The Pulse | Society | South Asia

India’s Public Health Collapse Is a Ticking Time Bomb for the Whole Region

The failure of the Modi government may spell disaster for the COVID-19 recovery of India’s neighbors.

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India’s Public Health Collapse Is a Ticking Time Bomb for the Whole Region

Health workers carry a patient after a fire in Vijay Vallabh COVID-19 hospital at Virar, near Mumbai, India, Friday, April 23, 2021.

Credit: AP Photo/Rajanish Kakade

If you relied on most Indian news channels and central government announcements, you might think nothing was amiss in the country, with the only event of consequence being the election in West Bengal. Yet the deluge of social media posts and footage from India as well as international news coverage paint a far starker picture of people dying outside of hospitals and in the streets while waiting on care. They report that cremation furnaces’ grills have melted from overuse, while others are forced to cremate their loved ones in parking lots. Even as India continues to shatter COVID-19 records, experts warn that the true figure is multitudes higher than official counts.

The second wave is bringing even New Delhi and other cities with the nation’s most developed healthcare systems to the brink. Some have questioned why the Biden administration took so long to publicly address and pledge medical aid (via the Department of Defense and other channels) for a calamity affecting such an important ally and the world’s largest vaccine manufacturer. The Biden administration likely needed time to navigate the Trump administration-era contracts with vaccine manufacturers prohibiting the donation of vaccines. But another likely factor is perhaps that the central Indian government itself doesn’t want to draw international attention to this national catastrophe.

The Indian people, by contrast, are desperate from relief. Nothing short of active medical assistance, such as Moscow’s COVID-19 diplomacy, is likely to pique their interest. Given the central government’s lack of prioritization or ability to successfully manage the crisis, it is all the more important for foreign governments, international bodies, the private sector, NGOs and publics to assist however they can.

Indeed, it is becoming clear that India’s central government has failed to adequately prepare for this second wave. Instead, the central government declared victory earlier this year and reopened businesses and allowed public gatherings, including massive religious festivals. There has been a veil of secrecy around the “PM Cares Fund,” with $1.2 billion that the Modi government solicited and earmarked for pandemic preparedness reportedly unaccounted for. Despite being the world’s largest vaccine manufacturer, only about 20 million Indians have reportedly been vaccinated.

Even once the scope and scale of the second wave – and the dangers it poses for the entire country – became clear, the central government’s response has been catatonic and detached. Instead of rectifying policy errors and prioritizing the second wave response, the BJP – keen on potentially unseating one of its most ardent critics in West Bengal – has busied itself with organizing multiple political rallies in West Bengal. Prime Minister Narendra Modi himself appeared in one of these rallies, without a mask. Although Modi has since backed out of delivering a final in-person campaign speech in West Bengal, the government refused to postpone elections as millions went to the polls in one of India’s most populous states. This singular focus on campaigning and sloganeering has alienated even ardent BJP and Modi supporters, as evident from netizens responses.

Indian NGOs have also reported that police have restricted their abilities to deliver oxygen supplies. Senior BJP members have mocked the opposition’s offers to cooperate on a COVID-19 response, and there are reports that both BJP and Congress-ruled states have restricted donations of oxygen and other medical supplies from states ruled by the other party. That marks a dangerous politicization of humanitarian aid and public health coordination under dire circumstances.

These public health failures are rooted in and contextualized by a range of broader shortcomings on the part of the Modi government. There has been a significant trend of authoritarianism, which includes consolidation of power by the ruling party at the federal level, centralization of power by the federal executive branch (including curbing the power of the judiciary), and limitations of civil rights and liberties including restrictions on NGOs and the press. There continue to be significant limitations on civil rights and liberties as well as a range of human rights abuses, especially in Kashmir, large parts of India’s northeastern states, and in the “Maoist corridor.”

The ruling party and their allies have permanently weaponized communal issues for political gains, leading to both state violence and vigilante lynchings against Muslims, Dalits, Christians, and other vulnerable groups. There has also been significant tension between the federal government and various state governments, including sharp objections to the National Registration Act and, most recently, the status of Burmese refugees. Farmers continue to oppose the central government’s commitment to re-regulating the agricultural sector in perhaps the largest protests in human history. Likewise, the central government has overseen sluggish economic growth since 2019, which has been exacerbated by the COVID-19 pandemic.

The main silver lining is that not all is doom-and-gloom with regards to India’s pandemic response. The southern states seem to be fairing much better than their central counterparts. Kerala particularly continues to serve as a model of public health readiness, such as through its surplus production and sharing of oxygen supplies. However, the public health catastrophes in other states may lead to further travel restrictions between states and even within among different municipalities in the same state. The pandemic perhaps drive home a stark reality: Indian publics actually live in “multiple Indias,” with vast disparities with regards to the quality of governance, economic opportunities, wealth inequality, workers’ rights, educational opportunities, public health, civil rights and liberties, and a range of other social development indicators. These disparities, and the fallout of the pandemic, may exacerbate tensions between states and contribute to increased social conflict and political instability – with potentially lasting and even permanent ramifications for  the Indian federation.

Furthermore, the failure of the central government may spell disaster for the COVID-19 recovery of several of India’s neighbors. The ruling BJP party’s scheduling of political rallies and the refusal to cancel the West Bengal elections has likely contributed to the emergence of a “triple mutant” strain, which will not only ravage Bengal, but neighboring Bangladesh as well. Despite New Delhi’s heavily militarized, “shoot-to-kill” approach to border security with Bangladesh, the border remains porous as cross-border communities trade, farm, and visit relatives in the other country. As Bangladesh grapples with its own second wave, there are already reports of at least two India-originated strains in the country. Any large-scale outbreak could pile even more pressure on an already overburdened public health system that is less developed and capable than India’s. This would not only spell disaster for Bangladesh’s populace and economy and serve as a significant tension point in Bangladesh-India relations (especially in the view of the Bangladeshi public), but it may even cause Dhaka to significantly recalibrate its relations with New Delhi – to the benefit of Beijing, Islamabad, and other powers. After significant public pressure for action, Dhaka closed its borders with India for travel, but not trade.

While Bangladesh is the most immediate vulnerability, other countries in the region may also be in danger to varying degrees. Sri Lanka’s exposure is somewhat diminished due to Colombo’s willingness to exercise vigilant travel controls, while the situation in neighboring Tamil Nadu seems relatively stable. Nevertheless, reported COVID-19 cases in Sri Lanka are increasing, albeit accompanied by a rise in the number of tests done. As the country braces for a third wave, authorities are reportedly considering another lockdown.

Nepal shares an open border with India, and its case curves eerily mirrors India’s, just a few weeks behind. The new mutant strains from India have already been detected within Nepali borders and are believed to be fueling the current surge in cases. Nepal’s healthcare system is the least developed in the region, and a mass outbreak there would be devastating. Hospitals are already struggling and experts expect them to run out of beds entirely in a week or less.

Pakistan’s mountainous terrain along Kashmir and its generally militarized border with India may serve to insulate the country from some of the spread. Although the pandemic has inspired an outpouring of sympathy from ordinary Pakistanis – including pleas for Islamabad to assist New Delhi – the pandemic may actually serve as yet another unexpected spoiler in the recent détente between Islamabad and New Delhi.

The second wave engulfing India presents many vital lessons for India, the region, and the international community. India and Brazil offer yet another brutal reminder that failure to prepare and the politicization of public health can bring even regional and superpowers to their knees. A more profound lesson is the unforgiving nature of global public health, with any one failure endangering publics around the world. Global cooperation is not optional “soft power” diplomacy and philanthropy, but a vital necessity. Indeed even once developed countries successfully roll out the vaccines to their populations, constant mutations present potent threats for even individuals fortunate enough to be fully vaccinated. This virus knows no borders, and if international governments countries and publics don’t find ways to assist each other to confront a mutual shared threat, this scourge may eventually overwhelm even the most robust public health systems and capable governments.