Quint and The Times of India). 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 hospitals. Even the Centre allotted 480 tonnes of oxygen to Delhi, after many pleas, have not been actually delivered. 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, oxygen etc by the states of 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.
Third, 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.
With a poor infrastructure, 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 101 recognized journalists and at least 330 health-workers have died while on job due to Corona. While there is hardly any major measures being taken on behalf of the 5 crores membership claiming RashtriyaSwayamsevakSangh, the few lakhs strong community of 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.
India has started airlifting oxygen generators and other supplies from abroad, with countries including Australia, the U.K., Germany, China and even Pakistan 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.In the words of the director general of the World Health Organization, the pandemic is a global inferno: “If you hose only one part of it, the rest will keep burning.” In India, where crematoriums have been burning so long that their metal structures have started to melt, the hose isn’t even turned on yet.
Fourth, 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 Covaxin. In the meantime, the government was keen to wield its heft as the “pharmacy of the world,” exporting doses even as it vaccinated only 0.2% of its population per day. 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, as reported by Scroll, 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. Less than 10% of Indians have had at least one vaccine dose till now, and the current pace of inoculation is too slow. With limited vaccine supply, 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. Vaccines available to the Centre at Rs.150 per unit, and being offered to the states at Rs.300 and to the private hospitals at Rs.600 per unit. The top court, hearing a suomotu 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 from 1 May when vaccination for all above 18 years of age would begin, 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”. The Liberalised Pricing and Accelerated National COVID-19 Vaccination Strategy issued by the Centre recently isviolative of Article 14, 19 and 21 of the Constitution. 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. The two vaccines which have been supplied to other countries are the Covaxin& the Covishield, with claimed respective efficacies at 81% &70%. The Covaxin developed by Bharat Biotech is a two-dose whole virion inactivated vaccine, which needs to be given in two doses separated by a duration of 28 days. Covishield, manufactured by SII is a recombinant vaccine against Covid19. 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 backfoot in multiple issues which have come under international attention; farmers’ protests and suppression of dissent being some examples?
While the country is tackling with the issue of shortage & building capacities, the politics between the centre and the states has spilled into the distribution of vaccines. Various states pushed the Union Health Ministry to supply more vaccine doses for vaccination of everyone above the age of 18 yrs. In response, the centre has asserted its view that the states having the second-wave of the spread of Covid19 are politicizing the public health issue and concurrently spreading lies. The centre also accused the states of not carrying out enough tests, contact tracing & ramping up the health infrastructure. The truth is on both the sides, and loser is the common citizen.
Fifth, celebrations too soon
Cases peaked around 93,000 per day in September, 2020—less than a third of the daily tallies India is reporting this April—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 NarendraModi 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 Feb. 21, 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.” India’s leaders ignored warning signs in the data and the news of variants circulating in other countries.
Sixth, 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 The Indian Express reports, as late as in January 2021, a Covid Genomic Consortium, 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).”
Seventh, 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, and 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 implement the same.
While many nations have taken resort to localized containment zone, limited operations, occasional and localized curfews over the last one year, the Prime Minister now appeals to state governments to consider lockdowns as the last resort when the cases (total and daily) are several times higher than March 2020.
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 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, however, suggested a complete lockdown for a few weeks in India as an immediate step.
Eighth, 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 held mass rallies ahead of elections and promoted the KumbhMela, a Hindu pilgrimage that drew millions of worshippers to a single town, which had 40 to 70 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 KumbhMela, 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 told 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.
Ninth, 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 initially claimed that the fund is a private fund, and 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, specially TMC MP MohuaMoitra, has raised question as to why there is no accountability of the PM Cares Fund. She had also noted that an unfair treatment of identical contributions to PM Cares and 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. More than 70 per cent of the Fund’s corpus comes from these 38 donations. 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, as noted earlier.
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. Surely the very name – PM Fund – makes people think this is government authority. Cabinet ministers are trustees administering the PM Caresfund.
Tenth, 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 $190 million or 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, India’s central administrative area located near Raisina Hill, New Delhi. The area houses India’s government and parliamentary offices and has been is described as the “power corridor” of the country. The project seeks to improve infrastructure for the Government of India, including retrofitting and refurbishing some heritage buildings to make them functional and safe for future use.Scheduled between 2020 and 2024, the project first aims to revamp a 3 km Rajpath between RashtrapatiBhavan 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 near the North and South Blocks 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 (US$2.84 billion), and the parliament building alone costs ₹971 crore (US$137.89 million).
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. Many conservationists and historians have criticized the project for “robbing” Delhi of its heritage and an attempt to “erase” India’s colonial history. The Supreme Court – hearing legal challenges against the environment clearance and change in land use of the new Parliament – has expressed its discontentment with the way in which the ceremony was being conducted before the court had ruled on the case, but still allowed it to proceed.
Eleventh, state-level faulty execution of COVID management
Several High Courts have pulled up the state and the central governments for their failures in COVID crisis management and that shows that the judiciary is also aware of the worsening manmade disaster in India today.
The Delhi High Court came down heavily on the state government in a hearing, saying its confidence in the government is shaken with regards to handling the crisis from the second surge. “We cannot let people die like this,” the division bench of Justices VipinSanghi and RekhaPalli said while hearing a case on shortage of oxygen supply and COVID-19 essentials.The court, slamming the government for rampant black marketing of oxygen cylinders and essential drugs in Delhi, asked it to submit a report about the deaths which have taken place in Delhi on account of a shortage of oxygen.
During a hearing on the suomoto proceedings on the surge in COVID-19 cases in Gujarat, the Gujarat High Ccourt said the affidavit submitted by the state paints a rosy picture and is not in touch with the ground reality.
The Calcutta High Court directed all authorities to strictly enforce the ban imposed by the Election Commission on rallies and gatherings on 2 May, the day of the counting of votes and declaration of results of the Assembly elections in West Bengal, three other states Kerala, Assam and Tamil Nadu and the UT of Puducherry.
The Bombay High Court, noting that the bodies of COVID-19 patients cannot be kept lying for hours waiting to be cremated, directed the Maharashtra government and the BMC to inform it about the condition of crematoriums across the state and in Mumbai.
Twelfth, 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. RavindraBhat 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.
Looking at the dismal scenario, commentator Ruchir Joshi noted in The Telegraph, that the central government simply took the pandemic as an extremely useful tool gifted to it by the gods, a tool it could use to further its agenda — to stifle dissent, to topple Opposition state governments, to ‘win’ elections. Now, when things are spiralling tragically out of control, the government’s main concern — yet again — seems to be about managing perceptions. The French have a saying, ‘Breaking the thermometer to bring down the fever.’ We are where we are today because of this trail of broken thermometers.
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.
Prof Ujjwal K Chowdhury,
The writer is an educationist, a regular columnist, television panellist, and working currently as the Pro Vice Chancellor of a Kolkata based university.