In early 2020, the Coronavirus took all countries by surprise, causing the first Covid storm (Covid-1). Even countries with a sound public health infrastructure struggled to manage the crisis arising from system overload. It was well understood world-over that the three rules of masking-distancing-hygiene were vital primary measures. Lockdowns were announced, and understood as only a means to check Covid spread and to “buy time” to gear-up and expand public health infrastructure, to handle the on-going and future load.
Early on, scientists and health professionals had declared that the Coronavirus was not going away anytime soon, and predicted at least a second Covid wave (Covid-2). Scientific research for a vaccine began, along with governments playing political games.
Our national economy was seriously damaged during Covid-1, due to the combination of disease incidence, grossly inadequate health system response, and the 4-hours-notice total lockdown. At the personal level, stunned socio-economically under-privileged workers migrated en masse, walking home hundreds of kilometers without food or money, many dying on the way – an avoidable humanitarian crisis. Engrossed in petty political games, governments were taken entirely by surprise just like Coronavirus did. The official reaction to the exodus was as for Covid-1, wholly inadequate.
Sadly, few if any lessons were learned from Covid-1. Rather, India’s victory over Covid was trumpeted among the international community at Davos. On the back of a wounded economy, now Covid-2 is raging and government’s Principal Scientific Advisor has warned about the certainty of Covid-3. Hopefully, this warning will be heeded unlike the warning for Covid-2, which was neglected. People are variously fearful, angry, dejected, disappointed, bewildered.
The casualty rate in every country is alarming. Only, some countries are worse than others. Comparing our statistics with countries worse affected is no consolation to those who have lost loved ones. As far as our country is concerned, it has laid bare the precarious state of our public health system. Of course, this neglect of public health and the public health system is not recent. Its pathetic status is the result of successive governments’ neglect over decades, of their duty towards People and their basic needs.
Our Constitution Article 47 reads: “The State shall regard the raising of the level of nutrition and … the improvement of public health as among its primary duties”. The context is provided by Article 37, which reads: “… the principles laid down [in the Directive Principles of State Policy] are … fundamental in the governance of the country”. A written test for politicians and wannabe leaders on knowledge of our Constitution could be shockingly revealing.
Another of the several reasons for public healthcare being so poor, is that it is viewed as curative. Preventive healthcare, especially including nutrition, safe drinking water and sanitation, has been neglected. Most persons in power over the years probably did not bother to make the connection between public health and nutrition, and in any case, neither was a priority for successive central and state governments, with the possible exception of Kerala. Needless to say, public health depends upon the functioning of the public health system.
The pandemic is about the public health system. It specifically concerns infrastructure in its multiple aspects – medical testing and investigation facilities, hospital beds, intensive care and normal care facilities, ambulances, expendables (medicines, PPE, vaccines, etc.), and last but not the least, training and deployment of adequate medical, nursing, and other staff. All this including for rural areas, where the majority of our population lives. No less important, the management of the system at the political, administrative and hands-on medical levels – noting the hierarchy of power – which determines outcomes.
When management at any one level falls short, another level compensates until normalcy is restored. But when the system is overwhelmed, as in this pandemic, and top management fails in anticipating situations based on expert advice, to plan finance, purchase and procurement, the subordinate levels struggle to compensate. When they don’t succeed, chaos results.
The blame-game began early on, but served little purpose, because all political parties and all political leaders were complicit in neglect of public health at one time or another, to varying degrees.
Top leaders at centre and states are empowered and responsible to direct and manage crises. The lower echelons look up to them for leadership, even while they fight the daily battles, as our frontline health workers continue to do at huge cost to themselves. Leaders must take responsibility for setbacks and failures just as, and especially if, they justifiably or otherwise claim credit for successes.
At least now, hopefully, the political class will understand the national implications of neglecting their sworn duties, and political leaders of all parties at all levels will understand the gravity of the situation. If they have taken credit in the past for anything, they must also accept moral responsibility, although that calls for a rare type of courage. Notwithstanding, blaming and accepting blame will not help us move forward. Moving forward and meeting challenges effectively, depends upon understanding what went wrong and taking appropriate urgent measures, not focussing on who went wrong, because that is well known.
Today, we are ravaged by Coronavirus and are haemorrhaging economically. Our People need governance and inspired leadership in our hour of crisis. In our march into the future, every Indian citizen will rally behind a leader who practices what he preaches; who sets the correct personal example; whose utterances bear the mark of truth; who understands that he is accountable to the People, connects with ordinary people with humility and listens more than he speaks; who will condemn what is wrong and commend what is right; who does not seek fame or personal glory, and who understands and accepts that governance is team-effort.
Such a leader would hopefully also study and understand the Constitution of India, which should guide all aspects of governance today and in the future.
Maj Gen S.G.Vombatkere focuses on development and strategic issues