Covid-19: Building Resilience to Pandemics | K N Ninan

by K N Ninan

If there is one lesson that the Covid-19 pandemic has taught us, it is as to how governments in the developed and developing world have been caught napping and unprepared to meet a disaster of this nature and scale. Even after the global community overcomes the pandemic questions will linger on as to why governments including the Indian Government failed to act in time such as closing its international borders even though first reports of the corona virus appeared in January 2020. The pandemic has affected around 9 million people spread across 185 countries and caused over 4.7 lakh deaths. In the USA alone the number of affected people has crossed two million people with deaths exceeding 119,000. In the United Kingdom, Brazil, Italy and Spain the number of deaths in each country ranged between 28.000 to 50,000 deaths.

The fact that India has comparatively reported lower number of deaths (over 13,000 deaths respectively) may lull us into complacency as to how well India has managed to control the pandemic. Whether these are due to the lower level of testing and screening of vulnerable people or other factors needs probing. Why is it that developed countries with well-endowed health infrastructure and indicators compared to India failed to anticipate the flood of affected people seeking critical care. Scenes of patients lying on floors in hospital corridors or put up in tents or pavements outside hospitals in developed countries point to a total collapse of the hospitals to cope with such huge numbers of affected people. As per World Health Organisation statistics, the number of hospital beds per 10,000 population in the USA, UK, Italy, Spain and France ranged between 28 to 83 as against only 6.6 in India. Even Sri Lanka fares better than India with these figures being over 35. In terms of medical doctors per 10,000 population the average figures for these developed countries ranged between 26 to 42; for India this was only 8.6. The number of nursing and midwife personnel per 10,000 population for India was just around 17 as against between 57 to 145 for these developed countries. Although there are no official statistics on the number of ventilators available in the public sector in India, some agencies suggest that taking into account the number of ICU beds available in the public sector and assuming that 50% of these have ventilator facilities then the number of ventilators available in India may range between 17850 to over 25,000. Just imagine if India had to cater to one million patients as in the USA. Besides there is great disparity in health infrastructure across states in India and between urban and rural areas.

The government has relied on the Epidemics Diseases Act of 1897 and the Disaster Management Act of 2005 to tackle the Covid-19 pandemic. The former enacted by the colonial government to tackle the bubonic plague in Bombay in 1896 lists out the powers of the government to address epidemics and penalise offenders. But it failed to define an epidemic or pandemic. Despite around 16 million people dying in India due to the Spanish flu after World War I and recent epidemics such as SARS, swine flu, nipah, plague it is a surprising that successive governments have not thought it fit to enact a comprehensive legislation to tackle such pandemics. The Disaster Management Act appears to be largely geared to addressing natural or man-made disasters such as floods, droughts, cyclones or industrial mishaps and not specifically to health disasters such as the Covid-19 pandemic. Although the UPA government appointed a task force to review the act its report submitted in 2013 is gathering dust or eaten by termites. The Modi government drafted a bill on Public Health (Prevention, Control and Management of Epidemics, Bioterrorism and Disasters in 2017 to replace the Epidemics Act of 1897 but it is yet to be tabled in Parliament.

Building resilience is key to tackling disasters and pandemics. When a devastating cyclone struck Odisha state in 1999 over 10,000 people perished whereas a similar calamity fifteen years later reported only less than 50 deaths due to superior warning systems and evacuations. India needs to learn from Japan which is highly prone to disasters such as earthquakes, tsunamis and landslides. There are manuals to familiarise the public on what to do if an earthquake, tsunami or fire occurs. For instance, the Earthquake Survival Manual issued by the Tokyo Metropolitan government advises the public that if an earthquake occurs then turn off gas, oil heaters and if a fire occurs put it out immediately. Protect yourself from falling objects whether indoors or outdoors. If you are indoors then open the door immediately since the earthquake may jam the doors and you may be trapped inside. Periodic disaster drills are conducted in government offices, educational institutions and corporate offices to familiarise people on how to cope with disasters. Even fire drills are conducted so that people know how to use a fire extinguisher or exit a building if it catches fire. We know the chaos and death toll that occurred when a fire broke out in the Carleton building in Bangalore years ago when it was found that the emergency fire exit door couldn’t be opened since unwanted office furniture was dumped there.

The government needs to ramp up and improve access to public health. Government health expenditure in India is a depressing 1% of GDP as against 8-10% in the developed countries. Government needs to re-orient its priorities. Should it squander Rs 20,000 crores on remodelling the central vista in Delhi or invest this in public health, education and research. Sadly, whenever governments face a fiscal crisis it guillotines expenditures on these sectors.

(The author is an economist) Email: ninankn[at]yahoo.co.in