Redeeming India

To restore our reputation we must define a good health outcome by Diwali - and follow some principles to get there

This has been a dispiriting, emotionally draining month. Sadness at the loss of life that has hit so many families combines with frustration at how unnecessary much of the suffering is. Domestic and international press coverage of our second wave has been graphic and dire, but it merely sensationalises the grim reality. India can redeem itself only by transforming our health outcomes. What does good look like. And what principles must we follow?

Delivering “Good” needs insurance, protection and a cure: Start with Insurance. By Diwali, every state should have the health infrastructure in place to cope with a future wave. Our health experts can tell us if it is reasonable to plan on the basis of the second wave, and not go beyond.  Doctors are speaking of the need for dealing with a spread among children, for example, a terribly depressing prospect, and one we had better prepare for. Health infrastructure includes hospital beds, ICU capacity, medical supplies, oxygen, and enough trained staff. And it includes the logistical capacity, coordination and leadership, so lacking in this last month, to move supplies from where they are to where they are needed. 

Next is protection — Covid-appropriate behaviour: As the tragedy of this last month unfolded, state governments started enforcing safe behaviour. People, scared witless by what they see on their TV screens, are staying home. But it is worth reminding ourselves that it is not the norms that have changed, but following them. My big fear is that as the second wave ebbs, careless behaviour will return. Covid-appropriate behaviour has to be a long-haul project for the next year. So masks (not chin-straps) in public and social distancing. Strict limits on the use of inside spaces, which must be well ventilated. And no large gatherings — whether social, business, political or religious. How large is large? At a time like today, maybe two people. When we are much more in control, maybe 10 or 20. 

And the Cure —Vaccination: By Diwali, we need to have vaccinated the great bulk — over 75 per cent — of our population (adults, certainly, but also perhaps children over the age of 12). This means 8 million vaccinations a day, or 1500 million more doses. Can we do it? Only if we have enough vaccines. Leave the cities to industry, and let each state government focus on rural areas. 

Illustration: Binay Sinha

The most damning aspect of our current tragedy is how unnecessary it all is. Our government has failed the country on several counts:  A lack of preparation by both the Union and states even when cases started rising rapidly in mid-February.  And irresponsible ignoring of Covid- appropriate behaviour by people.  “People” is a broad term — it includes the prime minister, chief ministers of states with elections or religious events, and down. All this must change for India to redeem itself in six months. But our biggest failure is grossly incompetent handling of vaccination by the Union health ministry. Four months into our vaccination programme, we have ordered just 230 million doses — against a requirement of almost ten times that. Let the health ministry at least follow its own protocol and order half that number, which is what it has reserved. And work, manufacturer by manufacturer, with what it will take to scale to a regular supply of over 10 million a day. The health ministry also meddles in what states and private hospitals and manufacturers can do with vaccines.  The net result is that where we were regularly hitting 3 million vaccinations a day in April, we are struggling to reach 1 million in May. Where is the accountability for this grand failure?

Principles of change: Start by recognising wrong-doing, and what must change. While I am all for “positivity”, such sloganeering seems to have become a recipe for complacency and denial. We need action and change, not obstruction and obfuscation. So let’s start with clear metrics of what good looks like. And transparently share how things really are. 

The Union government has a critical but limited role in what must be done. The real implementation — of health infrastructure, Covid-appropriate behaviour, and vaccination — is by each state. Can Union and states agree on a set of metrics across all three areas? Covid beds of various kinds and medical staff per 1,000 people? Guidelines for what is a permitted gathering by infection growth? Vaccination by proportion of population fully covered? Can the Union Government (reminding itself that it is the national government for all 28 states, regardless of who rules them) act as a repository for best practice, spreading and encouraging the many good things underway in patches across the country. What did Mumbai do to cope with the surge in Covid infections better than Delhi? How can a fine voluntary effort underway in Pune (PPCR), become a model for every large city in the country? How has Kerala kept its mortality at a fraction of the national level? And task MPs and MLAs to directly own vaccination in their constituencies. 

We can also learn much from international best practice. US President Joe Biden has a meeting every evening (starting his first day in office) when he reviews how many vaccinations were done in the US that day.  He is very upset when the daily target is not met. And his picture is not even on the vaccination certificates.

Publish all of this data.  Trust will follow transparency, it will not follow hubris and blaming others.

Respect the intelligence of people.  Tell them what is going on. How many have actually died of Covid— the only thing worse than high mortality is fudging the data so everyone comes up with their own wild estimate. How many beds we have to what we should, state by state. How is the spread of infection against agreed norms, and what this means for limits on movement. How many vaccines we have and where, now, and in June and July. 

And lastly, we really are all in this together.  Leaders must lead, not go missing when things get really tough. And just as we expect much change from the Union and state governments, let’s expect much change from us all. From industry, in taking on the responsibility of vaccinating people well beyond our own employees. From companies, shops and NGOs in fostering Covid-appropriate behaviour. And from people in following it — not only in May when we confront daily horrors, but through to when Covid infections are completely in control.

The writer is co-chairman Forbes Marshall, past president CII, Chairman of Centre for Technology Innovation and Economic Research and Ananta Aspen Centre | ndforbes@forbesmarshall.com