In March last year, the first wave of SARS CoV-2 (Covid-19) was just starting to wash up on the Indian shores. I detailed then in an op-ed, how complacency & ignorance was hurtling us into harm’s way. It was early days for India as compared to more developed countries. As of 23 Mar 2020, worldwide casualties had crossed 15000, with Italy leading the body bag count. Over 350,000 had been infected globally. Graphs had taken an exponential turn. Indian numbers for Covid-19 had officially crossed just 400 cases, with just seven dead by last week of Mar 2020. Figures were doubling every four days then.
How we started
On Mar 22, 2020. PM Narendra Modi called for a 14-hour ‘Janata Curfew’ that most of urban India diligently followed. Our lack of social discipline was on public display when soon after the curfew people took to the streets in hordes, rang bells, banged plates, sounded conches, set off fire alarms in apartment complexes, burst crackers & raised a din enough to wake the dead. The virus couldn’t care less. But the government should have read the winds for what lay ahead.
One of the most draconian lockdowns ever witnessed in history followed soon after. PM Modi, in a televised 8PM address, drew a ‘Lakshman rekha‘ outside our doors, locked up one-sixth of the world’s population and threw away the keys. Though it unleashed an administrative and humanitarian nightmare, to his credit, the draconian measures seemed to work as India emerged out of the first wave relatively unscathed. Europe and US at that time were experiencing widespread devastation from the second wave. It should have alerted our decision makers, given the state of health care in India.
How we strayed
Even as other countries were investing heavily in development of vaccines, PM Modi invoked an ‘Atma nirbhar Bharat‘ campaign to rally the masses towards self-reliance, vaccines included, with a token investment in Bharat Biotech (through the ICMR). The early successes of Serum Institute of India (SII) and Bharat Biotech, however modest, was amplified to signal that India — the vaccine factory of the world — was ahead of the curve. Developed countries had by then placed enough orders (with funding) to vaccinate their population a few times over.
One year later, as of May 2021, we have bought roughly 350 million doses (Covishield and Covaxin put together) for a population of 1390 million that would require about 2000 million shots of a double-dose vaccine to get past the 70% inoculation mark. Just an elementary back-of-envelope calculation would have revealed our orders and investment in vaccine development were grossly inadequate. As on May 16, 2021, about 18 crore total doses have been administered so far. Approximately 4 cr, or 2.8% of the Indian population, has been fully vaccinated (CoWin data). The vaccination drive has plateaued due to shortage of vaccines. A long uncertain road lies ahead.
The compounded effect of centre-state bickering, vaccine nationalism and premature declaration of victory dulled us into believing that India had beaten the virus through superior planning, or magically achieved ‘herd immunity’. By December 2020, life had almost returned to normal on the Indian streets. Speaking (virtually) at the World Economic Forum in Davos on Jan 28, 2021 PM Modi said that “fears about a Covid tsunami in India were unfounded as India had not only defeated COVID but it has also built adequate infrastructure to handle it”.
In Feb 21, The ruling party proudly passed a resolution 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 ‘Atma nirbhar Bharat’. The party unequivocally hails its leadership for introducing India to the world as a proud and victorious nation in the fight against Covid“. It may be recalled that as early as 2017, the party had announced that “India was on the way to become “Vishwa Guru” (guide of world) under Prime Minister Narendra Modi’s leadership“. As a follower of philosopher Jiddu Krishnamurti, I was intrigued at the usage of this term and on what basis we chose to bestow such honorifics.
The vaccine rollout in January 2021 elicited little interest as public messaging at highest levels sent confusing signals to a lockdown-fatigued, vaccine-hesitant, complacent and terribly undisciplined nation. Add to this assembly and local panchayat elections in five states and mass congregations for religious festivals. Political parties of all hues participated unabashedly in election campaigning, duly watched over by the Election Commission (EC) late into Apr 2021 when the graph of second wave had almost turned vertical.
Where we have reached
The collective outcome of all this is predictable even for a layman. We squandered our initial successes, gained at immense cost to the poorest of the poor. One year later, it’s deja vu again. And this time the agony found expression because now the middle and upper class were running for oxygen cylinders and ICU beds. The pandemic is ravaging our hinterlands where deaths are simply attributed to bimari (sickness). India today is the epicentre of Covid-19 with daily reported cases exceeding 400,000 with more than 4000 ‘official’ deaths daily. The real count is estimated to be way higher. In a recent tweet, Chinmay Tumbe, epidemic researcher, faculty at IIM, Ahmedabad and author of ‘The Age of Pandemics’ put a conservative estimate of actual Covid deaths in Gujarat alone to be about ten times of that reported.
Dr Ashish K Jha, MD, professor and Dean at Brown University’s School of Public Health, wrote in a series of tweets, how an additional 4000 deaths per day over the pre-pandemic count of 27000 deaths per day can hardly overwhelm crematoria and burial grounds in India. As per his calculations, Covid is causing an additional 25000 to 50000 deaths daily. That’s staggering 6-10 times of official count. He rounds off with a grim warning: “There’s an old saying in global health. You can ignore, fail to test for, or undercount whatever disease you want. But you can’t ignore the dead; In India, the dead are telling us the disease is much worse than the official statistics. And we have to listen.”
The downstream effects of such a massive undercount should be a matter of deep concern. Sadly, we have developed a dismissive and disdainful attitude towards statistics and big data. In this 2017 article that appeared in Economic Times, Abhijit V Banerjee, Pranab Bardhan, Rohini Somanathan & TN Srinivasan argue that “from being the world leader in surveys (1940s), we are now one of the countries with a serious data problem while people talk about the really good data you can get in Indonesia or Brazil or even Pakistan“. They spoke of the slow erosion of centres of statistical excellence such as the National Sample Survey Organisation (NSSO) office at the Indian Statistical Institute (ISI) in Kolkata founded by luminaries like Prasanta Chandra Mahalanobis. As per their findings, we are at a point where the “NSS and the GDP data produced by the Central Statistical Organisation (CSO), now tell entirely different stories“. There is little you can do with bad data. Fudged data is even worse.
The vaccine conundrum
India had a successful vaccination program that was adopted as a model by many countries. We have made and exported more vaccines than any other country for years. We have eradicated smallpox, polio and dealt with many epidemics with a robust vaccination program starting at the Primary Health Centre level. Even the most capitalist countries like the USA follow a model where the Centre procures and distributes the vaccine to states and hospitals through a phased rollout.
Though we had placed disproportionately small orders for Covishield and Covaxin, the initial rollout seemed to be in line with global best practices. However, a dramatic change was ordered on Apr 19, 2021 when the second wave swept across the country. All adults above 18 yrs of age were declared eligible for the vaccine even as major shortages became evident. Under the new policy, centre would procure 50% of vaccines at negotiated prices while leaving the states to procure the remaining 50% after settling for a price to be set by vaccine manufacturers. This practically upended the ‘free vaccine for all’ policy that was the lodestar of Indian immunisation programs in the past. Now states are left running helter-skelter, floating global tenders, setting the stage for price-gouging by vaccine manufacturers and the pharma lobby. Murali Neelakantan, former global general counsel at Cipla, and Ashish Kulkarni, who teaches at the Gokhale Institute of Politics and Economics, Pune, have argued in this detailed interview that the fragmentation caused by this sudden U-turn in policy is “mind-bogglingly bad economics” and have asked whether there is any other country in the world that follows this approach.
In another long-form story that delves into the present situation of vaccine shortage in India, Samanth Subramanian notes that “government negligence, corporate profiteering, opaque contracting, and the inequities of the global pharma market combined to bring India to this moment of vaccine crisis”.
How did we arrive here?
If one looks at the political landscape since 2014, the organisational drift towards majoritarianism, narrative-building, prioritising of optics over substance, and ‘shock and awe’ therapy is hard to miss. The Mar 2020 lockdown at 4-hours notice threw migrant workers and unorganised sector under the bus, triggering the biggest forced migration ever seen post partition (1947). While this may have pummelled the first wave into submission, no evidence exists that the lockdown period was utilised to scale-up defences at centre or state level for a possible second wave of much greater magnitude. Yes, we did manage to ramp up PPE and testing kits, hospital beds, ICUs, ventilators, etc. But the vaccine strategy was surely a sham; disproportionate to ground realities.
Crucial institutions have been breached. Prominent media houses from the fourth estate, officials from the executive and judiciary, venerated sports and film stars — all showed tardiness in identifying and calling out crucial gaps in our handling of the pandemic. For a democracy of India’s size and diversity, we need public intellectuals and institutions who shine a light on truth — often dark & invisible like the coronavirus — no matter which party is in power. Nationalistic ‘influencers’ — apathetic, neutral or aligned to the ruling party — either kept quiet or peddled propaganda. Dissenting voices — often top experts in epidemiology — were trolled and ridiculed. It is very easy to side with the powerful. But often, it is those who critique and seek answers, and their collective wisdom, that inform policy. But the government was growing increasingly tone-deaf by then.
As a nation, we seemed to have forgotten the cost of absolutism & the treachery of silence. Look at photos from ‘super-spreader’ religious congregations between Jan to May this year. What happened to our collective conscience? When did normalisation of deviance become the norm? Even as we scaled new peaks of stupidity in public behaviour each day, no party, leader or institution rang the alarm on bizarre anachronisms unfolding during a pandemic till it became too insidious for public consumption. We are a terribly indisciplined country — a coronavirus’ killing field. Yet we drove through all the flashing red lights. Cabinet ministers sat on press conferences selling Coronil & quackery, vacillating on vaccine decisions against a novel coronavirus. Such arrogance in the face of the biggest pandemic since the 1918 is hard to fathom.
As the numbers started spiralling out of control, citizens expected their leader to rise to the occasion with a sound plan, humility and fortitude. Instead what we received was carefully curated ‘Mann ki Baat‘ monologues and televised addresses. No oratory can paper over brazen negligence of approving mega events, exporting oxygen & vaccines across the globe while leaving our own to gasp, die, and suffer the indignity of mass cremations and unmarked graves. High officials have turned into petty trolls on social media; almost as if lashing out at dissent and blaming the opposition is a daily charter. Twitter is one of the platforms where this unrelenting abuse and defense of the indefensible plays out on a daily basis. The pandemic has enlarged and exposed our fault lines like never before.
We took our eye off the ball, led by blind nationalism. Snake-oil peddlers & charlatans were given official patronage while educated sycophants with huge ‘followers’ failed to hold governance to account. We promoted mysticism & downgraded science.
Strangely enough, not a single minister or leader in Indian government has yet been sacked or taken ownership for the most abject capitulation to a humanitarian disaster ever seen in my living memory. We are still wallpapering over gigantic cracks; polishing brass & painting over the corrosion while scores of dead bodies surface downstream of where the Maha Kumbh was recently held with much aplomb.
The shock wave of this unprecedented second wave will overwhelm us in the days to come. The government should stop “narrative building” & focus on data science. They must listen to epidemiologists (not crony capitalists in the garb of surgeons) and come clean with the numbers. Fudged data may look good for a while but it will come back to bite. The virus is smarter than all of us & it has no religion. No state can cover itself with glory while the neighbour suffers. We all are inextricably intertwined, like it or not. Either all of India wins or we all lose. The world cannot heal till India with one-sixth of the world’s population heals.
Aid is pouring in from countries most Indians cannot even place on the map. This is a balm, not the cure. Experts have pointed out that till more than 60-70% of the population is vaccinated, the only solution is masks, social distancing, lockdowns and more misery. This will wreak havoc on a nation that lives in its villages but whose economic engines are overcrowded cities. Children have not been to school for more than a year. Regular offline classes have again been pushed to 2022 or beyond. How soon before we have to deal with a mental health pandemic?
For starters, let’s put accountability back into office. PM Modi, a social media savvy but oddly private person, has been putting out curated content since 2014. This does not behove a parliamentary democracy. The Prime Minister must hold daily press conferences and take tough questions. When the PM fields tough questions, it will send shivers down rank and file. The Indian bureaucracy thrives on lack of accountability. We were told Modi will set this right, but there’s no sign yet that he has been able to turn them around. Heads must roll if required. We may hopefully see a tide reversal then.
For a detailed analysis of the subject and what we need to do to get out of the current crisis, here’s a detailed piece by Neeta Sanghi who has over three decades experience in managing pharmaceutical supply chains. It is titled ‘What we need to do to ensure India’s Covid vaccine shortage doesn’t get worse‘. I am sure there are many experts in our country who are exemplar in the field of immunisation and managing epidemics and pandemics. There may be differing views, but all roads must lead to Rome. KV Balasubramaniam, who formerly led Indian Immunologicals, another vaccine manufacturer, estimates that to achieve herd immunity in a year, taking into account a 5% wastage margin, India needs about 200 million doses per month. Demand has outstripped supply many times over and we do not hold all the aces in this game. The next few months will be very crucial for India. Many experts have advocated a return to basics — centralised procurement and distribution of vaccines after negotiating with economy of numbers. But that ship may have already sailed for this government.
When we emerge from this tragedy, the scars will be visible on everyone, including those who live in ivory towers & ‘bio-bubbles’. Sadly, we are reaping today the collective crop of our class system, indiscipline, & above all, our failure to speak truth to power. We may criticize the western world, but in moments of grave crisis, their uncompromised institutions & conscience leaders stood up and got counted. We can no longer afford to consume toxic TV channels that spew hatred; neither can we afford to sleepwalk into ‘us versus them’ distractions or engage in idol worship.
Vishwa Guru, heal thyself. Covid second wave is our criminal negligence coming home to roost. We must recognise and implement necessary course corrections on a war footing. Another wave won’t be kind on our children.
©KP Sanjeev Kumar, 2021. All rights reserved. Views are personal. I can be reached at firstname.lastname@example.org or via Twitter @realkaypius