* Editorial 2

India needs to enhance the surveillance system, vaccinate quickly, and reprioritise healthcare services

A health worker administers a COVID-19 vaccine to a woman in Noida on May 18.PTI

The failure to plan and prepare for multiple waves of COVID-19 in India has resulted in the despair and helplessness we are seeing today. Since more waves are expected, what lessons can we learn from the present in order to plan for the long term? This article speaks of the challenges and the road ahead.

Surveillance strategy

First, while it is easy to blame modellers for failing to predict waves, the reason why they are not able to do so is that clear data are unavailable. There is unreliable testing and under-reporting of cases and deaths even now. This does not instil confidence in any of the modellers to come up with realistic estimates. Under-reporting and manipulated data inputs can only provide faulty projections. The Central and State government should use real-time data by encouraging reliable reporting and initiating standardised definitions. This is the time to have a standardised definition of how many cases are expected per million population. Instead of admiring the efforts of administrations in the areas that have fewer cases, efforts should be made to detect the minimum number of cases, to instil confidence in people that the surveillance system works in the state. This can only be done through the syndromic approach of identifying suspect cases and through a reliable testing strategy which does not change when there is a surge in cases.

The COVID-19 trajectory in other countries shows that there will be multiple waves in India. In Japan, the health system is crumbling during the fourth wave. Identifying impending waves is very important in mitigating a catastrophe. India missed building containment and mitigation measures while Maharashtra was seeing a surge in cases during the second wave. This lesson should be incorporated into plans for future waves. A strong surveillance system reporting the minimum number of cases will thus provide reliable early markers of an impending wave. Review mechanisms should be strengthened to detect the outbreak in the initial stages and extinguish it before the pandemic spreads to other areas.

Concurrent genomic sequencing in real-time in the fixed proportion of samples will give us an idea of the likelihood of the variants causing several outbreaks. If the outbreaks in Kerala, Punjab, and Maharashtra were noticed from the results of genomic sequencing, India could have advocated for local lockdowns in high-burden areas and imposed severe restrictions to stop the wide spread of the second wave. We can prevent the adversities of future waves by relying and acting on the inputs of a strong surveillance system.

Vaccinating the population

Next, through vaccination, we can turn the story around. India can emerge as the world’s biggest exporter of vaccines in addition to helping citizens in the country. The Central government should proactively reach out to all the vaccine manufacturing firms in the west and invite them to collaborate with Indian firms under the ‘Make in India’ programme. India needs to fast-track the manufacturing of all vaccines which have been approved for use by various regulatory authorities through a single-window clearance. India can become a soft superpower if it facilitates faster manufacturing by helping the Indian industry. This is not an unrealistic ambition as the country has already proved how it can scale up testing facilities within a short period of time. At this stage, there needs to be greater impetus in stepping up manufacturing and coverage of vaccines. Not many countries in the world have the wherewithal to manufacture their own vaccines if India cannot cater to the vaccination needs of its own citizens and that of the world.

With newer variants of concern emerging, it is important to update the vaccines depending on how the virus changes. This provides a clear case and a good business opportunity for setting up manufacturing facilities in both the public and private sectors. Vaccines might be the shot in the arm for our economy. Greater financial allocations, stepping up systems to expand vaccination, applied research, enhancing effective communication, and monitoring effectiveness will solidify India’s role in the future for preventing and managing pandemics.

Since 2009, the World Health Organization has declared six public health emergencies of international concern, including COVID-19. In the near future, India has to have a system that can respond to newer pandemics in the making. We cannot build reactive systems for each wave and each pandemic. Nearly 60% of known infectious diseases and up to 75% of new or emerging infectious diseases are zoonotic in origin. Respecting the boundaries of animals and preserving the ecosystem in its natural form is important in order to prevent future pandemics. Therefore, the country needs to adopt the ‘One Health’ agenda in its entirety and ensure that environmental health and animal health are given similar priority as human health.

Robust public health workforce

The rapid spread of SARS-CoV-2 shows us the importance of timely and efficient public health responses. We can only fight better when we have a battle-ready public health workforce. Unfortunately, our health systems are collapsing. Doctors and nurses have to bear the burden mainly because of a depleted or absent public health workforce. It is an essential to hire front-line workers in public health who can engage in surveillance and contract-tracing, and mobilise people for primary healthcare services, including vaccination. The front-line public health workforce is particularly absent in urban areas, while critical care capacity (oxygenated beds, ICUs) is limited in rural areas. Irrespective of the urban-rural divide, the country needs to reconfigure the health systems to ensure that one Accredited Social Health Activist (ASHA) worker is hired for every 1,000 people, an Auxiliary Nurse Midwife (ANM) and nurse practitioner are hired for every 5,000 people and a hospital with at least 100 beds, including beds with emergency and critical care services, caters to a population of 30,000-50,000.

 

It is time to have plans for pandemics. We need to improve the health system and public health and regularly review plans to ensure that we prevent future disasters. For now, it is important to have enhanced surveillance to detect and contain future waves, expand vaccination, and work towards building a robust pandemic preparedness plan.

Giridhara R. Babu Professor and Head, Life Course Epidemiology at the Indian Institute of Public Health, Bengaluru

The Tamil Nadu government should reclaim the lost political vision in city planning

In the last few decades, Tamil Nadu, the most urbanised among the major States, has lost its political vision in city planning. Housing policies and urban planning have been presented as a techno-bureaucratic exercise, preventing the political leadership from taking ownership and responsibility. In the process, the citizens find their needs unrepresented. With large urban projects on the anvil and the third master plan for Chennai on the drawing board, it is time for the Dravida Munnetra Kazhagam (DMK) government to repoliticise planning and adopt a vision consistent with its people-friendly promises.

Planning of the past and present

For long, the State government stood apart with its innovative planning practices. In 1948, it produced a comprehensive housing report and impressive solutions for the housing shortage. As early as the 1960s, it created a comprehensive plan for Chennai. It set up the Slum Clearance Board in 1971, the first of its kind in India. The then DMK government adopted a radical policy to make the State slum-free. The iconic photograph of then Chief Minister M. Karunanidhi taking a boat ride in the rejuvenated Cooum is a telling example of how urban development projects remained an essential part of the political agenda. Former Chief Minister Jayalalithaa supported solar-powered greenhouse schemes for the rural poor. State leadership directly associated itself with planning policies, and building liveable cities was central to political action.

What changed over time? First, policymakers depoliticised planning and presented it as a mere technical exercise of allocating resources such as land and money. They deployed what political scientists Matthew Flinders and Jim Buller describe as ‘institutional and preference-shaping tactics’ to achieve this. Institutions were created to give experts a longer rope, reduce political interference, and avoid short-term considerations in planning. However, they are meant to function within the parameters set by the elected political leadership. This appears increasingly absent in Tamil Nadu.

As Flinders and Buller point out, using the ‘preference-shaping tactic’, institutions create a choiceless situation by offering the opinions of experts as the only solution. They exclude contesting views from public discussion. There is no political moderation of expert-driven agendas. While theorists may argue that depoliticisation improves efficiency, on the ground, as planning and policies keep failing, the credibility of politicians erodes significantly.

A telling example of depoliticised planning is the Tamil Nadu Affordable Urban Housing and Habitat Policy, 2020. It thrives on ambiguity and opaqueness. It has reduced state role and allows the market to take care of low-income housing without providing any information on shortage, household incomes, and affordable housing prices. It remains silent on the numbers of households that cannot afford the housing supplied by the market. On the contrary, early plans, such as the 1948 report, offered empirical evidence, transparent assessment, and a clear political agenda. That report acknowledged that 75% of the population in Chennai belonged to the low-income group with an income of ₹50 or less a month. These families could not afford houses built by the market at the cost of ₹5,000. The government then took full charge of providing housing for lower-income households. Similarly, in 1971, the government admitted that the Housing Board had failed to deliver since it had diluted its mission by focusing on higher-income groups. The government created a separate board and invested its resources in low-income housing.

In contrast, current policies do not disclose the conditions of housing and cities. They do not clearly commit to keeping the sale price of low-income housing within the affordable range in private projects that avail themselves of financial support from state-supported shelter funds. The case of the third master plan for Chennai appears no different. The activities have commenced without any political framework. Will the government agree if the planners again propose a market mechanism to allocate land use and resources? What outcomes do they want the plans to achieve?

The way forward

As economist Allan Drazen explains, the government must acknowledge the divergent sets of interests and choose the mechanism to negotiate them. Only political leadership can offer a widely accepted framework. The government must take ownership and ensure specific outcomes. The possibilities are merging the Housing Board, which increasingly functions as a developer, with the Slum Board; pooling all land and resources and using them only for low-income housing; enforcing wider consultation; moving away from conventional land use planning; and adopting strategic urban design projects to make spaces for people and safe streets.

A. Srivathsan is a Professor at CEPT University. Views are personal

India should note that it was the progressives who pushed the U.S. to back the TRIPS waiver

K.V. Prasad

It is tempting to surmise the shift in the U.S.’s approach on providing COVID-19-related aid to India as well as on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver on COVID-19 vaccines, drugs, therapeutics, and related technologies as being driven by the Comprehensive Global Strategic Partnership with New Delhi. But it is more than just that. The development was a result of the determined push by some sections of the political and business class, civil society, and Indian Americans. Besides them, the progressives in the Democratic Party made a big difference.

President Joe Biden called Prime Minister Narendra Modi in late April expressing the U.S.’s determination to be with India in its most difficult hour. To reduce the negative perception over Vice President Kamala Harris’ tepid response to the crisis in India, the administration arranged for her to address a diaspora event where she brought up her Indian roots and lamented over the deteriorating situation in the country.

The responses by these top leaders to assuage the Indians and Indian Americans came at a time when a section was seeking to underscore New Delhi’s past folly of banking on Washington in times of need.

Urging Biden to act

Among the progressives who urged the President to act soon were Congresswoman Pramila Jayapal, Chair of the Congressional Progressive Caucus, and Congressman Rohit ‘Ro’ Khanna, the Democratic vice chair of the Congressional India Caucus.

Incidentally, while Ms. Jayapal’s comments on human rights violations in Jammu and Kashmir annoyed New Delhi earlier, Mr. Khanna urged the Indian government to maintain democratic norms and allow peaceful protests by farmers, at a meeting of the leadership of the India Caucus with Indian Ambassador to the U.S., Taranjit Singh Sandhu. Irrespective of these positions, the progressives saw the aid and TRIPS waiver through a different prism.

To contextualise the role of progressives, days ahead of the May 5 decision of the Biden administration on the TRIPS waiver, 110 members of the U.S. Congress wrote to President Biden urging him to support the waiver. The signatories included Ms. Jayapal, Mr. Khanna, and Congressman Raja Krishnamoorthi who represents Illinois. At the same time, Senator Bernie Sanders and nine other Senators made a similar plea to the White House. Thus, the Biden administration’s decision on the waiver and the vaccines, characterised as courageous by many, was a result of the push by the progressives.

Joining in this effort, the co-chair of the Congressional India Caucus, Brad Sherman, and over 50 colleagues wrote last week to President Biden seeking supply of specific items amid concern that as long the virus persists in India “there is the potential for additional variants that could pose a threat to a vaccinated America”. The overall approach is to work with India in its battle against the second wave and prepare for subsequent ones.

 

Not to be ignored

The outreach by Mr. Sandhu and his South African counterpart to members of the U.S. Congress on the waiver notwithstanding, it is evident that the progressives have a grip on policymaking. Its members’ pronouncements on other issues that India finds unpalatable could happen again. But India will have to remain engaged with this section instead of offering a cold shoulder as it did in the recent past. As the adage goes, all politics is local.

K.V. Prasad is a journalist and former Fulbright-APSA Fellow with the U.S. Congress

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