The massive scale of illness and deaths caused by the mighty second Covid wave has prioritized both the need and the desire to understand the causes of this wave, the severe inadequacy of treatment and the horrific number of deaths. As a consequence, we are now flooded with all kinds of theories which range from the weird (5G towers and more) and deceitful to the naive.
Many naive analyses pin the responsibility for the crisis on the "system", as if it were some autonomous machine; some blame evil, entrenched "elites". A recent piece in The Indian Express blames "an outdated administrative system" and a "knowledge elite" for failing to tackle the Covid surge.
It is indeed true that routine failures in the established bureaucracy are commonplace in every crisis. Vast sections of this officialdom are dysfunctional, riven by petty corruption, and manned with staff with low levels of competence, commitment and empathy. Public institutions are terribly under-funded and under-staffed - most of these offices with a non-existent or barely-maintained infrastructure. Walk into a public hospital in any city, especially outside the metros, and the appallingly decrepit ethos will hit you in the face. But It is incredibly naive to say that it is an "administrative system" to blame. It is political, policy-defining entities who should be held responsible for having allowed such a "system" to come to pass over decades. At every point of time, the "system" has been owned and operated by those holding the reigns of power.
Similarly, it defies all logic how the current Covid crisis can be attributed to the apparent villainy of some "knowledge elite" which has apparently monopolized and hoarded knowledge. This "elite" seems to refer to the "3,000 eminent scientists and professors in our elite institutions".
Scientists have spoken out - though one can question whether those who are close to the governments of the day have spoken enough truth to power. However, it is equally true that bureaucracies have political masters, and in this country, they have little professional autonomy; scientists can find themselves similarly trapped, especially when it comes to policy matters.
A common trope of the "it-is-the-system-to-blame" analysis is to lament how well "other systems work compared to ours". For instance, it is observed that the website of the Centre for Disease Control (CDC) in the US provides Covid statistics in great detail whereas "none of these clinical facts are known for India". This is grossly incorrect - abundant data is hosted by various government websites (Ministry of Health and Family Welfare - MoHFW, Indian Council of Medical Research - ICMR) though it certainly is not that well-organized or analysed. However, the real problem is that data collection and storage is centralized, by design, with the ICMR, which has been rather unwilling to share it with the broader scientific community. So much so that scientists have petitioned the Prime Minister for this data to be made accessible to them. Therefore, if such data has not been researched well enough, the fault lies with those who have instituted this monopoly.
Of even greater importance is the unreliable quality of official data related to the numbers of Covid cases and deaths, and the failure of governments to ensure data integrity. The media reports (1, 2, 3) everyday of the mismatch (1, 2) between the official figure of deaths and that observed at crowded cremation locales. It has also been reported that sometimes private labs were told not to test, citing the excuse of being overwhelmed with samples. It is unlikely that bodies floating in our sacred rivers or those buried on their banks have been recorded in official data. The disempowering impact of such inaccurate data has also been widely discussed. Such data provides a false basis for any kind of forecasting, planning and epidemiological modelling. It has been suggested that the real infection incidence as well deaths seem to be underestimated by factors ranging from 2 to 20. The issue has also been flagged by High Courts (1, 2). This is the biggest "virus in the system". Despite this, many experts in the country have been working with limited data and in trying circumstances. Numerous teams from the IITs too have offered engineering solutions and launched projects on various aspects of the Covid pandemic.
But the unarguable fact is that political priorities are the biggest determinant of how effectively things function, especially in a crisis. For instance, plenty of guidelines and protocols are given on the MoHW and ICMR websites, but some of these are not up to date - despite all scientific evidence available demonstrating that drugs such as hydroxychloroquine, favipiravir and ivermectin have little efficacy, they continue to be recommended. These are government- run and owned websites. Clearly, the responsibility of having accurate, updated and effective guidelines on these websites is the responsibility of the state, not any "knowledge elite ". But what can one expect when the AYUSH ministry itself continues to push unvalidated herbal solutions?
What is worse is that eminent persons demonstrated their support for scientifically unverified Covid "cures", such as Chyawanprash and Kadha, and, of course, Coronil. This is likely to have encouraged people to explore these "cures" (apparently Coronil is so much in demand that it is reportedly out of stock) in good faith instead of following validated protocols upon suspicion of infection. While groups of scientists have been trying to bust misinformation on Covid remedies, an internet search does not reveal any similar campaign launched by the government. A high-profile and persistent campaign by government agencies would have prevented people from experimenting with nebulizers, camphor, garlic, eucalyptus oil and cowdung.
A positive demonstration of what can be donel if people at the top want it, is provided by the Brihanmumbai Municipal Corporation (BMC) which has done an excellent job of running ward-level "war rooms" to manage patient flows and hospital admissions, and of maintaining a reasonably updated dashboard (see here for more details). So if online services (like ambulance dispatch or bed allocation) or sufficient infrastructure (like beds, oxygen plants, ventilators, ICUs) do not exist the fault lies with the political leadership at various governance levels (centre, state, municipal) because they forgot to invest in these and pass appropriate orders, - and are now unable to scale up and organize a quick and effective plan of action as the BMC did.
The "system" and "elites" are just smokescreens. They obscure the many more important things that political leaders and policy-makers should have done (or not) to contain the ravages of the Covid surge. Were alerts issued by scientists, on behalf of committees instituted by the government, about the likelihood of mutant strains driving an upswing in Covid infections taken seriously? Were warnings that the Kumbh Mela would be an infection super spreader given the importance they deserved? Ditto for mega election rallies.
The likelihood of oxygen shortage, as well as those of hospital beds, ventilators and ICUs were known to the "system". In fact, this alert was issued by a parliamentary panel in November 2020! It was the job of "system" owners to take necessary action in response to this alert. Even more apocryphal is the tussle between different governments on the issue of oxygen allotment to states that culminated ultimately in the setting up of a committee by the Supreme Court. This was not bureaucratic wrangling but a battle between political agents.
Finally, look at the mess that we have on our hands regarding vaccination strategy. It is proceeding terribly slowly, in fits and starts, with huge crowds at vaccine centres and a general shortage of the vaccine shots. Ramping up of vaccine production should have been invested in at the start of the pandemic. Some planners forgot to do basic arithmetic about how much stock we have and what vaccination rates we can sustain. Lots of confusion prevails about the prices, availability and distribution of vaccines. No one knows how so many people who are digitally disadvantaged will get access to vaccines because the only pathway is currently through the online CoWIN platform.
The fundamental issue with a "systems'' and "bureaucracy" discourse is that it drains out all the political components from the understanding of social problems. And it can disguise accountability. But most certainly the Covid crisis has not arisen from a "system" that is being conspiratorially run by an indolent "knowledge elite"!
(Anurag Mehra is a Professor of Chemical Engineering and Associate Faculty at the Center for Policy Studies, at IIT Bombay.)
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