India’s Covid-19 tsunami
It is humbling when a columnist must retract his words soon after penning them. Just two months ago, after India rushed millions of doses of Covid-19 vaccines to over 60 countries, I praised the country’s 'vaccine diplomacy.' India’s aspirations to be recognised as a global power had been given a real boost. Now, with more than 300,000 new cases a day and the death toll evidently much higher than reported, India is no one’s idea of a global leader.
In my own defense, I was worried that India had exported three times as many vaccines as it had administered domestically. The country was clearly lagging behind its own target of immunising 400 million people by August, after vaccinating some three million healthcare workers in a campaign that began only on January 16. '[M]ounting concern about rising case numbers, the emergence of Covid-19 variants that may not respond to existing vaccines, and an economy that has not yet fully recovered,' I noted, 'will intensify the challenge India confronts in fulfilling its obligations to developing countries while also meeting domestic demand.'
At the time, I did not realise the scale of the challenge. The number of infections surpassed 17 million in recent days, and the official death toll now exceeds 190,000. Hospital beds are now overflowing, oxygen supplies have dwindled, vaccination centres have run out of doses, and pharmacies are unable to meet the demand for antivirals. India is reeling.
How did everything go so wrong so soon after India recovered from the first wave of the pandemic last year, resumed normal life and economic activity, and started exporting vaccines? The list of errors is long.
Begin with symbolism over substance. On national television, Prime Minister Narendra Modi urged Indians to bang plates together. Two weeks later, he instructed them to light lamps at a specific moment. Superstition replaced science-based policies in confronting the pandemic.
Modi also enlisted Hindu nationalism in the fight against Covid-19. Just as the epic Mahabharata war was won in 18 days, he claimed, India would win the war against the coronavirus in 21 days. At no point was this based on anything more than wishful thinking.
Another error was ignoring the World Health Organisation’s advice. From the start of the crisis, the WHO recommended a containment strategy that required testing, contact tracing, isolation, and treatment. While a handful of states, like Kerala (which recorded India’s first Covid-19 case on January 30, 2020), initially implemented such measures successfully, the Modi government’s ham-handed response resulted in their uneven application in several states.
Then there was over-centralisation. From the first nationwide lockdown, announced by Modi in March 2020 with less than four hours’ notice, the central government managed the pandemic under obscure provisions of the Epidemic Diseases Act and the Disaster Management Act, which allowed it to ride roughshod over India’s federal structure. Instead of delegating India’s 28 state governments the authority to design strategies tailored to local conditions, the central government tried to manage Covid-19 by decree from Delhi, with calamitous results.
And, no surprise, the initial lockdown was mismanaged. State governments, the public, and even central government officials were caught unprepared. Chaos resulted, with some 30 million migrant workers, stranded without work in cities, forced to walk home, sometimes for days. It is estimated that 198 people died along the way. Some five million micro and small enterprises closed, unable to recover from the shutdown. India’s unemployment reached the highest levels ever recorded.
As the crisis began to slip out of control, the central government, following then-US President Donald Trump’s precedent, passed off more and more responsibilities to state governments, without adequate funding. The state governments struggled to mobilise doctors, nurses, health workers, testing kits, personal protective equipment, hospital beds, ventilators, oxygen cylinders, and medicines to fight the pandemic. The government mobilised a huge amount of funds for a new relief entity called 'PM-CARES,' but to this day there is no public accounting of how much money is in the opaque PM-CARES Fund and where its resources have been allocated.
When the pandemic seemed to have waned, the authorities settled into complacency, taking no precautions or preventive measures against a possible second wave that many warned could be more devastating than the first. Testing, tracking, and isolation of infected people and their contacts fell rapidly into disuse by the end of 2020. And just when people stopped following appropriate behavioural guidelines, the virus evolved an extremely infectious variant. Super-spreader events proliferated: election rallies and religious festivals packed together unmasked throngs. The contagion raged.
Although India produces 60 percent of the world’s vaccines, the government took no steps to scale up the production of the two Covid-19 vaccines cleared for manufacture in the country. Nor did it permit the import of foreign vaccines, help expand available manufacturing facilities, or license other Indian firms to produce doses. India launched its vaccination drive nearly two months after the United Kingdom, but by April, only 37 percent of health workers, and barely 1.3 percent of India’s 1.4 billion people, had been fully vaccinated. Only 8 percent had received at least one vaccine shot.
Here, too, the authorities initially bet on centralisation, and its refusal to grant emergency-use approval to vaccines from abroad led to a nationwide shortage of vaccines by mid-April. It was only at this point that the government delegated the vaccine roll-out to state governments and public and private hospitals and permitted the import of vaccines approved by the United States, the UK, the European Union, Russia, and Japan. Even then, the central government failed to distribute vaccines equitably to the various states, resulting in some of the worst-affected (like opposition-ruled Maharashtra and Kerala) running short of vaccines as cases peaked.
Like India’s government, I was prematurely self-congratulatory about the country’s vaccine diplomacy. At a time when Indians were unable to access the vaccines that might have protected them, India’s 'Vaccine Maitri' program was not smart, but hubristic. Global leadership must begin at home, and today home is a country whose mortuaries, graveyards, and crematoria are running out of space.