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Killed by Procedure

Two learnings emerge. Firstly, our bloated bureaucracy and bureaucratic procedures have to be overhauled to make them capable of responding quickly to an emergency. Secondly, public health should not be guided by partisan politics, and a robust and effective national public health agency should be nurtured, to respond to public health threats, and to help prevent the next inevitable pandemic.

Devendra Saksena | New Delhi |

The governance model in India operates on the principle that the wisdom of generalists is paramount and domain specialists, however learned they may be, should defer to generalists. Unsurprisingly, bureaucrats rather than public health specialists had the final say in crafting the nation’s response to the coronavirus pandemic, and bureaucratic measures rather than basic public health measures are being tried out to control the raging pandemic.

For example, the first wave of Covid-19 infections was sought to be contained by a stringent sixty-eight-day lockdown. Yet, daily Covid infections that were less than 100 at the beginning of the lockdown ballooned to around 8,000 by 1 June 2020. The hurriedly imposed lockdown led to an exodus of migrant labour to their native places in the most inhuman conditions and also ruined our economy, with our GDP falling by 24 per cent in the first quarter of FY 20-21.

The Government justified the human and economic cost of the lockdown as a collateral damage, necessary to contain coronavirus infections and build the country’s capacity to fight the pandemic. The hollowness of claims of having augmented medical infrastructure and the country’s production capacity of medical consumables between the first and second waves of the pandemic, stands exposed by the current shortage of medical equipment, right from hospital beds to ICUs to medical oxygen to PPE kits to vaccines.

The Government is now on a massive buying spree from China, with the Western world pitching in with medical aid. Significantly, Government of India’s policy, designed by Manmohan Singh in 2004, in the wake of the Tsunami, and reiterated at the time of the Uttarakhand disaster (2013), was of not accepting foreign aid under any circumstances. Reliance on bureaucratic wisdom at the time of Covid-19 pandemic is somewhat strange, given the fact that we have the venerable National Centre for Disease Control (NCDC), (established in 1909) whose mandate is to deal with pandemics by “employing epidemiological and diagnostic tools” and “investigating and recommending control measures for the out-break of various communicable diseases.”

We also have the Indian Council of Medical Research (ICMR), established in 1911, as the apex body for the formulation, coordination and promotion of biomedical research. Inexplicably, both these organisations are not at the forefront at the fight against the Covid-19 pandemic. Probably, being only minor adjuncts to the Health Ministry, these organisations were not thought capable of tackling the pandemic, and bureaucrats, in their superior wisdom took over the leadership of the management of the Covid-19 pandemic.

If there can be solace in scoring brownie points, the US Centres for Disease Control and Prevention (USCDC), an agency that was once at the forefront of global disease detection and control, initially dented its image in its handling of the Covid-19 pandemic. It may, however, be pointed out that the White House Coronavirus Task Force had repeatedly altered the advisories of USCDC scientists about Covid19, including recommendations on social distancing in bars and restaurants, and making a downright foolish recommendation, on the advice of the White House Coronavirus Task Force, that people showing no Covid-19 symptoms need not be tested for Covid-19.

Later on, in September 2020, the USCDC drafted an order requiring masks on all public transportation in the United States, which was blocked by the White House Coronavirus Task Force. Thus, due to political interference, in the initial stages of the pandemic, the US CDC, comprehensively failed to handle the Covid-19 pandemic. However, being fair to the USCDC, it could be said that rather than relying on basic public health principles to tackle the pandemic, the US Government like the Indian Government, was obsessed with magic bullets vaccines, new medicines, or a hope that the virus would simply disappear.

With the departure of Trump, USCDC has regained its credibility and is capably leading the struggle against the Covid-19 pandemic. Nearer home, as soon as the first wave of Covid-19 infections ebbed, our response mechanism went into hibernation; bureaucrats tasked with keeping a watch over the pandemic shifted their attention to other, routine, but probably more important matters. Since, the political leadership wanted to hold elections and religious congregations despite the obvious danger of rising infections, the top leadership declared that the pandemic had been vanquished.

The Government changed its tune only in late April 2021, when the second wave of coronavirus infections had attained tsunami proportions. Initially, in a typical bureaucratic response, the Government denied a shortage of critical equipment and drugs and those talking of shortages or suggesting novel measures to fight the pandemic, including ex-PM Manmohan Singh, were branded as vested interests and malcontents. Upping the ante, the Prime Minister announced a Tika Utsav (Vaccination Festival) from 11 to 14 April 2021, and vaccination of all adults from 1 May, though most vaccination centres were running short of vaccines.

When newspaper reports in early May 2021 suggested that the vaccine shortage had arisen because the Government had not ordered a sufficient number of vaccine doses and that the last order for vaccines had been placed in March 2021, the Government replied that it had ordered 16 crore vaccine doses on 28 April 2021. However, no one in Government explained how such a large quantity of vaccines was supposed to be manufactured and supplied, in time for the vaccination drive starting on 1 May 2021. Caught in the ugly controversy, the owner of Serum Institute of India, Adar Poonawala fled to London, citing a threat to his life.

Last heard, a top minister of the Government has been deputed to bring him back. Notably, India’s vaccination drive had begun on 26 January 2021 with 3,000 vaccination centres with a target of 100 vaccinations daily on weekdays – at which rate it would have taken more than 10 years to vaccinate the target population.  The horrendous results of neglecting the Covid-19 pandemic are now manifest; all cities have long queues of ambulances gathered outside over-full hospitals, that have little oxygen or critical medicines.

The crumbling health infrastructure has given up the ghost; in addition to deaths from Covid-19 infections, a number of fires, oxygen leaks and shortages, have taken a ghastly toll of innocent lives. Giving the lie to Government death statistics, crematoriums and graveyards have long waiting lists, denying dignity to the dead. The reason for the delayed response of the Government is obviously the status-quoist nature of the bureaucracy, which can never be proactive, only reactive; when the second wave of Covid-19 infections started to build up in February 2021, no decision-maker had the foresight or courage to say that the Government should prepare for a sustained rise in the number of infections.

Consequently, no one planned for deploying extra hospital beds, more medical oxygen or more ICUs. The Government took its time in ordering extra doses of Covishield and Covaxin on 28 April 2021, that too, after 1.32 crore persons had registered for vaccination, on the first day on the Cowin portal. Then, bureaucratic procedures are highly time-consuming, even emergent actions are approved only after the relevant file has travelled from the bottom functionary to the top level.

Often, other departments also have to be consulted; if money is to be spent the file goes to the finance department, if a law point is involved the file travels to the legal department. Thereafter, tenders are placed and the purchase is approved by a purchase committee. Such antediluvian procedures hampered the fight against the pandemic that grew by leaps and bounds. Daily, on a continuous basis, the Supreme Court and almost all High Courts are hectoring the Central Government and State Governments to control the ravages of the Covid-19 pandemic.

The Supreme Court has noted with dismay that in many cases sufficient resources were available but were not deployed optimally because of administrative incompetence and lack of coordination between the Central and State Governments. The Delhi Government has accepted defeat, after losing the battle, both against the Centre and the Covid19 pandemic, and has mooted calling in the army to control the Covid-19 pandemic. Two learnings emerge.

Firstly, our bloated bureaucracy and bureaucratic procedures have to be overhauled to make them capable of responding quickly to an emergency. Secondly, public health should not be guided by partisan politics, and a robust and effective national public health agency should be nurtured, to respond to public health threats, and to help prevent the next inevitable pandemic.

(The writer is a retired Principal Chief Commissioner of Income-Tax)