THE COVID BLAME GAME: FAULT vs RESPONSIBILITY
Assigning responsibility to stakeholders will shine the light on the structural constraints undermining India's battle against covid-19. #EPISODE 22
Dear Reader,
A cheerful Monday to you.
For the last few weeks our journey in the unwelcome company of the SARS-COV-2 virus has been a nightmare. It is like we are stuck in a dark tunnel with no end in sight. It is a testing time as hospitals with maxed out capacities struggle to care for the sick, just as the rising death toll drains our emotional strength. Worse we have to cope with those among us who see this as an opportunity to profit from human suffering.
Yet at the same time it is heartening to see so many people throwing themselves to the cause of helping—often strangers—the afflicted. Sharing a real heart warming story published in the Indian Express on Sunday of how a student temporarily adopted a 93-year old covid patient as her grandmother to provide care during her convalescence in the hospital. This story has a happy ending as both won the battle against covid-19.
Even as we explore solutions to mitigate the horrible fallout of the covid-19 pandemic, India runs the risk of being overwhelmed by a backlash of explosive outrage. Most of us are struggling for explanations to achieve emotional closure. The policy missteps amplified in social media and sharp comments from the courts only make us angrier. With all due respect to everyone, I suggest we try and look at this differently. Instead of ascribing fault we should explore assigning responsibility. Yes, it is a fine line between the two. Every stakeholder—including us common people—has an assigned responsibility. It is my case that by going down this path you are better placed to explore solutions, which at the least can help avoid making the same mistakes in the future; especially in dealing with the next wave of the pandemic.
The caption for this week’s picture—“There is no light without shadows, just as there is no happiness without pain”—is from Isabel Allende.
And thank you for your support. A big shoutout to Balesh, Vandana B, Gautam, Premasundaran, T P Balakrishnan, Yugainder, Abhijit, Rahul and Aashish for your informed comments and amplification. I was remiss for not acknowledging your support last week. Grateful. And, many thanks to readers who hit the like button 😊.
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Read on
THE BLAME GAME
Over the last few weeks the intensity of the blame game over the spread of the covid-19 pandemic has grown exponentially. Understandable as the mutated version of the SARS-COV-2 virus has spread ferociously and with a deadly fallout. Lately, this shrill exchange, playing out largely on social media, has assumed frightening form and substance (sometimes through deliberate disinformation). It is also breeding an air of all consuming negativity (Exactly why I have retreated from WhatsApp groups).
How do we make sense of this? Indeed it is almost next to impossible to reason as you are likely to be pilloried by either side or even both. I shall, with due respect to all those we have lost (including some of my friends and relatives just outside the immediate family circle), attempt to put this in context. After that it is for you to draw your own inferences and lessons.
I believe that to a large extent the binary environment around us is shaping these extreme views. And this in part is due to the way we have framed the discourse: focusing on finding fault instead of assigning responsibility.
The minute we look to ascribe fault there is a certain finality to it. A ring of judgement. Something that sets the tone: agree or disagree. The ensuing blame game is inevitably rhetorical and precludes debate.
Alternatively if we look to assign responsibility to all stakeholders, implicitly we are seeking accountability. Not only is the latter opening up space for a dialogue it also holds everyone, including institutions, up to institutional scrutiny—something that will survive the course of this pandemic and serve up genuine solutions.
So to allege that the covid-19 pandemic is somebody’s fault is a contestable claim, especially if it is influenced by one’s ideological predilections. Instead if we are to assign responsibility—by first identifying an individual’s or an institution’s assigned role and matching it with their actions/inactions as they case may be--then it may frame the context better. More importantly it will help identify the cause. Something that can help us fix the gaps such that subsequent generations can be spared a similar tragedy. This effort is not exhaustive. It merely seeks to set you thinking.
The Playbook
What most of us forget, and consistently at that, is that this is a once in a century pandemic. The last time an event of this proportion hit the world it was the Spanish Flu of 1918. Over two years it felled 500 million people. Mercifully, medical advancement and the relentless efforts of covid-warriors is protecting us against such a devastating death toll.
Effectively, there is no playbook to fall back upon. Exactly why even developed countries succumbed similarly in the first wave. Mysteriously though, China, the ground zero for the virus, has remained unscathed; the World Health Organisation reports a little over 100,000 infections in the last 18 months! Presumably the intrepid reporters of the New York Times can provide us some explanations with their brand of investigative reporting. (Those interested in checking the data can click here.)
At the moment, Japan is on the verge of being overwhelmed by a fourth wave, something that may nix this year’s Olympics scheduled in Tokyo. Similarly South America is swamped by a fresh wave.
This is in no way to suggest a fatalistic stance or complacence. Instead the intent is to induce a sense of realism. We need to acknowledge that no country can possess the capacity to deal with a pandemic. It will have to leverage its existing capability through strategic deployment.
Healthcare Capacity
But this does not mean that we can’t have a plan to deal with such an eventuality. Exactly what you do in war gaming.
In India’s instance we dropped the ball long ago. The sins of decades of public policy neglect in health are coming back to haunt us. Not only do we not possess the medical infrastructure to stage a battle, the country does not own a central database capturing existing capability.
The annual National Health Profile only profiles medical infrastructure in the public sector and that too at the end of the previous year. The assets in the private sector are not collated in one place. However, some scholars, in the aftermath of the onset of the covid pandemic last year, managed to draw up a database in April last year. Those interested in reading about the methodology can click here.
What they discovered is revealing.
“India has approximately 1.9 million hospital beds, 95 thousand ICU beds, and 48 thousand ventilators. Most of the beds and ventilators in India are concentrated in seven states – Uttar Pradesh (14.8%), Karnataka (13.8%), Maharashtra (12.2%), Tamil Nadu (8.1%), West Bengal (5.9%), Telangana (5.2%) and Kerala (5.2%).”
Stack this against the fact that cumulatively, since 3 January 2020, the World Health Organisation estimates the total number of infected in India at 21.8 million. Yes, India has managed to ramp up ventilators and temporary bed capacity. But this won’t even come close to dealing with the surge in demand for healthcare.
The Syndemic
Even before the covid-19 pandemic struck, India’s health situation was a ticking time bomb. This is because over the last few decades the country’s disease burden has leaned towards non-communicable diseases (NCDs), even while it failed to put the lid on the spread of communicable diseases like tuberculosis. It is estimated that six out of 10 Indians die from NCDs such as cancer and heart attack.
Therefore, right now, a variety of NCDs are interacting with the ongoing severe respiratory syndrome associated with the SARS-COV-2 virus. It makes this pandemic doubly dangerous. The lack of a health infrastructure has only worsened the odds for India’s fightback.
This situation is not a pandemic. Instead it is what medical experts describe: A Syndemic. The term was coined by Merrill Singer, an American medical anthropologist. Experts maintain that this is an extremely dangerous situation which substantially enhances the health risk to a population.
In the final analysis it is hopefully apparent to you that a rhetorical blame game—of the kind we see playing out in every Parliament session--will only kick the can down the road. Bury the underlying challenge. This is no longer an option. India cannot afford to look the other way on the erosion in its health fabric. The covid-19 pandemic is a wake-up call. Instead it is time to force a scrutiny of the difficult circumstances that hamstring India’s fight back. And for this the onus is on the basic pillars of Indian democracy: the government, Parliament and the judiciary.
To begin with we have to accept that unfortunately there is no short-term fix—the vaccine project, even if all the kinks are ironed out, will take two years to cover the target population of 900 million. We have to take it step by step. For now the focus is to mitigate the human toll. And the government needs to walk the talk on cooperative federalism. The good news is that the spread of the covid virus in the second wave has either peaked or poised to do so. For now this is the best news.
Recommended Reading
This week I am sharing a utility created by a team which includes Akhliesh Tilotia, someone I had first met when he worked for the government. The app which taps data from the Cowin portal—where we register for our vaccines—helps you check, based on your pincode, if covid-19 vaccination slots are available.
To access the app click here.
Till we meet again next week. Stay safe.
From Srikanth Srinivas:
Anil, you make an interesting set of points, and raise an interesting set of questions. Some thoughts in response:
1. Blame is an expression of collective frustration about what is happening, but ultimately too much of it is unproductive, and distorts perspectives. It also hardens positions.
2. Social media is - in my opinion - an organising structure. It can create communities like the ones seeking to access ways of getting people medicines, treatment and hospital beds, or plants ideological flags that draw like-minded people into a different kind of community. The most egregious outcome is polarisation. Like you, I’ve withdrawn from most platforms.
3. I think it’s important to draw a distinction between responsibility and accountability. The first is shared, the second cannot be. In the blame game, accountability takes a back seat. It matters, because it’s accountability - which also means answerability - that gives us lessons for the future, both immediate and long-term.
4. We - as individuals and parts of organisations - are held accountable for the decisions we take and duties we are charged with every day. Political leadership is accountable for action or inaction - both of which are decisions - for their duties too.
5. The state of our medical system and infrastructure is a discussion that will stretch the limits of your calculus :) and mine. It warrants a complete and detailed discussion I hope you’ll take up. But this much we know: it’s been neglected for too long, and if we continue to let this happen, this neglect can be classified as wilful.
Let’s hold people - ourselves, politicians, the bureaucracy - accountable.
From Madhukar Sinha:
Every newspaper seems to have a slew of commentators who commentate on everything under the Sun. Covid-19 is their current pastime. As usual they point out the flaws in the way the Government and of course the ruling party have handled the pandemic. Somewhere in the narrative is just wee bit of a hint that the ruling party is incompetent and things might have been better under some other dispensation. None has a suggestion how things can be improved from now onwards.
At the risk of joining the same ranks (albeit not being a professional commentator, I may be excused, please) I would like to say the following:
1. It is a fact that the bureaucracy of the country, but for some honourable exceptions, has failed miserably. The fault may lie with the Political leadership in Ministries which possibly tried to play the Chief Executive in every field but more so with the bureaucrat who yielded this space over the past decades and abdicated the responsibility for which they were bred in the system.
2. The sheer disdain for experts that has been visible in every field and the need to dominate all spaces where the Politician does not enter has resulted in our administrative system being woefully ill-equipped to handle such emergencies.
3. It won't be correct to ascribe our inability to handle this pandemic to its once in a century frequency. The administration has to war-game such situations and develop protocols for such events which can be suitably modified around a basic structure of responses and proactivity.
4. While the emergency action on containing the 2nd wave would need to continue apace, the time is more than ripe to create an action plan to prevent, or at the worst, limit the 3rd wave. Enough learning has occurred from the first two waves to develop a strategy and not only tactics for such approach.
5. Relying on Political leadership to provide guidance in what is essentially in administrative domain should be given a go-by. There is enough talent and experience and good intent available in the system to take this initiative on war-footing right now.