The harsh fact is India is still not adequately prepared to tackle future disasters. What can be done to remedy this?
There needs to be better health sector governance across states and districts, breaking down silos of laws and regulations and driving convergence in how India reacts to a crisis
NEW DELHI :
We demand rigidly defined areas of doubt and uncertainty," Vroomfondel famously said in The Hitchhiker’s Guide to the Galaxy. Well, he might have demanded it and we might want it, but the world isn’t like that. There is risk (with known probabilities) and, more commonly, there is uncertainty (with unknown probabilities).
An exogenous shock and consequent uncertainty hit us on 30 January 2020, with the first identified case of covid-19. We didn’t know its severity then, nor did the rest of the world, thanks largely to China’s reticence. Every documented instance of plague/pandemic/epidemic has occurred because of cross-border movement of humans across borders.
Had India clamped down on border movements, say, in the first week of February 2020, the spread of the virus would have been controlled. But it is always easy to be wise after the event. In that state of uncertainty, the Union government imposed a lockdown on 25 March 2020, roughly one year ago.
The word governance means more than government alone. There are layers within the government—Union, state, local body. One outcome of covid-19 has been greater attention on unifying and rationalizing laws, breaking down silos and eliminating multiplicity (more about that later).
So, in various phases, the lockdown lasted till 31 May 2020. From 1 June 2020, given the need to revive the economy, there has been a staggered process of un-lockdown. Without government interventions, India would have fared worse under covid-19, although this remains a counterfactual argument.
Without getting into details, examples of state interventions are MGNREGA, Pradhan Mantri Jan-Dhan Yojana, National Social Assistance Programme, Saubhagya, Pradhan Mantri Jan Arogya Yojana, Ayushman Bharat, Swachh Bharat Abhiyan, and DBT.
Rural India was relatively insulated from both covid and lockdown. In addition, rural India has benefited more from public welfare schemes, facilitated by the fact that Socio Economic Caste Census (SECC) rural is more robust than SECC urban. For rural India, there has been a better and easier matching of household identification (such as in MGNREGA and SECC) with individual identification (such as in Ayushman Bharat and Aadhaar.).
If there was a problem with urban migrants returning to rural India, that was largely because the identification requirement of Inter-State Migrant Workmen Act of 1979 was never implemented. Had the intent of the legislation been enforced, there would have been a register of migrant workers, with portability of welfare benefits for returning migrants.
There are fairly broad-based signs of economic revival now, although segments with human-to-human interface (travel, tourism, hospitality) are still subject to restrictions and it will take a while for them to recover. There are also lags between growth revival and the employment market recovering.
Doom and gloom
If we cast our minds back to 25 March 2020, there was a model that received a lot of attention then; one that projected India would have 800 million infections and 2-2.5 million people dead. International newspapers and magazines went to town, projecting devastation in India, since India was so under-prepared. India was expected to fail in handling covid-19. It was almost as if some commentators wanted India to fail.
The fact is, by any metric, especially if normalized for population, Indian numbers—11.5 million infections and 160,000 deaths—are lower than alarmist projections. (In some states and specific regions within states, daily numbers have started to inch up again. Fatigue about lockdown and casualness about social distancing measures are probably responsible.)
A failure to explain India’s low numbers has led to all kinds of explanations— natural immunity, Neanderthal DNA, under-reporting of infections/deaths, weaker strain of the virus, BCG vaccination, avoidance of handshakes and use of namaste.
After the first couple of months, the much-maligned Indian system delivered PPEs, masks, ventilators, face shields, gloves, gowns and so on. More than hardware of hospitals and beds, software of doctors and healthcare workers delivered, far more efficiently than in many advanced countries that were evidently better-prepared.
This does not negate the importance of improving health infrastructure (hardware and software), spending more on health and improving efficiency of such expenditure.
One should read a compilation recently brought out by the Ministry of Housing and Urban Affairs on how many Smart Cities responded to the pandemic. The compilation isn’t exhaustive and is only restricted to Smart Cities. But one gets to know about how Agartala got 183 women SHG groups to produce masks under Deendayal Antyodaya Yojana, Bareilly’s community kitchen, Bhopal’s use of drones and so on.
These local government and citizen initiatives made a difference rather than Neanderthal DNA. True, these initiatives were not systemic, as they should be, but were driven by specific individuals.
The lockdown of 25 March effectively shifted the transmission curve to the right and enabled such supply-side responses. Further down the lockdown line, India’s vaccine production is itself a remarkable instance of Make in India. The planned capacity of six different vaccines is going to be 3.6 billion doses in 2021.
There are seventy different countries to which India has exported almost 60 million doses of vaccines, a sharp contrast to some advanced countries which are refusing to part with vaccines. Within India, 36.5 million people have been vaccinated. Given recent spikes, there are valid arguments for widening eligibility and persuading people to vaccinate themselves.
On the whole, for covid-19, the cliched image of the big fat Indian wedding might be appropriate. There is chaos and crisis. No one quite seems to know what is happening. But at the last moment, everything is managed.
This is not to suggest complacency or suggest that everything went off well in reacting to covid-19. However, the under-estimated, maligned and under-governed India surpassed many external observers.
Nevertheless, what this crisis illustrates is heterogeneity and variation within states and even in districts within the same state. Some districts not perceived as being very well governed performed extremely well, both in handling lockdown and covid-19. Others, perceived as well governed, didn’t do that well.
Which layer of government acts when there is an epidemic/pandemic? Under the Epidemic Diseases Act of 1897, the Union government has no powers beyond action at the border (seaports and airports). The rest is a state subject. Indeed, the twelfth schedule to the Constitution mentions powers, authority and responsibilities of municipalities.
Legally speaking, who decides on lockdown or un-lockdown? Will it be the Union, state or municipal government? Will it be the district magistrate invoking, and subsequently not invoking Section 144 of the Code of Criminal Procedure?
This isn’t a new issue. Health is on the state list of the seventh schedule, not even the concurrent list. Notwithstanding ICMR, Union health ministry and NHM (National Health Mission), the right and responsibility for action against something like covid-19 vests primarily with states.
Today, it is covid-19. Tomorrow, it might be a different disaster, natural or man-made. There is the Disaster Management Act of 2005, which was invoked for Covid too. Under this legislation, there have to be national plans, state plans and even district plans to handle disasters. Though all the states and union territories have disaster management plans now in addition to the national one, the quality of these leaves a lot to be desired and most districts still do not have district-level plans.
Therefore, in the unfortunate event of the country facing another disaster, India is still not adequately prepared. One reason for that may be legal. Any piece of legislation needs constitutional support.
Under what provision was the Disaster Management Act passed? The report of Rajya Sabha’s standing committee tells us, “The proposed legislation is relatable to entry 23 (social security and social insurance) in the concurrent list of the Constitution. This will have the advantage that it will permit the states also to have their own legislation on disaster management."
Legislation on disasters under the umbrella description of social security and social insurance doesn’t sound right. The third report of the second administrative reforms commission stated, “Due to the cross-cutting nature of activities that constitute disaster management and the vertical and horizontal linkages required, which involve coordination between the Union, state and local governments on the one hand and a host of government departments and agencies on the other, setting up of a broadly uniform institutional framework at all levels is of paramount importance... This could best be achieved if the subject of disaster management is placed in the concurrent list of the Constitution."
There are other related points. A pandemic is about mortality and morbidity, which means capturing data on both and evolving suitable policy responses is necessary. If general data on deaths are faulty, specific data on covid-related deaths are also likely to be deficient.
Vital statistics means data on births, death, marriages and divorces. Today, in most countries, including India, this is done through a civil registration system (CRS). Legislative support for this is provided through the Registration of Births and Deaths Act of 1969, which requires mandatory registration of births and deaths.
The law clearly identifies responsibility for registration and specifies penalties for violation. CRS is akin to a complete population census. To validate CRS and test its efficacy, since 1969, there has been a sample registration system (SRS). This shows that though death registration numbers have improved over time, 25% of deaths are still not registered and some states don’t do this at all. Given this, in all states, does one expect all covid deaths to be reported and registered?
Reporting and registering death is one thing. Ascribing cause of death is another. There is a process for medical certification of the cause of death. The latest report, published in 2020, reports figures for 2018. With an urban lens, one often assumes that the certification of cause of death is universal. As the 2020 report illustrates, it is anything but that. By no means is this a problem caused by covid-19. But covid-19 flags inadequacies very starkly.
The Spanish Flu, the last major pandemic, triggered governance improvements in many advanced countries, particularly in health. By that logic, as a reaction to covid and lockdown, there needs to be a stronger template for health sector governance across states and districts, breaking down the silos of laws and regulations and driving convergence in how India reacts to an external crisis, health-related or otherwise.
More specifically, this requires a relook at the seventh schedule. The Spanish Flu can be dated to 1918-20. Some elements of the Constitution are inherited from the Government of India Act of 1935 and its precursor, the Government of India Act of 1919, which is of the same vintage as the Spanish Flu. There is a message there, one that should not be forgotten once the worst of covid-19 is out of the way.
Bibek Debroy is chairman, Economic Advisory Council to the Prime Minister.