India is no stranger to pandemics. The first cholera pandemic began in the subcontinent in 1817. By 1930, the third major outbreak of bubonic plague had killed 12 million Indians. The tragedy of the Spanish flu may feature prominently in the collective cultural memory of the West. But it claimed most of its victims in India, where 18.5 million people lost their lives.
Admittedly, today’s India — often considered an economic powerhouse — is a far cry from the way things were at the time of the Spanish flu. Acche din aane waale hain (“good days are coming”) was Prime Minister Narendra Modi’s campaign promise in 2014. Yet the country remains dangerously ill-prepared and vulnerable to the COVID-19 pandemic under Modi’s leadership.
This is partly because of the government’s lethargic response to the crisis. On January 30, just a few hours before the World Health Organization (WHO) declared the novel coronavirus outbreak to be a global public health emergency, Indian authorities announced the first confirmed COVID-19 case in the country. This was after a week of media reports speculating that the outbreak had already begun in India. At the time, China had reported 7,711 cases.
The authorities had taken few preventive measures at this point. Until late January, only three airports in India were carrying out thermal screenings, even though there had been confirmed cases of the outbreak outside China.
When the first Indian case was reported, there was just one laboratory in the whole country conducting tests on coronavirus samples. The Ministry of Health and Family Welfare didn’t launch its COVID-19 awareness campaign until March 6.
In the meantime, the only government advice on preventive measures had come from the Ministry of AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, Sowa Rigpa and Homoeopathy). On January 29, it issued an advisory notice that listed Ayurvedic practices and Unani medicines as recommended remedies.
In the weeks that followed, there were a handful of confirmed COVID-19 cases for individuals with a travel history. The government responded by increasing the number of screenings at airports; by mid-March, it had suspended the issuing of tourist visas. All travelers — including Indians — from countries hardest hit by the pandemic had to go into quarantine for fourteen days after their arrival.
On March 3, Modi’s first tweet on the subject assured people that there was “no need to panic.” The prime minister stressed that there had been “an extensive review regarding preparedness on the COVID-19 Novel Coronavirus. Different ministries & states are working together, from screening people arriving in India to providing prompt medical attention.”
Failure to Prepare
A study prepared by the University of Southampton listed India as one of the thirty “high-risk” countries for an outbreak, because of the number of visitors from highly vulnerable cities in China, so a focus on incoming travelers was justified.
However, India’s high population density, poor sanitation infrastructure, and high rates of internal migration also meant that the virus was bound to spread quickly among those who came into contact with infected travelers, inevitably leading to a much wider community transmission of the virus, where the original source of infection could not be traced.
In 2008, the National Disaster Response Force (NDRF), operating under the Government of India’s National Disaster Management Authority, had drawn up plans to prepare for “large-scale biological catastrophes.” These plans included “community preparedness for social distancing and lockdowns, the creation of state-level stockpiles of critical medical equipment and protective clothing, and ensuring all hospitals were prepared for biological disasters that could involve sudden mass casualties.”
But the NDRF faced resistance from several government ministries, and its powers were curtailed under Modi’s watch. This time around, the NDRF didn’t finalize its contingency plan until March 19. By that stage, there were already confirmed cases of the outbreak among individuals without a travel history.
On March 24, Modi announced a nationwide lockdown that would last for three weeks, with a “total ban” on trips outside the home, applying to “every state, every district, every lane, [and] every village.” He made the announcement at 8 PM for a lockdown that was due to begin at midnight. With just four hours’ notice, panicked citizens flouted social distancing norms and rushed to buy essential goods.
Modi subsequently urged people not to panic and assured them that vital commodities would be available. However, with widespread reports of police brutality against individuals buying or selling essential goods, there was little clarity about the practicalities of ensuring an uninterrupted supply of such items.
The sudden announcement also meant that millions of migrant workers, who play an indispensable role in the economies of India’s major cities, were left in a double bind, without any source of income, yet unable to return home. Thousands of people thronged city bus depots and train stations, while others walked for hours to reach their villages.
The government established the Prime Minister’s Citizen Assistance and Relief in Emergency Situations Fund — the “PM CARES Fund” for short — to help the country’s poorest. But many people have questioned the need for a new relief fund when $500 million still remains unused from the preexisting Prime Minister’s National Relief Fund established in 1948.
There is much speculation that corporate donors are simply using the new fund to channel the money they have already allocated to corporate social responsibility (CSR). Large corporations are required by law to allocate 2 percent of their net profits toward CSR activities. If confirmed, this would mean that no additional funding was made available: the companies would be using the “PM CARES Fund” to seek favor with Modi, while smaller NGOs that might otherwise have benefited from CSR donations lost out.
The world’s biggest lockdown hasn’t flattened the curve, either. By March 24, there were officially 536 cases, but that number was artificially low, because of India’s poor testing rate. With an increase in the number of tests, the number of active cases had gone up to 11,487 by April 14, when Modi announced an extension of the lockdown until May 3.
As of April 23, there have been 21,700 cases. The head of New Delhi’s All India Institute of Medical Sciences, Dr Randeep Guleria, believes that community transmission has already begun, although the government vehemently denies it.
Of course, it’s no coincidence that the new relief fund is directly linked to the prime minister, even in the name that it carries. With Modi’s government facing widespread criticism for its response to the pandemic, it has engaged in a public relations campaign to boost his profile as a leader who cares about his people.
Following the prime minister’s call, the country observed a “Janata curfew” (people’s curfew) between 7 AM and 9 PM on March 22, with citizens banging pots and pans for five minutes at 5 PM in support of health workers fighting the pandemic. His daylong curfew, while it may have been ineffective against the outbreak, was supposed to test the country’s readiness for a longer lockdown and — as Modi himself tweeted — “add tremendous strength to the fight against COVID-19.”
On April 5, Modi called on Indians to switch off their lights and light up candles and lamps at 9 PM for nine minutes in a show of solidarity against “the darkness of the pandemic.” Hashtags like #9pm9mins and #IndiaFightsCorona — along with the prime minister’s handle @narendramodi — trended across the social media platforms of India’s rich and famous.
More recently, the Indian lockdown scored “100” on a Stringency Index developed by the Blavatnik School of Government at the University of Oxford. Modi’s Bharatiya Janata Party (BJP) hailed this as a vindication: “The ‘full marks’ underline [the] Modi government’s proactiveness, seriousness and swiftness in implementing [an] effective lockdown.”
The Blavatnik School of Government responded tersely to the BJP’s tweet:
Thanks for your interest in our tracker, which simply records the number and strictness of government policies. The related stringency index should not be interpreted as measuring the appropriateness or effectiveness of a country’s response — there are no “marks” as such.
In other words, the fact that a lockdown is especially strict does not mean it will be effective in countering the spread of the pandemic.
Scapegoats and Shortfalls
With the COVID-19 pandemic coming hard on the heels of an uptick in misinformation stories, heightened Islamophobia, and a period of widespread communal violence, there have also been ongoing efforts to blame Muslims for the outbreak. This began when a group of Muslim missionaries who were infected with the coronavirus unknowingly spread it to communities across the country after a meeting in Delhi in March.
Later, images from Pakistan went viral across social media platforms as supposed “evidence” of Muslim communities in India openly flouting the lockdown. There are now reports of hospitals refusing to admit Muslim patients unless they have test results proving that they are not infected with COVID-19.
But none of this can erase the fact that neither India’s public health care system, nor its wider economy, is ready to cope with a major outbreak. A 2019 study exposed the dire state of the health care sector: with only 1.4 percent of India’s GDP allocated for health spending, public infrastructure was already severely under-resourced when the pandemic began.
India only has one doctor in the public health system for every 10,189 people. In total, there is a shortfall of 600,000 doctors and 2 million nurses. Furthermore, an estimated 42 percent of doctors in urban India don’t have a medical degree. In rural areas the picture is even worse: only 19 percent of “doctors” have medical qualifications, and a third is reported to have no more than secondary school education.
Add a pandemic to the mix and the results could be catastrophic. In mid-March, the Ministry of Health and Family Welfare estimated that there was one isolation bed available for every 84,000 people, and one quarantine bed for every 36,000. There were also just 40,000 respiratory systems in the entire country.
Access to affordable COVID-19 testing kits has also been a significant concern. While testing at government facilities was free, the public health care system had reached the limits of its capacity by late March, and the government allowed private facilities to conduct tests. It capped the cost of testing at such facilities at 4,500 rupees ($56), still a relatively high figure for most Indians, which meant that many people couldn’t afford the test.
The Indian Council of Medical Research called for “free or subsidized testing in this hour of national public health emergency.” However, it was up to private health care providers to decide whether they would follow this recommendation.
On April 9, the Supreme Court ordered the government to provide free testing even at private facilities. Later, the court modified its order, declaring that the test should be free for the country’s poorest while leaving it for the government to define who was eligible.
Ostensibly, this decision would enable higher rates of testing. But that’s easier said than done since there is only one approved domestically produced testing kit. Due to the rise in global demand, the Indian authorities have had difficulty acquiring imported kits and protective gear.
The Great Slowdown
The Indian economy is equally vulnerable. When Modi rose to power in 2014, he promised to reproduce the economic development that the western state of Gujarat had seen under his leadership at the national level.
However, India under the Modi government has not been an economic success story. In fact, a 2019 Harvard University study found that the Indian economy was experiencing a “Great Slowdown,” because of diminishing exports and investments.
Of course, the most prominent stain on Modi’s economic policy-making record was the haphazardly implemented demonetization of Rs 500 and Rs 1000 banknotes in 2016. This policy was supposed to undermine the black market and funding for illegal activities.
Yet 90 percent of all the currency in circulation was demonetized as a result, and the main victims were ordinary citizens who had been blindsided by the measure and were left desperately short of cash. The Reserve Bank of India reported that demonetization led to the loss of 1.5 million jobs, and there was a 2 percent drop in the country’s GDP.
As all economic activities came to a standstill after the lockdown, the growth rate of 5 percent for the 2020–21 financial year that had been projected earlier — already dismal — had to be revised downward to 2 percent, which would be the lowest in three decades. This is a worrying sign for a country with massive infrastructural needs, where almost five million people join the workforce every year.
In a bid to stimulate the economy — and partly in response to protests by migrant workers against the extension of the lockdown — the Indian government allowed some sectors to restart operations from April 20.
These sectors include agriculture and construction, both of which are heavily reliant on migrant workers, who will now be allowed to move within a state for purposes of employment. The effect of these measures on the economy (or the spread of the virus) is thus far unclear.
It is too early to determine the long-term effects of India’s ongoing tryst with its latest pandemic. Nonetheless, the country already stands as a cautionary tale. The full spectrum of vulnerabilities exposed by the outbreak shows the extent to which countries in the Global South — many of which lack the kinds of resources that India has at its disposal — are susceptible to the pandemic.
However, the Indian experience also has broader implications. From the obvious parallel between the downgrading of the NDRF by Modi and Trump’s gutting of the Centers for Disease Control and Prevention (CDC), to the glaring weakness of public health care systems and policies in countries of the North and South alike, this pandemic has revealed issues of universal concern.
Just as the race to find a vaccine for COVID-19 has galvanized efforts across the world, this crisis should also be an opportunity to collectively address these wider concerns and devise global solutions.