Maharashtra’s Health Minister Rajesh Tope last week expressed concern about the state’s rapidly depleting Covid-19 vaccine stocks. Soon after, the Union Health Minister, Dr Harsh Vardhan, claimed that this was a “deplorable attempt to distract attention from state’s failures and spread panic among people”. Harsh Vardhan said that the Maharashtra government had displayed a “lackadaisical attitude” that had ”singularly bogged down the entire country’s efforts to fight the virus”.

Discussions on television have contributed to this perception about Opposition-ruled Maharashtra’s Covid-19 efforts, polarising public opionion. Unfortunately, these debates have foregrounded politics and ignored the science of public health.

It is obvious from the numbers that Maharashtra has been one of the worst-affected states in the country. With 5,64,746 active cases as on April 12, the state has the highest number of cases in the country. But absolute numbers do paint a fair picture – one cannot compare apples and oranges. If comparable denominators are used to calculate the scale of the pandemic, the story is different.

As of April 9, Maharashtra stood seventh in the total number of cases per million population (25,929), after Delhi (42,085), Goa (41,986), Ladakh (38,715), Puduchery (34,829), Kerala (34,545) and Chandigarh (28,370). It also stood fifth in the number of deaths per million population (452), after Delhi (667), Goa (579), Puduchery (551) and Ladakh (474).

There are other factors to consider. The second wave of the pandemic in India hit Maharashtra first. The numbers show an interesting change from the first wave. Maharashtra’s fatality rate has significantly reduced in the second wave, with current weekly case fatality rate at less than 0.6%. While some of this may be attributable to the newer strains of the virus, the state’s efforts in terms of early diagnosis and stringent treatment protocols cannot be ignored.

High urban population

When the pandemic came to India last year, Maharashtra, the country’s second-most populous state, was always expected to have a high number of cases. As one of the most economically progressive states, Maharashtra has a very high urban population – almost 50%. Around the world, urban populations have seen a higher number of Covid-19 cases than rural areas. Maharashtra seems to follow the same pattern.

Moreover, Maharashtra witnesses a high footfall of international travellers. Given that Covid-19 is an imported disease, Maharashtra naturally became the epicentre of the pandemic in India. Similar patterns have been found in the international hub of Delhi as well. Singling out Maharashtra is not justified.

Covid-19 protocols

It is evident that Covid-19 protocols are not being seriously followed by people across the country, which is a key reason that India has not been able to contain the pandemic. This inappropriate behaviour has not been limited to Maharashtra.

With recent weeks seeing elections in four states, both Prime Minister Narendra Narendra Modi and Home Minister Amit Shah have addressed enormous, densely packed rallies. Health Minister Harsh Vardhan has proudly tweeted out images of these events in which masks are a rarity.

Another source of criticism for the Maharashtra government has been its weekend lockdown and the possibility that more restrictions could follow. Government supporters on social media have criticised this, concerned about the economic impact of a shutdown on the national economy.

This is an irony. Though the country-wide lockdown last year had severe downsides, the Centre, in the Economic Survey of India 2021, justified the restrictions, claiming that “India restricted the Covid-19 spread by 37 lakh cases and saved more than one lakh lives”. If that is the case, surely Maharashtra should also be allowed to exercise a similar option to protect the lives of its citizens?

There’s also the matter of transparency. The Maharashtra government has been upfront in its reporting of Covid-19 cases. Other states, however, have concealed data by recording that Covid-19 patients have died of pre-existing conditions like diabetes or hypertension. Given this situation, it doesn’t seem fair to compare Maharashtra with other states.

Another attack on Maharashtra was launched by Union Minister Prakash Javadekar last week, when he claimed that the state had wasted five lakh doses of the coronavirus vaccine. However, it is important to understand that wastage is an expected element of any large-scale vaccination drive. There are several reasons why vaccines get wasted, including vials being damaged during transport or handling, the breakdown of cold chain and vaccine expiry.

The Union Health Ministry has urged the states to limit the wastage to below 1%, but the current national average is around 6%, with some other states wasting over 10%. Maharashtra’s health minister has refuted the Javadekar’s claims, noting that vaccine wastage in the state is less than half of the national average.

The vaccine shortage that is being talked about by many states, including Maharashtra, is a real problem. Many vaccination centres in the state had been temporarily shut because of the lack of vaccine availability. This will have severe repercussions, especially given the high number of new infections in the state.

Vaccine diplomacy

But why is there a shortage in the first place? The significant reduction in the number of cases after October 2020 allowed India to become complacent and carry out vaccine diplomacy by exporting doses to dozens of countries. This effort was widely hailed by the public. India’s ambassador to the United Nations boasted that India has supplied more vaccines to the world than to its own people.

While India has always been a significant exporter of vaccines, doing so at the cost of its own people was always bound to have serious consequences. This is one of the likely reasons that we are facing a shortage.

The Centre is adamant on not allowing the states to give vaccines to those below 45 years of age, despite the fact that people in this age group have also been infected by the second wave. However, this rule seems to have been broken in some places. For instance, 900 ineligible beneficiaries at IIT Gandhinagar in Gujarat were vaccinated.

With Maharashtra being the epicentre of the pandemic and the situation worsening by the day, shouldn’t the state get a bigger share of vaccines? The supply is definitely not commensurate with the scale of the crisis. States like Uttar Pradesh and Madhya Pradesh are still getting precedence over Maharashtra in the number of vaccine doses supplied by a considerable margin. That is neither scientifically, nor morally justifiable.

There is no right answer

India has been trying to fight the coronavrus crisis for over a year and experts know that no strategy can be completely fool-proof – whether it is the Centre’s or a state’s. But instead of providing real support to the state, the Centre seems committed instead to dividing public opinion for political mileage.

It is also worthwhile reiterating that though public health is a state subject according to the Indian Constitution, many key decisions during Covid times are still in the hands of the Central government. States have managed many a crises in the past, such as it the swine flu epidemic in Maharashtra in 2009 or the Nipah outbreak in Kerala in 2018. Instead of playing a monitoring role, the Centre could play a facilitating role and help states perform their tasks. It could help the states replicate the best practices from around India and produce better health outcomes.

Had this been a flood or an earthquake, we would have perhaps seen unhindered support pouring in from all quarters. India should remember that the Covid-19 pandemic is akin to a natural disaster and politicising the management of the crisis will leave the population vulnerable. This is what Indians need to worry about, more than the Maharashtra’s perceived “lackadaisical attitude”.

Dr Sumedh MK is a public health professional, currently working as a consultant with the Maharashtra government’s public health department. The opinions expressed in this article are personal.