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Mainstream, VOL LIX No 27, New Delhi, June 19, 2021

Pandemic: Lessons to Learn | Suranjita Ray

Friday 18 June 2021, by Suranjita Ray


Ever since Covid-19 hit India, it was apprehended that given its density of population and poor health care system, it would remain a challenging task for the state and its people to overcome the pandemic. This fear came true in the second surge in 2021 which saw the collapse of the health system every day despite all efforts by frontline workers. Though a second wave was expected, the thousands of deaths which left the nation grieving were not.Etched into our memories are experiences of large number of people struggling for space in hospitals, emergency wards, intensive care units, crematoriums and graveyards, and the sights of bodies floating in Ganga and buried in the shallow graves. The experiences elucidate the state’s failure to secure not only right to life but also dignity in death.

It is difficult to express the pain, suffering, despair and grief of families who experienced these horrors. Several homes have been shattered. Hundreds of children across the country are orphaned as they lost their parents. Many of us have lost near and dear ones in our immediate circles. The loss of ‘saviors of life’ in this battle has left us helpless. Yet the hope to rewrite the pandemic as a passing phase which India battled to sustain itself is the only hope that will take us through this catastrophic health crisis. The need of the hour is to learn lessons from the present crisis to prevent such devastating experiences in future.

The Prime Minister in his speech to the World Economic Forum in January this year stated that India should inspire other countries as it defeated Covid-19in a big way. Huge gatherings in religious ceremonies and election campaigns through rallies and roadshows violated the norms, guidelines and protocols of Covid appropriate behaviour. No serious measures were takenby the government to prevent the spread of the virus in spite of the early warnings of a second wave. The spread of the infection was alarming. Though the government claimed that they were working on a ‘war footing’ to tackle the spread of the virus, most of the deaths in the second wave were due to denial of the basic health care services. The official estimates of deaths are much less than the actual deaths that occurred due to Covid-19.

In fact, thousands of deaths could have been prevented had the strategies been worked out to secure hospital facilities and oxygen supplies. We saw a complete breakdown of the health care system. The situation was worse as there was hoarding and profiteering though black marketing of oxygen cylinders and lifesaving drugs when people were gasping for breath due to shortage of oxygen and unavailability of oxygen beds in hospitals. It exposed the lack of foresight and failure of preparedness of the state. The everyday experiences of people at the ground level show that poor health infrastructure is a major reason which deprived several Covid patients of adequate treatment. Testimonies of people reveal several systemic flaws in the health care system.

To confront the pandemic, an in-depth understanding of the severity of the flaws and challenges in the health care system is important. The government needs to acknowledge the flaws and correct its course of action. Immediate measuresto strengthen public health system should be at centerstage of the policy agenda. It is therefore important to upgrade the health infrastructure especially by increasing the number of hospitals and hospital beds, sources of oxygen supplies, manufacturing and accessibility of Covid-19 vaccines and drugs, and huge vaccination drive in order to immunise 1.3 billion people.

Purposive behaviour is a necessary part of policy definition. Policies that secure the life of people cannot be chance occurrences and do not, by and large, just happen. It cannot be the choice of the government but is its responsibility. This responsibility is not just moral but also political as the government that is elected by the people has to secure the fundamental rights of its citizens, the most important being ‘the right to life’.

Therefore, the policies to secure basic health care in a pandemic should be designed carefully, with clarity, specificity, foresight, vision and transparency to accomplish the targeted objectives. They should aim at achieving definite results although this is not always possible. In this case, the vaccination policy must be a usefully thought-out and well-planned course of action which should outline a blueprint to implement specific action programmes to achieve the targeted goals within a time span. The conflict between the Centre and states on procurement and distribution of vaccines has exposed the lack of a road map to implement mandatory vaccination which is most essential at the moment. In fact, the vaccination drive has gained enough political colour as both the ruling party and the opposition parties have been blaming each other for the lack of a correct strategy on the vaccination policy.

Mandatory Inoculation

India has a history of successful prevention of diseases such as small pox, chicken pox, polio and measles through vaccines. Increasing healthcare spending through Pradhan Mantri Atmanirbhar Swasth Bharat Yojana should prioritise a multipronged strategy strengthening immunization programmes. Since, the fundamental principle to mitigate the spread of the corona virus is to inoculate people, it was pertinent to revisit the vaccination policy to ensure that each one is vaccinated. Given the shortage of Covid vaccines, experts have been suggesting speeding up placing of orders and centralized procurement of vaccines.

An aggressive vaccination programme for procurement and distribution of vaccines alongside improving health care services across the country is crucial. The governments have to have a vision and a mission to prioritise delivery of health care services and should be responsible and accountable for the failures to save the lives of thousands of people in the pandemic. The most fundamental commitment of a state that represents its people is to ensure their right to life.

Justice D.Y. Chandrachud who headed the three-judge Special Bench hearing a suo moto case on several aspects of the government management of Covid-19 argued that it was significant to have policies to anticipate changes, policies that should be enforceable on the ground, and policies that need to be clear-cut in order to fight the pandemic (see also Rajagopal, 2021: 10). He stated that policies need to be amended by taking cognizance of the errors which is not a sign of weakness but that of strength. He had made it clear that the Supreme Court would not remain a ‘mute spectator’ to a national calamity.

The Bench questioned the dual pricing policy for vaccines between the Centre and the states. It also asked why the marginalized section should not be treated at par with people having co-morbidities for early vaccination. The Supreme Court’s order of May 31, which was published on June 2, emphasised that the government needs to have a policy on vaccination to address issues of shortage and equity(see also Rao, 2021: 10; Rajagopal, 2021: 9). The Court also sought to know why Rs. 35,000 crore allotted for vaccines in the budget 2021, cannot be used for free vaccines to people between the age group from 18 to 44. It observed that the Centre’s vaccination policy for this particular age group as ‘arbitrary and irrational’.

Therefore, the Centre’s decision to centralise vaccine procurement policy is valid. Many argue that the U-turn in the policy was because of constant pressure from the opposition parties and Supreme Court’s criticism of the policy that was announced earlier which stated that 25 per cent of all procurement of the vaccines would be done by the state governments from May 1 onwards. The decision to reverse this policy is important given the urgency to vaccinate all the people after tens of thousands of deaths in the second wave. Announcing the decision to revert to a system of centralised programme of vaccines against Covid-19, the Prime Minister in his address to the Nation on June 7 stated that Centre would procure up to 75 per cent of the doses of vaccines and provide them free to the state governments for all citizens above the age of 18 years from June 21. Private institutions can procure 25 per cent of the vaccines from the manufacturers, and there will be a cap of Rs 150 per dose as service charge over the cost of the vaccine. He assured thatthe process of procuring vaccine from abroad has been sped up to increase vaccine availability.He also appealed to all to enhance vaccine awareness.

While the Prime Minister stated that several wings of the government had been put into service to fight against ‘once in a century’ pandemic, and a vaccine task force had been set up in April 2020 itself, it is important to draw a road map for universal immunization programme to ensure availability and affordability of vaccines. He avowed that CoWin portal is appreciated world-wide. However, getting vaccination slots by registering on the portal and reliance on digital means deprives half the population who have no access to technology. At present the administration of Covid-19 vaccines is in favour of the urban population who have access to technology and can afford to pay.With the spread of the virus to rural areas where people have little knowledge of the disease, counselling is the most important step. People have to be educated about the use masks, sanitizers, and social distancing. Since the culture of community living makes social distancing less possible in areas inhabited with tribal population in particular, it is crucial to explain the disease to prevent its spread. It is critical to do away with vaccine hesitancy. Mandatory inoculation is the most urgent need of the people and the duty of the government.

Public Health Care and Relief Measures

Despite the world’s largest government sponsored healthcare programme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), which aims to provide free access to healthcare for 50 crore hospitalization (500 million) people in the country, adequate administrative mechanisms and processes need to be worked out to implement health care policies efficiently. A National Health Policy which should aim at controlling diseases and securing well-being of the people is the way forward.

Though universal health coverage has been a mantra for several years, and the government claimed that Indian health care industry would grow to become a $ 280 billion industry by 2020, no firm steps have been taken in terms of adequate financing or redesigning the architecture of the health care system. Every year 1 million Indians die due to inadequate health care facilities. Around 700 million people have no access to specialist care. While the Social Security Code 2020 attempts to include informal workers, who constitute 91 per cent of the workforce within the social security administration, there is no provisions for free basic health care. Fear and anxieties related to health need to be addressed.

The public health standard should include basic minimum food, drinking water, housing, minimum wages, Public Distribution System (PDS), and primary health care (Ray, 2020). Several steps to strengthen the local Primary Health Centres, Community Health Centres, communication facilities, medical staff, anganwadi workers, Accredited Social Health Activists (ASHA) workers alongside roping in the local institutions and voluntary services are important even if the vaccination drive has to be carried out. Action plans and programmes to secure health care services have to be formulated and implemented with the help of the Civil Society Organisations, Non-Government Organisations, Voluntary Organisations, Panchayati Raj Institutions and community participation at the grassroots.

The lockdown in the first and the second wave have pushed millions of people into extreme poverty. Though a series of relief packages have been implemented for the distress, people who have lost their jobs, wages and savings and had to bear the additional burden of healthcare expenses are in a deplorable condition. According to Centre for Monitoring Indian Economy (CMIE) during the last year 90 per cent of families witnessed reduction in their income and the unemployment rate rose by 14.7 percent by end of May 2021. Studies find that more than 20 crore people have been pushed below the poverty line (research team at Azim Premji University).

Suggestions for immediate relief/safety nets include universalization of PDS and free food grains for 6 more months alongside cash transfers. The government’s decision to extend Pradhan Mantri Garib Kalyan Anna Yojana until November this year which will provide free ration to all beneficiaries under National Food Security Act, 2013, is therefore a relevant step. As MGNREGA remains an important source of livelihood, the scheme needs to be expanded in both rural as well as urban areas. The employed should be given minimum wages and the unemployed should get an un-employment allowance. Putting money in the hands of the needy is the immediate relief from distress in a pandemic and lockdown (see also Ray, 2020).

We must express our gratitude to all those who lost their lives while serving the nation, people and humanity. Their families must be compensated. Children who have lost their parents have to be taken care. Therefore, the announcement of the government to provide financial assistance under PM-CARES to all children who have lost both parents, the surviving parent, legal guardians or adoptive parents to Covid-19 is an important measure.A scheme will be specially designed to create a corpus of Rs 10 lakh for each child when he or she reaches 18 years of age. The government also announced extended pension coverage under Employees’ State Insurance Corporation (ESIC) scheme to all registered dependants who died due to Covid-19, and expansion of fiscal benefits under the Employees’ Deposit-Linked Insurance (EDUI) for members registered under Employees’ Provident Fund Organisation (EPFO).

An improved health care system reflects a state’s concerns about the basic needs and rights of its people. In fact, economic revival can only be possible if people are secured of their basic right to health care services. A major responsibility of a government for the people should be to secure basic health care services. The most fundamental principle of a pro-people’s state is not only to secure their life and livelihood but also to uphold dignity after death. A great tribute to people who succumbed to Covid-19 in the first and second wave would be to learn lessons from the flaws and to improve the public health system. A strong political will and commitment of the government alongside strict norms around Covid-appropriate behaviour is imperative to prevent another surge.

(Author: Suranjita Ray teaches Political Science at Daulat Ram College, University of Delhi. She can be contacted at suranjitaray_66[at]yahoo.co.in)


Rajagopal, Krishnadas (2021) ‘Policy Should be Clear, Flexible: SC’ in The Hindu, June 1, Page 10.
.................. (2021), ‘SC Flayed Decentralised Procurement, Paid Jabs” in The Hindu, June 8, Page 9.
Rao, K Sujatha (2021), ‘Injecting Confusion’ in The Indian Express, June 4, Page 10.
Ray, Suranjita (2020), ‘Relief in the Package’ in Mainstream, VOL LVIII No 23, New Delhi, May 23, (online issue).

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