Covid 19 Ex Gratia Details

The mismanagement of the COVID-19 pandemic has been independent India’s gravest governance failure. The Union government under Prime Minister Narendra Modi did not take adequate measures to prevent and contain the pandemic. Therefore, there is a Need for a White Paper (Chapter-1) that examines the government’s acts of omission and commission, its impact on India and suggests constructive measures to improve policy responses to the current and future waves of the pandemic. The Modi government’s handling of the COVID-19 crisis began with its Early Inaction in January 2020 (detailed in Chapter-2). The government ignored early warnings from experts and political leaders from the Opposition. It failed to learn from the lessons and response models of other countries which had been hit by the pandemic. It did not scale up nationwide the lessons from Kerala’s experience in successfully suppressing a virus outbreak (the Nipah virus). This inaction for a period of nearly two months was completely avoidable but it has cost us dearly. Instead, the Modi government should have: • Acted with seriousness and urgency after the outbreak of the pandemic in other countries, learnt from their lessons and followed the 3Ts –– Testing at scale, Tracing with diligence and Treating with precision. • Screened all international passengers and quarantined them as necessary from January 2020, since the virus had already spread beyond China and Hong Kong by January 18, 2020. • Tested symptomatic persons with no travel history. According to a mathematical model prepared by the Indian Council for Medical Research (ICMR) in February 2020, such a move would have identified 50% of all infections in India. The government’s failure to proactively manage the pandemic in India continued in its Policy Response to the First Wave (detailed in Chapter-3). Its initial response consisted of measures like the Janata Curfew, thali clanging and diya lighting, which did not adequately communicate the risks from COVID-19 to the public. It did not prepare them to undertake appropriate preventive measures. Instead, PM Modi announced a nationwide lockdown with only four hours’ notice. It triggered a terrible humanitarian crisis impacting approximately 4 crore migrant workers and disrupted the livelihoods of poor families. The highly publicised PM-CARES Fund turned out to be an opaque entity with no transparency on utilisation of funds. Medical ventilators procured through the Fund were even found to be defective. The government ignored the suggestion of epidemiologists to conduct door-to-door screening to detect and curb the spread of the virus at the nascent stage. It ignored the advice of experts about the ineffectiveness of lockdowns. While the lockdown bought the government time to enhance testing and hospital facilities, its efforts on this front were demonstrably inadequate. The lockdown thus imposed severe social costs without the equivalent benefit of disease control. Instead, the Modi government should have: • Communicated clearly and transparently about COVID-19 risks and ensured that people followed appropriate safe behaviour. • Acted on warnings of epidemiologists, virologists and other scientists who projected the rise in caseload. • Decentralised resources and empowered and equipped local authorities to arrest the spread of the virus. • Prepared a response-plan ahead of time, based on the experience of other countries, including the earmarking of resources and the ramping up of infrastructural requirements such as hospital beds and medical oxygen. Two characteristics that stand out from the Modi government’s handling of the pandemic are Hubris and Political Avarice (detailed in Chapter-4). The government declared victory over COVID-19 prematurely in early 2021. It deceptively used the ‘Vaccine Maitri’ scheme as a tool to project the Prime Minister’s image globally, when the bulk of exports were contracts placed directly with private sector vaccine manufacturers. Further, at a time when large gatherings should not have been allowed, the ruling party demonstrated political avarice by conducting large election rallies during the eight phases of the assembly election in West Bengal, when the nation was already reeling from the second wave of the pandemic. Earlier, during the first wave, the Modi government denied that COVID-19 posed a major threat to public health until the Bharatiya Janata Party (BJP) government had been installed in Madhya Pradesh. Instead, the Modi government should have: • Acted swiftly on warnings from scientists and the Indian SARS-CoV-2 Genomic Consortia (INSACOG) about contagious new variants of the virus. • Avoided declaring victory over COVID-19, which instilled a false sense of safety among the public, who believed their leaders and lowered their guard. • Banned large gatherings, including election rallies, and postponed panchayat elections in Uttar Pradesh. • Insisted that even small gatherings should follow strict protocols on the number of people allowed, social distancing, and masks. The Modi government’s practice of Ignoring the Signs and the Science (detailed in Chapter-5) proved disastrous. It notified ICMR, a research organisation, as the nodal agency to manage the pandemic instead of the battle-ready National Centre for Disease Control (NCDC) and National Institute of Virology (NIV). The government disregarded warnings and recommendations from scientists. It did not act on INSACOG’s timely alert about the prevalence of a mutated, highly transmissible strain (B.1.617) of the virus, with fatal consequences. The government did not rectify the under-reporting of the number of cases and deaths during both waves, crucial to frame policies based on accurate data. It did not adequately assess and prepare responses to the risks of community transmission. Further, its ministers publicly promoted unscientific remedies such as Coronil. Instead, the Modi government should have: • Selected the appropriate, experienced organisation to coordinate containment of the pandemic. • Strengthened institutional infrastructure, e.g., expert panels, COVID-19 Taskforce and INSACOG, and not prematurely declared victory over the virus. • Updated protocols and treatments at regular intervals in line with emerging scientific evidence. • Acted on expert recommendations about new strains of the virus and their potentially aggressive impact on an impending second wave. • Reinforced testing infrastructure. During April and May 2021, India experienced severe shortages of medical oxygen and Intensive Care Unit beds in both public and private hospitals, leading to innumerable avoidable deaths. Mass cremations were reported from multiple cities. India’s healthcare infrastructure was overwhelmed by the rising number of patients affected by the second wave of the COVID-19 pandemic. After India’s experience with the first wave of COVID-19, the Modi government should have put in place measures in anticipation of the second wave. There were ample warnings from experts and lessons from the experiences of countries that faced the brunt of COVID-19 before India. Unfortunately, through its actions and inaction, the Modi government failed to prepare India to face the second wave of COVID-19. Its Unforgivable Negligence (detailed in Chapter-6) pushed our country into a colossal disaster. Compounding the problem, the government tried to silence sections of the public and the media by directing social media platforms to block trenchant criticism of its COVID-19-related failures on the grounds of spreading misinformation and creating panic. It also failed to provide adequate support to state governments in their efforts to contain the pandemic. Instead, the Modi government should have: • Strengthened healthcare infrastructure, particularly in district hospitals. • Instituted a comprehensive testing strategy nationally. • Ensured the availability of required medical supplies and equipment. • Set up sufficient oxygen generation plants and ensured the availability of oxygen cylinders and tankers across India. • Enhanced public risk communication to ensure awareness of and compliance with COVID-19 safety protocols, especially in rural India. • Promoted effective cooperation with state governments. • Prioritised transparency and provision of accurate data, including compliance with World Health Organization protocols on reporting COVID-19 deaths. • Instituted an ex-gratia relief of at least Rs. 4 lakhs for the families affected by COVID-19 deaths. As the second wave of the COVID-19 pandemic gathered momentum, vaccine shortages were reported across India. This situation was the direct result of the Modi government’s Vaccine Mismanagement (detailed in Chapter-7). Despite knowing the magnitude of the universal vaccination drive that India required, the government’s approach towards vaccination has been ad-hoc, short-sighted, unscientific, and inequitable. The Modi government did not intend to vaccinate all Indians and called this strategy ‘Smart Vaccination’, ignoring multiple warnings to the contrary, and thereby committed the critical error of not placing sufficient orders in advance, cascading to the vaccine shortages since April 2021. Consequently, the government placed its first vaccine orders as late as January 11, 2021, and even then, ordered only 1.65 crore doses from the two domestic manufacturers. It failed to provide adequate advance support to India’s vaccine manufacturers to expand production capacity leading to minuscule supply and also delayed licensing Covaxin (developed jointly by ICMR and Bharat Biotech) to other Indian firms. It abdicated its responsibility to procure adequate, affordable vaccine supplies and offloaded this task onto states despite the disadvantages that they faced. It insisted on measures such as mandatory registration on the Co-WIN platform prior to vaccination for the 18-44 age group, which favoured digitally literate, urban middle classes and excluded the vast majority. It arbitrarily increased the dosage interval for Covishield to 12-16 weeks without evidence. Finally, it announced a target to vaccinate all adults by December 2021 without a roadmap. Instead, the Modi government should have: • Placed orders globally for vaccines as soon as India faced the first wave. • Ramped up production capacity, by proactively providing grants to public and private sector units to upgrade and expand their facilities, and by invoking compulsory licensing for made-in-India vaccines and their raw materials. • Focused diplomatic efforts to secure access to vaccines, raw materials and peripherals for our population, before making international commitments. • Procured vaccines centrally and allocated them in a fair and transparent manner, giving states control over implementation. • Improved vaccine access by limiting digital, physical and financial exclusion. • Fixed dosing intervals for vaccines based on evidence of efficacy against different variants of the coronavirus. • Revealed a detailed roadmap and strategy on vaccinating India fully at the earliest with clear timelines of vaccine production and allocation. Among the major Impacts of Policy Failures (detailed in Chapter-8) was that India was forced to break away from its 17-year long tradition of not accepting foreign aid to deal with domestic crises. The Union government then delayed the distribution of the foreign aid it received and is yet to make public the details of donations. The near collapse of India’s healthcare infrastructure led to avoidable deaths due to acute shortages of medical oxygen, deaths of frontline workers due to COVID-19 and the growth of an illegal market for anti-viral drugs and oxygen devices. India was partly saved by civil society organisations and political parties that stepped up to provide crucial support to families of COVID-19 patients, including those affected by the lockdown. Courts have reprimanded the Modi government for its policy failures, including an “arbitrary and irrational” vaccination policy. The Allahabad High Court even described the death of patients due to the mishandling of the pandemic as equivalent to a ‘genocide’. Instead, the Modi government should have: • Ramped up the logistics for additional oxygen production and supplies and enhanced the production of antiviral drugs and other medical care necessities. • Promoted data transparency, including the allocation of medical resources and foreign aid to states, as well as disbursements from the PM-CARES fund. • Focused on building sufficient capacity of hospitals and of healthcare personnel to ensure that all COVID-19 and non-COVID patients get adequate attention. The Modi government will finally do some justice to our people if it implements Key Policy Recommendations for the Way Ahead (detailed in Chapter-9). It should: • Ensure that all Indians receive free and universal vaccination in the shortest possible time frame. The government should share a detailed weekly roadmap of progress towards its announced December 31, 2021, deadline to vaccinate all of India’s adults. • Collaborate with vaccine manufacturers, raw material suppliers, and foreign governments to ensure a steady supply of raw materials and vaccines for India. • Invoke compulsory license provisions under the Patents Act 1970 to ramp up domestic vaccine production. • Allocate vaccines to states based on a transparent, justifiable formula, centered on evidence, equity and particular local requirements. • Make accurate vaccine-related and COVID-19-related data publicly available in a transparent manner. • Implement political and administrative measures including a national level, All-Party committee to review measures to contain the pandemic, to improve coordination with state governments, and to collaborate with civil society. • Decentralize decision-making, management of critical resources and transfer funds to the district level to organize essential health services, from primary to tertiary care, and address regional imbalances. • Prepare for possible third and future waves by heeding expert advice, scaling up testing significantly (especially in rural areas), and pooling human resources at the state and district levels. • Provide ex-gratia relief of at least Rs. 4 lakhs for all COVID-19 related deaths under the Disaster Management Act, 2005. • Implement relief measures including a minimum income support scheme for the poor and most vulnerable, continue free food supplies to the poor, reduce excise taxes on petrol and diesel, grant wage subsidies to Micro, Small and Medium Enterprises (MSMEs), increase budgetary support to the Mahatma Gandhi National Rural Employment Guarantee Scheme and provide relief for the urban poor.

As the COVID-19 pandemic continues to take its toll on India, it is imperative that the Modi government set aside divisive and discriminatory political agendas, exclusionary policies and implements these recommendations to help mitigate the ongoing second wave, and to ensure that India is well prepared to face future waves of the pandemic.