By Devaansh Samant (MPA ’23)

When COVID-19 came to India, the outlook was bleak. Desperate images from other countries made speculation worse. Italy and USA were struggling in March 2020, and if richer countries with robust health systems were stretched, how would India cope? The contrasting realities of the first and second wave show how politicization (not “technocratization”) of healthcare swung outcomes in India. The following case study shows the scale of impact that healthcare can have when considered in tandem with concerns such as equity and accessibility, which are typically relegated to the realm of politics.

The first wave: A concerted success for politicians and citizens

Despite gloomy forecasts, India managed the pandemic exceptionally well in initial months. The graph below paints a compelling picture using case counts for March-April 2020.

How did this happen? Constructive politicization and public commitment.

India's Prime Minister – Narendra Modi – imposed an unprecedented nationwide lockdown on 24th March. On that day, the 7-day average for daily confirmed cases was just 54. This was a rapid and proactive response. Italy was the first country to impose a national lockdown on 8th March, and by that time, its 7-day average for daily confirmed cases was 812. India’s lockdown had tragic consequences. An estimated 45 million migrant workers were left stranded by the sudden decision. But the merits of decisiveness are evident in the slow trajectory of disease spread.

When individual freedoms were sharply curbed, collectivist sentiment also played its part. While many countries were arguing about whether masks and lockdowns were necessary, on 22nd March, citizens all over India publicly demonstrated their appreciation for essential workers. Another political masterstroke.

The bottom-line? Political and public commitment helped India perform better than any expert predicted.

The second wave: Devasting impact of political failure

With lockdowns and mass-scale community engagement, India played its aces early. What next?

Just one year after leading the charts on public health performance, India witnessed a devastating second wave. Between March and July 2021, daily confirmed new cases soared beyond 350,000. At its worst, the daily death toll crossed 4,000, and official figures likely do not cover the whole story. (This article attempts to estimate the real toll of COVID in India).

What went wrong?

Leading publications, such as The Hindu and New York Times, carried damning verdicts on the political leadership. Even Lancet, a leading medical journal, published an article zooming in on the dysfunctional politics of India's Covid response. The scrutiny is justified. There are several high-profile mistakes with clear political origins: hosting election rallies despite identified risks of the Delta variant, relaxing curbs on large-scale religious gatherings, stalling on building oxygen infrastructure out of complacency, and mishandling the vaccine supply ramp-up. Meanwhile, citizens did not enforce enough accountability. Public outrage reached the news but did not sustain long enough to trigger the internal inquests and political consequences it should have. 

Just as politics made India's COVID response during the first wave, it broke it during the second wave.

What next? Politicizing healthcare reforms

India’s initial performance shows what happens when healthcare is politicized constructively. But historically, healthcare has not been a hot topic in India. Amartya Sen and Jean Dreze, write in India: An Uncertain Glory, “…the overall coverage of health issues in editorial discussions remains minuscule – about 1 percent of the total editorial space”. It is no surprise then, that between 1990 and 2016, India's healthcare access and quality ranking has not moved significantly.

Whatever the reasons for an earlier lack of politicization, COVID has politicized healthcare irreversibly. With that comes an opportunity. Will we be able to tell our children thirty years from now that the healthcare they enjoy is the result of our generation learning from a calamity? As development professionals we cannot stay within technocratic comfort zones of developing mobile apps. We need to proactively bring politics into our thinking. Ideas such as inclusive representation deserve as much attention as “Digital Health” initiatives. Meanwhile, major news outlets need to be pressured into airing constructive criticism and politicization of government healthcare policies (PMJAY and Digital Health Mission).

Humanity has responded to seemingly insurmountable challenges in the past. The World Wars gave rise to the United Nations and a nuclear non-proliferation treaty. The pandemic is another such watershed moment – let's not forget about the politics of healthcare in 2022.