COVID-19 has had a major impact on India’s economy, society, politics, and foreign policy. As of now, India is nearing 14 million reported infections, more than 170,000 people have lost their lives, and it is the second-worst affected country in the world. India fumbled on more than one occasion while responding to the pandemic. And yet, for a developing country with a poor health infrastructure, India’s response has not been entirely unsatisfactory, and it may have learnt crucial lessons from the epidemic. This paper seeks to examine, and analyze, India’s response to the pandemic.
Covid-19 in India
In late December 2019, China officially informed the World Health Organization’s (WHO) local office that 27 cases of ‘pneumonia of unknown cause’ had been detected in Wuhan. Around ten days later, the country reported its first known death from coronavirus disease (COVID-19) caused by severe/acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(Naming the coronavirus disease (COVID-19) and the virus that causes it, n.d.).[i]WHO’s initial response was that the outbreak constitutes a public emergency. However, on the 30th of January 2020, it recognized the seriousness of the disease and declared the outbreak a public health emergency of international concern. Around the same time as the WHO statement, the first case of COVID-19 was reported in India; a student who had returned to Kerala's Thrissur district from Wuhan University was found to be infected. Later in February, more students tested positive for the virus that led to the Indian state of Kerala declaring COVID-19 as a 'state calamity'. India recorded a steep rise in infections with numbers touching 1000 cases around the end of March. The WHO declared COVID-19 as a "pandemic" on March 11, 2020 prompting the Government of India to announce a 21-day lockdown from March 25, 2020. With the rise in cases, the national lockdown was further extended until May 3, then May 17, then May 31, before a phased unlock was announced. In June 2020, the country started a phased reopening of its economy (Bharali et al., 2020).[ii]Amid a record 75-day lockdown, India recorded more than 250,000 Covid-19 cases and 7200 deaths (Half a million COVID-19 cases in India: How we got to where we are, n.d.).[iii]In India, from 3 January 2020 to 30 March 2021, there were 12,095,855 confirmed cases of COVID-19 with 162,144 deaths. (India, n.d.).[iv]
Following tables show the worst and least affected Indian states.
Worst affected Indian states (top 5)#
# Not included the UTs, only states.
Least affected Indian states (top 5)#
# Not included the UTs, only states.
Source: (Covid-19 India Tracker, 2020).[v]
Month wise details of COVID-19 tests conducted (March to October)
Source: (The Outbreak of Pandemic Covid-19 and Its Management, 2020). [vi]
Among other factors, elections in India contributed to the spread of the virus. During the October-November state assembly elections in the Indian state of Bihar, election rallies held by politicians were attended by the masses, even though the Election Commission of India had ordered that no more than 200 people could attend outdoor rallies (PTI, 2020).[vii] TV footage from Bihar showed massive rallies attended by people ignoring social distancing norms. Amid concerns of a fresh wave of the virus, India is going to hold assembly elections in five states, and reports show that political leaders are holding massive rallies flouting COVID protocols (ET Bureau, 2020).[viii]
India’s Containment Strategy
For a country as huge, diverse and under-developed as India, fighting a major pandemic such as COVID-19 was not going to be easy. India’s first instinct was to shut down the country, which it did for a considerable period of time - 75 days, from 25 March to 7 June 2020 (Daniyal, 2020).[ix] But despite the shutdown, the pandemic continued to surge in certain pockets and through super spreader events. Moreover, the country’s response to COVID-19 was not a uniform one, varying across states and between rural and urban settings.
India established robust disease surveillance measures by mid-January and issued a series of travel advisories and restrictions. International travel restrictions were imposed, and most types of existing visas were suspended, especially those traveling from countries that reported a high number of cases. Domestic flights were also restricted. Around the same time, all passengers arriving from mainland China and Hong Kong were subject to thermal screening at three major international airports (Sinha, 2020).[x] Thermals screening was extended to all international flights by early March (Management of Covid-19 Pandemic and Related Issues, 2020).[xi]
Equally importantly, the country decided to repatriate and quarantine Indian nationals arriving from abroad. As per the data released by the Ministry of External Affairs, “As of March 10, 2021, around five million people have returned to India under Vande Bharat Mission (VBM). Ministry of External Affairs has incurred Rs335 million (as of December 31, 2020) to assist Indian nationals in distress to bring them to India under VBM”(Times Now Digital 2021).[xii]
Challenges faced by India in containing Covid-19
The lopsided availability of healthcare infrastructure across different states was one of the criticisms of India’s handling of the pandemic. For instance, a study by researchers at the Center for Disease Dynamics, Economics & Policy concluded that India has approximately 1.9 million hospital beds, 95 thousand ICU beds, and 48 thousand ventilators. Most of the beds and ventilators in India are concentrated in seven states – Uttar Pradesh (14.8%), Karnataka (13.8%), Maharashtra (12.2%), Tamil Nadu (8.1%), West Bengal (5.9%), Telangana (5.2%) and Kerala (5.2%) (Kapoor et.al., 2020).[xiii]
A similar study by Brookings highlights that some Indian states such as Bihar, Jharkhand, Gujarat, Uttar Pradesh, Andhra Pradesh, Chhattisgarh, Madhya Pradesh, Haryana, Maharashtra, Odisha, Assam and Manipur fall below the national level figure(0.55 beds per 1000 population). These twelve states also account for 70% of India's population (Singh et.al., 2020).[xiv]
Given the country’s poor health infrastructure, it became apparent as the fight began to contain COVID-19, that India’s response to the virus was going to be tough. To begin with, the country simply did not have sufficient hospital beds and ICUs for its population. According to the Department-Related Parliamentary Standing Committee on Health and Family Welfare, “Data from National Health Profile–2019 states that there are total713,986 Government hospital beds available in India which amounts to 0.55 beds per 1,000population. As per Reports, 12 States stand below the national level figure” (The Outbreak of Pandemic Covid-19 and Its Management, 2020).[xv]
The Committee’s report, released at the end of 2020, further stated that, “lack of hospital beds and the inadequate (too few) ventilators further complicated the efficacy of the containment plan against the pandemic.” In May 2020, it was reported that India needed as many as 75,000 ventilators against the available number of 19,398(ANI, 2020).[xvi] During the peak summer in 2020, some hospitals had to deal with problem of unexpected electricity shortage which affected the functioning of ventilators thereby adding to the misery of the covid-19 patients (Raja, 2020).[xvii]
As the numbers of cases were on the rise, a frantic search for vacant hospital beds became quite harrowing. Instances of patients being turned away from overburdened hospitals due to lack of vacant beds became the new normal. India witnessed unprecedented news stories wherein patients and their families going door to door across various hospitals carrying oxygen cylinders in search for hospital beds (The Outbreak of Pandemic Covid-19 and Its Management, 2020).[xviii]
India’s effort to carry out contact tracing was implemented with some vigor during the early months of the spread of the disease, especially by states such as Kerala[xix], but it began to falter as the epidemic started spreading rapidly. India’s Covid-19 containment rules require the states “to identify contacts as early as possible for preventing spread of further transmission.” But the states simply did not have the wherewithal and personnel to do so (Farooqui, 2020)[xx]
The National Centre of Disease Control had instructed states that “Attempt should be made to identify all household members, social contacts, contacts at work place and contacts in health care settings who have had contact with a confirmed case anytime between two days prior to onset of symptoms and the date of isolation.” But this was not to happen because people avoided contact tracing by officials owing to social stigma associated with COVID-19 infection, and a fear of unhygienic government-run quarantine facilities (Saikia, 2020).[xxi]
The epidemic began spreading through the country with certain hotspots, especially in urban areas. The Parliamentary Standing Committee in its report also observed it, stating that “poor contact tracing and slow testing in the initial phase of pandemic led to the increased number of infections in the country (The Outbreak of Pandemic Covid-19 and Its Management, 2020).”[xxii]
Early on during the spread of the epidemic, the government also issued several confusing and contradictory guidelines which led to ineffective control of the disease. The Parliamentary Standing Committee, for instance, observed “that plethora of guidelines issued by the Ministry in the course of the containment of outbreak of pandemic Covid-19 also caused ambiguity in interpretation of multiple guidelines. The contradiction in guidelines and the resultant chaos among the general masses could have been averted by making the public aware of the provision of guidelines and better implementation of the advisories. Needless to say, particularly the separate guidelines on the quarantine issue by different State Governments created more panic and confusion” (The Outbreak of Pandemic Covid-19 and Its Management, 2020).[xxiii]
One of the biggest mistakes that the government of India committed, however, was shutting down the country without notice, planning, or consultation with stakeholders. A recent report by BBC reported that the Government of India headed by Prime Minister Modi "did not consult key ministries and states" concerning the lockdown decision. The report further suggests that a lack of consultation was evident in the mismanagement of the migrant crisis that India witnessed due to the lockdown(India Covid-19: PM Modi 'did not consult' before lockdown, 2021).[xxiv]
When Prime Minister Modi announced the lockdown in late March 2020, he gave less than fourteen hours’ notice to the country. A number of key decision-making ministries, including chief ministers, were caught by surprise, even though they had to implement the prime minister’s decision. This had the biggest impact on the country’s inter-state migrant workers. Millions of these workers did not know what to do at the sudden loss of income due to the economy being shut down. They had no way to get to their homes in rural India since the railways, the lifeline of the country, was shut down with a 3.5 hour notice. Tens of thousands of migrant laborers had to walk hundreds of miles with their families to reach their native villages with the government doing little to help them.
According to a Brookings Institution study, between 2 to 10 million migrants were impacted by the pandemic.[xxv]
Analysis also shows that the sudden lockdown would have far-reaching implications for the health sector. “Between 100,000 and 200,000 children missed routine vaccinations during February and March. Treatment for tuberculosis also showed declines. Claims for cataract eye surgery and joint replacements fell by over 90 percent, and significant declines were also seen in cardiovascular surgeries, child delivery, and oncology. These findings raise concerns about a potential resurgence of vaccine-preventable illnesses, infectious diseases, and chronic ailments” (Bharali et al., 2020).[xxvi]”
Given the complexity that is India, the measures taken to address the COVID-19 challenge, however insufficient they may be, have to be appreciated. As Poonam Khetrapal Singh, the WHO's regional director for Southeast Asia, points out “India took bold decisions such as screening people at ports of entries, tracing contacts, training health workers, scaling up testing capacities, preparing health facilities and engaging with communities (Krishnan, 2020).[xxvii] Despite the various challenges, the central and state governments managed to raise awareness about the disease, impose lockdowns for the most part, produce vaccines at home and contain the spread of the pandemic.
What was missing from the measures was a lack of prior planning before major announcements and coordination between state governments and the center.
India’s vaccination efforts
At present, Covid-19 vaccination drives are in full swing in the country. As on 24thMarch,2021 India has vaccinated a cumulative total of 5,08,41,286 people(Awasthi, 2021).[xxviii]
India is a global vaccine manufacturing hub, with the capacity to mass-produce vaccines developed domestically and internationally. The infrastructure of India’s Universal Immunization Programme (which inoculates about 55 million people a year) allows for an added advantage in a vaccine rollout.
An estimate suggests that the total expenditure on vaccine roll-out would amount to 60 to 65 trillion Indian Rupees (around 7.5 bn. Euros). India’s approved vaccines include Serum Institute of India’s locally-made Oxford & AstraZeneca vaccine, ‘Covishield’, and the homegrown coronavirus vaccine, ‘Covaxin’, jointly developed by Bharat Biotech and Indian Council of Medical Research.
India presents unique concerns in fighting the pandemic due to its sheer size and the complexity of its diversity, beliefs, and practices. In addition, poor social indicators, like lower life expectancy, higher fertility, high child mortality, wide-spread illiteracy, poverty, poor sanitary conditions, and open defecation, make for a deadly mix. These indicators highlight the gravity of the situation that can worsen conditions in the face of a massive community outbreak of the epidemic. More so, this also goes to show the sheer vulnerability of India and its people while faced with a deadly virus such as COVID-19 (Mufsin & Muhsin, 2020)[xxix]
This unique complexity of India is also conducive to culturally rooted and domestically-driven misinformation and misconceptions that add to the problem. One often finds political, religious and other influential figures peddling ill-informed ‘truths’.[xxx] This was especially evident during the pandemic.
Local ”remedies” to treat Covid-19 were peddled by popular yoga gurus, as well as government agencies. The Indian government’s Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), for instance, released an advisory on January 29 in which it claimed that Unani Medicines were useful in symptomatic management of Corona Virus infection (PIB Delhi, 2020).[xxxi] Then there were fringe Hindu groups who advocated the use of cow urine for treating COVID (PTI, 2020).[xxxii]“Misguidance in the form of suggesting cow urine as a protection against the virus; religiously-oriented obligations that discourage social distancing; and mass disregard and refusal to adhere to rules restricting and in some cases prohibiting altogether cultural gatherings suggest that such behavior escapes the particularity of any one religious, cultural and geographic identity” (Mufsin & Muhsin , 2020).[xxxiii]
Large religious gatherings have become common despite the real danger of being super spreader events. Hundreds of thousands of Hindus attended the Kumbh Mela in Haridwar, Uttarakhand. This was not the first time religious gatherings were held amid the pandemic. Given the religious nature of these functions, local authorities often find it difficult to cancel the event, or screen and monitor tens of thousands of devotees. However, these religious gatherings, in the middle of a new wave of the pandemic, are worrying.
An international gathering of a Muslim missionary group, Tablighis, had brought in hundreds of foreign nationals from Thailand, Nepal, Myanmar, Indonesia, Bangladesh, Malaysia, Sri Lanka and Kyrgyzstan. More than 4,500 people gathered together for a meeting despite a government order prohibiting large gatherings. Many of them had arrived in the city by early January itself, stranded in the Nizamuddin area of Delhi when the lockdown was announced.[xxxiv] The situation, at best an offense against the government order, suddenly assumed a religious color with “Tablighi virus” and “Corona Jihad” trending on social media and flashing on TV screens. In other words, even though they were not the only group to have flouted Covid guidelines, they were singled out due to their religious identity.
Yet another undesirable outcome of the pandemic was a spike in various forms of discrimination. Across the world, including India, societies could become more self-seeking and inward-looking, leading to further pushback against liberal policies regarding migration and refugees. New questions are likely to be asked about the source of goods when trade resumes. More stringent imposition of phytosanitary measures by advanced states on products emanating from the less developed countries might become the new normal. Lockdowns and travel restrictions could potentially legitimize the rhetoric around border walls in more conservative countries. Tragically, therefore, while one answer to global pandemics is political globalization, COVID-19 might further limit it. Within India too, there could be a trend towards discrimination, with ‘social distancing’ producing undesirable social practices. People with Mongoloid features getting called “coronavirus”, and gated communities have discriminated against those quarantined, indicate a new age of discrimination. Covid and the resultant lockdown also adversely affected the already marginalized sections of the Indian society: the poor, lower castes and women. Those without sufficient means or savings to ride out the lockdown-induced economic stress were perhaps the worst affected. In a country where there is little social security for the under privileged, they had to fend for themselves. Reports also indicate that domestic abuse has increased as a result of the lockdown (Seth, 2021) [xxxv]
Puritan claims based on birth and class and the associated declarations about hygiene could become sharper. The more the virus persists, the deeper such practices will get.
2. Political implications
One visible impact of covid-19 has been on shifting the balance of center-state relations in India. For instance, during the initial stage of the pandemic in March 2020, the central government implemented the central disaster management law and announced a national lockdown. The central government, through the Ministry of Home Affairs, issued a set of guidelines for states to follow thereafter. This arrangement eroded the decision-making power of Indian states and increased their financial dependency on the center during the pandemic (Burman, 2020).[xxxvi]
COVID-19 brought the already frayed center-state relations under greater stress. There have been differences between the Centre ruled by Bharatiya Janata Party, and the opposition-ruled states on a range of issues such as “the management of the disease itself; the management of the lockdown; a roadmap for lifting restrictions so that normalcy returns; and allocation of financial resources to meet the health, social and economic challenges ahead” (PTI, 2020).[xxxvii]
Even though health is a state subject under the Indian Constitution, New Delhi’s intervention in managing the pandemic is a result of the deadly nature of the virus. The government of India’s intervention invoked the Epidemic Diseases Act, 1897, and declaredCovid-19 a ‘national epidemic’ giving overarching powers to the central government (PTI, 2020).[xxxviii] What made the states more concerned was “the use of the Disaster Management Act, 2005, to declare a national lockdown. This Act gives the Centre sweeping powers for administrative and financial control. And states are feeling the heat in the rules and regulations that have been framed for the lockdown” (PTI, 2020).[xxxix]
One of the things states have been unhappy with was the center’s alcohol ban. Banning the sale of alcohol blocked a major source of income for states at a time when all economic activity was brought to a standstill. “The loss of liquor tax revenues an estimated seven billion rupees ($92 million) a day -- has prompted calls from states like Punjab to lift the ban”(Chaudhary, 2020).[xl] It is important to note here that the Central government had not consulted the states while announcing the lockdown – the central government made the grand announcement and left the responsibility of implementation to state governments. This has contributed to fissures within the country’s federal structure and further deepened the mistrust between the central government and the states.
Right to privacy
The pandemic has also led to privacy concerns and worries about state surveillance. Since May 4, 2020, Government of India has mandated the installation of a contact-tracing smart phone app called Aarogya Setu to monitor those with the disease. While this is not unique to India, what makes it more worrying in the country, according to critics, is that this contributes to the preexisting tendency in the government to enhance the surveillance of citizens. As Dhar points out: “There is real danger that Aarogya Setu could be a gateway to nationwide surveillance. National security, personal safety, and dispersal of essential services, and now disease surveillance in the past few years, the Indian government has used all of these as pretexts to infringe more and more on privacy. The country has already seen an unbridled drive toward digitalization, automation, and surveillance, and the COVID-19 crisis has added a new layer to this, one that could have far-reaching humanitarian, social, and economic consequences” (Dhar, 2020).[xli]
So, from a conceptual point of view, while the state has failed in its ability to save citizens from the pandemic notwithstanding its claims about national security preparedness, it has returned, with more power, legitimacy and surveillance technologies. And yet there is little resistance from the general public thanks to existential concerns about the pandemic and similar dangers. In fact, the nervous citizenry will want the state to be omnipresent and omnipotent, no matter the consequences. Nations around the world, that were losing influence to global economic forces, have a chance now to return as the last resort of the people.
3. Economic implications
Covid-19 has derailed the Indian economy and sent the system into serious recession. Industrial and manufacturing output is down and unemployment has spiked. According to data from the Centre for Monitoring Indian Economy, the country’s unemployment rates shot up from 8% in March 2020 to as much as 24% in April 2020 – an immediate impact of the lockdown. As people returned to formal and informal jobs in the following months, unemployment rates shrank once again, falling to 6.5% in November 2020. In December 2020, unemployment rates rose to 9%, with as many as nine million people losing jobs between September and December (Johari, 2021).[xlii]
Even before the pandemic itself, the Indian economy was facing a slowdown(PTI, 2020).[xliii] Real GDP growth, for instance, had come down from an average of 7.4 percent in FY16/19 to 4.2 percent in FY19/20. Covid-19further accentuated the downturn and real GDP contracted by 23.9 percent (year-on-year) in Q1 FY20/21(The World Bank in India: Overview, 2020).[xliv]
Food inflation in the country went upto 11% in October 2020, and more Indians have fallen under the poverty line, as a result of the pandemic (Inani, 2021)[xlv]
Due to the return of Indians especially from Gulf states, remittances to India are likely to drop by 23 percent from $83 billion last year to $64 billion this year, according to World Bank estimates (PTI, 2020).[xlvi]
According to data from the Centre for Monitoring Indian Economy, India’s unemployment rates shot up from 8% in March 2020 to as much as 24% in April 2020 – an immediate impact of the lockdown (Johari, 2021).[xlvii] However, the situation seems to be looking up in 2021. Reports show that India’s unemployment rate in February 2021 stood at 6.9 per cent, lower than 7.8 per cent in February 2020, which shows that the unemployment rate has recovered to pre-Covid levels(Sharma, 2021).[xlviii]
COVID-19, geopolitics, and emerging global order
One country that is likely to come out stronger from this crisis is China. Reports indicate that China has now managed the outbreak of COVID-19, and its industrial production is recovering even as that of every other country is taking a hit. The oil price slump will quicken its recovery. When the USA, under President Trump, found itself in denial mode and the members of the EU were looking after their own interests, China appeared to use its manufacturing power to its geopolitical advantage. Beijing offered medical aid and expertise to those in need; it has increased cooperation with its arch-rival Japan; and President Xi Jinping spoke to the UN Secretary General on how the international community can fight the virus. These Chinese actions are a smart economic investment for geopolitical gains. This will aid Beijing’s claims to global leadership, push Huawei 5G trials as a side bargain, and showcase how the Belt and Road Initiative is the future of global connectivity. COVID-19 will further push the international system into a world with Chinese characteristics/overtones.
China is set to overtake the US as the world’s largest economy by 2028 and the pandemic has further increased the GDP-gap between India and China.
However, India and its allies/partners have now ramped up efforts to counter Chinese plans for using the pandemic as an opportunity to improve its standing in the region. In mid-March 2021, QUAD[xlix] countries, U.S., Japan, Australia and India, stepped in to address the pandemic. In their first summit meeting, the QUAD leaders pledged to supply at least one billion doses of vaccines, including one developed by Johnson & Johnson, to Indo-Pacific nations by the end of next year. Under this arrangement, the U.S., Japan and Australia will fund the production and delivery of the vaccines by a private Indian firm, Biological E. Australia will use its regional logistics expertise to deliver the vaccines (Dhume, 2021).[l]
Given the ‘anti-China’ tone of the QUAD over the years, there is little doubt that the QUAD’s efforts at addressing COVID-19 is to undercut Chinese efforts in this domain.
India’s Vaccine diplomacy
Being a global pharmaceutical giant, India made impressive strides locally manufacturing COVID-19vaccines. India has been at the forefront of shipping vaccines to foreign nations, especially countries in need of the vaccine. Its “Vaccine Maitri” campaign has sent millions of locally-made Covishield vaccines, manufactured under license from Oxford-AstraZeneca, to over 60 countries so far. Indian vaccines have been delivered to countries such as Afghanistan, Bangladesh, Bhutan, Sri Lanka, the Maldives, Myanmar, Nepal, the Seychelles, Cambodia, Mongolia, and Pacific Island, Caribbean, and African countries. One of the reasons why Indian-made vaccines are more welcome than those made in western counties is because the former is way cheaper and affordable, especially for poorer nations in Asia and Africa.
New Delhi believes this would contribute to India’s standing in the world. External affairs Minister Jaishankar stated in the parliament that “Our reputation as the 'Pharmacy of the World' has been reinforced in that process. So indeed has the faith in 'Make in India'. But more than the vaccines themselves, our policies and conduct have emerged as a source of strength for the stressed and vulnerable nations of the world.” (Kumar, 2021).[li]
India’s vaccine diplomacy, however, is not entirely its own doing. Its ability to produce the vaccines is contributed to by many outsiders. As Dhume points out: “In reality, India’s vaccine prowess comes from collaboration, not self-reliance. Take Serum Institute, the firm that gives India much of its Covid-vaccine muscle by pumping out 2.5 million doses a day of the AstraZeneca vaccine, and by collaborating with other Western firms, including Novovax. The “Made in India” vaccine Indian diplomats tout was developed by AstraZeneca in collaboration with Oxford University and with financial assistance from the U.S. Serum Institute took a risk by commencing manufacture of the AstraZeneca vaccine before it was clear that it would be approved by the WHO, the U.K. or India. (U.S. regulators are yet to approve it.) But that risk was underwritten in part by the Bill and Melinda Gates Foundation, which promised to offset potential losses”(Dhume, 2021).[lii] While this conflicts with the country’s ‘atmanirbharbharat’ (self-reliant India) narrative, this does show India’s ability to respond to pandemics.
China was promoting its own version of vaccine diplomacy as well. Back in March 2020, China had explicitly linked its decision to supply medical supplies overseas with its "Health Silk Road" initiative as part of Belt and Road initiative. By early February 2021, three Chinese vaccine makers (Sinopharm, Sinovac, and CanSino) had received overseas orders for more than 572 million doses, accounting for nearly eight percent of all doses under contract globally (Huang, 2021).[liii]
India’s vaccine diplomacy is also viewed as a way to promote its soft power over that of China in the region. Keeping this in mind, India also revived the SAARC forum to address the challenge of COVID-19. In 2020, India had established an emergency fund for SAARC nations and contributed $10 million to that purpose. Thereafter, in March 2020, Prime Minister Narendra Modi had held a SAARC meet on COVID-19 pandemic (Mohan, 2021).[liv]Regional efforts continued in 2021 with Modi addressing a workshop on "Covid-19 Management: Experience, Good Practices and Way Forward” with health leaders, experts and officials of 10 Neighbouring Countries- Afghanistan, Bangladesh, Bhutan, Maldives, Mauritius, Nepal, Pakistan, Seychelles, Sri Lanka(Ministry of External Affairs: Government of India, 2021).[lv]
India’s response to COVID19 was swift but incoherent, it lacked coordination and consultation across various branches of the government, and between the center and the states. And yet, India learnt to deal with the disease over time. Despite the country’s inadequate health infrastructure and poverty, it managed to deal with the pandemic somewhat successfully. However, the pandemic will have a long-lasting effect on the Indian economy.
A worrying factor is that even a pandemic like COVID-19 has not prompted the country to increase spending on healthcare. The union health budget still remains at about 0.34% of GDP which is only a slight increase from 0.31% in 2020. As economist Deepa Sinha points out “if a globally debilitating pandemic could not prompt the government to prioritise health spending, it is difficult to imagine what will”(Sinha, 2021).[lvi]
India needs to pandemic-proof its health security, boost public health expenditure, and create a coordinated national emergency plan that can take on a similar pandemic in the future. Much spending on health and vaccine research along with innovation in health technologies is required. There is an urgent need for a legislative upgrade in India’s colonial-era epidemic diseases act. India’s fight against covid-19 is far from over, but the feeling one gets in the last month of the first quarter of 2021 is that India may manage to overcome one of the worst epidemics in human history without too much damage.
Postscript (dated May 29, 2021)
The main report on the impact of COVID 19 and India’s response to the pandemic was written in early 2021. However, in the succeeding months, the second wave of the pandemic started wreaking havoc in the country. I decided against revising the article even though much of the analysis of the first wave was dramatically changed by the second. And yet, revising the report wouldn’t have served any purpose given that the COVID situation in the country continues to be dynamic and any analysis at this point of time could be found wanting eventually.
What is fundamentally different about the second wave is the infectiousness of the disease and its spread into India’s rural landscape.
Latest data on infections and fatalities
According to the World Health Organization, from 3 January 2020 to 2 June 2021, there have been 28,307,832 confirmed cases of COVID-19 with 335,102 deaths.[lvii] The national capital New Delhi recorded 956 fresh cases and 122 fatalities on the 29th of May, the lowest in over two months. Positivity rate slipped to 1.19 per cent, according to health department data. For reference, COVID test positivity rate in Delhi reached a peak of 36.2% on April 22 and stayed above 30% for another week.[lviii] This is the first time since March 22, when 888 infections were recorded, that daily cases in Delhi have fallen below 1,000.[lix] This is clearly an improvement from early May when India was reporting 400,000 new cases a day. Reports indicate that the second wave is impacting younger population more than during the first wave: Youngsters between the ages of 26 and 44 account for about 40% of all cases and around 10% of deaths.[lx]
By the end of May 2021, India administered 201,203,166 vaccine doses.[lxi] However, as a New York Times report indicated only 12 percent of 1.3 billion Indians were fully vaccinated by the 28th of May with only 3.1 percent fully vaccinated.
Independent analysts believe that India’s Covid data is highly underreported. As The Economist puts it: “In most states, deaths are not attributed to covid-19 without a recent positive test result. But testing, especially outside big cities, is not widespread. Even with more than 1.5m Indians now getting tested each day, the rate of testing relative to population is still less than a tenth of that in Britain, for example. And because of the surge in cases, labs even in Delhi, India’s capital, are overwhelmed. They now take days to deliver results; many die without knowing they are positive, or after getting a false negative.”[lxii]
Writing in Foreign Affairs, Ramanan Laxminarayan, Founder and Director of the Center for Disease Dynamics, Economics and Policy in Washington, D.C, made a shocking argument that the Indian government had itself suggested that reported cases reflect only one in 25 to 30 actual infections. If that were accurate, he argues, “India may have had as many as 700 million cases even though it has reported only 26 million cases. The number of COVID-19 deaths is likely four times the official figure, reaching upward of roughly 1.2 million—by far the highest total in the world.”[lxiii]
Mayday calls of May!
The month of May was the most catastrophic month for Indians especially for those in Delhi. For several weeks together, vaccines were running short, and hospitals had no medicine or oxygen for patients let alone beds. Vehicles carrying COVID positive patients queued outside hospitals waiting for someone to recover or die so that a bed becomes vacant for the waiting patients. There were also queues outside the city’s cremation grounds which were running out of slots to cremate the dead. Social media handles were dominated with SOS calls for medicine, oxygen cylinders and hospital beds. Overcrowded hospitals and overworked doctors were unable to handle the emergency. Reports indicate that since March this year COVID has killed over 500 doctors and sickened hundreds more in India.[lxiv] The emergency calls for help have ceased in the cities, but the spread of COVID to the rural heartland, especially Uttar Pradesh, one of the worst hit states in India where its rural population has little access to medical care, is deeply concerning.
Reasons for the second wave
The most important reason why the second wave hit India hard is its poor preparedness. Just before the second wave of COVID-19, the Indian government was in a hurry to declare victory and move on – that seems to have cost the country dearly. An article in the Lancet journal castigated the government saying: “Yet before the second wave of cases of COVID-19 began to mount in early March, Indian Minister of Health Harsh Vardhan declared that India was in the “endgame” of the epidemic. … Modelling suggested falsely that India had reached herd immunity, encouraging complacency and insufficient preparation, but a sero-survey by the Indian Council of Medical Research in January suggested that only 21% of the population had antibodies against SARS-CoV-2.”[lxv]
On 8th of April during an interaction with the chief ministers, Prime Minister Modi too claimed that “We defeated Covid without vaccines”.[lxvi] Modi declared victory over COVID even though several of the country’s public health specialists and doctors were repeatedly arguing that the pandemic was far from over.[lxvii] The fallouts of such political rhetoric were all evident in the second wave. The nonchalant politicos did not prepare for the second wave: health facilities were not created, essential medicines were not stored and oxygen was out of stock when the devastating second wave arrived.
The false triumphalism and lack of calibrated policy response based on scientific advice led to the second wave and the devastation that it has caused. Despite warnings by public health experts, the government allowed the Hindu festival Kumbh Mela to take place where millions of Hindus turned up to bathe in the Ganges river. While around 9.1 million pilgrims took the holy dip in the Ganges from January 14 to April 27, on the 12th of April itself 3.5 million thronged the river[lxviii] with local authorities unable to impose COVID protocols. The New York Times reported that “At one point, officials dismissed warnings by scientists that India’s population remained vulnerable and had not achieved “herd immunity” as some in his administration were suggesting, said people familiar with those conversations.”[lxix]
Through the month of April when infections were spiking every day, the Election Commission of India decided to go ahead with elections to five state assemblies and to local bodies in UP. Modi's massive election rallies in West Bengal, often without wearing masks, where tens of thousands of people turned up to listen to him even as COVID cases were spiralling in the country did send a “wrong message” to other political parties who followed suit not wanting to be left behind.
As the COVID infections reduce in the country, the next big worry is finding vaccines for its close to 1.36 billion population. Even on the vaccine count, the Modi government dropped the ball in 2020 itself while most countries were frantically placing orders for the vaccines which were still in the early stages of development. India had not started procurement of vaccines until January this year. By then, most vaccine manufactures had already made commitments to sell vaccines to those placed orders first.[lxx] As a result, India today is facing a severe vaccine shortage. While India has officially opened vaccination for all adults, the reality is that there are not enough vaccines even for those above the age of 45. The central government has often argued that the state governments should place order for vaccines on their own, but the global vaccine manufactures are reluctant to deal with individual Indian states. Central government has stated that by the end of the year all Indians would be vaccinated but provided no details about how it plans to procure vaccines.
The first wave of COVID had mostly affected the urban population in the country with marginal impact on the country’s rural areas where around 65% of the country’s population live. The migrant worker population from rural India was severely hit by the first wave, but the impact was primarily economic. This time, however, the impact is not just economic even though the economic impact has been severe as well.
Even though only 12% Indians have been partially vaccinated (and 3.1% fully vaccinated), India is vaccinating faster than its South Asian neighbours. But the sheer number to be vaccinated and the unavailability of vaccines will slow the country down. Given that the authorities are already warning of a potential third wave, the government’s inability to vaccinate it population quickly could lead to another disaster.
Happymon Jacob is Associate Professor of Diplomacy and Disarmament Studies at the School of International Studies, Jawaharlal Nehru University. He is also the founder of the Council for Strategic and Defense Research, a New Delhi-based think tank.
Disclaimer: Views expressed in the text are solely of the author and do not necessarily reflect the views of Hanns Seidel Foundation.
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