Imagine that Jawaharlal Nehru was the prime minister (PM) today. There is a global pandemic raging, the economy is in trouble, the Chinese have invaded the country and Pakistan is up to its old tricks with skirmishes on the western border. Being a committed democrat, Mr Nehru calls a session of parliament to discuss the present crisis and give an account of his government to parliament. This is how the fiercely independent press of that time could be reporting it.
The President, on the advice of PM Nehru who called on him last week, called a special session of parliament today. Although the people are fully supportive of the PM’s efforts in handling this unprecedented crisis, there is a small but strong Opposition led by one of his old friends, C Rajagopalachari, with other leaders like Dr SP Mukherjee, Dr BR Ambedkar, Atal Bihari Vajpayee, SA Dange, AK Gopalan, Acharya Kripalani, Maharani Vijayaraje Scindia, Meghnad Saha and Sardar Hukum Singh, all of whom are determined to hold the government to account.
Yesterday, the PM was asked a number of uncomfortable and specific questions on 10 key issues surrounding the health crisis and there was a consensus that his leadership of the nation is being questioned, perhaps for the first time in his career.
1. Intelligence failure—how did a leader of one of the Opposition parties know and assess COVID to be a serious risk in February? Will the PM admit that he was wrong to be dismissive of this threat? How did Kerala know and prepare so well for the pandemic before all the other states and the Central government did? Is it true that both USA and India knew about the epidemic in November but didn’t think it to be serious enough to prepare for it? Where does the responsibility lie for this failure? Did the Indian embassy in Beijing not inform New Delhi that there was an epidemic in a huge Chinese city which was rapidly spreading to the rest of the province and ultimately to the world? Who in New Delhi decided that, despite daily reports from the Indian consulate in China, it was not a serious enough issue for India to do anything until March?
Did the Indian government have a similar plan? If it did, when were those plans last checked to test if they were still effective? When was the last time those plans had a mock drill to test those plans? It is expected that boards of directors of companies will have a risk management committee and satisfy itself on a periodic basis that the risk management framework identifies risks accurately and in a timely manner and there are mitigation plans for each of those risks.
Shouldn’t the government be held to same standard? When was the CMC meeting called and why was there so much chaos and lack of coordination if the CMC was in charge of the crisis? Did the CMC bring this to the attention of the cabinet committee on security (CCS)? If this was not considered a 'crisis', clearly here is a structural failure. Given the recent global experience of SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) and the foresee-ability of a global pandemic, surely the blue book should have been updated for health crisis. If the CMC meeting was not called, there seems to be an institutional failure at the highest level.
Even after the expert committees were announced, it took weeks before they were constituted and even after months now, they don’t seem to be making much progress or provide any assistance. It is unclear what data is needed for decision making by government and how it plans to get it. The NITI Aayog and Indian Council of Medical Research (ICMR) leadership have neither the experience nor the expertise in managing an epidemic or any other healthcare crisis. The National Centre for Disease Control (NCDC), which was established to deal specifically with a health crisis, has been completely sidelined. Is the PM intending to undermine and humiliate a premier expert institution?
- This is a specialist body with an international network that constantly gathers intelligence and prepares for a health crisis like COVID. It should have been checking and rehearsing its disaster management plan to confirm if the assumptions it had made based on past experience were still true. It should have updated data regarding drug manufacturing capacity, hospital beds, equipment, doctors, etc and their availability at the local level where NCDC has dedicated resources.
When was the last time that this was done? Is there a periodic update of information to the NCDC and from the NCDC to government? When did NCDC know of COVID? What actions did it take when it knew? Did it update the government on its unpreparedness for an epidemic and suggest a plan of action? The Delhi government has stated in the High Court in July that it still doesn’t know how many hospital beds are available and cannot track availability. Government should have used specialist epidemiologists and executed the disaster management plan. Only Karnataka seems to have an epidemiologist in charge.
5. Clear communication and cooperation with states. Since health is a state subject and the PM is a great believer in cooperative federalism, why is there a widespread perception that there is chaos and no one really knows what to do—everyone is just flapping about? Given that the PM is a great communicator, why have there been more than 5,000 notifications, circulars and clarifications in 100 days and yet no clarity on what the government proposes to do or is doing?
6. The PM has been a great advocate of the development of scientific temper among Indians. Did the PM not understand the seriousness of the issue when he was informed by his scientists and other health experts or was the PM too arrogant to listen to them? Was he relying on the Chinese government to help?
His initial messaging was that it’s not a serious problem and people could be easily protected by an Ayurvedic kadha as a prophylaxis. He then amused them with the thali bajao and diya jalao gimmicks and had his ego massaged by the expression of love for him by the masses.
When did he understand the gravity of the pandemic and the consequences for India? How long after he realised it that he announced the sudden lock-down? What was the basis for the decision to impose a nationwide lock-down without any notice? What was the basis for the decisions to extend the lock-down? What data will determine the easing and lifting of the lock-down?
7. The PM is a great advocate of modern technology as a solution to all problems. The AS (Aarogya Setu) app was hastily created by a few 'volunteers' and promoted by the government as a 'COVID kavach'. Focus of the government seems to be on headline management and daily “master stroke” rather than disaster management. Every week, some IIT or government scientific research department or institution announces that it has had a globally pioneering breakthrough but nothing seems to come of it thereafter!
The AS app is a good example of an impotent 'digital' solution offered for every problem. Can he explain how the data from the AS app was used to take decisions? Together with the Ayurvedic kadha it seemed to send the message that COVID was not really a serious issue and would be easily managed in less than three weeks. What was the basis for that confidence and why did the basis for that confidence fail?
8. While the Indian PM was flapping about, the Singapore PM was clear in his communication and stated the situation just as it was—there was clear admission of what was not known and what precautions are to be taken. There was a financial package announced in March and enhanced in May and June to provide social security for the needy. The Indian government is still to make a coherent announcement and all the announcements made by the PM and the FM (finance minister) have had little or no real impact on the people and the economy. Will the PM and FM explain what they were thinking and why it didn’t work according to their expectations?
9. Failure of healthcare infrastructure: Why is it that the government is unsure about testing and treatment protocols? The masses still don’t know when to get tested and where to go for testing and treatment? What is the institutional structure to learn from actual doctors and patients about what works and what doesn’t, so that all of India can benefit from best practices? Why are there no daily updates and a process to ensure that the healthcare workers (HCWs) are updated daily on what’s changed and what the best action plan is?
The way the government has made announcements regarding hydroxychloroquine (HCQS), azithromycin, zinc, paracetamol, ibuprofen, remdesivir, favipavir and plasma therapy, it is confusing even for the professionals. How are patients to give informed consent when even HCWs don’t know what to do?
Failure to share real data and scientific information is shameful. Whether it was real infection or morbidity numbers, regulatory approval status and updates, hospital bed scarcity, PPE (personal protective equipment) availability, price control initiatives to ensure that there isn’t profiteering by a few rich businessmen at a time of crisis, the government seems to be hiding its ineffectiveness.
Is the government under pressure from its rich friends to approve expensive treatments without there being enough scientific evidence that they are effective? If there had been provision for compassionate use along with clinical trials, would remdesivir and favipavir have been approved without full disclosure of the clinical trial results? Does the PM approve of the manner in which certain religious charlatans have been fooling the trusting public with magic cures and remedies? What action has he taken against these snake oil merchants?
How can the PM justify the Pradhan Mantri Jan Arogya Yojana (PMJAY) when less than one patient per hospital per day has been treated under that scheme? Does the PM not understand the inequitable access to health resources, especially for the poor and the middle classes? Does the PM know the price of medicines and other consumables that are essential in this crisis? How does he justify price caps on cough and cold medication but not on hospital charges, medicines to treat COVID, masks and PPEs? All of these consequences should have been anticipated and actions to mitigate these should have been in the disaster management plan.
10. Will the PM accept that his government has failed to provide governance during this crisis but has, in fact, undermined several institutions and structures that have led to not just a mismanagement of the crisis but will do long-term harm to the nation?
The PM and several of his Cabinet members sat all day listening to the speeches in the Lok Sabha and while appearing stoic, took copious notes of all the points made by the Opposition leaders. He is likely to face questions regarding his failed foreign policy and the aggression by China and Pakistan today and on the economy tomorrow. His reply, which is eagerly awaited, is scheduled for Friday after a meeting of the cabinet that morning.
(Murali Neelakantan is Principal at amicus. He is a dual qualified (English solicitor and Indian advocate) and has previously worked on the “Connecting for Health” project in the UK