The second wave challenge (The Indian Express)

Written by S. Mahendra Dev

The second wave of the pandemic is receding although it continues to have a significant adverse impact on lives, livelihoods and the economy. Meanwhile, the threat of a third wave is looming large. The impact of the pandemic on the economy is expected to be lower this time as the lockdown is less stringent. However, one difference between the first wave and second wave is that the latter is spreading to rural areas also. It is known that rural areas have poor health infrastructure. Similar to the first wave, inequalities are also increasing during the second wave. Thus, India has to address both growth and inequality issues.

The overall GDP growth would be less than the earlier expectations — the GDP growth in 2021-22 is expected to be around 8 per cent. The level of real GDP in 2019-20 was Rs 145.7 lakh crore. At the end of 2021-22, the level of GDP may be the same or lower than that in 2019-20. In other words, India would have zero per cent or negative growth over the two-year period FY20 to FY22. This is on top of the continuous slowdown of the economy during the eight quarters preceding the pandemic. India may become a $5-trillion economy only in 2026-27 or beyond with the assumption of 12 per cent nominal growth in the next few years. In other words, much more effort is required to compensate for the lost growth and put the economy on a higher growth path.

The country has to address the issue of rising inequalities for achieving higher sustainable growth and the well-being of a larger population. Inequalities were increasing earlier also, but the first and second waves of the pandemic have widened them further. The State of Working in India 2021 report of the Azim Premji University revealed that both poverty and inequality increased during the first wave. According to this report, the pandemic would push 230 million people into poverty. CMIE data shows a decline in incomes and rising unemployment during the second wave. In the week ended May 16, 2021, around 56 per cent of households reported a loss of income compared to a year ago. Unemployment increased to 14.5 per cent in the same week and it is high in rural areas also. India is suffering from a job crisis. The recent RBI Bulletin says that the impact of the second wave appears to be U-shaped. “In the well of the U are the most vulnerable — blue collar groups who have to risk exposure for a living and for rest of society to survive; doctors and healthcare workers; law and order and municipal personnel; individuals eking out daily livelihood; small business, organised and unorganised — and they will warrant priority in policy intervention.”

The recovery seemed to be K-shaped during the first wave. The share of wages declined as compared to that of profits. A large part of the corporate sector could manage the pandemic with many listed companies recording higher profits. On the other hand, the informal workers including daily wage labourers, migrants, MSMEs etc. suffered a lot with loss of incomes and employment. The recovery post the second wave is also likely to be K-shaped with rising inequalities.

What are the policies needed for higher growth and a reduction in inequalities? The government should have a three-pronged approach.

First, an aggressive vaccination programme and improving the healthcare facilities in both rural and urban areas is needed. Reducing the health crisis can lead to an economic revival. Vaccine inequality between urban and rural areas has to be reduced. As rural areas have poor health infrastructure, more efforts are needed to reach the rural areas for vaccination. The crisis can be used as an opportunity to create universal healthcare facilities for all, particularly rural areas. Other states can learn from Kerala on building health infrastructure.

Second, the budget offered some good announcements relating to capital investment in infrastructure. The Development Financial Institution (DFI) for funding long-term infrastructure projects is being established. A boost to infrastructure investment, including in rural areas, can lift the economy out of the Covid-19 induced slowdown. The government has to fast track infra investment. This can revive employment and reduce inequalities.

Third, there is a need for safety nets including cash transfers. The informal workers and other vulnerable sections including MSMEs have been dealt back-to-back blows in the last 13 months due to the first and second waves. A majority of workers have experienced a loss of earnings. Therefore, apart from its focus on infrastructure, the government has to provide safety nets in the form of free food grains for six more months, expand work offered under MGNREGA in both rural and urban areas and undertake a cash transfer to provide minimum basic income.

On economic growth, the RBI Bulletin says that “the biggest toll of the second wave is in terms of a demand shock” as aggregate supply is less impacted. There are two views on a consumption revival. One view is that once the second wave subsides and the majority are vaccinated, consumption will return to normal levels. The second view is that demand will be a constraint because of loss of incomes and employment. In the medium term, the investment rate has to be increased from the present 30 per cent of GDP to 35 per cent and 40 per cent of GDP for higher growth and job creation. There is positive news on exports as the global economy is reviving. Export is one of the main engines of growth and employment creation. However, in recent years India’s trade policy has become more protectionist and the country has to reduce import tariff rates.

Monetary policy is already very accommodative and there are limits to more accommodation. In the near term, fiscal policy has to play a more important role in achieving the objectives of growth, jobs and equity by expanding the fiscal space by restructuring expenditure, widening the tax base and increasing non-tax revenue. Of course, fiscal policy has to return to a stable path in the medium term.

 The writer is director and vice chancellor, IGIDR, Mumbai.

Courtesy - The Indian Express.

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Free shots for all: This must be India’s vaccination strategy (The Indian Express)

Written by Jean Dreze 

 

At a time when fair and speedy COVID-19 vaccination is of the essence, the Indian government has done a great job of putting us at the mercy of vaccine manufacturers. It is bad enough that we depend, as of now, on just two suppliers — the Serum Institute of India (SII) and Bharat Biotech. What is baffling is that the government has now allowed them to set their own prices — “whatever you want in terms of being reasonable and fair”, as SII chief Adar Poonawalla candidly explained in a recent interview to CNBC. For good measure, suppliers are also allowed to set different prices for different buyers (the Centre, states and private hospitals), enabling them to charge what different segments of the market can bear. This is the polar opposite of the “single-payer model” in healthcare, where the government tries to get the best possible deal from drug manufacturers by acting as the single buyer.

In the single-payer approach, the central government would order all the vaccines and then distribute them equitably between states, and possibly some private healthcare providers. This was, more or less, the situation in the first phase of the COVID-19 vaccination programme, when most of the vaccines were sold to the central government at a negotiated price of Rs 150 per dose. However, a radical change occurred on April 21 with the release of the central government’s policy note on “Liberalised Pricing and Accelerated National COVID-19 Vaccination Strategy”.

It is important to read the fine print of that policy, effective from May 1. The stated intention was clearly to supplement central procurement (limited to 50 per cent of vaccine supplies from then on) with a vaccine market where each manufacturer would charge one transparently declared price to all buyers other than the central government, that is, states and private hospitals. That intention, however, was defeated the very same day by SII, which announced different prices for states and private hospitals, with a much higher price (Rs 600 per dose) for the latter. And if suppliers can get a higher price from private hospitals, why would they take interest in selling to the states?

The danger of states being squeezed out was made worse by another aspect of the Centre’s new policy: It allows private hospitals to set their own prices for vaccination. Their prices will be “monitored”, but not controlled. In practice, monitoring is likely to be symbolic, giving private hospitals a free hand. In short, the stage has been set for a thriving vaccine market where private hospitals charge hefty prices for vaccination and manufacturers make money by selling a good portion of their supplies to private hospitals at inflated prices.

The central government’s policy note makes a virtue of “liberalised” pricing on the grounds that it will incentivise vaccine production. But production can equally be incentivised in the single-payer system by paying an adequate price — it’s just that the central government would have to foot the bill. So, the real function of this pricing policy is to save the central government some money. Why not tax the rich instead and foot the vaccine bill? It’s not a lot: Even if the price paid by the central government were to be raised from Rs 150 to (say) Rs 300 per dose, buying two doses for two-thirds of India’s adult population of 850 million or so would cost Rs 34,000 crore — less than what has already been allocated for COVID-19 vaccination in the 2021-22 Budget. Further, in a single-payer framework, the government would probably be able to negotiate a much lower price than Rs 300 per dose (perhaps even lower than Rs 150) without undermining production incentives.

Leaving the financial aspects aside, why would we prefer central procurement to “liberalisation”? The main reason is that it would lead to a more equitable distribution of vaccines in the population. Today, India is facing an acute shortage of COVID-19 vaccines. In the public sector, there is (or was, until now) a reasonably equitable system where vaccination is provided free of charge to everyone in expanding priority categories such as health workers, the elderly, everyone above age 45, and so on. In the private market, on the other hand, scarce vaccines are distributed according to their ability to pay: The poor are excluded as the rich jump the queue. The problem gets worse when private provision degenerates into an extortionate black market, as might happen in a situation of vaccine scarcity (much as with oxygen and COVID-19 medicines today).

If it were the case that expanded vaccination is held up by the government’s lack of capacity to vaccinate, rather than by a shortage of vaccines, there might still be an argument for promoting private provision: It would augment vaccination capacity. But the main constraint today is a shortage of vaccines. India’s public sector is perfectly capable of vaccinating en masse, if vaccines are available. This has been well demonstrated in earlier vaccination programmes, including some that involved 100 million shots in a single day.

As argued earlier, liberalisation does not really ease the shortage of vaccines, it just shifts some of the financial burden from the central government to private buyers. But the savings are at least partly illusory, since liberalisation also enhances the bargaining power of manufacturers in public procurement negotiations. In any case, trimming the vaccination budget is hardly a priority when COVID-19 threatens to sink the economy.

The central government’s vaccine policy is an extension of liberalisation to a domain where it does not belong. The way it came about, as Adar Poonawalla revealed in the CNBC interview, is that the private sector “lobbied” (sic) for it. As far as the public interest is concerned, free vaccination at public health centres is a much better strategy. Any proposed departure from it should be examined “not only with the most scrupulous, but with the most suspicious attention” as Adam Smith wisely advised us to consider business-sponsored proposals many years ago.

The writer is visiting professor at the Department of Economics, Ranchi University.

Courtesy - The Indian Express.

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In healthcare, Gujarat is in BIMARU league (The Indian Express)

Written by Christophe Jaffrelot , Sharik Laliwala

The government was high on confidence as the BJP had outperformed expectations in the local elections held a few weeks before. But the hubris was misplaced, since the second wave had started in February.

On March 3, 2021, Nitin Patel, Gujarat’s deputy chief minister, who is also the finance and health minister, congratulated his state government for having excelled at containing the COVID-19 virus while presenting the annual budget in the legislative assembly. He went off-track in his budget speech to note how other states kept patients in open grounds and stadiums, but, in contrast, none of that took place in Gujarat because of “our speedy decisions to ramp up health infrastructure.”

The government was high on confidence as the BJP had outperformed expectations in the local elections held a few weeks before. But the hubris was misplaced, since the second wave had started in February. By the first half of April, non-availability of hospital beds, life-saving drugs, and oxygen supply became an everyday sight in major cities across the state. Even the most privileged citizens — elites and the middle-classes — for whom Narendra Modi as the state’s CM carved out special concessions like tax breaks and land policies, were left to fend for themselves.

The malaise in Gujarat stems from a systemic problem that piecemeal augmentation cannot ameliorate — the retreat of the state from essential infrastructure and the privatisation of the health industry. In turn, it left the state organs unprepared to deal with the pandemic. Just in terms of hospital beds, Gujarat fares worse than most of India. Data from the Centre for Disease Dynamics, Economics and Policy show that there are 138 hospital beds in the country per one lakh population, while in the rich, industrial state of Gujarat, this number is below 100. Even socio-economically backward regions like Rajasthan and Uttar Pradesh have a better hospital bed availability with 123 and 130 beds per one lakh people respectively. The same holds for critical care beds.

Instead of filling these deficits, the government’s chest thumping in the budget presentation hid finer details. Even in times of the pandemic, the state government cut capital expenditure on public health infrastructure — as opposed to the budget estimate of Rs 914 crore, it spent only Rs 737 crore in 2020-21. The budgeted capital outlay on medical and public health is just Rs 856 crore in 2021-22 translating to less than Rs 150 per resident. It is lower than the budgeted figure for the same in socio-economically backward states like Bihar (Rs 2,437 crore). The total budget for Gujarat’s health and family welfare ministry stood at Rs 11,323 crore for 2021-22. In other words, the state government reserved less than 0.7 per cent of the state’s GSDP and fewer than Rs 5 daily expenditure per state resident’s healthcare. The percentage on healthcare services in the budget declined from 5.54 per cent in 2018-19 to 4.98 per cent in 2021-22 — far below the 8 per cent recommended by the National Health Policy.

The state’s withdrawal from the public healthcare system in the last few decades, a phenomenon that runs parallel with economic liberalisation, has put its track record on health indices in the league of the so-called BIMARU states. As per the NFHS-5 (2019-20), close to 80 per cent children in Gujarat under the age of five years suffer from anaemia. Not only is this figure worse than in Assam and Bihar, it is a jump of nearly 17 percentage points from that recorded in NFHS-4 (2015-16) when Gujarat was already performing worse than the national average of anaemic children. Almost 40 per cent of the children under the age of 5 years are stunted in the state. Amongst women aged between 15 and 49 years, 65 per cent are anaemic as per NFHS-5 (2019-20), a rise from 55 per cent in NFHS-4 (2015-16).

Gujarat is anything but vibrant on cumulative parameters of income, education, and healthcare as measured by the Human Development Index (HDI). Based on the Global Data Lab’s estimation, Gujarat ranked 23rd amongst 36 states and union territories of India in 1990. The high-growth trajectory of Gujarat under Modi’s chief ministership made no difference to this ranking. By 2018, the state was still at the 22nd position.

It was not always the case. Under Madhavsinh Solanki’s regime in the early 1980s, Gujarat experimented with welfare measures by improving access to education for SCs and OBCs, strengthening its public distribution system, and initiating mid-day meal programmes for school-going kids. However, it soon faced a backlash in the form of a political convergence of anti-reservation Patels and upper castes that resulted in the rise of BJP. The political discourse, subsequently, shifted from rights and emancipation to the law-and-order situation — given a grim history of Hindu-Muslim violence — and ethnic (sub)nationalism, leading to the folding of the then nascent welfare state.

Under a BJP dispensation since the mid-1990s, movements for rights are abhorred and questioning the state provokes repressive measures. Aspersions on the people and dissenters, which diverts attention from state responsibilities, continues even today in the face of the COVID-19 crisis. For instance, in the Gujarat High Court’s ongoing suo motu litigation to audit the COVID situation, the state counsel repeatedly chided the press for giving bad publicity and instigating fear in the minds of the public at large. Instead of correcting course, by building trust in the public, cabinet ministers in Gujarat, in their media interactions, blame Opposition parties for spreading anxiety amongst masses. Not a single all-party meeting has been called for, the kind that Kerala and Maharashtra have done to brief Opposition leaders and seek their views and support. Perhaps, it is not surprising that the destruction of an infant welfare state — which lies at the crux of its present inability to deal with the pandemic — took place at a time of “democratic backsliding” in Gujarat. The systematic underestimation of the number of casualties by the state reflects the same trend.

Jaffrelot is senior research fellow at CERI-Sciences Po/CNRS, Paris, and professor of Indian politics and sociology at King’s India Institute. Laliwala is a researcher on Indian Muslims and Gujarat’s politics. He was previously associated with Trivedi Centre for Political Data at Ashoka University and Centre for Equity Studies, New Delhi.

Courtesy - The Indian Express.

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What explains the high numbers of COVID cases in Delhi? (The Indian Express)

Written by Neelkanth Mishra

A study found that in January this year 56 per cent of Delhi residents had COVID-19 antibodies, suggesting that the number of infections in the city was 16 times the number of reported cases at the time.

Does seroprevalence (the presence of antibodies) help at all in preventing serious infections and death due to COVID-19? If yes, then why is Delhi, which appears to have crossed herd immunity levels of infection, still seeing such a high number of daily new cases and deaths? Why are cities across north India reporting deaths several times higher than normal?

Let us start with Delhi. A study found that in January this year 56 per cent of Delhi residents had COVID-19 antibodies, suggesting that the number of infections in the city was 16 times the number of reported cases at the time: An infection becomes a case only after a test. This infection-to-case ratio appears high, but is nearly half the national average of 28 in December last year, and is consistent with a well-known characteristic of this disease, that most infections are asymptomatic.

Cases since January add up to about 3 per cent of the population, implying that even if the infection-to-case ratio was 8, another 24 per cent of the population has been infected. Add to that the 15 per cent who have received at least one vaccine shot, and we reach a hard-to-believe 95 per cent of the population with antibodies. There is undoubtedly some double-counting in this (some people have been infected twice; some after being vaccinated), the infection-to-case ratio may be lower in this wave, and the January seroprevalence study may have errors. However, even if the cumulative number is 75 per cent, it is above levels at which herd immunity is reached, making it hard to explain 24,000 new cases a day at a positive-test ratio above 30 per cent (a high ratio means cases are being under-counted). More importantly, even if re-infections occur or vaccinated individuals catch symptomatic disease, the probability of serious illness or death is materially lower. And yet, Delhi has been reporting more than 400 COVID-19 deaths a day, almost the same as daily registered deaths in a normal year due to all causes.

Suspicion that the virus evades antibodies is natural, but there is strong evidence of vaccines being effective against serious illness and death, including in India. Similarly, in Mumbai, the slums, where 57 per cent of the population was estimated to have antibodies at the end of the first wave, account for less than 10 per cent of active cases in the second wave, and the non-slums, where only 16 per cent had antibodies, are badly hit. More anecdotally, such trends have been observed in other cities too.

Why then is the impact not visible in Delhi? One reasonable explanation can be patient migration. Compared to the first wave, the virus appears to have made deeper inroads this time, with significant rural and semi-urban spread being reported from several states. Unlike last year, when district borders were closed for a long time, patients can now travel, and are most likely reaching neighbouring big cities in search of better medical care. Some states have sealed district borders, but one assumes and indeed hopes that patients in need of serious care are permitted to cross. The factors that led to the rural areas being largely spared in the first wave perhaps still apply (like higher pre-existing immunity and fewer social situations that spread the virus including air-conditioned offices, restaurants or malls) but higher infectiveness of the new strains could have increased their vulnerability. The lack of testing infrastructure may have exacerbated the spread.

This can also explain the abnormally high deaths in several cities in north and west India, where the daily death numbers have been reported to be several times above normal. This distress is not visible in the southern states, which have deeper penetration of healthcare services, and people do not have to travel to cities for relatively simple ailments. Even in cities where more than half of the population above the age of 45 (90 per cent of all COVID deaths are in this age group) has been vaccinated, death numbers are not falling. Nearly 60 per cent of the deaths are still occurring in districts with Tier-1 and Tier-2 towns, even though they account for only a third of the population. As only serious patients would make the long inter-city journey for medical attention, this influx of often earlier undiagnosed cases increases the reported case fatality ratio (CFR) in cities (the ratio of deaths to cases). In Delhi, despite the number of active Covid cases now falling, the number of occupied beds continues to rise. The inflow of patients from other districts also changes herd immunity dynamics (the calculation of the level at which a population reaches herd immunity assumes a closed system).

This hypothesis should not be hard to test: Home addresses of admitted patients even for a statistically relevant sample size should suffice. Obviously, the objective of this exercise would not be to deny access to “outsiders”, but to understand the problem better, and then devise the right strategies. More frequent seroprevalence studies, deeper spread of testing kits and involvement of ASHA workers to improve awareness can be useful interventions.

Such an exercise would save lives: Better awareness and testing in rural and semi-urban areas can help slow transmission, provide the needed early treatment that can be critical (it is often too late by the time patients make it to a city hospital, that is, if they can get a bed), reduce vaccine hesitancy, and also reduce crowding of urban hospitals.

It can also reduce the economic impact of the pandemic, as hurt livelihoods also affect lives. If governments are better informed about where the spread of the infection is, they can better choose where to impose activity restrictions, obviating state-wise restrictions. As a hypothetical example, Pune’s COVID centres can continue treating patients from surrounding villages, and even as the reported number of deaths remains elevated, the city can be gradually opened up.

Once a flood has hit, one must provide succour to the affected population and pump out the water, but often, the best way to deal with it sustainably is to stem the flow upstream. If the hypothesis of rural and semi-urban infections showing up as serious cases in cities is correct, it is as important to increase testing and awareness in rural areas as it is to expand the capacity of oxygen beds in large cities. As we prepare for the inevitable future pandemics (or even a third wave of this one), a revamp of the rural healthcare system needs to be front-and-centre in government’s priorities.

The writer is co-head of APAC Strategy and India strategist for Credit Suisse.

Courtesy - The Indian Express.

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Delhi to London, a reconnection (The Indian Express)

Written by C. Raja Mohan 

Labour Prime Ministers Tony Blair and Gordon Brown certainly sought to make amends, but the party drifted steadily away from India. (Illustration by C R Sasikumar)

As Delhi and London break the corona jinx on the long-scheduled summit between Prime Ministers Narendra Modi and Boris Johnson with a digital conversation scheduled for Tuesday, cooperation on taming the pandemic is inevitably at the top of the agenda. Like India today, Britain had gone through a horrendous COVID crisis some months ago; and there is much for the two leaders to talk about.

Beyond the immediate relief supplies of oxygen and other medical equipment needed to treat COVID victims, India and the UK must tap into the enormous potential for bilateral strategic cooperation in the health sector and contributions to the global war on the virus.

The issue of resilient medical supply chains is expected to figure not only in the bilateral conversation between Modi and Johnson, but also at the Group of Seven ministerial meeting in London this week. Foreign ministers of India, Japan and Australia would also join this meeting to set the stage for the “Group of Seven Plus Three” physical summit next month hosted by the British Prime Minister.

The possibilities range from ramping up vaccine production to the structuring of a strong public health system in India, the absence of which has been so terribly felt in the last few weeks. The current pandemic is neither the first nor will it be the last.

Even as it overcomes the current COVID wave, Delhi must seize the opportunities to work with its international partners in overcoming India’s failings that have been so mercilessly exposed in the last few weeks. Britain and the G-7 are well-positioned to help transform India’s internal capabilities as well as benefit from them in the management of future global pandemics.

While the health sector will necessarily dominate the conversation between Modi and Johnson on Tuesday, there is other bilateral business that has been pending for too long. Few Western powers are as deeply connected to India as Britain. Yet, building a sustainable partnership with Britain has been rather hard. While India’s relations with countries as different as the US and France have dramatically improved in recent years, ties with Britain have lagged.

One reason for this failure has been the colonial prism that has distorted mutual perceptions. If the anti-colonial resentment against Britain is always seething barely below the surface among the Indian political and bureaucratic classes, London has found it difficult to shed its own prejudices about India.

The bitter legacies of the Partition and Britain’s perceived tilt to Pakistan have long complicated the engagement between Delhi and London. To make matters worse, the large South Asian diaspora in the UK transmits the internal and intra-regional conflicts in the subcontinent into Britain’s domestic politics.

While there is no way of fully separating South Asian and British domestic politics, Delhi’s problems have been accentuated by the British Labour Party’s growing political negativity towards India. For generations, Indian elites grew up thinking Labour was more empathetic towards India, while resenting the Conservative condescension.

The last three decades have seen an important turnaround. The Tories have become natural partners for Delhi, while Labour has become more meddlesome in India’s domestic politics. Here is a paradox: The Labour Party and its intelligentsia that never miss a chance to denounce the empire can’t seem to resist talking down to India. The Tories, who are certainly sentimental about the Raj era, are more open to seeing India in its own right. They are also more willing to view India through the prism of shared interests.

A quarter-century ago, the Labour Foreign Secretary Robin Cook, travelled with Queen Elizabeth to the subcontinent to mark the 50th anniversary of Independence in 1997. Speaking in the name of a values-based foreign policy, Cook held forth on self-determination for Kashmiris.

The soft-spoken Indian Prime Minister Inder Kumar Gujral, who heard about Cook’s remarks on Kashmir when he was on an official visit to Cairo, reacted by dismissing Britain as a “third rate power”. Gujral also accused Britain of creating the Kashmir problem in the first place and slammed its temerity to tell India how to solve it. Both sides quickly got into damage limitation, but the Queen’s visit, meant to signal goodwill, ended up doing the opposite.

Labour Prime Ministers Tony Blair and Gordon Brown certainly sought to make amends, but the party drifted steadily away from India. Under Jeremy Corbyn’s leadership, the Labour Party had become rather hostile on India’s internal matters, including on Kashmir. More recently the Labour Party was quick to jump into controversy over the farmers’ agitation.

In contrast, the Conservatives have been warming up to India. Tory Prime Minister John Major was quick to support India’s economic reforms in the 1990s. David Cameron, who wrested power from Labour in 2010, sought to revive the relationship with India. His successor, Theresa May, too was eager to advance bilateral ties but Delhi and London continued to struggle in translating the new goodwill into strategic outcomes.

What is new in the relationship is the strong political will on the part of Modi and Johnson to find a fresh basis for the bilateral relationship. The two leaders are expected to announce a 10-year roadmap to transform the bilateral relationship that will cover a range of areas.

Both Modi and Johnson confront a whole new set of circumstances for their countries and recognise that India and Britain need each other to achieve their larger goals. On trade, for example, both are on the rebound from their respective regional blocs. Britain has walked out of the European Union and India has refused to join the China-centred Regional Comprehensive Economic Partnership. Although both will continue to trade with their regional partners, they are eager to build new global economic partnerships.

While remaining a security actor in Europe, Britain is tilting to the Indo-Pacific, where India is a natural ally. Delhi, which is looking at a neighbourhood that has been transformed by the rise of China, needs as wide a coalition as possible to restore a semblance of regional balance. Britain could also contribute to the strengthening of India’s domestic defence industrial base. The two sides could also expand Delhi’s regional reach through sharing of logistical facilities.

Delhi and London are said to be exploring an agreement on “migration and mobility” to facilitate the legal movement of Indians into Britain. Both sides are committed to finding common ground on climate change. As they deepen their bilateral partnership and expand regional and international cooperation, Delhi and London may find it easier to manage the irritations over Pakistan and South Asian diaspora politics in Britain. If Modi and Johnson succeed in laying down mutually beneficial terms of endearment, future Labour governments might be less tempted to undermine the partnership.

The writer is director, Institute of South Asian Studies, National University of Singapore and contributing editor on international affairs for The Indian Express.

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Let’s put up a better fight (The Indian Express)

Written by Sachin Pilot

COVID is the overwhelming tragedy of our times. We in India are in the eye of the storm. After emerging seemingly relatively unscathed from the first wave — although bearing witness to the forced march of millions of migrant labour bereft of hope and help was soul searing — the second wave has besieged our battered administrative and infrastructural defences, and shows no sign of abating. Grieving families are shocked by the ferocity and the horror of this infection. Children, youth , the elderly, the partially vaccinated — no one has been spared from the wrath of the disease. Smouldering pyres and makeshift graveyards are signifiers of the magnitude of this calamity. The heartbreaking glow of funeral fires continues to illuminate our dark plight.

We pause to acknowledge the tireless efforts of those selfless Indians whose names and faces shall remain unknown, those manning the frontlines of this battle with tremendous courage and selfless dedication. Their ranks include our healthcare professionals, our sanitation staff, the thousands of Indians labouring to manufacture medicines, replenish oxygen tanks, dispense care, and yes, even to light the funeral pyres. As in the watershed moments of Indian history, the heroines and heroes of this struggle are not necessarily in elected offices. They constitute the groundswell of decent, every day, ordinary Indians, who in the middle of their own existential struggles, have summoned great reserves of resilience and resourcefulness to ensure that the light of life continues to shine — in our families, in our communities. These are the truly valiant.

There has been an obvious failure of accountability. In a democracy, accountability cannot only be electoral — elections are not synchronised with the tragedies that befall a nation.

Accountability remains a daily process, steered by the integrity of institutions — courts, civil servants, auditors in an unfettered media — to ensure that government policy and interventions remain faithful to the stated objectives of public welfare. In public life, accountability remains a moral imperative, driven by conscience and introspection.

Human existence has been punctuated with calamities. India’s citizenry has witnessed our share of misery and suffering. With independence, we inherited the colonial legacy of devastating famines, and recurring epidemics. Systematic planning and implementation of the green revolution, development of public distribution systems, and large scale hydroelectric projects ensured that India never suffered another famine. Until we became self-sufficient in food grains of our own, we accepted PL480 grants from the US to tide over the transient phase. These successes of our past — in combating hunger and poverty, and launching mass immunisation programmes – were not painted in political colour. These were national endeavours, enlisting the support of all.

Despite the remarkable pace of scientific innovation in developing a vaccine — unprecedented in modern history — our administrative, economic and governance structures failed to anticipate the necessity for a parallel scaling of the public health infrastructure to enable a seamless vaccine rollout, and provide medical supplies and care for the afflicted. This oversight has proved to be our undoing. The mutation of viruses with the advance of the pandemic — a well-known fact proclaimed by health experts globally — was largely ignored when mutant strains were first detected within our borders. As the first wave subsided, the government thought they had slayed the Hydra, the mythical Greek monster who would generate multiple new heads after each decapitation. In the months when a high-level task force should have been convening daily, developing tactical and strategic responses for inoculation and advancing treatment protocols in both urban centres and mofussil towns, we slipped into a smug stupor. This complacency led to premature declarations of victory, unthinking rollout of state elections, and congregation of masses at religious gatherings. These super-spreader events simply enabled the virus to proliferate exponentially, and made India a laboratory for new and deadlier variants.

Notwithstanding the appalling human costs, the mounting economic costs will be impossible to ignore in the coming months, pushing more people into poverty, hunger. In the absence of a streamlined and coordinated strategy between all levels of administration — at the national, state and municipal levels — the multiple shocks of the pandemic shall be felt, and remembered, for a generation. The three tiers of government have different strengths, resources, and reach. The systematic weakening of complementarities between them have contributed to the escalation of the crisis. Instituting mutually supportive decision making between different tiers of government is critical to restore the faith of citizens in their government. Even in the midst of the pandemic, the first steps towards this remediation of institutional ruptures must commence.

Clear and transparent communication is the need of this hour, and the best antidote to rumours and false information. This is a time for truth and a time for compassion. In this spirit, the government must accept plain speaking and criticism of its actions in the media, rather than expending precious energies in stifling voices of dissent. Social media platforms should be free to disseminate useful information rather than being persecuted. Alleviating the suffering of millions of Indians will require the cooperation and support of each one of us.

This is no time for scientific nationalism. We must be open to help in the form of knowledge, vaccines, technology, and equipment from the most qualified global agencies. Global challenges demand pooling of goodwill and sharing of resources. At the same time, national resources must be converged on the manufacturing and supplying of pandemic related equipment. Repurposing some public sector plants to supply oxygen has begun belatedly, but more can be done. On international platforms, we must push for suspension of patent protection for pandemic related medicines. The international community has been willing to extend an open hand offering help. We must accept this with grace.

Finally, this is a time for humanitarianism. Beyond all other isms. The light of truth and compassion must prevail. All actions must be selflessly non-partisan. Our training, our experience, our skills must all be deployed in the service of the nation and not sequestered within organisations and government departments, concealed in layers of political ideology. We must ensure that the spirit of our country remains intact, and that our words and actions embody the core values of decency, dignity, empathy and compassion.

Victory over the pandemic and succour for the traumatised soul of the nation will not come so easily. A three pronged approach with mass vaccination, massive support for healthcare infrastructure, and an unprecedented deployment and distribution of provisions and medication must be carefully planned, logistically streamlined and implemented quickly. Assets like our post office network and community service centres must supplement the efforts of the existing health infrastructure to deliver and administer vaccines. We must swiftly adopt best practices from other nations where active inoculation, widespread public use of masks, direct financial support to the needy, and successful messaging of treatment protocols have mitigated the worst of the ongoing pandemic.

We may have lost this battle, but we must still prevail in this war. This is a time for our national leadership to look within, to put aside differences, and to come together in a great outpouring of support for our people. Irrespective of our individual political affiliations or ideological leaning, we should all be committed to the resolution of the present crisis. No individual or organisation can achieve this alone. Thoughtful, inclusive and deliberative measures to course correct are urgently needed. The lives of our people — today and tomorrow — are at stake.

 Pilot is former Union Minister of Corporate Affairs.

Courtesy - The Indian Express.

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The kids are not alright (The Indian Express)

Written by Amit Sen 

This might give us an idea about how much we prioritise child mental health and well-being at a national level. (Illustration: C R Sasikumar)

The second wave of COVID-19 has left us reeling, exposing the cracks and bigotry in our systems like no other time. It has left most infrastructures shaken and wanting but, mostly, it is our health and welfare services that have come under scrutiny. Post COVID, the central government increased the health budget from 1.2 to 2.5 per cent of GDP (from 2020 to 2021), which is still way below developed countries, or even developing countries in our own subcontinent. Within this, the allocation to mental health, on an average in the last couple of years, has been a paltry 0.05 per cent of the health budget. And within that, child and adolescent mental health get a minuscule fraction, if anything at all. This might give us an idea about how much we prioritise child mental health and well-being at a national level.

What makes this even more befuddling is the abject apathy towards shocking realities: India has one of the highest rates of child abuse, depression and suicide amongst children and youth in the world.

Needless to say, the pandemic and consequent lockdown have had a profound impact on mental health and well-being, especially among the youth. Adults across the world, including India, are reporting a four-fold increase in anxiety and depressive symptoms. Adolescents and young adults in the age range of 18 to 25 are exhibiting even higher rates of emotional distress, as well as a marked increase in substance misuse, suicidal thoughts and behaviours.

A WHO survey has found that the COVID-19 pandemic has disrupted or halted critical mental health services in 93 per cent of countries worldwide while the demand for them is increasing. The scenario has been no different in India, with its limited facilities; child mental health services came to a grinding halt when the first lockdown was announced abruptly, in March 2020. After the initial lull, when people were jolted by the physical and financial implications of the lockdown, tens of thousands of families and young people started reaching out for help, many in a state of panic and confusion.

It is ironic that we often understand and appreciate the value of something only once it’s broken. Besides the imminent physical threat and trauma that the pandemic has caused, the disruption of daily life as we know it has had jarring effects on mental health, particularly for children. The daily rituals of school, playground, hobbies and mealtimes with the same people and activities may appear mundane and repetitive, but they form the platform for emotional safety and stability that are prerequisites for any child’s healthy growth and development. It was not surprising, therefore, when parents in the throes of despair started reaching out to us, helpless in the face of the disrupted sleep cycles, constant demands for junk food, frequent tempers and emotional meltdowns, and a breakdown of trust and communication with their children. Their efforts to reclaim parental control and instil routine and discipline only made matters worse. The fact that the parents themselves were grappling with institutional breakdown, whether school, their jobs and salaries, transport or access to medical services, didn’t help matters.

And as the weeks stretched to months, holidays had to be cancelled, birthdays and festivals couldn’t be celebrated, and young people could no longer meet their closest friends or favourite cousins, or visit relatives as they would during vacations. It was as if the pandemic had snatched away valuable connections, freedom and agency that bring pleasure and joy to our lives, and the consequent deep sense of loss led to hopelessness and despair. Quite early in the lockdown, we began to realise that the young people who couldn’t get back to their families in time were the worst affected.

Sensing a need in the community, we opened a dedicated brief therapy service for adolescents and young adults who were affected by the COVID crisis. Hundreds of young people reached out for help; having got cut off from family and friends, they were battling with loneliness and isolation, trying desperately to shrug off real and imagined fears that surrounded them. Many had lost their fledgeling jobs and others could not go to their dream colleges as they had planned. What struck us was that the same young people who were considered capable, well-adjusted and successful before the pandemic were struggling to hold on to shreds of hope in the face of complete uncertainty about their future, and slipping into anxiety, depression and self-destructive behaviours.

One can’t even begin to imagine the plight of children who were caught up in the treacherous walk back home with families of migrant labourers, young people who experienced separation and death due to COVID; or the ones who were exposed to domestic violence, deep financial crises and suicide — all of which have seen a sharp increase in these times. Such experiences can be deeply traumatic and leave resistant scars that can take a lifetime to heal. Or worst still, they can be passed on from one generation to another in the form of mistrust, paranoia and violence towards oneself or others.

Traumatic events cannot get more complicated or devastating than this one. Natural disasters like a tsunami or an earthquake are finite and give us a chance to recover after the devastation they cause. This pandemic is relentless, more like an endemic war zone but on a global scale. Just as we were beginning to raise our heads and were limping back to a semblance of normalcy, the second wave hit us, wiping away any hope that we were tentatively gathering.

Yet, we must hold on to anchors that help us keep afloat. Even if one can’t generate hope in this chaos, there could be a conscious effort to re-connect with memories and meaning, to have faith in our values and vision, to learn how to take one day at a time and enjoy the small gifts of life. Young people can be willing partners in the discovery of spaces and novel ways of connecting to the world around us, and this process itself can be protective and healing for them.

Most importantly, this can be an opportunity to question the given. The pandemic has jolted humanity and made us question the way we have treated nature and our environment, and has raised doubts about the meaning of success, the institutions that define it and our mindless pursuit of the material. It has also given us a chance to reconsider our priorities in terms of the mental health and well-being of our children, which could have a profound impact on the choices they make to shape our future world. But the question is: How much of mind-space and resources are we willing to devote to creating a “new normal” for our young people and their future, and indeed for humanity to survive?

  The writer is a child and adolescent psychiatrist working in Delhi.

Courtesy - The Indian Express.

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Jab at justice (The Indian Express)

Written by Pallav Shishodia

We live in a time that comes once in a century. The pandemic carries on with no end in sight, except the departure of near and dear ones. What can the Supreme Court of India possibly do to safeguard the right to life guaranteed under Article 21, for which it is duty-bound to exercise jurisdiction under Article 32 of the Constitution of India?

Let us consider one aspect, namely, universal vaccination. It is a glimmer of hope when a small country like Israel resumes normal life after the vaccination of almost its entire populace. China, too, impresses with large-scale vaccination and pandemic-free movement of its people and economy, though too many reliable details are not available from the other side of its iron curtain. The Supreme Court of India can facilitate speed and deeper penetration of universal vaccination, which is now commonly accepted as the only possible solution to the pandemic in the long run.

There has been an enormous burden on the Government of India (GoI) to conceptualise, roll out and respond dynamically to the goal of universal vaccination within and outside the country, as the pharmacy of the world. The unprecedented severity of the second wave has moved us away from a universal to a domestic, inward gaze. It reveals that any institution, howsoever well-meaning, committed and hard-working, in this case, the executive, has the limitation of one. The scattered and untapped energy of civil society, NGOs and public-spirited people needs a proactive push from the judiciary to rally behind science, scientists and medical wherewithal.

First, the conceptual issue, which still intrigues us. Should the vaccination be confined to 18-plus or be made available to all? An informed debate as to desirability, availability and targeted goals is needed. The Supreme Court can provide an open and transparent platform by invitation to eminent individuals and impleadment of institutions such as WHO, ICMR, AIIMS, IITs, major universities, hospitals from India and abroad. On its part, the Supreme Court can have a dedicated bench available for e-filing and virtual hearing anytime that is convenient for the judges during and after normal judicial hours.

Let it be clear that this exercise on conceptual clarity is not for an academic seminar. In retrospect, we might have evaded some of the horrendous consequences of the second wave if there had been a wider authoritative debate beyond the self-serving media. For the road ahead, this exercise is extremely important for a more effective vaccination regime.

To ensure an equitable and pervasive rollout with easy availability of vaccines, the legal frame of three Ps (production, price and patents) needs a rigorous look by the court to protect life. The environment cases provide a long line of precedents — if at all any jurisprudential basis is needed. This time, the danger is far greater than sporadic events of pollution from industry, mining and infrastructural development. There cannot be a better case for proactive suo motu jurisdiction to ensure the right to life.

It is time to question patents, real and allegedly WTO-protected, or claimed by vaccines that have been developed with aid from the state in research and development. These patents, if established, must be immediately acquired with just and adequate compensation and made accessible to all manufacturers. This was done for medicines for AIDS. It can be done again under the Patents Act. The Court can also issue mandamus to undertake this exercise on an emergency basis. Thereafter, all pharmaceutical companies with Good Manufacturing Practices (GMP) as per the Drugs and Cosmetics Act must be allowed to manufacture vaccines at a pre-approved price of cost + 6 per cent return on investment. States can also be directed to incentivise the setting up of new manufacturing facilities as a possible third wave, periodic booster doses and the need for ancillary vaccines make it a long-term phenomenon. Of course, all this has to be ensured in addition to the free import of vaccines approved by advanced nations.

The availability of all the vaccines, whether indigenous or imported, must be free for all the recipients to be paid by GoI. The vaccines can be distributed to states on a pro-rata basis as per population and price adjusted as part of general revenue sharing in GST. After all, we are one nation with one tax. Those who want to pay may channelise their charity elsewhere but not to distort priorities in the vaccination drive.

Likewise, the vaccine administration needs to be ramped up both in state and private facilities. We need a massive Swachh Bharat-like propaganda exercise and mobile vans for “at your doorstep” vaccination. For vaccine hesitancy, we need to incentivise the vaccination through a direct deposit of Rs 500 in Jan Dhan accounts for each vaccinated member of BPL families. This vaccination can be made compulsory for identifiable categories of persons from MGNREGA beneficiaries to Aadhaar Card holders to income-tax payers to bank account holders to driving-licence holders. There must be a strict penalty to be recovered from those who do not get vaccinated without medical reasons. Private efforts can be made eligible for reimbursement of cost.

The Supreme Court needs to, can and must look into systemic issues where a lot needs to be done, can be done and must be done with utmost urgency. Vaccination is one major issue amid a clamour for oxygen, medicines, medical infrastructure and lockdowns. The politics which goes with all this is inevitable in a democratic society. So be it! The Supreme Court can steer us, with greater emphasis on the right to life. The pandemic may leave nothing and nobody behind to bicker about.

The writer is senior advocate, Supreme Court of India.

Courtesy - The Indian Express.

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Don’t worry about the deficit (The Indian Express)

Written by Abhishek Anand , Lekha Chakraborty

As India reels from a new wave of COVID-19, concerns are being raised about the premature halt to its economic recovery. After an estimated contraction of -8 per cent in FY21, the IMF raised its growth forecast for the Indian economy in FY22 from 11.5 per cent to 12.5 per cent in its latest World Economic Outlook Report.

“The upgrade in the forecast was because of the evidence we were getting from high-frequency indicators in the past two months in terms of the normalization of economic activity,” said Gita Gopinath, chief economist at IMF. As India battles to contain the surge in COVID-19 cases, several states have already imposed severe restrictions at the local level. The services sector has been hit the most as a consequence of these lockdowns and it would be difficult for India to deliver on this optimistic growth projection.

Against this background, what role can fiscal policy play support the economy? This question becomes important as the monetary policy is already accommodative and may not have enough room to further boost the economy. The RBI has reduced the benchmark repo rate by 115 basis points since 2020. With headline as well as core inflation inching up in recent months, the RBI may not be in a position to further cut the policy rate.

But does the government have enough fiscal space to provide stimulus to the economy? Remember, as per the latest Union Budget, the fiscal deficit is estimated to moderate from 9.5 per cent of GDP in FY21 to 6.8 per cent of GDP in FY22. This expected decline in fiscal deficit is not on account of lower fiscal spending but because of expectations of sharper revenue growth. The revenue receipts are estimated to grow by 15 per cent and fiscal spending by 1 per cent this financial year. With the debt to GDP ratio already more than 90 per cent, additional fiscal expansion will not be an easy choice for the government.

However, extraordinary times call for extraordinary measures and the government will have to find ways to create fiscal space. This has become especially important as the economy is yet to shrug off the impact of the previous lockdown. With the total suspension of economic activity after the imposition of the lockdown, the unemployment rate reached unprecedented levels as per CMIE. The unemployment rate increased by nearly 14.8 percentage points, rising to 23.5 per cent in Apr 2020. The unemployment rate fell in later months after the lockdown measures were eased and economic activities gathered momentum. However, the normalisation of the unemployment rate in such exceptional times can be misleading as it could partly be a consequence of a fall in the labour force participation rate.

Under these difficult circumstances, immediate measures must aim at providing the requisite social safety net to the poor and the vulnerable. The central government has already announced it will distribute an additional five kg of grain to the 800 million beneficiaries of the National Food Security Act, which is welcome. However, given the unprecedented uncertainty brought about by this COVID wave, the ration support under the PDS should be raised further.

Lockdown measures may remain in place for longer than initially intended and we may see a spike in unemployment rates. The government should also consider transferring cash to the bank accounts of the poor, just as it did last time, to compensate the poor for the loss of income. This becomes important as MGNREGA — the “employer of last resort” policy of the government — may not provide the safety cushion that it is indeed to as long as lockdown measures remain in place.

The current crisis has exposed the faultlines that cripple our health system. Given the nature of the pandemic, the best stimulus perhaps would be to provide free vaccinations to the population as the benefits of faster and wider vaccine coverage more than outweighs its monetary cost. Immunisation is a public good. As we get over this crisis, the government must increase its outlay on physical and human health infrastructure.

How can this additional fiscal cost be financed? Part of this additional cost may be financed by reducing non-essential government expenditures and use it for COVID-related expenditure. However, this may not be enough to cover all the expenses and the government may need to resort to additional borrowings from the market than budgeted earlier. The government should not be deterred by a worsening fiscal deficit in the short run as the additional growth that it generates may make debt consolidation easier when things normalise. As emphasised by Union Finance Minister Nirmala Sitaraman, we “do not fear deficits” in the time of the pandemic.

Given that a timely deficit may not have adverse macroeconomic consequences, surviving this pandemic first by enhancing the required spending is crucial. The RBI may allow inflation above the upper bound of 6 per cent only in the short run. Chances are that the RBI may increase the interest rates the moment we realise that inflationary expectations are not just transitory. The plausible rise in interest rates may also be crucial to prevent capital outflows, given the global “economic outlook” when the US economy adopts an easy monetary policy combined with a huge fiscal stimulus to catalyse the convergence of its economic growth to pre-pandemic levels.

 Anand is a graduate student at Harvard Kennedy School and Chakraborty is professor at NIPFP and Research Affiliate at Levy Economics Institute of Bard College, New York.

Courtesy - The Indian Express.

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We are all responsible for India’s devastating second wave (The Indian Express)

Written by Dipit Sahu 

India logged over three lakh COVID-19 cases in the last 24 hours. However, just about one and a half months back, there were only around 14,000 infections daily. Something went drastically wrong because the sudden avalanche of cases had led to an acute shortage of oxygen, medicine, beds, and even oxygen in the hospitals. We may go back to business as usual as soon as the current surge is over. But a moment of self-realisation and introspection is urgently needed before we go to sleep peacefully after shifting all the blame on our political leaders. And while we are witnessing the surge all around, we need to pause for a moment and think — is the current situation not of our own making? 

We need to accept that the politicians do not decide what we do in our everyday routine. Several of our countrymen who went holidaying in the Maldives early this year or gleefully held parties and large gatherings were not instructed by the politicians to do so. It was we Indians who decided to throw caution to the wind and let our desires rule our lives. We need to remember governments can only issue guidelines, but we have to follow them when no one is watching. Everyone was busy planning their reunions, their next holiday destination, or beautiful picnic locations. The Indian wedding industry was already slated to be back to the pre-COVID level by the year-end (I know of at least two such events which had to be suddenly canceled in the second wave). What was our medical community thinking when they held the national physical conference in March this year in the middle of the pandemic? Did we believe that because we are doctors, nothing can touch us? Most of us are responsible for flouting the well-established norms if we look hard. And some are waiting for the surge to die down to plan for their reunions towards the end of the year. Some may call this pandemic fatigue, and they are perhaps tired of staying indoors, but several people early this year had an attitude of everything-is-ok and nothing-can-go-wrong-now.

Precisely five weeks ago, I took a photograph of a busy marketplace with several hundred people, and not a single person wearing a mask. That photograph showed no sign of being from the COVID era. I had casually wondered whether all these people were immune or just considered themselves immune. And we now realise it was sheer irresponsibility and carelessness, the result of which is abundantly clear. A section of society even believed that Indians have higher immunity than Caucasians because of exposure to the common cold virus. Several articles were gloating over our superman-like immunity to the virus and attempting to explain the miraculous vanishing of the virus from the Indian hinterland. As is now apparent, all those theories had no basis. Let this sink in while we stare at the loss of countless fellow Indians — we are not stronger or more immune than any other race because of our ability to live a hard life. We certainly don’t have better immunity just because the common cold is more prevalent in India. 

Of course, the country’s leadership, exemplary last year, behaved recklessly this year by allowing political rallies and religious gatherings. But the infections soared even in those states where no elections or religious meetings were organised. Political leaders are, in the end, just a reflection of our society and of how we think and behave. They are not God-sent. Counting on others to control our fate, relying on others to always bail us out is an inherently weak and foolish approach. In the movie Rocky Balboa, Rocky reprimands his son: “And when things got hard, you started lookin’ for something to blame, like a big shadow”. Isn’t this what we are all doing now, blaming the whole fiasco on the readily-available figure — the politician  — in order to feel good and in order to believe that we never made a single mistake. Unless we realise and own up to our mistakes, we may land in the same situation again in the future. We need to remember that our actions during the relatively-quiet period will decide how long the infection stays silent. The change does not seem significant if we realise that we only need to give up the luxury of gatherings, meetings, and loud marriages for a while to live to the fullest in the not-so-distant future. It remains to be seen if we can do better after the second wave settles down. But it’s time we held the mirror up to ourselves. It will all start and end with our attitude of self-realisation. 

The writer is consultant shoulder surgeon, Sir H N Reliance foundation hospital, Mumbai & Jupiter Hospital, Mumbai.

Courtesy - The Indian Express.

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Crisis as teacher (The Indian Express)

Written by Radha Goenka

Guts and hope. As Indians, we have both of these traits in abundance. Sometimes these illustrious traits lead us to wonderful outcomes, and in other instances to foolish ones. What else would explain the current COVID mess that we have landed ourselves in, where we now boast of the largest number of positive cases in the world. But then, we have God on our side. Clearly, when we thronged in millions at the Kumbh Mela during a pandemic, we believed God would save us from any harm. Guess what, he didn’t. But, fortunately, something else probably will. We have hope and we will show courage in the face of adversity to find innovative solutions. That is what we do as Indians. We will find a way through this mess, together.

It’s guts and hope that always get us to find innovative solutions to the mind-boggling problems we face. In India, today, 97 per cent of our kids go to school. A seemingly impossible task 20 years ago. India’s successful school enrollment is a case study the world learns from today. How did we do this? We introduced programmes like the “Mid-day Meal” that got people to send their kids to government schools for a free healthy meal. How innovative was that?

It’s time again for us to dig deep to find creative solutions to the mammoth education crisis that we are staring at. With public schools being completely shut for an entire year now, the majority of our kids have had no access to any form of education for over 12 months. Due to obvious problems like lack of smart devices and access to the internet, these kids have missed an entire year of schooling. Most of them have probably also forgotten what they already knew. Their families, especially in rural India, have gotten used to having the extra hands at home and will possibly be reluctant to send their kids to school ever again.

And that is why, we need to put our heads together and solve this gaping education crisis we are facing as a country. In the short-term we could do three things.

First, and most importantly, we must focus on reopening schools. The majority of the world has opened their educational institutions in some format or the other. We need to think creatively on how to restart our schools. For example, we could use outdoor locations, teach in smaller groups in local community centres. We could increase the duration of the academic year, to give the system more time to make up for the last year, and facilitate widespread teacher vaccinations drives. Getting our kids back into the physical school, even for a few days a week, is of paramount importance given the practical gaps in online education that our schools currently face.

Second, we should redefine who the “teacher” is and expand it to include parents, volunteers and older children in the community. These people can support the traditional teacher and create continuity in the learning process. We could do this by giving autonomy to school authorities and creating decentralised community-based solutions. Local authorities can work with their communities to create new localised learning solutions. This will also provide great opportunities for smaller experimental public-private partnerships. The best practices from these solutions can be scaled up for increased impact. After all, decentralisation and autonomy are the cornerstones of innovation.

Third, we should focus on using new touch points to educate our kids. Bridging the digital divide to enable online learning will take time. But accessing and creating free standardised content that can be easily disseminated through existing widespread mediums like television, radio and telephone can be done immediately. We will also need to create new standardised assessments to ensure that continued learning on these platforms is taking place.

While trying to bridge the gap the pandemic has created with short-term solutions, we should also view this as an opportunity to solve the larger problems that we face in education. This period has given us time to pause, rethink and renew at an individual, corporate and political level. Why not do the same at an institutional level for education? We could look at this crisis as an opportunity to solve the largest problem we face in our schools, which is, lack of good quality education. While most of India goes to school, most are not learning at school. Not learning enough at least — 75 per cent of kids in Class 3 don’t have basic reading and arithmetic skills according to the ASER 2018 Report. And the higher education figures are even worse.

The biggest learning from COVID’s impact on education globally has been the possibilities and benefits of virtual schooling. Kids in developed parts of the world and less than 1 per cent of privileged Indian kids continued to learn online through this year. While there were a lot of challenges and shortfalls in this transition to online learning, there were also huge gains. Availability of new and interactive global content, that included games, apps and much more, and access to high-quality global teachers. If you want to learn Spanish why not learn from a teacher in Spain? While many doors shut, many others opened. The success and potential of online learning is clearly evident in the prosperity of companies like Byju’s, Unacademy and White Hat Junior.

We can learn from this and solve our quality-education problem by democratising “content”. To do that we first need to bridge the “infrastructure divide” and create access. If our government could digitise India with Aadhaar cards and bank accounts, they can surely do the same for education. Access to low-cost internet doesn’t seem to be a big problem with the vast network connectivity we have achieved as a country. Funding and creating access to infrastructure of devices is the only real gap.

Next, we need to relook at our content with an increased focus on building English literacy. Basic functional English that connects us to the vast learning opportunities on the internet — 90 per cent of the content on the internet is, after all, in English. This is a fantastic opportunity for us to move out of our regional thinking and truly enable our children by giving them limitless opportunities of self-learning available on the internet.

A long-term outlook of digitalisation of education will truly democratise education. It can be an opportunity to provide equal access to the best quality of education to all. Globally, there is no shortage of high-quality content in education. In fact, we can even view this as an opportunity to train our teachers online and give them access to high-quality global training. In the long run, we can create a truly high-quality hybrid education model that combines the best online learning tools with well-trained face-to-face teachers.

The pandemic has happened. It’s here. It will feature in history as a horrible time when lives were lost. We will lament and learn from it. But it won’t define us. How we respond to it, however, will. How we innovate will tell our stories of hope and grit.

As Viktor Frankl said, “between stimulus and response there is space. In that space is our power to choose our response. In our response lies our growth and our freedom.” Through our response, let’s define the Indian education story differently.

  The writer is founder, Pehlay Akshar Foundation and director at RPG Foundation.

Courtesy - The Indian Express.

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A reality check with the US (The Indian Express)

Written by Arun Sahni

Prime Minister Narendra Modi with US President Joe Biden (File Photo)

Events in the recent past with respect to Indo-US relations in the Joe Biden era are contrary to the national narrative playing out in the public domain — that bilateral relations are at an all-time high. Post the euphoric Trump-Modi relationship, the officialdom has gone overboard, including by trying to move the Indian mind space towards the advantages of a closer relationship with the US. They seem to have forgotten the “trust deficit” that had earlier impeded a closer relationship between the two like-minded democracies. This was exacerbated by the US’s continued support of Pakistan despite its despicable proxy war with India and meddling in Afghanistan. India, therefore, needs to be astute and cautious, especially as suspicion has now been precipitated due to the prolonged period it took for Washington to overcome its hesitancy and permit the export of key ingredients for the manufacturing of the urgently required COVID vaccine. This was not a stray event, but the proverbial last straw on the camel’s back.

On April 7, USS John Paul Jones (DDG 53) transgressed India’s Exclusive Economic Zone (EEZ), with utter disregard of the Indian policy requiring prior intimation. The tenor of the US press release was arrogant, as it stated that the FONOP (Freedom of Navigation Operation) was consistent with international law, of which it is not a signatory. Earlier, a US Human Rights watchdog, Freedom House, downgraded India’s status from “Free” to “Partly Free”, attributing it to India’s current policies. Washington has been reluctant to include India in the Afghanistan negotiations and has not been forthcoming about waiving the provisions of CAATSA (Countering America Adversaries Through Sanction Act) to accommodate India’s past contractual obligations. This insensitivity creates doubts about the US’s unconditional support to India when the chips are down. Will it play hardball in supporting India in a manner similar to the response of the erstwhile Soviet Union in 1971? That was a different era and India is no longer in that state of helplessness. But the US leadership needs to nurture trust through its actions.

Geostrategic realities have brought the Indo-Pacific region centre stage. The shifting of the economic centre of gravity from the Atlantic to Asia has reinforced the importance of geo-economics in a connected and globalised world. China’s geographical location, its extensive economic bandwidth and ruthless pursuit for preeminence will inevitably cause turbulence. The perception is reinforced by its hegemonistic actions in the SCS, Taiwan straits, Hong Kong, Himalayas and Xinjiang. Russia’s diminishing stature and the rise of China will reflect in the future world order, but after an extended period of strife with the US. The pandemic has not only increased the pace of change but also confirmed that it is irreversible.

It is imperative that India take appropriate action to safeguard its future interests and so, has willingly partnered with the US to form a collaborative grouping of like-minded countries. The Quad, proposed a few years ago, has slowly but surely gained acceptance. Its role, shape and size are a subject of a separate debate But its relevance is non-debatable in ensuring freedom of navigation and a rules-based order. Concurrently, urgent structural reforms are required in international multilateral institutions to address the aspirations of the majority from Asia and Africa, instead of only pandering to the whims of the developed world or being a puppet of China. India will require US support to become a part of these rule-making institutions.

It was, therefore, mutual interest that led to the positive trajectory in this new chapter of India-US relations. The US, to counter intensifying strategic competition with China, needed a partner in the region and India was the logical choice. For Delhi, closer relations with Washington served its interests. But romanticising our growing proximity with the US as the balm for all our ills is where there is a need for greater attention. We cannot be lulled into complacency.

The progression of bilateral ties highlights that in the medium term, most of the actions have been to the advantage of the US. It took the initiative in starting the 2+2 dialogue between the ministers of defence and external affairs. This has over time resulted in India signing three foundational agreements — LEMOA (Logistic Exchange Memorandum of Agreement) in 2016, COMCASA (Communications Compatibility and Security Agreement) in 2018 and BECA (Basic Exchange and Cooperation Agreement) in 2020. These provide US troops access to Indian facilities and have facilitated military sales to India. It is revealing that US military sales have in the last decade grown from being negligible to $20 billion. The US has displaced Russia as being the largest source of arms imports. CAATSA, the self-serving US Act, now impinges on India’s strategic autonomy to exercise choice in conducting trade /purchase, thus straining our time-tested relationships with Russia and Iran. There is now the lure for India to be part of the “Five Eyes” network on intelligence sharing. It all looks very promising, but will India be included as an equal member in the club?

Historical experiences are illuminating: Over-dependence on the US will always have the downside of being left in the lurch when its interests have been served. Therefore, pragmatism demands that we give primacy to our national interests in this evolving relationship, and not burn our bridges elsewhere.

 The writer is a former army commander of the Indian Army.

Courtesy - The Indian Express.

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The vaccine responsibility (The Indian Express)

Written by K. Sujatha Rao

In traumatised India, saving lives has become the highest priority to be achieved by vaccinating 70 per cent of the adult population or 654 million people. This article seeks to analyse the implications of the new vaccine policy announcements on April 20.

In the past three months, only 40 per cent of the 30 crore high-risk population were vaccinated, partly due to the initial vaccine hesitancy and later vaccine shortage. As mortality data of Wave II shows 44 per cent deaths among 20-50 years, the government has expanded eligibility criteria to include all adults from May 1. This expansion in the context of another 60 per cent target population yet to be vaccinated with a single dose, and uneven supplies, will result in distortions and inequities, with the more vocal and assertive in urban areas getting access rather than the powerless and vulnerable in rural areas and urban slums.

India’s monthly COVID vaccine manufacturing capacity is about 60-65 million doses — 60 million by Serum Institute of India (SII) and 1-5 million by Bharat Biotech (BB) against our final requirement of 1.45 billion doses to cover 70 per cent adults. India’s failure to firm up advance purchase agreements with other vaccine producers or move with alacrity with the Sputnik application is attributed to a mistaken notion that SII and BB would be adequate for India’s needs. Clearly, a detailed demand-supply analysis would have enabled a more calibrated expansion of the eligibility criteria. Government has announced three important decisions: One, earmarking 50 per cent of the capacity for GoI, the rest for the open market; two, waiving bridging studies for market entry of foreign players; and three, astonishingly, permitting companies to set the price. The utilisation of the vaccines by the GoI is unclear — are they for states and if so how much and on what terms, or for vaccine diplomacy, and from which quota will the foreign obligations be met.

With every state individually contacting the suppliers and bargaining price and supply, the discretion will be with the supplier — who to sell to, when, where, how much and at what rate. This will undoubtedly create interstate inequities, where the poorer states will stand to suffer due to poor bargaining power, while the better off may end up paying higher rates but at the cost of sacrificing the already underfunded welfare programmes.

Recently, the SII and BB announced their pricing policy — Rs 400 and Rs 600 per dose for the state government and Rs 600 and Rs 1200 for private parties respectively. The SII vaccine is available in European markets for Rs 161 per dose, Rs 210 ($3) per dose for GAVI and will be provided at Rs 150 to the Central government. The third entrant is Sputnik that proposes to start production in June and is considering charging Rs 750 per dose.

The CEO of SII also made three interesting admissions in interviews — that though the Rs 150 per dose gives normal profits, the intention is making super profits; that his (not the nation’s) first priority will be to supply vaccines to Maharashtra; and third, most worryingly, the private sector will emerge as the main provider of vaccinations in the country, not the state governments.

Pricing is dependent on actual cost of inputs, expenditure incurred on clinical trials, sales promotion and small profit. For SII, investment has been minimal since the development costs have been borne by Oxford University and AstraZeneca. Government has also extended emergency authorisation, besides Rs 3,000 crore as grant/advance purchase amount, in addition to the USD 300 million already received from GAVI to expand vaccine production. Though the GAVI grant was given six months ago, SII does not seem to have expanded its production. It has now promised to manufacture 100 m doses per month by July end. How much of this will be available for India is unclear.

Bharat Biotech’s Krishna Ella is on record that he might have spent about Rs 350 crore for development of the vaccine that includes Phase 3 trials. With the Rs 1,500 crore grant support from the Centre, BB hopes to expand production to 700 million doses per year from the current level of 60 million.

Over seven states have announced their willingness to procure for ensuring free vaccination to their people. So, while UP and Bihar do not even have decent laboratories, instead of spending their resources on building their shattered health delivery system, they will be spending an estimated 0.47 per cent and 0.6 per cent of the SDP respectively for providing free vaccines.

What is interesting about the current political economy discourse is the tendency to treat central grants as belonging to “the GoI” as separate from “them” the states, even though the money spent is from the direct and indirect taxes paid by the people. This is strange thinking as the Central government is legally obligated to control the “interstate spread of infectious diseases” (Entry 29 of the Concurrent List under Schedule VII of the Constitution). Assistance to states to combat such diseases is its fundamental duty. It is under such an understanding and because of the wide externalities that infectious diseases entail, that the Centre has always procured vaccines and other consumables for states under all National Infectious Disease Control Programmes.

Besides, such an arrangement also makes economic sense. In centralising procurement and being the sole buyer, government gets the market power to obtain highly competitive rates and ensure robust quality assurance processes and coordinate supplies based on transparent objective criteria. Secondly, government also has the power to cap prices of all essential drugs, based on the costing carried out by the NPPA.

With the incentives offered to foreign players, there is now a more competitive environment. In the event of attempts at cartelisation, government can invoke compulsory licensing and expand production through the 18 manufacturing companies in India, boosting availability at an administered price. Simultaneously, GoI should aggressively take up with the US to support its demand for waiver of the IPR on vaccines and help expand its availability at affordable prices. In other words, an intelligent use of authority by the GoI can halve the estimated expenditure of about Rs 60,000 crore and ensure a more efficient utilisation of the saved funds to strengthen health systems.

The next two years will be difficult. This is not the time to create monopolies and allow profiteering. Instead, this is the CIPLA moment when it took on the MNCs and crashed the market of HIV/AIDS drugs from USD12,000 to USD300 per person saving millions of lives round the world. Needed is a commitment to peoples’ welfare.

  The writer is former Union health secretary.

Courtesy - The Indian Express.

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