Harsh Mander: Despite warnings, Modi government had let India sleepwalk into the second wave

Along with grief, indeed because of our grief, we must also give ourselves spaces for rage.

Rage for the rotting human corpses that floated in rivers, corpses that burnt through nights and days on street corners, or were buried in anonymous mass shallow graves. Rage for the people who died profoundly lonely deaths, inside hospitals separated while dying and often even after death from everyone they had loved.

Rage for people who dies choking for oxygen outside hospitals. Rage because there were just not enough hospital beds, oxygen, doctors, nurses, medicines. Rage for a government that did not plan for medical oxygen, new hospital infrastructure, vaccinations, testing kits, medicines, ambulances and hearses. Rage for a public health system built primarily on private profit, that failed people when they needed it most.

Rage because India probably lost more people than any other country on the planet, to Covid-19, and to a myriad more health crises caused by the abrupt and cruel closure of our health systems, to hunger and joblessness, and to despair. Rage for literally lakhs of grievable lives, lives that could have been saved if only we had a government that cared.

Rage because the stunningly reckless hubris of the Prime Minister’s centralised and opaque decision-making. Rage because he chose at every stage of this unfolding humanitarian crisis to either not seek or brashly brush aside the counsel of scientists and economists. Because he wound up five of 11 empowered groups of scientific epidemiology experts (and the meetings of the others stopped). Because his government was not guided by the country’s considerable experience in successfully combating both AIDS and polio. Because India dangerously neglected genome sequencing which would have helped early tracking of mutations.

Rage because the Prime Minister refused to consult even his cabinet or chief ministers, or learn from the experience of governments around the world. Because he brashly declared premature victory over the virus, ignoring the warnings of scientists of the likelihood of the virus continuously mutating into more infectious and lethal forms.

Because, as observed by veteran journalist Prem Shankar Jha, he did not learn from the new “waves” that had already in 2020 hit countries like Belgium, Iran, South Korea, Germany, the Czech Republic, Spain and the United States. Jha notes that was only the leaders of three “large democracies with insecure but ruthless leaders in power: Brazil, the US and India” that chose recklessly to ignore the danger of new mutants and consequent waves.

Misplaced priorities

Rage because saving the lives of crores of “ordinary” Indians was never the priority of his government. Their lives were dispensable – their immense suffering when their livelihoods were suddenly choked overnight immaterial. Rage for a government that refused to be moved even when lakhs spilt onto the highways, trekking hundreds of kilometres with the children strapped on their backs to reach their homes.

Rage because the only comment of the Prime Minister in Parliament two years later was to blame Opposition parties for trying to help the migrants travel more safely on trains and buses to their homes. Rage because even as people were dying across the country, he thought it fit to pose for photographs in his official garden with peacocks and ducks.

Rage because his government supported by a compliant media and tens of thousands of Hindutva volunteers on social media and in villages and cities across the country cynically manufactured India’s Muslims as the scapegoat responsible for the spread of the virus.

Rage because Prime Minister Modi has never once accepted responsibility, let alone apologised, for the cataclysm of the second wave and for the lakhs of lives lost that could have been saved had he not ignored the counsel of science. Rage because his government allowed, encouraged and even organised super-spreading religious gatherings of lakhs and election rallies as in West Bengal in which massive crowds and the Prime Minister were most unmasked.

Rage because hundreds died in Uttar Pradesh because the government did not think it fit to postpone the local elections to a safer time. In his opinion piece for The Wire, Jha caustically into what he describes as Modi’s “utter irresponsibility” that lowered India’s guard fatally. It “emboldened lesser leaders in his party…like the Chief Minister of Uttarakhand [who] not only refused to cancel the Kumbh Mela but put out advertisements to draw more devotees from around India”. In fact, the number of recorded cases rose steeply by 1,800% in just a week after lakhs gathered for the Kumbh Mela in Uttarakhand. The Guardian notes that this was the single largest super-spreading event during the pandemic on the planet.

Rage because the Indian government opted for unpitying fiscal tight-fistedness instead of placing the equivalent of at least the minimum wages in the hands of every household in the informal economy, and doing nothing to rescue millions of tiny, small and medium enterprises that employed 11 crore of India’s poorest workers, accounted for over 40% of manufacturing, and contributed 30% of the GDP.

Rage because an estimated 97% of the Indian people became poorer because of the failed handling of the economy in the pandemic. Rage because schools that should have been the last to close and the first to open, remained shut for close to two years, throwing millions of India’s poorest children out of education, depriving them of the only chance they had of overcoming the poverty of their parents.

Rage because his government did not ramp up hospital beds and did not draw in the private health care sector to join in the national effort to save lives in the pandemic without profit. Rage because India, the world’s largest producer of vaccines did not produce or buy sufficient stocks of vaccines and did not plan for sufficient quantities of medical oxygen and its transport and for essential medicines.

Rage for leaders who displayed a pathological lack of public compassion. Rage because the government abandoned its people at a moment when they most needed it.

Rage for people who profiteered from human suffering, making super-profits from vaccines, medicines, hospital beds and ambulances that could have saved lives and firewood and hearses that could have offered solace and dignity after death.

Rage for what we have become as a people.

What went wrong?

How did the Indian people slip deep into the hell of the summer of 2021? What threw them into the most terrifying and most lethal humanitarian crisis that the country has endured since the cataclysmic Partition seven and a half decades back? How did the government manage to get everything so drastically wrong? Where did we lose our way?

India, after all, had the space of a year and a quarter after the virus first entered the country’s borders to prepare for – and substantially prevent – the tsunami of death and travail that eventually engulfed the country, one that swelled its figures of recorded infections and deaths to the highest in the world.

There was, in particular, a precious window of five months of relative respite from surging infection and death after October 2020. Governments in many other countries used such interludes to bolster and brace their medical infrastructure and preparedness for the next surge of the mutating virus. But the Modi government responded instead with criminal hubris that ultimately cost maybe a million lives, maybe more. The piling of bodies on city pavements for 24x7 burning pyres, mass graves and bodies thrown into rivers, people choking to death outside hospitals in parking lots or on hospital corridors amidst distraught relatives, all that have burned their way into our collective memory.

Some contemporary Indian commentaries of this time used the metaphor of hell to describe the dread and tumult of the second wave. “Ward rounds are now scenes from Dante’s Inferno”, wrote Mumbai physician Zarir Udwadia in the Financial Times. “Row upon row of patients waging a desperate struggle to breathe, their cries for help often falling on deaf ears as overworked medical staff struggle just to keep going. Essential drugs are not in stock and, most frightening of all, oxygen, that very essence of life, is in short supply.”

“It is rationed at all hospitals and so scarce in some, that patients are dying when it runs out,” Udwadia wrote. “Oxygen cylinders are sold at black market rates (Rs 50,000 rupees for a cylinder costing Rs 6,000) as desperate patients, realising it is futile to even contemplate getting a hospital bed, prepare for the worst and stock up at home.”

Debasish Chakraborty, Dean of the School of Business at Seton Hill University, also deployed devastatingly the metaphor of Dante’s Inferno. He spoke of India as now in the proverbial “Ante-Inferno” with the sign “Abandon all hope, you who enter here”. He speaks of hell as “the conceit, egotism and self-approbation of the Modi government”, its “callous indifference to the potential loss of human lives, their sufferings and the indignities in death” of allowing lakhs to gather for regional elections and the uninterrupted celebration of the Kumbh Mela, which incidentally The Guardian reported to be the biggest super-spreader event on the planet through the pandemic.

He takes you through the nine circles of the India hell, including no tests for Covid-19, no doctor to consult who you can afford, no hospital bed, no oxygen that takes your life, no death certificate, no helpers to get to your body to the crematorium, no wood or priest that your family can afford and the bribes they pay to ensure that you leave this world.

He rages, “Your sin, in fact, the collective sin of the country – choosing a government that substituted bigotry for inclusiveness, incompetence for efficiency, and smugness for governance – has partially been accounted for. You personally paid with your life. You ended up being George Floyd, unable to breathe because the knee of incompetence, indifference, and braggadocio sucked the air out of you.”

Dr Jalil Parkar of Lilavati hospital in Mumbai told The Guardian, “The whole healthcare system has collapsed and doctors are exhausted. There is a shortage of beds, shortage of oxygen, shortage of drugs, shortage of vaccines, shortage of testing.”

Leading medical journal Lancet, with surgical precision and forensic fairness, assigned responsibility for all these failures to many acts of omission and commission of the Narendra Modi government. In an unsparing editorial, it cited estimates from that time of the Institute for Health Metrics and Evaluation, that India could see 10 lakh deaths from Covid-19 by August 1, 2021.

As we saw, many experts agree: the numbers could be even higher. “If that outcome were to happen”, Lancet declared, “Modi’s government would be responsible for presiding over a self-inflicted national catastrophe.”

An editorial in The Wire is equally scathing: “The second surge of Covid-19”, it observes, “has caused a national calamity the likes of which India has not seen since independence”. It speaks of “growing evidence that it could have been countered and appropriate steps taken to minimise its deadly impact”.

The first wave overwhelmed healthcare systems everywhere, even in affluent countries, but, the editorial notes, “no country that went on to its second or third waves has seen the kind of chaos and death that India has. Or the kind of official bloody-mindedness that was on display with the green-lighting of potential super-spreading gatherings for politically expedient reasons”.

Failed state

Many commentators spoke at the time of the second wave of India as a failed state. Feminist activist Farah Naqvi described in agonising detail the horror of failing to find a hospital bed and oxygen for her ailing father, senior journalist Saeed Naqvi, and how the family coped. She titled her article fittingly with the question: “What we did when our government collapsed.”

Several other analysts agreed with her assessment of state failures. Yamini Aiyar, President of the Centre for Policy Research declared, “India has transitioned to a failed state”. “The ‘fiction’ of India’s health system is now exposed,” she added. “And as hapless citizens struggle to find oxygen, basic medicines, hospital beds, the once sound and functional ‘head’, or more specifically the national government, is no longer visible. Indeed, it has abdicated from all responsibility, from leadership and governance.”

Ruchir Sharma in the Financial Times said that the pandemic showed how “broken” the state was. The Economist said the “state has melted away in India”. India Today, a magazine not known generally to be stridently critical of the government carried a cover also describing India as “the failed state”.

The government, said Lancet, gave the impression that “removing criticism on Twitter” was more important “than trying to control the pandemic”. The forensic of its editorial pointed first to the government declaring a premature victory over the pandemic.

Union health minister Harsh Vardhan had pronounced before the second wave of the pandemic that India is in the “endgame”. In a self-congratulatory speech in Davos, Prime Minister Narendra Modi declared, “Many reputed experts and top institutions… predicted that India would be the most affected country from corona all over the world. It was said that there would be a tsunami of corona infections in India, somebody said… two million Indians would die…But India did not allow itself to be demoralised.”

“Rather India moved ahead with a proactive approach with public participation,” Modi said. “We worked on strengthening the Covid specific health infrastructure, trained our human resources to tackle the pandemic and used technology massively for testing and tracking of the cases. Today India is among those countries which have succeeded in saving the lives of the maximum number of its citizens and… the number of people infected with corona today is rapidly decreasing”.

The complacency that flowed from such declarations of triumph from the highest levels of government led the state to choose to ignore and stonewall many warnings from epidemiologists and senior leaders of the dangers posed by a second wave and by new mutants of the virus.

For instance, as far back as November 2020, a high-powered committee of Members of Parliament had anticipated a number of the crises that surfaced during the second wave and had recommended many remedies. Had the government heeded these suggestions, much of the suffering and death could have been prevented.

The committee highlighted “shortage of emergency supplies, red-tapism, shortage and quality of testing kits and delay in domestic production.” It noted that India produces 6,900 metric tonnes of oxygen a day, but in normal times the medical need is just 1,000 – the rest goes to industrial use. It said, therefore “there is a strong need to ensure that the oxygen inventory is in place” for hospitals and “oxygen prices are controlled”. Appropriate measures to cap the price of the oxygen cylinders, “so that the availability, as well as affordability of the oxygen cylinders, is ensured across all hospitals for medical consumption”.

The report urged the government to produce more vaccines and collaborate with maximum vaccine producers on a large scale to make more vaccines available, given the potential rise in the cases. And it described the availability of hospital beds as a “crucial aspect of the pandemic” because “the total number of government hospital beds in the country was grossly inadequate keeping in view the rising incidence of Covid-19 cases”.

Warnings ignored

In early March, a committee of scientists established by the government as the Indian SARS-CoV-2 Genetics Consortium had, according to Reuters, forewarned officials of “a new and more contagious variant of the coronavirus taking hold in the country”.

Indian SARS-CoV-2 Genetics Consortium was a team of scientific advisers charged with detecting “genomic variants of the coronavirus that might threaten public health”. Indian SARS-CoV-2 Genetics Consortium was linked with 10 national laboratories that study virus variants. It had detected the variant B.1.617 as early as February, according to the report. Dr Shahid Jameel, chair of the Indian SARS-CoV-2 Genetics Consortium, expressed concern that authorities did not heed their evidence and advice adequately, and did not restrict large gatherings.

“As scientists, we provide the evidence”, he said to Reuters, “policymaking is the job of the government”. Rakesh Mishra, director of the Centre for Cellular and Molecular Biology, part of the Indian SARS-CoV-2 Genetics Consortium, said “We could have done better, our science could have been given more significance. The expert group reportedly struggled even to get funding initially.”

Dr Jameel said India started seriously looking at mutations fairly late, with sequencing efforts only “properly started” in mid-February 2021. India was sequencing just over 1% of all samples at that time. “In comparison, the UK was sequencing at 5-6% at the peak of the pandemic,” he told BBC. “But you cannot build such capacity overnight.”

The government also assumed that the country had “reached herd immunity, encouraging complacency and insufficient preparation, but a serosurvey by the Indian Council of Medical Research in January suggested that only 21% of the population had antibodies against SARS-CoV-2”. Genome sequencing, Lancet said, needed to be expanded “to better track, understand and control emerging and more transmissible SARS-CoV-2 variants”.

Zarir Udwadia in the Financial Times also indicts of the “self-assured hubris” of the health minister who “crowed” in January that “India has flattened the Covid graph”.

India squandered the time we had between the two waves, which could have been used to “ramp up vaccine supply, ensure oxygen plants increased production and reinforce the importance of social distancing and masking”. Instead “we allowed massive election rallies to continue in five states and the Kumbh Mela saw 35 lakh pilgrims pack the banks of the Ganges”.

He laments the way “religious sentiments, political machinations and nepotism often trump public health principles and common sense in India”. The virus was forgotten “for we had already declared ourselves the victors”. And then the second wave struck “with the ferocity of a tidal wave, making the events of 2020 seem like a ripple in a bathtub”.

As The Guardian reported, the Bharatiya Janata Party governments in New Delhi as well as in Uttarakhand (which hosted the Kumbh Mela) insisted on going ahead with the celebration despite dire warnings from scientists of the march of the second wave. The Prime Minister featured in a full-page advertisement inviting devotees to the Kumbh, claiming that it was “clean” and “safe”. The BJP vice-president, Baijayant Panda, claimed that “Hinduphobic elements” were falsely maligning the event by labelling it a super-spreader. Uttarakhand Chief Minister Tirath Singh Rawat declared that “faith in God will overcome the fear of the virus”. He was among millions of devotees who took a dip in the Ganga without a mask.

Ashish Jha, dean of the School of Public Health at Brown University, estimated that the Kumbh Mela was possibly “the biggest superspreader event in the history of the pandemic”. T Jacob John, a former director of virology at the Indian Council of Medical Research, said that “Pilgrims from all states carried variant viruses and seeded epidemics.”

The Guardian collected accounts from the states of Madhya Pradesh, Uttar Pradesh, Bihar, Kashmir and Karnataka, of the virus spreading to far corners of the country. But officials did not trace and test the Kumbh returnees and their contacts, and confided in anonymity that they were instructed to not do so, presumably to deflect criticism.

The absolute contrast with a much smaller gathering of the Tablighi Jamaat in Nizamuddin in Delhi in March the earlier year, in which participants were aggressively traced and the results publicly broadcast daily by feverish television anchors, could not be starker, and more culpable. Still, we know, for instance, that in the week after the festival there was a 1,800% rise in cases detected in Uttarakhand alone.

Lancet too criticised the way in which the government casually and peremptorily brushed aside warnings and instead encouraged massive gatherings for elections and religious congregation. These events were “conspicuous for their lack of Covid-19 mitigation measures”. Even as the second wave was baring its teeth in April, an unmasked Prime Minister expressed satisfaction at the large crowds that had gathered to hear his election speeches in Bengal, packed closely together and also mostly unmasked.

“Leadership across the country did not adequately convey that this was an epidemic which had not gone away,” said K Srinath Reddy, president of the Public Health Foundation of India to The Guardian. “Victory was declared prematurely and that ebullient mood was communicated across the country, especially by politicians who wanted to get the economy going and wanted to get back to campaigning. And that gave the virus the chance to rise again.”

‘Botched-up’ vaccination

Lancet also critiqued the “botched-up” vaccination drive. When the second wave hit India, just 2% of the population were fully vaccinated. Data of the government, released in September 2021, highlights how massive are the numbers of deaths and hospitalisations that could have been avoided if the government had prepared in advance to procure sufficient vaccines and had rolled out a mass vaccination programme from January itself.

The government data showed that there were 121 weekly reported deaths per million among the non-vaccinated. Against this, there were just 2.6 weekly deaths per million among those who had received their first vaccination dose. For those fully vaccinated with the third dose, the death average fell even further to 1.76 weekly deaths per million.

The data for four months (April 18, 2021-August 15, 2021) showed that vaccine efficacy in preventing deaths was 96.6% after the first dose and 97.5% after the second dose. Think of how the vast majority of deaths could have been prevented if the government had done nothing else except ensure that it procured enough vaccines and vaccinated a majority of its people in the early months of 2021.

Udwadia aptly describes the “vaccine saga” as a scandal all of its own. Instead of wooing every credible manufacturer to stockpile the 170 crore doses India would need, we basked in our “vaccine superpower” status.

“The government got its basic maths hopelessly wrong: by March, India was supplying vaccines to 74 nations and exporting far more doses than it had used to inoculate its own citizens,” Udwadia said. “Initial vaccine hesitancy has now given way to vaccine desperation with densely packed crowds clamouring to get a precious dose only to find that most centres in Mumbai have no stock left. With only around 5% of India’s vast population vaccinated, herd immunity (70% vaccinated) is more than 700 days away.”

Lancet also underlined the need for government to publish “accurate data in a timely manner”, and forthrightly explain to the public what is happening and what is needed to bend the epidemic curve.

These failures build upon “the chronic under-investment and neglect of public health”. In its 2021 Budget, India allocated only 1.26% of its GDP to public health. “This pandemic has cruelly exposed our weakest links – badly equipped and understaffed public hospitals and chronic shortages of beds. That coupled with leadership that lacked vision and foresight may just change the map of India forever.”

Jagadish Shettigar and Pooja Misra, like many analysts, point to India’s abysmally low public spending on health. In a ranking compiled by the World Health Organisation, India is found to stand disgracefully at the very end of the line, at a lowly 184 out of 191 countries in health spending. The United States spends over 16% of its total GDP on healthcare, while Japan, Canada, Germany spend over 10% of their GDP on healthcare. India has 1.4 beds per 1,000 people, one doctor per 1,445 people, and 1.7 nurses per 1,000 people.

Preventing another wave, Lancet reminds us, would have required the government “owning up to its mistakes, providing responsible leadership and transparency and implementing a public health response that has science at its heart”. As we shall see in the coming chapters, there are no signs that the government heeded any of this sage advice.

Read the other parts of the “Tsunami of suffering” series here.

Harsh Mander is a Richard von Weizsacker Fellow, Chairperson of the Centre for Equity Studies and convenes the Karwan e Mohabbat, a people’s campaign to fight hate crime with solidarity and atonement.