Fraternity in time of COVID-19

A lesson from the pandemic

The consequences of the COVID-19 pandemic are far-reaching and will require far-sighted policy responses. The mortality and morbidity risks of such unexpected and sometimes unknown viruses, and the fear and panic that result, give rise to several questions for society, compounded by the economic repercussions that spill over. The first, and the most obvious, there are exceptional costs to the health system, of treatment of the infected, quarantining of those suspected to be infected, and of outbreak control. A pandemic of this kind tends to overwhelm the healthcare system, severely constraining its capacity to deal with routine health issues, exacerbating the burden of those in health poverty.

Besides this, COVID-19 has driven down productivity and forced a lockdown on education, the economy, and transportation and public services. The economic costs of this near-complete lockdown are considerable. In the iniquitous society, economy and polity that India presents, the consequences of this pandemic are impacting people in unequal ways. In the absence of a social protection net, the disadvantaged and vulnerable populations, particularly the poor, are experiencing its impact disproportionately. For the vast majority of them, it is truly a question of life versus livelihood, or if you believe in poetic injustice, to be or not to be.

Unprecedented in recent times and therefore posing a public policy challenge, addressing the economic risks wrought by COVID-19-like epidemics will require policies that reduce their likelihood and that will position India to respond swiftly when they do occur. But, governments -- at the Centre and in the states -- are in an unenviable position, faced as they are in the immediate and short run, with the spectre of a precipitous decline in revenue and the inevitable ballooning of expenditure.

Several factors complicate the exit strategy and the return to normalcy: managing the epidemic risk in the most productive but high-risk cities -- Delhi, Kolkata, Mumbai, Chennai, Bengaluru, and Hyderabad -- all in the red zone. Urbanisation has simply meant more humans live in close quarters, amplifying the transmissibility of epidemics. In all of these cities, the growth in population from in-migration has meant the proliferation of slums, compelling people to live in conditions with sub-optimal sanitation and poor access to clean water. India, with a case fatality ratio (CFR) of 3.4, higher than the US and China at the same stage of the pandemic, suggests the prevalence of co-morbidity, a concern for the future.

Over the medium term, we face an even more daunting threat -- the known unknown: climate change. Zoonotic epidemic threats are elevated by the insidious march of climate change which is expanding the habitats of various common disease vectors, such as the Aedes aegypti mosquito, which can spread dengue, chikungunya, zika, and yellow fever. Locally, extreme climate events like sudden and untimely floods and prolonged chronic droughts are rendering livelihood sustainability far more vulnerable. The greater challenge -- the unknown unknown -- is the pathogens that are currently unknown. In December 2015, the World Health Organisation listed epidemic-potential disease priorities requiring urgent R&D attention. That list was updated in February 2018. India will do well to increase the budget allocated for medical research significantly, while at the same time giving impetus to private sector medical research.

Foremost is the need to create incentives for drug discovery, new and improved vaccines, and perhaps even more important, expanding effective and affordable treatment. We must recognise a significant market failure when it comes to vaccines against individual low-probability pathogens that collectively are likely to cause epidemics. The low probability that any single vaccine of this type will be needed, high R&D costs, and long gestation returns, has simply meant that private industry, driven as it is by profits, is loath to investing in their development. The profit-seeking interest does not sit well with the social good of minimising the risk posed by these diseases in the aggregate. Farsighted public policy can overcome this market failure by ensuring that the Indian Council for Medical Research and its network of institutions is provided with the human resources, infrastructure and the budget that it needs.

The policy choices that government must exercise ought to be an eclectic mix to achieve different and often competing objectives, including: to minimise the likelihood of outbreaks or limit their spread; to mitigate the health impact of outbreaks that cannot be prevented; and with yet others, to moderate the economic consequences.

If there is just one lesson that we must learn from COVID-19, it is that a simple minimalist menu of policy priorities pursued with essentialist rigour will help, and must include: improved sanitation, provision of clean water, and better urban infrastructure; strengthening the primary and the secondary public healthcare system in the rural and urban centres alike; and promoting nutrition in early childhood and for pregnant and lactating mothers to ensure good baseline levels of health, making people less susceptible to infections.

In particular, policies to protect spending in these areas even when budgets are constrained must be made politically non-negotiable to safeguard all citizens from major health shocks that can adversely impact human capital and impede human development.

But the heart of the matter, as a society, is the challenge of fostering a sense of fraternity. India has long been a country in search of an Indian. If nothing, COVID-19 has shown that the consciousness that we are Indians first, sublimating intersectionality, must permeate our core values. Babasaheb Ambedkar emphasised that “Fraternity means a sense of common brotherhood of all Indians.” This pandemic has demonstrated first-hand the virtue of his sage advice. This alone can protect our collective well-being in the future. After all, our real strength is in standing together as one people regardless of caste, creed, language, religion and region -- the true manifestation of India.

(The writer is Director, Public Affairs Centre, Bengaluru)