– Against Punch / Gwydion M Williams
For Ashish Yechury (1986-2021), journalist.
IT IS hard to overstate the hold of COVID-19 on India. WhatsApp bristles with messages about this or that friend and family member with the virus, while there are angry messages about how the central government has completely failed its citizens. This hospital is running out of beds and this hospital is running out of oxygen, as Prime Minister Narendra Modi and his cabinet shy away from it.
Thirteen months after the World Health Organization announced the world was in the midst of a pandemic, the Indian government is staring into the headlights like a pierced animal, unable to move. While other countries are well advanced in their immunization programs, the Indian government is resting and watching a second or third wave land heavily on Indians.
As of April 21, 2021, the country recorded 315,000 cases over a 24-hour period. This is an extraordinarily high number. Keep in mind that in China, where the virus was first detected at the end of 2019, the total number of cases detected is less than 100,000. This tip has raised eyebrows: is it a new variant, or is it -this the result of a failure to manage social interactions (including the three million pilgrims who gathered at Kumbh Mela this year) and to vaccinate enough people.
The utter failure of the Indian government, led by Prime Minister Modi, to take this pandemic seriously is at the heart.
A glance around the world shows that governments that ignored WHO warnings have suffered the worst devastation from COVID-19. From January 2020, the WHO had asked governments to insist on basic hygiene rules – washing hands, physical distance, wearing a mask – then later suggested screening for COVID-19, contact tracing and social isolation. The first set of recommendations does not require immense resources. The Vietnamese government, for example, took these recommendations very seriously and immediately slowed the spread of the disease.
The Indian government has acted slowly despite evidence of the dangerousness of the disease. On March 10, 2020, before the WHO declared a pandemic, the Indian government reported around 50 cases of COVID-19 in India, with infections having doubled in 14 days. The Indian Prime Minister’s first major act was a 2pm Janata curfew, which was dramatic but not in line with WHO recommendations. This ruthless lockdown, with four hours’ notice, sent hundreds of thousands of workers on the road to their homes penniless, some dying by the side of the road, many carrying the virus to their towns and villages. Prime Minister Modi executed this lockdown without checking with his own departments, whose advice could have warned him against such a hasty and unnecessary act.
Prime Minister Modi has taken the whole pandemic lightly. He urged people to light candles and bang pots, make noise to scare off the virus. The lockdown kept spreading, but there was nothing systematic, no national policy that can be found anywhere on government websites. In May and June 2020, the lockdown continued to expand, even though it made no sense for the millions of working-class Indians who had to go to work to survive on their daily wages. A year after the start of the pandemic, there are now 16 million people in India with detected infections, with 185,000 people confirmed to have died from the pandemic. You have to write words like “detected” and “confirmed” because the mortality data in India during this pandemic has been totally unreliable.
Consequences of privatization
THE consequences of the transfer of health care to the private sector and the underfunding of public health have been devilish. For years, advocates of public health care, such as Jan Swasthya Abhiyan, have called for more public spending on public health and less reliance on profit-oriented health care. These calls have fallen on deaf ears.
Indian governments spent very small amounts on health – 3.5% of GDP in 2018, a figure that has remained the same for decades. India’s current health expenditure per capita, by purchasing power parity, was 275.13 in 2018, roughly the figures for Kiribati, Myanmar and Sierra Leone. This is a very low number for a country with the kind of industrial capacity and wealth of India.
At the end of 2020, the Indian government admitted that it had 0.8 doctors per 1,000 Indians and 1.7 nurses per 1,000 Indians. No country the size and wealth of India has such a low medical workforce. It’s getting worse. India has only 5.3 beds per 10,000 people, while China, for example, has 43.1 beds for the same number. India has only 2.3 intensive care beds per 100,000 people (compared to 3.6 in China) and it has only 48,000 ventilators (China had 70,000 in Wuhan alone).
The weakness of the medical infrastructure is entirely due to privatization, where private sector hospitals run their system on the principle of maximum capacity and do not have the capacity to handle peak loads. The optimization theory does not allow the system to cope with power surges, because in normal times it would mean that hospitals would have excess capacity. No private sector will voluntarily develop excess beds or excess fans. This is what inevitably causes the crisis of a pandemic.
Low health spending translates into low spending on medical infrastructure and low salaries for medical staff. It is the wrong way to run a modern society.
Vaccines and oxygen
SHORTAGES are a normal problem in any society. But India’s shortages of basic medical supplies during the pandemic have been scandalous.
India has long been known as the “pharmacy of the world” as the Indian pharmaceutical industry sector is adept at reverse-engineering a range of generic drugs. It is the third largest manufacturer in the pharmaceutical industry. India accounts for 60 percent of global vaccine production, including 90 percent of WHO measles vaccine use, and India has become the largest producer of pills for the US market. But none of this helped during the crisis.
COVID-19 vaccines are not available to Indians at the necessary rate. Indian vaccinations will not be complete until November 2022. The government’s new policy will allow vaccine manufacturers to raise prices, but will not produce fast enough to meet needs (India’s public sector vaccine factories are inactive) . No quick large-scale purchase is contemplated. There is also not enough medical oxygen and promises of capacity building have not been kept by the ruling party. The Indian government exported oxygen, even when it became clear that the national reserves were depleted (it also exported valuable injections of Remdesivir).
On March 25, 2020, Modi said he would win this Mahabharat – this epic battle – against COVID-19 in 18 days. Today, more than 56 weeks after that promise, India is more like the bloodstained fields of Kurukshetra, where thousands of people lay, the war not even half-time.
CounterPunch.org, April 26. Vijay Prashad, Indian historian, journalist and commentator, is the Executive Director of Tricontinental: Institute for Social Research and the Editor-in-Chief of Left Word Books.