Saving lives and livelihood in lockdown
The threat from a rapid diffusion of the coronavirus disease (Covid-19) initially threatened to become India’s most severe health crisis since the Spanish Flu, which killed almost 15 million people a century ago. Increasingly, however, it is spiraling into an economic crisis and could easily spin out of control into a humanitarian crisis.
Prime Minister Narendra Modi’s speech conveyed a clear sense of the gravity of the situation. Give the structural constraints — India’s population density, weak health and sanitation infrastructure, and limited resources more generally — the need to slow the spread of infection is paramount. Whether the decision to lockdown the country for 21 days should have come earlier, should have been made with more preparation, should have been longer or shorter in duration, will be intensely debated, but its need is unequivocal.
At the same time, given India’s population density, the cramped and squalid conditions in which tens of millions people live, not only will social distancing have limited effectiveness (household members of every infected person will be at high risk), but the loss of livelihoods and access to basic necessities will impose significant human costs.
The short-term tradeoff between lives and livelihoods is manifest and nobody really knows where the precise balance lies. Too limited a lockout period risks the lives of potentially hundreds of thousands of people; too restrictive a lockout could result in the eruption of serious social unrest.
The public health challenge
There is little doubt that a lockdown that is somewhat longer than the 14-day upper-limit incubation period of the coronavirus is essential, not because it will annihilate the virus but slow its spread and buy desperate time. But now that the lockdown has begun, what should the State do and what are the instrumentalities of the Indian State to manage its multiple — and conflicting —goals?
To save lives, the government has taken the first major step at social distancing, and while this continues, it must heed the advice of the Director-General of the World Health Organisation(WHO), “Test, test, test. All countries should be able to test all suspected cases, they cannot fight this pandemic blindfolded.”
This requires ramping up the manufacture and distribution of a) personal protection equipment (from disposable face masks, to eye protection, gloves and gowns); b) lab testing and diagnostics, c) manufacture of medicines needed to treat secondary infections and complications and ventilators and d) rapidly creating dedicated hospitalisation facilities for those with serious infections.
The economic challenge
But what about livelihoods? Here, the key lies in not creating anything new, but protecting and ramping up select existing programs and supporting private actors in specific areas. The key is extreme selectivity, knowing that there is little time and limited capacity.
The Finance Minister’s proposals are broadly in the right direction, with a mix of cash (PM-Kisan, Jan Dhan) and kind (increased allocations of rice or wheat and free distribution of gas cylinders to beneficiaries under the Ujjwala scheme). Importantly these measures use existing plumbing — the Jan Dhan Account-Aadhar-Mobile (JAM) infrastructure and the Public Distribution System (PDS) — which despite some weaknesses, can ensure rapid delivery at scale.
The nearly 60 million ton grain mountain of Food Corporation of India can be rapidly drawn down via free rations through PDS. With the rabi wheat crop about to be harvested, it might be better to draw down rice reserves to a greater extent, else wheat markets could be hit hard.
Concurrently, there are three critical supply chains that need to be maintained: energy (electricity, fuel and cooking fuel); delivery services for essential goods; and agriculture harvesting and supply chains.
Electricity generation and distribution are not manpower-intensive activities. Distribution is, but hopefully there will be limited disruptions over the next few weeks. The very success of Ujjwala means that dependency on cooking gas has markedly increased, and free delivery to BPL families for a few months will be provide considerable relief.
The critical lacuna is agriculture where the government has to be more flexible, whether allowing farmers to sell outside Agricultural Produce Market Committees (and waiving manditaxes), allowing herders to graze their flocks and bring their goats to markets, and critically allow all seed supply operations which are hugely important for the planting of the kharif crop.
To manage the conflicting objectives of lives and livelihoods around agriculture, the government needs to work with arthiyas(middlemen) and farmers groups. Instead of farmers coming to the mandi, which then becomes a hotspot for disease transmission, it will be necessary to have the gram panchayats work with arthiyas to bring to the 22,000 Gramin Agricultural Markets and from there (if necessary) to the APMCs. As Mekhala Krishnamurthy argued in an excellent piece in ThePrint, with the rabi harvest in full swing, farmers need to be able to sell their produce and schemes such as Madhya Pradesh’s SMS-based pre-registration systems to try to regulate arrivals and manage logistics, while ensuring some social distancing.
Responses cannot be one-size-fits-all and will need to be tailored to local needs. Agriculture is a state subject and states and district administrators should have flexibility and be encouraged to be innovative and not punished for thinking out of the box
Deploying all institutions
But how should all this be done? What are the instruments the State has at its disposal? The enactment of Disaster Management Act 2005 established the National Disaster Management Authority (NDMA) in 2005, headed by the Prime Minister. The NDMA is the country’s apex body for disaster management, and is responsible for laying down policies and guidelines for disaster management and ensuring effective responses.
In 2009, India adopted a National Policy on Disaster Management. Following the Sendai Framework for Disaster Risk Reduction 2015-2030 (the first major international agreement of the post-2015 development agenda), the revised National Disaster Management Plan of 2019 recognizes that the State has the primary role to reduce disaster risk but that responsibility should be shared with other stakeholders including local government, the private sector and other stakeholders.
While the plan covers a wide range of emergency events, it largely envisaged local or regional effects, not the sort of systemic wide emergency that can bring down critical infrastructure and supply chains and overwhelm health care facilities.
With the NDMA acting as coordinator both horizontally (across government departments) and vertically (with states and districts), in addition to the 15 year old National Disaster Response Force (NDRF – a specially trained force which is structured like paramilitary forces for rapid deployment), the government needs to rapidly redeploy the three pan-Indian organizations with the largest human and organizational resources: the military; central armed police forces (CAPFs); and the Indian Railways.
The army has the best ability to rapidly scale up quarantine and hospitalisation facilities. The CAPFs need to be deployed in ensuring crucial supply chains (and, where needed, supplemented by the army). The railways have a network of 182 Accident Relief Trains, 165 Accident Relief Medical Vans (ARMVs). Each of these should be dispatched to a poorly resourced district to augment its weak health care facilities.
Concurrently the government needs to do five things.
One, there needs to be clear messaging about behavioral changes aimed not just at the public but also the police. If even the Prime Minster folds his hands, requesting the public to keep indoors, the police should be given stronger guidance and need to be under strict instructions that force should be the last and not the first resort.
Two, the State needs to work with industry to rapidly develop and manufacture diagnostic tests, personal protection equipment, medications and ventilators. This needs to be done in Mission Mode, working alongside empowered leadership from the private sector with deep experience and credibility in manufacturing. For each product requites one team, that midwives the manufacture of the product from selecting the design and standards, to identifying a set of manufacturers, ensuring working capital, and robust input logistics chains and output distribution channels. They need to be indemnified and protected against any future CAG, IT type enquires. Yes, there are risks in this approach, but the risk in delay are manifestly greater.
Three, the government needs to leverage the credibility and trust enjoyed by many civil society organisations to get essential services to vulnerable populations who the state cannot reach easily, such as migrants, older people or people with disabilities. And it should do so with fealty to its own National Disaster Management Plan of 2019 which pointedly devotes a whole chapter on social inclusion, emphasising, “While hazards do not discriminate, people do.”
Four, from health care to supply chains, from the civil services to public utility personnel, several million Indians will necessarily be part of maintaining essential services. They are serving the country at considerable risk to themselves. They need to have first claims to personal protective equipment and testing and better life insurance. The Finance Minister’s proposal for Rs 50 lakh medical insurance cover to health professionals is very much in the right direction.
Five, the government needs to recognize that in a crisis of this magnitude it needs the best expertise and competence, whether bureaucrats (serving or retired), or personnel from the private sector and civil society. Loyalty and ideology may have their place — but the costs today are simply too grave and manifest.
Finally, the Prime Minister has to realize that more than anything else, he will be remembered in history most by how he and his government handled this grave national peril. His leadership will require bringing the country together in a way that has not been his government’s strong suit. He needs to strongly lead with a spirit of cooperation with all states (such as a regular conference call with all the Chief Minsters), reach out to the political opposition and to all communities. History will then remember him as a healer and unifier, which will be critical to pull the country out from a spiraling national crisis.
(Devesh Kapur is the Starr Foundation South Asia Studies Professor and Asia Programs Director at the Paul H NitzeSchool of Advanced International Studies (SAIS) at Johns Hopkins University, Washington, DC. The views expressed are personal)