By Rita Jalali
COVID-19 is tearing through India causing immense suffering to millions. The country is experiencing a second wave with a massive surge in cases and death rates. From a previous daily high of 93,180.43 confirmed cases on September 17, 2020 (seven day rolling average) the cases have risen to over 400,000 daily cases, far exceeding the highest global one-day record several days in a row. According to official counts, a total of 234,083 deaths have occurred as of May 7, 2021 with over 3000 deaths reported daily since the end of April. India’s health infrastructure which was always weak and underfunded is unable to cope with the flood of patients. There is a dire shortage of oxygen, drugs, and hospital beds in rural and urban metropolitan cities. Patients are being turned away from hospitals. Even crematoriums do not have enough wood or space for funeral pyres.
The official data on cases and death rates do not reveal the true extent of the pandemic. Shortage of tests in some parts of the country and hesitancy to get tested in the middle of the pandemic has hidden the actual prevalence of the disease. Large-scale seroprevalence studies in India have shown case counts are only a fraction of the total number of people who have been infected (with only 6 percent of the infections reported).23 Regarding death data, according to media reports, a single crematorium is reporting more deaths than official figures for the entire state.24 In addition, testing is not being conducted on dead bodies and deaths are being attributed to existing comorbidities. Finally, India’s death registration system is incomplete. Many of the deaths occur at home without medical attention. According to the Registrar General of India in 2018, only 86% of deaths were registered and of these only 21.1 were medically certified deaths in hospitals. In late April, more than 350 Indian scientists signed a petition asking the government to publicly release details on COVID-19 data.25
What explains the massive surge in cases?
While new variants of the SARS-CoV-2 virus may explain the surge in cases, the evidence for this is not yet definitive. However, the government’s poor management of the crisis has played a major role in how the virus has ravaged the country. As cases declined from September onwards, the central and state governments assumed that the worst was over. The national COVID-19 task force did not meet for months this year. Not enough was done to monitor the outbreak with testing declining from October 28, 2020 when the first surge was peaking and not rising until April 11th the following year. Large-scale gatherings- from cricket matches, election rallies to religious congregations attended by millions – were all allowed. COVID-care centers were dismantled; nearly a year into the pandemic, only 33 of the 162 oxygen plants planned for district hospitals in 14 states were completed (and 14 of them, the largest number were sanctioned for BJP-ruled Uttar Pradesh).26
Hubris and misplaced priorities have also exemplified the government’s handling of the crisis. Senior members of the government, including the Prime Minister repeatedly proclaimed that India had successfully contained the pandemic, and “saved humanity from a big disaster” (Prime Minister Modi’s speech at Davos).27 Warnings about the new and more contagious variant of the virus from government scientists (the SARS-COV-2 Genetics Consortium constituted by the central government) were ignored in early March. The government was more focused on winning local elections in 5 states where massive rallies were held while the country was witnessing a tidal wave of infections. In the middle of the pandemic, the Modi government has also prioritized construction of a new Central Vista in Delhi, including the Prime Minister’s house, declaring it an Essential Service to be completed by December 2022 for an estimated cost of more than $1.8 billion.
The government has even botched up the vaccination roll-out. Despite being home to the world’s largest vaccine manufacturer (Serum Institute of India – SII), only 2.3 percent of Indians have been fully vaccinated (as of May 6, 2021). The pace of vaccination has slowed down partly because of vaccine shortages. The government did not anticipate the need to build production and distribution capacity for vaccines (only contracting with SII for 21 million in February and another 100 million in March, when over 1.8 billion doses are needed).28 It donated vaccines (as of March 24, 2021, India, had exported more vaccines – 60 million doses – than it had administered domestically); until recently, failed to give emergency use authorization to foreign vaccine manufacturers approved by WHO; despite earmarked funds for COVID, shifted responsibility for vaccine procurement from the center to under-resourced states; and created a vaccine market with differential pricing so states now have to compete with each other and the private sector for a limited supply of vaccines (no other country has done this). These missteps may make it difficult for the government to achieve its goal of vaccinating 300 million people by August 2021 and will surely create inequities in access to vaccines.
Criticism of the government’s abysmal response to the pandemic has come from several quarters. The courts have accused the government of “genocide” for failing to provide supplies of oxygen to hospitals, of using unscientific methods to distribute oxygen to states, of not being transparent to the public about oxygen supply and distribution, and of relying only on a few government officials rather than a broad-based expert committee to decide on allocation of oxygen to states. Critics, including the media and opposition political parties, have accused the BJP ruled central government of giving preference in distribution of life-saving drugs, oxygen, and even vaccines to states ruled by its own party. Even party workers, activists, and voters from the Prime Minister’s own party have criticized the government’s handling of the pandemic.29
Poor planning and implementation also characterized the central government’s response to the first wave of the pandemic. During my research on the first wave, I found the government had severely underestimated the number of people who could get infected in the country – testing reagents were stockpiled for only 70,000 tests by Feb. 25th, 2020 nearly a month after the first case was detected; only 64 labs were operational and only 6 storage units available to store COVID supplies six to nine weeks after the first case was found. Funds for COVID preparedness were allocated late; technical staff such as epidemiologists who are critical to any testing, tracing, and surveillance system were absent in many districts.
A government administrator in charge of a small tribal district in the state of Maharashtra has shown how foresight and planning (by ensuring adequate supplies of oxygen, hospital beds, isolation wards, doctors, and vaccines) can protect residents from a pandemic.29 In contrast, many parts of the country have been scarred by central and state government incompetence and people have had to appeal to the courts to force the governments to act to save lives.
Rita Jalali is a Scholar in Residence in the Department of Sociology and the Center on Health, Risk, and Society at American University.
23 “ICMR sero survey: One in five Indians exposed to Covid-19.” BBC News; Mukherjee et al. (2021) “Under-reporting does hurt the COVID fight.” The Hindu, May 4, 2021; Also see Mohanan et al. (2021). “Prevalence of SARS-CoV-2 in Karnataka, India.” JAMA. 2021;325(10):1001-1003. https://jamanetwork.com/journals/jama/article-abstract/2776292
24 https://indianexpress.com/article/india/in-bhopal-official-covid-toll-in-april-is-109-but-over-2500-at-pyres-graves-72997299788/; Also see, “As Covid-19 Devastates India, Deaths Go Undercounted.” New York Times.
28 Financial Times, May 4, 2021 “India’s vaccine shortage will last for months, biggest manufacturer warns.”