Abstract
In early 2020, when the COVID-19 pandemic was indiscriminately spreading around the world, the seeming ability of India, the world’s second most populous country (with over 1.3 billion people), to contain the virus within its borders and keep COVID-19 infection and mortality rates low relative to population size was seen as miraculous. However, the miracle ended when the ‘second-wave’ hit India in April 2021. On 1 May 2021, India became the first country in the world to record more than 400,000 coronavirus infections in a single day. This exponential rise in COVID-19 cases started on 28 April 2021 when India recorded 379,459 new COVID-19 cases and 3,647 deaths. This marked the eighth straight day of more than 300,000 cases a day—making India the second-highest COVID-19 case count in the world (over 20 million) with over 25 per cent of the global deaths from COVID. The following examines India’s fight against the pandemic, the failure to contain the second wave, the lessons learned and the way forward.
Besides its tragic toll on human lives and crippling national economies, the pandemic caused by SARS-CoV-2 (the virus that causes COVID-19) has also reignited an enduring philosophical and political debate: the relative performance of democratic and authoritarian rule in combatting the deadly coronavirus pandemic. Some have grudgingly concluded that the Peoples’ Republic of China (PRC) as the world’s most powerful authoritarian state has been far more successful in mitigating the spread of the virus within its borders and saving lives when compared to the world’s democracies, in particular, the preeminent liberal democracy, the United States of America. They express grave concern that ‘if, when this pandemic finally abates, the dominant global narrative becomes “It was China’s authoritarian system that helped us, while the democracies of the West floundered and selfishly turned in on themselves,” humanity will emerge from this devastating crisis into a radically different and more dangerous world, one deeply hostile to freedom and self-government’ (Diamond, 2020, p. 1).
To be sure, facing an unprecedented challenge, national governments have responded to the pandemic in particular ways. Nevertheless, if one takes prima facie an objective metric of the number of deaths due to COVID-19 infection, then democracies, in particular, the United States, the United Kingdom, Italy and Spain have among the worst records. Similarly, advanced democracies, in particular, the United States and the United Kingdom’s mitigation efforts to contain COVID-19 have been seemingly unorganised and haphazard compared to the performance of the Peoples Republic in containing the spread of the virus within its borders and limiting the number of fatalities. 1 Yet, this ‘authoritarian efficiency’ seems to be applicable only to China and not to other autocratic states such as Russia or to the once promising new democracies such Hungary and Turkey—which have slid into illiberalism and pseudo-authoritarianism. On the other hand, the experience of a number of democracies, including Taiwan, South Korea, the Nordic countries (Norway, Sweden, Denmark and Finland), Australia, New Zealand and the world’s largest democracy, India illustrate that democracies can effectively respond to unexpected and unprecedented crises—as these countries did with varying success in dealing with both the initial outbreak and subsequent mitigation efforts to control the pandemic.
What explains these discrepancies? Certainly, democracies with their multiple veto points and deliberative policymaking face greater constraints in timely and efficacious implementation, including quickly responding to unexpected crisis and highly improbable ‘black-swan’ events, 2 are no match for autocracies which can quickly promulgate and enforce unpopular measures via top–down edicts without consultation or respect for civil and individual rights and liberties. Nevertheless, as Francis Fukuyama (2020, p. 1), among others, have argued, the key to success in fighting the COVID-19 pandemic are ‘whether citizens trust their leaders, and whether those leaders preside over a competent and effective state’. The following pages with reference to India illustrate the critical determinant in the nation’s fight against COVID-19 proved to be a combination of competent (or more appropriately, a proactive) executive leadership; high-level of state capacity (i.e., not necessarily a strong centralised state, but state with competent bureaucratic and administrative capacity); and, perhaps most importantly, public trust and confidence in the political leadership, in particular, Prime Minister Narendra Modi.
No doubt, the pandemic put the Indian government (like other democratic governments), in a difficult position. Decision-makers had to balance protecting public health and saving lives while at the same time safeguarding individual rights and freedoms. The need for quick response to fight an invisible enemy often demanded the concentration of power in the executive branch (or the prime minister’s office) at the expense of state governments and other institutions. Moreover, as the guidelines, rules and regulations to limit the spread of the virus such as hand washing, wearing face masks, social distancing and limiting outside contact (including self-isolation) are difficult to enforce, their success greatly depended on broad buy-in from the citizenry and the public voluntarily obeying them. In short, ‘public trust’ is essential for effective compliance. If people have trust in their political leaders and the government, in particular, believe that those making decisions (and the rules) and are doing it for the common good and will also follow them, voluntary compliance from individuals and the larger society will be more forthcoming. For example, in the United States, widening political polarisation and a sharp erosion of public trust—with the Pew Research Center (2020, pp. 2–3) reporting that ‘during the last three presidencies—through the final years of the George W. Bush administration and the presidencies of Barack Obama and Donald Trump, the share of Americans who say they trust the government just about always or most of the time has been below 30%’, broad compliance with government mandates regarding the pandemic has been a challenge. For example, another Pew Research Center (Tyson et al., 2020) survey conducted in September 2020 of more than 10,000 Americans showed that only a slim majority (51%) of adult respondents would definitely or probably get a vaccine to prevent COVID-19, were it available today. The share who would definitely get a vaccine was barely a fifth of the total (21%). The reluctance to take the vaccine had much of do with the respondents’ political affiliation, their level of trust in government and how individuals processed the messaging by politicians and government officials. 3 On the other hand, because the Chinese government, in particular, the central government, enjoy relatively high levels of trust, it has made it easier for the authorities to garner broad consent and acquiescence and to adopt various measures, including punitive ones, to respond to the pandemic (Cunningham et al., 2020; Saich, 2016a, 2016b). In the case of India, the broad public trust and confidence that Modi enjoys has certainly helped the country in its fight against the COVID-19 pandemic—albeit, trust, although necessary, by itself is not a sufficient condition for success.
Political Trust and Inadequate Planning
According to the American firm, Morning Consult (2020), which tracks the approval ratings of world leaders, Prime Minister Narendra Modi’s approval rating has been consistently higher than any other world leader with 75 per cent approval. Similarly, an India Today ‘Mood of the Nation’ poll in August 2020 found that 78 per cent rated Modi’s performance as ‘good to outstanding’ compared with 71 per cent in 2019. 4 No doubt, this is an impressive achievement in a representative democracy with a low threshold for incumbents and where approval ratings can fluctuate widely. However, approval of and trust and confidence in Modi does not translate into trust in India’s political institutions and actors such as the parliament, the police, the legal system or political parties (including Modi’s own Bharatiya Janata Party (BJP) and politicians—which is consistently low. Nevertheless, this consolidation of trust in one charismatic individual certainly proved to be helpful as Modi’s reassuring presence and his appeal to the public to wear face-mask, avoid mass gatherings, practice good hygiene by washing hands regularly and maintaining social distancing resonated with the masses, with the majority approving his stance.
Nevertheless, at a time (in the first 6 months of 2020) when the pandemic was indiscriminately spreading around the world, the seeming ability of the world’s second most populous country (with over 1.3 billion people), to contain the virus within its borders and keep COVID-19 infection rates low relative to population size was widely seen as miraculous. Indeed, it was a miracle that India had dodged the bullet as the central government in the critical weeks between January and mid-March 2020 remained rather complacent (arguably relying on Modi’s messaging) as the authorities chose to ignore the advice of the World Health Organization (WHO) regarding extensive testing to detect, isolate and contain the virus from spreading. To the contrary, India had among the lowest testing rates in the world. However, when on 17 March 2020, India reported its third death from COVID-19 5 (although the 150 confirmed cases remained unchanged), the Prime Minister and his administration began to take more proactive measures to mitigate the spread of the virus—such as more comprehensive testing, contact tracing and surveillance, requiring thermal screening of all arriving airline passengers, limiting foreign arrivals to India by suspending visas, requiring all arrivals to undergo a mandatory ‘Universal Health Screening’, and mandatory two-week quarantine for all incoming travellers, including Indian citizens. In addition, Indian citizens in high-risk countries such as China, Iran, Italy and Japan were evacuated, and citizens explicitly advised to avoid all non-essential travel abroad. Nationally, the Modi’s government placed a ban on the export of medical equipment and pharmaceuticals and conducted targeted testing to weed out both the asymptomatic (or individuals who are infected but never develop any symptoms and the ‘pre-symptomatic’ (or the infected who have not yet developed symptoms but may develop symptoms later). Also, in order to stop community transmission, the central government ordered severe restrictions on mass-gatherings, including closing schools, restaurants, temples, gyms and swimming pools, besides mounting a massive public awareness campaign to inform and combat misleading information such that the consumption of curry powder, garlic or cow’s urine would prevent the COVID-19 infection.
On 24 March 2020, the Modi government abruptly announced a 21-day nationwide lockdown as a ‘preventive measure’ to contain the spread of coronavirus by banning all forms of ‘community gathering’. Apparently as a prequel to the lockdown, the central government ordered a 14-hour voluntary Janata or ‘People’s curfew’ on 22 March between 7
The Modi government subsequently extended the lockdown in phases: Phase 1: 25 March to 14 April (21 days); Phase 2: 15 April to 3 May (19 days); Phase 3: 4 May to 17 May (14 days); Phase 4: 18 May to 31 May (14 days), and again extended until 31 July, then to 31 August, and again to 31 October. Furthermore, to enhance intervention, the central government divided the 741 districts that make up the Indian union into three zones based on the spread of the virus or the number of confirmed cases into green, red and orange, with appropriate control and mitigation measures for each zone. However, contrary to conventional thinking, the pessimism that the peculiarities of India’s federal system which often makes cooperation between the Central government (or the centre) and the 28 states and 8 union territories contentious and difficult (especially when the party in power at the state-level is in opposition to that at the centre) did not materialise. In part, this was due to the fact that India’s federal system clearly defines powers of the central and state governments. Under the constitution, the central government has jurisdiction over 98 items, including defence, foreign affairs and finance. The states have jurisdiction over 59 items, including public order, the police and public health. Other government responsibilities are held concurrently by the central and state governments. Because under Indian federalism ‘public health’ falls under the purview of the state governments, it gave the state government’s considerable autonomy to craft their COVID-19 response policy. Indeed, the governments of Odisha, Punjab, Maharashtra, Karnataka, West Bengal and Telangana extended the third phase of the lockdown in their respective states even before the announcement from the central government. For its part, with the BJP enjoying a majority in parliament gave the central government a free hand in crafting the COVID-19 response. Indeed, the constitution’s under ‘extraordinary circumstances’ provisions, including two laws, the Epidemic Diseases Act (EDA) 1897 and the National Disaster Management Act (NDMA) 2005 served to empower the central government to make decisions regarding how to combat the pandemic as it saw best. Specifically, the EDA and the NDMA in giving the central (and also state governments) concurrent jurisdiction allowed both to take immediate ‘preventive emergency measures’ to control epidemics by closing ports of entry and exit, placing restrictions on all forms of mass meeting, including religious gatherings, closing recreational facilities, educational institutions and requiring all non-essential businesses to allow their staff to work from home.
The Pandemic Spreads and the Government’s Response
Nevertheless, beginning in April 2020, the number of reported cases began to steadily increase and in June, ‘transmission began increasing at an exponential rate. It took almost six months for India to record 1 million cases on July 17. Then, it took another three weeks to hit 2 million, 16 days to reach 3 million, and only 12 days to pass 4 million in early September’ (Yeung & Suri, 2020). By mid-September 2020, India’s infection rate climbed to the second-highest in the world (more than 4.4 million), and with the third highest fatalities (over 75,000). Although the Indian authorities continued to stress that India’s overall mortality rate (calculated by the number of deaths per 100 confirmed cases) was still low compared to other countries with high infection rates, privately there was growing concern that something had gone wrong in India’s fight against the pandemic.
In hindsight, the lockdown decision had far-reaching unintended consequences—something the Modi administration had failed to take into account, and more importantly, how to effectively address. Undoubtedly, experience from several countries, including the United States, several EU nations, Australia, New Zealand and China, among others seem to confirm that a sweeping nationwide lockdown was the most effective strategy in mitigating the spread of COVID-19. Indeed, a complete national lockdown was not only recommended by several national Medical Associations, including the WHO, it was also credited for curbing the pandemic’s spread in hard-hit countries like Great Britain, Italy and Spain. However, in hindsight, such a strategy turned out for be wholly inappropriate for a developing country such as India. More specifically, not only an estimated 300–350 million Indians still subsist barely above the poverty line, significant numbers (an estimated 65–100 million) earn their living as migrant workers in the country’s teeming metropolitan centres such as New Delhi and Mumbai. 6 Moreover, the sex and age composition of migrant labourers are diverse. They not only include young males but also nuclear and extended families with children and relatives who work as daily-wage earners in the cities formal, but mostly informal economy. If they are fortunate, they may get to live where they work, but migrant workers mostly exist cheek by jowl in the densely populated bastis (slums) that surround India’s big cities. It is not uncommon for India’s urban poor—whose ranks continue to swell with a steady stream of poor and destitute migrants from the countryside—to live in extremely cramped conditions with single adults and families sharing a single room, usually without access to clean water, ventilation or proper sanitation facilities such as toilets. Because COVID-19 is spread mainly through close contact from person to person, including between people who are physically near each other (within about 6 feet), maintaining good hygiene and social distancing in such an environment is simply impossible.
Although the central government was quick to blame the state governments for failing to properly implement the lockdown, in particular, failing to provide marooned migrant workers with food and shelter, there is no denying that the abrupt lockdown imposed without adequate consultation with state governments caught everyone off guard. The Modi government’s lockdown strategy had a devastating impact (albeit, unintentionally) on the urban poor, in particular, the most vulnerable and marginalised (the migrant workers)—and the most ironic, instead of controlling the virus, further accelerated its virulent spread. It seems that the lockdown was not only announced without sufficient prior notice but also with little or no advance preparation, indeed no contingency plans to deal with the potential human and economic costs of the lockdown. Within hours, millions of migrant workers found themselves in a state of limbo—literally stranded in different cities throughout the country, and without the wherewithal to sit out the three-week long shutdown (Patel, 2020; Stranded Workers Action Network, 2020). Because the urban poor, in particular, migrant workers mostly survive day to day on their daily wages and lack job-protection, employers, in particular, in the informal sector, predictably assumed no responsibility for them, in terms of their wages, housing and safety. Perhaps, even worse, the central government also neglected to put in place the necessary support for these workers such as providing them temporary shelter (in the sweltering heat) and basic provisions such as food and water. Making the situation even worse was the abrupt suspension of the transportation system until May 1, especially, bus and train services. Indian Railways, the lifeline of the country and the world’s biggest rail network carrying more than 25 million passengers daily cancelling all services (except for trains delivering goods) meant that migrant workers were left on their own to find their way back to their homes—sometimes hundreds, if not, thousands of miles away. The resultant exodus on foot saw hundreds of thousands of migrants, many with their families and meagre belongings in tow literally walking, often several hundred miles back to their homes. According to one account, ‘Within hours of his [Modi’s] announcement, millions of migrants began fleeing the cities, the key highways filled with men, women and children, carrying their belongings, trying to walk home, sometimes hundreds of miles away. Several people died in the process’ (Pandey, 2020, pp. 1–2). The long, arduous and sometimes dangerous trek without sufficient provisions, and no way to buy basic essentials on the road as private shops were closed and the few hastily erected government-sponsored relief shelters too few and far between, resulted in countless deaths 7 —but also an occasional uplifting story such as that of a 15-year-old girl who cycled some 700 miles with her severely injured father sitting precariously on an old bicycle back to their village. However, as the migrants journeyed back to their homes, unknown to them, some carried the deadly COVID-19 virus and in the process further spread it throughout the country. Although, after 1 May, the government organised special trains to transport the stranded migrants back to their homes, they failed to conduct COVID testing—again in the process sending potentially infected individuals back to their towns and villages. Again, in hindsight, instead of curbing COVID-19 spread, the poorly conceived and managed lockdown decision did the very opposite—it further accelerated what the authorities dreaded most: community spread.
In such an environment, mitigation efforts were further compounded by a chronically underfunded public health system. India’s overstretched public healthcare system, the result of successive governments underspending (receiving in 2020 only 1.6% of the nation’s GDP), simply could not meet the demands imposed by the pandemic. 8 Unable to receive timely help in the country’s vast network of government hospitals and dispensaries with its poor facilities and inadequately trained medical staff, nor able to afford the expensive state-of-the-art private hospitals and medical facilities, the vast majority of Indians simply had little recourse if they became infected (Duggal & Hooda, 2021). In fact, for millions, the harsh reality of the nation’s glaring socio-economic inequalities and entrenched poverty—where access to clean water is a luxury, washing hands regularly to prevent the spread of the coronavirus became a challenge.
As COVID-19 continued its deadly spread, with no clear indication when the nationwide lockdown would be eased or ended, the economic pressures became further exacerbated. In fact, the Indian economy was already slowing when the COVID-19 pandemic struck. Real GDP growth rate had dropped from an average of 7.4 per cent in 2016 to 4.2 per cent by early 2019. However, with the onset of the pandemic, in particular, following the national lockdown the economy took a nosedive with real GDP contracting by an unprecedented 23.9 per cent between April to June 2020—the worst contraction in the country’s history. Suffice it to note that the IMF’s prediction that the Indian economy was likely to contract by 10.3 per cent in fiscal year 2020–21 further alarmed policymakers.
With the economy literally closed pushing millions into the ranks of the underemployed and unemployed, the demand for public support predictably grew. For their part, most state governments could not do much as most were already facing budgetary problems due to the sharp slowdown of the Indian economy before the pandemic. With the onslaught of pandemic and near shutdown of all economic activity, state tax and revenue collections fell sharply pushing state governments to demand more assistance from the central government for resources. This, in large part, is due to the fact that under India’s centralised economic system, state and local governments depend heavily on transfers from the centre. However, the central government’s often standard pass-the buck response that state governments were fundamentally responsible for addressing public health, including the social and economic effects of the lockdown only served to further exacerbate centre–state relations. Under pressure from their constituencies, governments in the hard-hit states and union territories, for example, Delhi Chief Minister Arvind Kejriwal began to demand a “focus on the next stage. During COVID people lost their jobs, factories were closed, people faced losses, it became difficult for people to face themselves…. Let us now focus on reviving India’s economy’ (Yeung & Suri, 2020, pp. 1–2). Pushed to the wall, both the central and state governments began to quietly rollback the lockdown restrictions (in June) at the very time when infection rates were soaring (Kazmin, 2020).
Like governments in the advanced nations, the Modi administration also responded to the socio-economic shock of COVID-19 by boosting the economy with economic stimulus packages, including measures to mitigate the adverse impact on workers by compensating for lost income, assisting the most vulnerable through various social protection measures as well as liquidity and financial support for small and medium businesses. To its credit, the central government, recognising its earlier policy lapses, in particular, how its national lockdown measures had exacerbated the plight of vulnerable groups such as migrant workers devoted much attention to assisting the informal sector workers. Indeed, the authorities acknowledged that without immediate and targeted intervention to assist the vulnerable and the poor, millions of people who already live precariously close to the poverty line faced the risk of slipping back into destitution and poverty, including hunger. On 26 March, the government announced ₹1.7 trillion (US$22 billion) relief package to assist the poor, including migrant workers through cash transfers and initiatives to boost food security. Again, on 12 May, the Prime Minister announced a COVID-19 relief package of ₹20 trillion (US$260 billion) aimed at fiscal and monetary measures to boost the economy. These measures were to be complemented by initiatives such as the Pradhan Mantri Garib Kalyan Anna Yojana (a Food scheme) designed to provide poor households (both urban and rural) an additional 5 kg of wheat and rice (in addition to the 5 kg already allocated) and 1 kg of pulses for free for the next 3 months. 9 Altogether, these measures—albeit, modest—enabled millions to weather the pandemic as it guaranteed that their basic subsistence needs would be met.
The Decline in COVID Cases
Rather abruptly, reaching its peak in mid-September 2020 (with over 90,000 cases reported daily), there was a steady decline in the number of new cases to under 30,000 in December 2020. By the second week of February 2021, ‘India was barely counting an average of 10,000 COVID cases every day. The seven-day rolling average of daily deaths from the disease slid to below 100. More than half of India’s states were not reporting any COVID deaths. On Tuesday, Delhi, once an infection hotspot, did not record a single COVID death, for the first time in 10 months’ (Biswas, 2021, pp. 1–2). Although the reasons for this downward trend remain unclear, the prevailing view at the time attributed this positive development to the country moving towards some form of herd immunity—or that a threshold has been reached where enough people have developed some immunity to the virus. It was also claimed that the country’s relatively young population (in 2020, more than half of India’s population is under 25, more than 65% below the age of 35 and only 6% over 65 years) helped limit mortality as elderly people (over age 65) with pre-existing health conditions are found to have the highest risk of mortality to SARS-CoV-2. Moreover, because large numbers of Indians have already been exposed to a variety of diseases throughout their lives such cholera, typhoid and tuberculosis many have developed greater immunity to infectious and communicable diseases. 10
However, government policies both directly and indirectly also contributed to the decline. First, the highly centralised approach such as the complete nationwide lockdown on 24 March 2020 (with restrictions gradually relaxed in phases) under which all symptomatic patients and families were quarantined not in their residences but in healthcare facilities, and infected neighbourhoods declared ‘containment zones’ and isolating individuals who may have come in contact with those infected, helped mitigate the spread of the virus, especially in densely populated major cities. Second, the authorities were able to quickly overcome problems due to the lack of adequate medical equipment such as ventilators, oxygen meters, diagnostic and testing kits, quality disinfectants and sanitizers and protective face masks, among other essential supplies. Much of these goods were imported, not because of a lack of domestic production capability, but that it was more cost-effective to purchase it from low-cost producers abroad. As imports became unavailable or costly and local demand skyrocketed, domestic producers—both the public sector manufacturers and private industries—under Prime Minister Modi’s ‘Atmanirbhar Bharat’ or ‘self-reliant India’ initiative were encouraged (indeed, given incentives) to work together to boost production capacity. 11 Within a matter of weeks they were able to meet domestic demand, thereby enabling the government to conduct large-scale diagnostic test to detect infections and limit the spread of the virus.
And, third, making the test and treatment for COVID-19 free for some 500 million poor and vulnerable citizens facilitated extensive testing. Specifically, on 1 February 2018, the Modi administration had announced a plan to ‘fundamentally reform’ India’s healthcare system by improving access, quality and affordability to all Indian citizens, in particular, the poor and most vulnerable. Under the National Health Protection Scheme (NHPS), or in Hindi, the Ayushman Bharat Yojana (popularly known as ‘Modicare’) that the Modi administration proudly claimed would be ‘the world’s largest government-funded health program’, India would finally have a ‘National Health Protection Scheme’ to provide quality health insurance coverage to roughly 100 million ‘poor and vulnerable families’ 12 through reimbursements to an estimated 500 million beneficiaries (based on the assumption that an average family size consists of five individuals), of up to ₹5 lakh (about US$7,845) per family per year for secondary and tertiary care hospitalisation in an ‘empanelled public or private hospital’, establish 150,000 health and wellness centres 13 to provide a holistic approach to care by focusing on both prevention and health promotion, and make ‘comprehensive medical care’ accessible with free maternal and child health services, essential drugs and diagnostic services. Furthermore, to address the problem of shortage of qualified medical personnel, the NHPS proposed the establishment of at least one medical college for three parliamentary constituencies and one Government college per state, and further upgrading of the existing government medical colleges and hospitals. 14 Families and individuals covered under the NHPS will be able to access needed services from enlisted hospitals without upfront payments by providing their personalised smart card in the form of an ‘insurance card’ that is linked to the national identity card (AADHAR) database. 15 On 24 September 2018, Modi formally launched the world’s largest state-funded health insurance scheme, the Ayushman Bharat—Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY). Although the testing and treatment of COVID-19 was already available for free in public facilities when the pandemic first broke in India, on 4 April 2020, the Central government announced that the estimated 500 million individuals under the health assurance scheme could now receive free testing at private labs and treatment for COVID-19 in ‘empanelled’ or designated hospitals. This facilitated widespread testing and mitigation of real and potential cases.
A Bright Spot: New Delhi’s Vaccine Diplomacy
On 3 January 2021, the Drugs Controller General of India issued an emergency approval for two vaccines (Covishield and Covaxin) for restricted use against COVID-19, even though Phase 3 clinical trials were still ongoing. On 16 January 2021, India launched the world’s largest COVID-19 vaccination drive with the expectation to inoculate around 300 million people in the next few weeks using domestically produced vaccines. The following day Prime Minister Modi also announced India’s ‘vaccine maitri’ (or ‘vaccine friendship’) initiative noting that beginning on 20 January, India will start delivering free supplies or ‘gifts’ of COVID vaccines to countries in India’s immediate neighbourhood (in line with New Delhi’s ‘neighbourhood first’ policy), to be followed-up with deliveries to the rest of the world in the days ahead. 16
Specifically, India, as the world’s largest producer of generic drugs, pharmaceuticals and vaccines, coupled with some 3,006 vaccination sites spread throughout the country, expected that some 300,000 people will be given vaccines shots daily (Sharma, 2021). The two vaccines authorised by the Indian government (one developed by the University of Oxford and British-Swedish company AstraZeneca) which licensed the prestigious Serum Institute of India (the world’s largest vaccine maker by volume with the capacity to produce 50 million doses per month and expected to reach 65 million by end of March 2021) to produce the vaccine locally under the label of Covishield, as well as manufacture 60 per cent of the global supply under AstraZeneca’s name. 17 Covishield is not only far less expensive compared to vaccines made in the United States by Pfizer-BioNTech and Moderna, it also does not need to be stored in ultra-low temperatures making it possible to send to many developing countries which lack necessary storage infrastructure. The other produced by the Indian firm Bharat Biotech in collaboration with the Indian Council of Medical Research and the National Institute of Virology under the brand name Covaxin is India’s first home made vaccine against COVID-19. On 21 January, The Lancet released Covaxin’s Phase 1 trial data noting that the vaccine generates adequate immune response—albeit further efficacy trials were warranted. Some have raised concern that both vaccines have been approved too quickly without completing Phase 3 trials, which is critical in determining whether the vaccine produces the required immune response, including a better understanding of its potential side effects (Ella et al., 2021). Nevertheless, Modi’s assurance that the domestic produced vaccines were safe and effective, coupled with the fact that both Indian made vaccines were judged to be far superior (both in efficacy and cost) to their foreign counterparts, convinced the public to take the jab.
Moreover, given India’s extensive medical and pharmaceutical capabilities, it has become a veritable ‘Pharmacy of the world’. Sensing an opportunity to promote India’s ‘global brand’, the Modi government instructed domestic producers to ramp-up production infrastructure in order to speed vaccine production for export around the world. In fact, ‘India seems to have initiated “vaccine diplomacy”…. In addition to providing doses of vaccines as gifts to immediate neighbours, India is also ensuring its friends around the world have access to the vaccine. Brazil, a close Indian partner, has purchased 2 million doses, while Morocco has bought another 2 million. Saudi Arabia and South Africa also have purchased vaccines from the Serum Institute of India’. 18 The WHO, which approved the Oxford-AstraZeneca vaccine (i.e., the Indian made Covishield) for use in its COVAX vaccination program designed to provide poor countries around the world with ‘equitable access’ to COVID-19 vaccines, thanked India for ‘continued support’ in the fight against the pandemic. 19 WHO director general tweeted ‘Thank you #India and Prime Minister @narendramodi for your continued support to the global #COVID19 response. Only if we #ACTogether, including sharing of knowledge, can we stop this virus and save lives and livelihoods’. Similarly, Brazilian President Jair M Bolsonaro, thanked India for the vaccines. ‘Namaskar, Prime Minister @narendramodi Brazil feels honoured to have a great partner to overcome a global obstacle by joining efforts. Thank you for assisting us with the vaccines exports from India to Brazil. Dhanyavaad!’ 20 By mid-December 2020, India had ‘provided pharmaceutical assistance to nearly 85 countries on a grant basis to aid them tide over the pandemic … [and] supplied medicines to 133 countries in the fight against COVID-19’. This move helped New Delhi secure non-permanent membership in the UN Security Council during 2021–22. 21 No doubt, the Modi administration’s ‘vaccine diplomacy’ turned out to be a bright spot—enabling New Delhi to brandish India’s soft power on a global scale like never before. 22
The Pandemic Returns
Viruses mutate and COVID-19 is no exception becoming more virulent in the various mutations found in Britain, South Africa and Brazil. The second wave that hit India in April 2021 was the so-called ‘double mutant’ strain and it proved to be far more transmissible and deadly than earlier strains. Not surprisingly, if India’s highest number of COVID-19 cases reported in a single day was 97,860 on 16 September 2020, on 1 May 2021, India became the first country in the world to record more than 400,000 coronavirus infections in a single day. This exponential rise in COVID-19 cases started on 28 April 2021 when India recorded 379,459 new COVID-19 cases and 3,647 deaths. This marked the eighth straight day of more than 300,000 cases a day—making India the second-highest COVID-19 case count in the world (over 20 million) with over 25 per cent of the global deaths from COVID-19. This rise came as a rude shock to a country which believed that it was winning the battle against the pandemic, and as the global leader in vaccine production was helping the rest of the world in their fight against the COVID-19 scourge.
What explains the exponential rise in infections and deaths beginning in April 2021? Clearly, the belief that India had acquired herd immunity and could mitigate the spread of the pandemic lulled both the authorities and the public into a false sense of complacency. As Srinath Reddy, president of the Public Health Foundation of India notes: ‘Even sections of the scientific community propagated this view’ 23 —with even Modi boldly announcing at the World Economic Forum in January 2021 that India ‘saved humanity from a big disaster by containing corona effectively’. Arguably, with the pandemic threat seemingly under control the Modi administrations stated goal of vaccinating some 300 million people ‘within weeks’ also faltered—the situation made worse by the lack of sustained support for India’s private sector pharmaceutical firms from the government and the political opportunism displayed by opposition leaders such as Rahul Gandhi and Akhilesh Yadav—both of whom not only questioned the safety and effectiveness of the ‘Modi vaccines’, but also refused to get vaccinated. Although the Modi administration was widely applauded for exporting/sending over 60 million doses of the AstraZeneca vaccine to some 80 countries since January 2020, it is now being criticised for ignoring domestic need—a problem further compounded by the shortages of raw materials needed to produce the vaccine, due in part to the problems in the global supply chains and temporary U.S. curbs on exports of essential medical supplies. 24
Similarly, contingency planning and coordination often faltered. In part, this was due to the fact that India does not have a modern public health law with clearly delineated responsibilities, including legally binding obligations. As noted earlier, India invoked two separate laws: the EDA, 1897 and the Disaster Management Act, 2005 to fight the coronavirus outbreak. In practice, the two laws are an ad hoc legal architecture with overlapping statues which predictably resulted in a patchwork, if not haphazard, response against the pandemic. More often than not, the Ministry of Home Affairs, which apparently was delegated the power to ‘enhance the preparedness and containment of COVID-19’, in particular, facilitate coordination between the Union and State governments failed in its task. For their part, several state governments wilfully neglected their responsibilities—for example, leaving the fate of hundreds of thousands of migrant workers in the hands of poorly resourced and trained district and local-level administrators. In short, in the absence of a coherent nationwide strategy to contain the spread of the virus, public health measures were applied inconsistently—which in practice meant that quarantine measures such as the wearing of face-mask, maintaining social distancing, travel restrictions and business, workplace and school closures, not only varied widely from state to city but also from city to city.
It was only a matter of time before this lack of coordination would prove deadly. The reason why the second-wave resulted in so many preventable deaths is because the central government, including several state governments such as Maharashtra, Kerala, Rajasthan and New Delhi, engaged in free-rider behaviour hoping or assuming that the fundamental responsibility to mitigate the pandemic lay on the other. Predictably, they not only failed to procure needed supplies such as oxygen, ventilators, intensive-care hospital beds, personal protective equipment and ramp up testing and vaccination but also began converting quarantine facilities and makeshift clinics back to their original use. Furthermore, with the authorities seemingly relaxing or ignoring COVID-19 guidelines, the public, it seemed, also threw all caution to the wind by going back to pre-COVID behaviour such as not wearing facemasks and resuming social activities, including attending cricket matches and frequenting shopping malls. Not surprisingly, the perception that the failure to anticipate and control the second wave is due, in part, to Modi and his influential Home Affairs minister, Amit Shah prioritising politics over how to respond to the crisis is not entirely unjustified. Throughout April 2021, elections were held in five states which saw many politicians, including Modi and Shah campaigning ceaselessly, including participating in numerous large-scale political rallies—which at the time were aptly dubbed as superspreader events. In West Bengal, Mamta Banerjee, the leader of the ruling Trinmool Congress Party conducted several ‘mega rallies’, including a 12-mile stroll through crowded streets on a wheelchair—literally flaunting COVID prevention rules such as social distancing and the wearing of face masks. Last but not least, the month-long Hindu religious festival of Kumbh Mela, which began on 1 April, saw millions of pilgrims gathering on the banks of the Ganges River for prayers and a dip in the holy waters was only cancelled by local authorities 17 days later after a number of COVID-19 cases were detected.
The searing images of people gasping for breath and dying in India’s capital, New Delhi, because hospitals had run out of oxygen supplies was the result of a catastrophic failure of governance at all levels. Specifically, the failure to provide enough supplies of oxygen to hospitals and related medical facilities is due to two key factors. First, some state governments, in particular, the Delhi government’s neglect to expeditiously use the already allocated funds to set up eight oxygen plants. Specifically, in December 2020, the central government via the PM CARES fund had allocated the necessary financial resources to the Delhi government to set up eight oxygen plants and arrange oxygen tankers for delivery, but neither of these had been done—despite the fact that it takes just one week to set up the oxygen-producing facility. And, second, because of organised black-marketing of essential medical items such as oxygen. On 27 April, the Delhi High Court criticised the Delhi government led by the Aam Aadmi Party (AAP) chief, Arvind Kejriwal over its ‘failure’ to check black marketing of oxygen cylinders and other essential medical supplies, including warning the Delhi government that the court will order the central government to take over the duties if it fails to correct the situation. On 7 May, the Delhi High Court issued notice to AAP legislator Imran Hussain on a plea alleging hoarding of over 600 oxygen cylinders at his office at a time when the city was facing an acute shortage of medical oxygen to treat COVID-19 patients. In fact, on 25 June 2021, a five-member panel appointed by the Supreme Court to audit oxygen consumption in New Delhi hospitals found that the Kejriwal government inflated, indeed ‘exaggerated’, its oxygen need by more than four times during the 25 April to 10 May peak period of the second COVID-19 wave. Suffice it to note that this negligence had grave repercussion on oxygen supply to other states and resulted in many avoidable deaths.
Conclusion
In his The Confidence Trap, David Runciman (2015), argues that although democracies are bad at avoiding emergencies, they are good at recovering from them. The fact that India was able to roll-out a massive COVID vaccination drive covering millions of people on schedule on 16 January 2021 underscores Runciman’s observation. Indeed, in mid-October 2021, India achieved a milestone. Using three vaccines: the locally produced Covishield and Covaxin and the Russian-made Sputnik V, India had successfully administered more than a billion COVID jabs since the vaccination program began on 16 January 2021. 25 Altogether some 30 per cent or 291 million of those eligible have been fully vaccinated, while about 707 million individuals have received their first dose. By the end of 2021 about a billion people were vaccinated, a truly unprecedented global achievement.
Finally, the COVID-19 pandemic has also exposed the fault lines between democracies and autocracies. For example, a Pew report finds that across the world, there is a sharp rise in ‘unfavourable views’ regarding how Beijing has handled (and continues to handle) the coronavirus pandemic, with vast majorities in several countries stating that China has handled COVID-19 outbreak poorly and should be held accountable for its transgressions. 26 This view is particularly pronounced in the United States, where popular attitudes, which have been increasingly unfavourable, have hardened following the outbreak of the pandemic. Today significant majorities of both Republican and Democratic lawmakers as well as voters have a negative view about the Chinese government and growing concerns about China’s intentions. As Friedberg (2020, pp. 1–2) aptly notes, ‘At least in theory, the possibility therefore exists to forge the strong bipartisan consensus that will be needed to implement a coherent strategy across administrations’ to address the challenges posed by the world’s most powerful autocracy. Clearly holding China accountable would be a positive development for India.
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The author received no financial support for the research, authorship and/or publication of this article.