In COVID storm, the key principles driven home

Dead men do tell tales and history bears witness that pandemics leave their imprint among those they leave behind. In India, a full reckoning would take place when the pandemic is fully behind us. But even from deep inside the storm there are some first principles that have been driven home. Adherence to them would have undoubtedly mitigated the ghastly fallout of the virus.

Health care, not coverage

The first is the debate between universal health care and universal health coverage. That stands settled now, in the spirit of the landmark Aneurin Bevan’s-led National Health Service Act in 1946, which revolutionised health care in the United Kingdom by delinking it from a person’s income. It became a benchmark for the recognition that it could not be left to market forces to deal with public health.

The most comprehensive document prepared so far in India, by the high-level expert group appointed by the Planning Commission, submitted in November 2011, concluded that “progressive strengthening of public facilities” is the only way to reach medical services to the population as a whole. While finance was a concern to be dealt with, the centrepiece of health care was not insurance. After 2014, insurance has instead been a focus — good health to be somehow secured via insurance, as with Ayushman Bharat. But for all the hype, there is no getting away from strengthening public health facilities and making that the fundamental way of ensuring a healthy life for its people. India, already spending woefully limited amounts on health, for all the hoopla and hype, ended up reducing allocations in the February 2021 budget. The results are there to see.

Kerala, when it started investing heavily in public health care in the 1950s, was told it was too expensive for a poor State like it was then. But as it went on to demonstrate, primary health care was labour-intensive, generating its own virtuous cycle of trained personnel and a well-looked after populace. It enhanced the people’s ability to produce, to be economic assets and enriched the State much more than could be imagined.

Reason, not mumbo-jumbo

The second principle of so-called ‘New India’, of faith over science and the silencing of rationalists as ‘western’ and ‘alien’ to the ‘Indian ethos’, must be kicked very hard if India has to start breathing again. In the past seven years and even when the novel coronavirus pandemic was looming, top Ministers, including the Health Minister, were seen flanking the sides of a yoga guru proclaiming that he had found a cure for COVID-19. The World Health Organization had to step in and make it clear that it had not endorsed it. The Prime Minister has himself privileged myth over reason, most visibly at a hospital inauguration in Mumbai, in 2014, where he spoke of “plastic surgery” as an Indian invention, citing Lord Ganesh’s trunk. This set India back by centuries. The message downwards was clear; science, rationalism or expertise was ‘Nehruvian’ and not to be encouraged.

Public allocations for science have fallen and Indian scientists criticised two speakers at the Indian Science Congress “for making bizarre, unscientific claims, including that ancient Hindus invented stem-cell science”. Scientists held protests against the unscientific statements in Bengaluru, Kochi, Kolkata and Thiruvananthapuram on January 6, 2019. With the Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) coming under fire frequently for peddling non-cures with the weight of the Government of India behind it, it appears as if science itself was perceived as a threat to the ruling party’s ecosystem.

All through last year, no public health expert — and India has many — was empowered enough to be seen advising, directing, taking questions or giving out advice that the public could trust, and on occasion question policy. The thali banging, candle lighting, abrupt lockdowns, were all done via public addresses to the nation by the Prime Minister. There was no group with respected scientists or public health experts who could challenge government diktats or test decisions taken by the Narendra Modi government against scientific principles. The Prime Minister took to declaring victory over the pandemic on January 28. The Home Minister authoritatively announced to the media that rallies were not causing the surge in the middle of a crowded Bengal campaign. On if the Kumbh Mela should be allowed a year earlier, it was the Akhil Bhartiya Akhada Parishad that had the last word, not epidemiologists. It took hundreds of anguished scientists to write a letter urging that genomic data be collected and shared, like other civilised democracies, on the virus for the protocol to be altered. The wholesale junking of science even deep into the pandemic worsened the situation.

Data integrity, not hesitancy

Third, comes data integrity, which is shorthand for the credibility of any government, at any time. Data-hesitancy has been a feature of this government, whether it was about economic data, on making the GDP look good or on recording employment statistics. So changing baselines, withholding periodic labour force surveys or consumption survey data, set the path for continued data denial over testing last year and this year, over COVID-19 deaths. Other than the moral and human imperative of owing it to each Indian who dies, the basic courtesy of recording her existence and departure, not recording deaths faithfully, has deep practical implications. If you do not track it honestly and accurately, you do not understand the disease, and if you do not do that then you cannot handle it and lesser still, rescue the future by accurate predictions. In the case of COVID-19, India’s mortality data are many times lower than what is officially acknowledged, as discussed in detail by the latest assessments of the Institute for Health Metrics and Evaluation, and experts such as Dr. Bhramar Mukherjee, Dr. Ashish K. Jha and Dr. Murad Banaji. The discrepancy is above the regular margin of error seen in many countries. This is deeply damaging to India’s international standing as a reliable recorder of information. Not recording or diligently sharing data has consequences, for India and the world.

Our economics and the poor

The fourth and final principle that the pandemic has driven home is the importance of centring good economics around improving the lives of those worst-off. Recently, India has been anxious about turning into a ‘5 trillion’ economy. But there is no Security Council seat or grand entry into the big rich clubs of the world if India’s overwhelming majority, those who live under $1.90 a day, cannot be lifted out of the morass. Numerous surveys and reports have consistently hammered at the slide into poverty. The latest report by the Azim Premji University talks of 230 million Indians slipping below the breadline during the pandemic. India’s obsession with being Vishwaguru, egged on by misleading analysts deriding “Povertarianism”, talking of “freebies” cannot be a replacement to sound welfarism which must prioritise the majority of Indians who need a social security net. It is stunning disregard for global experience, whether it is Joe Biden’s big spending, Boris Johnson ending the age of austerity, Germany launching the biggest state spend since the war or China’s historic drive to end absolute poverty, and India’s own, when the International Monetary Fund acknowledged the fastest decline in poverty globally occurring in India between 2005-06 and 2015-16. Understanding “good economics” as what helps its majority, the most poor and vulnerable, must be a principle rather than a matter of embarrassment.

The virus is no sociologist but it responds to how society and human beings behave with it. Allowing gargles of cow urine to double as cures, giving it a free run to travel and diversify amongst large unprotected crowds or in a desperation to win elections such as in West Bengal, actively courting and boasting about mass gatherings till just days ago were all invitations to disaster, providing the virus with what it wanted — a chance to multiply, diversify, jump hosts and regions rapidly, adding as accelerators to the second wave.

This was contrary to what India did with smallpox and polio, with far fewer resources. There, its adherence to basic scientific and rational principles, helped its people, and the world beat back the disease.

The least good that might be hoped for, at an unimaginably high cost, is for COVID-19 to cure us of the basic distortion in our public and political culture which has been on a speed pill for the last seven years. Else, it would be hard to stop analysts from terming this the man-made, Indian, or worse still, Modi variant.

Seema Chishti is a journalist/writer based in New Delhi

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Printable version | Jun 21, 2021 2:58:08 AM | https://www.thehindu.com/opinion/lead/in-covid-storm-the-key-principles-driven-home/article34560810.ece

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