COVID-19 in India: A tale of crumbling health systems and political one-upmanship

India’s government had a year to ramp up its health infrastructure. Instead, crucial time was lost in denial, underestimation, political one-upmanship and blame games

May 31, 2021 by Jyotsna Singh, Priyam Lizmary Cherian
Photo: USA Today

The orange and the yellow of funeral pyres; crematoriums spilling over onto footpaths and parking lots; patients sitting outside hospitals, sometimes with oxygen masks on, sometimes looking for one as their oxygen levels dropped.

These are some of the images with which the world has come to associate India and its raging COVID-19 crisis. One would hardly find someone in urban areas who has not lost a relative or an acquaintance in the past six weeks due to the pandemic. Social media has been full of cries for help for hospital beds, oxygen cylinders, medicines and sometimes, for space to bury or cremate a family member.

From April 24 till the end of May, India recorded more than 300,000 cases a day, reaching a peak of nearly 400,000 a day in the first week of May. The death toll soared as well. The country has been registering more than 2,500 deaths a day since April 27. On a number of days in May, the daily death toll crossed 4,000. News reports suggest that these are conservative numbers, with many pointing to gross under-reporting.

Public health experts believe that there were indications that the second wave might unfold and this time, the consequences could be more severe. Many believe that this crisis could have been averted with timely efforts. However, what happened was that lives were served to the virus on a platter as those in power, especially at the Center, focused on politicking rather than preparing for the impending crisis. The government had more than a year to prepare, but crucial time was lost in denial, underestimation, political one-upmanship and blame games.

During the initial months of the pandemic in 2020, it had become clear that the country lacked sufficient public health resources to tackle it and that a strict lockdown was the only way to save lives. The unplanned lockdown led to an unprecedented humanitarian crisis and millions suffered hunger and destitution. But it was expected that the government would use this time to ramp up the health system. These hopes were in vain.

Take the example of oxygen. While patients and families were running from pillar to post looking for oxygen cylinders, concentrators and cans, the Indian news website carried an investigative report on April 18. According to the report, the Union health ministry had floated a tender on October 21 to set up Pressure Swing Adsorption (PSA) oxygen plants in 150 district hospitals across the country. Twelve more hospitals were added to the list later. called 60 of those hospitals and found that only 11 units had been installed and of those, only five were operational. In a series of tweets shortly following the publication of the report, the government said that only 33 PSA oxygen plants had been installed.

Similar mismanagement took place in the case of vaccines. As of May 31, only 43 million Indians have received two doses of the vaccine. This is hardly 2% of the country’s total population and with rampant shortages being reported in a number of States, many are struggling to even get the first dose.

Currently, two vaccines are available in India — Covishield produced by the Serum Institute of India and Covaxin produced by Bharat Biotech. It was only in late April –  after the onset of the second wave – that the government approached three public sector units (PSUs) to manufacture the indigenously developed Covaxin. Full-scale production will take place only by late 2021 or early 2022. Had the government approached PSUs in December, when Bharat Biotech started production, many more vaccine shots would have been available by now.

The vaccine policy of the Indian government also flouted all principles of equity. When the slots were opened for the 18-44 age group, access was available only through an online portal, excluding the population which does not have digital access. Many vulnerable groups, such as tuberculosis patients, people with disabilities, refugees, the homeless, low-income migrant workers, hard to reach populations etc. were not prioritized. On the other hand, with little to no price regulation, vaccines were made available to private facilities for hefty amounts, while government institutions faced shortages.

A similar policy paralysis led to shortages of medicines, equipment, and infrastructure such as pulse oximeters, hospital beds, self-isolation centers etc. The black market for all kinds of health products mushroomed. During the peak of the pandemic, people were left scrambling for all these, looking to friends and often complete strangers for leads.

At the same time, 2020 saw some extremely anti-people laws being passed in the Indian Parliament, bypassing the regular consultative processes in the name of COVID-19. Farmers have been protesting against three farm laws for the last seven months, and their struggle has gained support both in India and in the rest of the world. However, the government has refused to scrap these laws. Additionally, many other government moves, such as the Labor Codes and rampant privatization of Public Sector Units, have attracted criticism.

The country’s political leadership didn’t prioritize investments or an active policy response in the field of healthcare. But it did find time for election campaigns, encouraging large religious gatherings and building a new residence for the Prime Minister.

The past year also saw a new wave of political repression, with many more political and social activists, including students such as Natasha Narwal and Devangana Kalita, thrown into jail. Despite repeated calls by the public, and the fact that many of these political prisoners are older than 60 and some have even contracted COVID-19 in prison, the government has refused to free them.

It seems that instead of gearing up for a second wave of COVID-19, the government made use of the past year to further its political agenda, and remained busy with propaganda and consolidation of power. In early May, a high-level meeting of bureaucrats was organized as part of an image makeover attempt for India’s COVID-19 response. Clearly, the government did not register that what was needed was a sincere, empathetic, and people-centric approach as opposed to attempts to hush up reality and shut down those speaking the truth.

Instead, the floating bodies on Ganges will remain in the collective memory of people for decades, reminding us how the Indian state failed to ensure basic dignity, even in death, for its citizens.