Much has been said about the need for universalisation of vaccines and better coordination. But it is important to remember that a successful vaccination strategy will require transparency, citizen confidence and trust. (REUTERS)
Much has been said about the need for universalisation of vaccines and better coordination. But it is important to remember that a successful vaccination strategy will require transparency, citizen confidence and trust. (REUTERS)

As Covid’s second wave surges in India, history repeats itself

From curbs to blindness towards the plight of labour, from opacity in data to blaming citizens, it is 2020 all over again
By Yamini Aiyar
UPDATED ON APR 09, 2021 03:43 PM IST

History repeats itself, first as tragedy, then as farce. One year after the imposition of the world’s strictest lockdown, India is now in the grip of a second Covid-19 wave. Aided by new variants, Covid-19 is spreading rapidly as is the penchant of governments for arbitrary mini lockdowns, weekend lockdowns, full lockdowns and night curfews.

Hapless migrant workers, left without social security and uncertain job prospects, are once again queuing up at bus and train stations to go back home, their incomes already ravaged by the disastrous choices made last year. Like last year, there are no signs yet of any relief or stimulus in the offing as the economy takes an inevitable hit. Rather than pursuing coordinated policy action, the Centre and state governments are back at war.

Yet, consensus has been forged amongst all arms of the State to resort to familiar toolkits — coercive policy through confounding orders (from last-minute lockdowns to making masks compulsory while alone in a vehicle); opacity (critical data — vaccines and reinfection, vaccines and side effects, disease severity, lockdowns and transmission dynamics — are missing from the public domain) and blaming citizens for abandoning Covid-19 caution even as the political leadership has willingly thrown caution to the winds in pursuit of political power. The farce is now unfolding as rapidly as the second wave and its consequences will be tragic.

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Was this inevitable? Absolutely not. The year 2021 is not 2020. Despite many unknowns, India learnt important policy lessons that could have avoided repeating history in 2021. We learnt how to scale up testing, especially when it is demand-led — an implicit lesson for our vaccination strategy. Doctors and patients have a better understanding of treatment protocols. Crucially, we learnt a few things about transmission dynamic, especially that it is spatially clustered. Analysis by Centre for Policy Research on early testing data from Punjab in April 2020 traced 80% cases to less than 2% of the state’s polling booths. Even today, a cluster of states are contributing to the bulk of the case load.

Spatial clustering calls for an agile, localised, coordinated health response. From surveillance to treatment and vaccinations (demand for vaccines is likely linked to experience of surges, which is one explanation for the emerging supply constraints), health resources can be repurposed, as China did in Wuhan, to service areas where cases are surging. But this requires the Centre and states to work together through institutionalised coordination mechanisms that simply do not exist.

In his meeting with chief ministers on Thursday, Prime Minister Narendra Modi ruled out the possibility of a national lockdown, pushing instead for a localised, micro containment strategy with increased testing and tracing. The infrastructure is in place, the PM said. The challenge is that of governance.

But the reality is India needed far greater investments in our public health infrastructure, investments that go beyond protective kits and testing labs. Localised strategies require well-resourced public health systems — enhanced surveillance capacity, increased human resources at the community level and improved data systems. When the first wave began to abate, we had the opportunity to learn lessons and devise policy to respond to a possible second wave (this was never off the table) and future pandemics. Instead we got policy complacency and now a repeat of history.

Lockdowns or not, the second wave will have a serious impact on our battered economy. Images of migrant workers making their way home have once again made headlines. Despite the significant economic impact of the 2020 lockdown on the poor, calls for expanded income support were ignored. The finance ministry refused to unlock its purse strings, paving the way for a profit-led recovery. Once again, there are no signs of a relief package even as workers and firms face renewed uncertainty.

Crucially, as the second wave spreads, state governments are likely to face differential economic consequences, linked to transmission dynamics and state specific socio-economic profiles. If the Centre were to craft an appropriate response, fiscal support will need to be calibrated to state-specific needs. This will require the ministry of finance to devise an economic strategy, revisit GDP projections for 2021-22 and work closely with states. It didn’t do this in 2020, and has, so far, shown no signs of learning lessons from last year. Inequalities widened in 2020 and the second wave will only deepen this trend, laying bare the farce of equal citizenship.

Finally on vaccines, the magic bullet solution India was relying on. India’s vaccine strategy is stumbling precisely because we failed to learn lessons from 2020. Tight bureaucratic control, complete lack of coordination, and a strategy that blames citizens, both for vaccine hesitancy and for demanding universal vaccinations, rather than builds their trust, is dominating vaccination roll out. Much has been said about the need for universalisation of vaccines and better coordination. But it is important to remember that a successful vaccination strategy will require transparency, citizen confidence and trust. Key data need to be collected and made transparent to the public – on vaccination supply, on adverse effects, on reinfection rates. Only then will citizen confidence and trust be built. In the absence of data and transparency, large-scale vaccination will remain an elusive strategy.

Trust, confidence, transparency and co-ordination. These ought to be the tools for India as we respond to the second wave. There is still time to course correct. If not, history will repeat itself as farce. A farce India cannot afford.

Yamini Aiyar is president and chief executive, Centre for Policy Research

The views expressed are personal

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