Insights from India’s Encounters with COVID-19

The uncertainties relating to the COVID-19 pandemic continue to pose extraordinary challenges to policymakers worldwide. The recent lifting of restrictions in China raised the spectre of another wave of infections beyond its borders, which has thankfully not occurred…so far. Now, three years after the pandemic emerged, policy assumptions and responses are being re-evaluated—from whether the virus emerged as a laboratory leak, to whether vaccines have efficacy, to whether Sweden’s laissez-faire approach was superior to other countries’ ambitious interventions.

We examine India’s experience with COVID-19—impressionistically—to draw larger lessons for policymakers. India’s responses were a mix of hits and misses. Some measures helped contain the pandemic and assisted those in need. Other measures seemed performative—geared towards garnering glory on the global stage. Together, they throw light on the challenges of coping with a crisis in real time.

India had time to prepare as it could observe the impact of the virus in China and Europe before it experienced its first cases. Yet, while there was no scientific consensus on how to cope with the virus, policymakers focused on a national lockdown as the appropriate response, assuming that if people did not interact, transmission could be curtailed. This drastic measure was not justified by the number of infections, which were largely confined to international travellers.

By March 2020, the World Health Organization reported that India had conducted almost 5,000 COVID-19 tests and had responded with urgency and transparency. However, it had only confirmed 74 COVID-19 cases and 1 or 2 deaths. Experts did express concern about the accuracy of these numbers, given the lack of widespread testing and the possibility that community transmission may have commenced (Mansoor, 2020).

To test whether citizens would comply, the government urged Indians to observe a ‘janata curfew’ on a Sunday by remaining indoors from 7 a.m. to 9 p.m. Prime Minister Modi urged Indians to gather at their windows or balconies at 5 p.m. to clap, ring bells or beat on objects to send a resounding message of appreciation to the frontline warriors—nurses, doctors, cleaners, transport workers, police officers, and so on—valiantly striving to contain the contagion (Scroll, 2020).

Experts expected that a lockdown would be planned paying attention to concrete measures such as protection of frontline workers, public safety measures, and assistance for vulnerable sections through socio-economic financial packages. However, despite previous experience with epidemics such as Severe Acute Respiratory Syndrome (SARS) and H1N1, preparedness was inadequate; for example, there was a shortage of testing kits and personal protective equipment. The government was initially slow to assess the potential of community transmission and scale up testing and contact tracing. But it did put in place key bodies comprising scientific experts to guide policy. It also put its weight behind vaccine development efforts by Indian companies such as Bharat Biotech.

The first nationwide lockdown was suddenly announced on 24 March 2020. For some, this only caused inconvenience as they coped with the logistics of having to work from home. For others, it meant complete uncertainty about the future. The latter included migrant workers, whose presence and predicament were completely missed out by policymakers. Far from home, with their names and details featuring on no official database, without access to rations, they were left without employment, income, homes, food, transportation, or any policy support (Paliath, 2021). Nearly 11.4 million migrant workers attempted arduous, unaided journeys home on foot, resulting in at least 971 non-COVID-related deaths. In contrast, the Ministry of External Affairs made effective flight arrangements to repatriate Indian citizens stranded overseas.

Either altruism or a desire to be admired globally led India to publicly proclaim the launch of ‘vaccine diplomacy’. In early 2021, official figures showed that more vaccine doses had been sent abroad through the ‘Vaccine Maitri’ programme than administered in India. The speed and scale of exports astounded diplomats and policymakers abroad because exports continued even as a second wave engulfed India in early March 2021 and states were forced to try to secure supplies from the market amidst a global scramble for vaccines. Only in April 2021 did exports fall to 1.2 million doses when the Union government prioritized vaccine supplies for Indians (Mishra, 2021).

India experienced a massive surge in COVID-19 cases, recording the highest number of new cases globally at different times. This overwhelmed the healthcare system, leading to a shortage of hospital beds, medical supplies and personnel. Patients were turned away from hospitals, oxygen supplies were inadequate and crematoriums ran out of space (Bala, 2021). While healthcare workers tried their best, better results could have been achieved through centralized planning and coordination, digitized allocation of resources, and decentralized state-level execution (The Financial Express, 2021).

Scholars of state capacity have lauded India’s ability to conduct massive one-off exercises such as national elections. Similarly, the Indian government successfully implemented one of the largest vaccination drives worldwide, with over 2 billion doses administered as of March 2023 (Ministry of Health and Family Welfare, 2023). The government implemented innovative strategies such as using mobile vaccination vans to reach rural areas. But there were concerns about the allocation of vaccines, as some states faced acute shortages while others enjoyed a surplus.

The government harnessed technology and introduced apps to identify and track infected neighbourhoods, households and individuals, disseminate information about protocols and guidelines and for vaccine registration and issuance of certificates. Due to the urgency with which the apps were introduced, questions were raised about privacy, functionality and real-life impacts, for example if the app alerted that people in the room were infected. Ultimately, measures were taken to include people without mobile phones to register for vaccinations.

Effective bureaucrats were able to prevent contagion in densely populated Dharavi, Asia’s biggest slum. The ‘Dharavi model’ of COVID-19 management of ‘tracing, tracking, testing and treating’ (The Hindu, 2021b) involved door-to-door screening of individuals displaying symptoms, widespread testing and regular screening/testing of Dharavi residents who commuted to various parts of Mumbai for work, such as delivery personnel and industrial workers. Once a COVID hotspot, Dharavi saw single-digit daily cases in May 2021, during India’s deadly second wave. Mumbai’s municipal corporation also increased its vaccination and sanitation efforts in the area.

The government may have also demonstrated overconfidence through its premature declaration of victory over COVID-19 in India in early 2021 (The Hindu, 2021a) in an attempt at boosting its image. Instead, the Health Ministry should have actively worked on strengthening and continuing institutional COVID response systems like expert panels, ICMR COVID-19 Taskforce, INSAGOC, etc. An unjustified move was the dismantling of COVID response infrastructure after the first wave subsided, like the disbanding of the Empowered Groups (EG) under the Disaster Management Act and the resignation of various scientists and experts from government-established response groups.

The Health Ministry should have been proactively researching and updating medicines, diagnoses and side effects of both the treatment and recovery process of COVID. Adequate supplies of oxygen and medicines should have been prioritized, given that severe second waves have marked previous pandemics. The second wave demanded stronger infrastructure and was met instead by overburdened laboratories and hospitals.

The country’s frontline healthcare workers risked their lives to save others through measures including disseminating information, education, and communication at the community level, identifying potential COVID-19 cases and conducting vaccination drives. Citizen volunteers and political workers (The Economist, 2021) also played a crucial role in awareness campaigns, distribution of masks, sanitizers and other essential items, setting up of isolation and COVID care centres, arranging oxygen supplies and providing food and shelter to the needy. They also assisted in tracing and tracking patients, monitoring home isolation cases and providing assistance.

During the second wave of the pandemic, volunteers worked tirelessly to distribute oxygen concentrators and cylinders to hospitals and individuals in need. They set up food and medical aid centres and helped in the cremation of the worryingly large number COVID-19 victims. They also used social media platforms to disseminate information about COVID-19, its symptoms and preventive measures and encouraged people to follow COVID-19 protocols. Their tireless efforts, dedication and commitment helped in containing the spread of the virus, and their courage in the face of the crisis demonstrated the best of human values in action.

Economic Impacts

The lockdown had a severe impact on the economy. Large numbers of businesses and industries suffered significant losses. Millions faced job losses and financial hardship, adding to the sense of dread and uncertainty (EPW Engage, 2021). The economy is experiencing a K-shaped recovery with upper classes/large businesses recovering quickly.

Unemployment hit an all-time high, small businesses suffered losses, labour force participation fell and household incomes of the middle and lower classes decreased drastically. Nearly 56 million Indians were pushed into ‘extreme poverty’ in the first year of the pandemic, according to the World Bank (Mathew, 2021). The worst devastation occurred in the informal sector, which official data fails to capture adequately (Vyas, 2021). In response, the government proclaimed supposedly the world’s highest aid programme of 10% of GDP—which turned out to be closer to 2% (Karat, 2020)—one of the lowest government expenditures on COVID relief globally.

Through the launch of the Pradhan Mantri Garib Kalyan Anna Yojana in March 2020, the government provided free food grains to approximately 800 million beneficiaries under the National Food Security Act and Public Distribution System. This ensured that vulnerable sections of society had access to basic food supplies. Various state governments, local administrations and civil society organizations set up community kitchens to provide free meals, especially to migrant workers and daily wage earners whose livelihoods were severely affected.

The social safety net employment guarantee programme, Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), was a crucial instrument in ensuring continued livelihoods for rural citizens during the pandemic, including returned migrant workers. Demand for work under MGNREGA surged and the government enhanced its budgetary allocation. Workers created rural assets such as water conservation structures, farm ponds, and horticulture plantations, which have long-term benefits for the rural economy (Kumar & Chowdhary, 2021).

Key Concerns

Sensitive to criticism, the government cracked down on critical media coverage of the crisis (International Press Institute, 2023) undermined press freedom and hindered the public’s ability to access accurate and timely information. Journalists faced harassment, intimidation, and censorship, while social media sites ordered to remove tweets (Singh, 2021) critical of the government’s handling of the pandemic (Rights Risks Analysis Group, 2020). The government issued notices to several news outlets, including The Wire and The Hindu, warning them to refrain from publishing ‘fake news’ about COVID-19. Journalists were targeted by authorities for reporting on the absence of policy support and aid for migrant workers stranded during the lockdown. Press reports about apparent mismanagement in international media were termed foreign conspiracies.

The government was also criticized for letting political aspirations prevail over practicality. During the second wave, the government ignored the health impacts of large gatherings and prioritized conducting massive election rallies in West Bengal, held local elections in Uttar Pradesh and allowed mega religious gatherings to proceed (Dixit, 2020).

The pandemic also exposed education inequality in India, particularly for children from marginalized communities. School closures affected over 320 million children, disrupting their education and widening the already existing education gap. The shift to online learning, which was adopted as an alternative to classroom teaching, further deepened the divide between students with access to technology and the internet and those from underprivileged and rural backgrounds who lacked access to these resources. As a result, children from marginalized communities were left behind, which can have long-term implications in their education.

Moreover, the pandemic-induced economic crisis led to a rise in poverty, forcing many families to prioritize their basic needs over education, resulting in a higher dropout rate among students from marginalized backgrounds. The closure of schools also deprived students of access to the mid-day meal scheme, which provided them with a nutritious meal and incentivized them to attend school.

The digital divide widened the gender gap in education as well. Girls, already disadvantaged in accessing education, were disproportionately affected by the pandemic-induced school closures and online learning due to the lack of access to technology and societal biases. The government took steps to address the issue, such as launching the PM eVIDYA program and the DIKSHA platform, which provided online learning resources to students. However, these initiatives were criticized for being insufficient and inadequate in reaching out to the underprivileged sections of society.

Implications for Various Roads Ahead

India needs to draw lessons from the COVID experience to face the myriad challenges ahead. Globally and in India, the effects of climate change, air pollution, biodiversity loss and poor ocean health have impacted lives, livelihoods and led to socio-economic crises. Physical and economic impacts from climate change are already being felt, and some regions experienced extreme weather events at the same time as the pandemic. Without structural changes to our economy, continued environmentally unfriendly practices can potentially have catastrophic effects.

The Indian government needs to take steps to mitigate the impacts of climate change and promote sustainable development. This includes investing in renewable energy, promoting sustainable agricultural practices and reducing carbon emissions. The United Nations Intergovernmental Panel on Climate Change report from March 2022 cautioned (Krishnan, 2022) that if India does not take significant measures by 2030, the consequences of climate change will be permanent.

Multiple climatic and non-climatic risks can interact with one another, resulting in heightened overall risks affecting various sectors and regions Dixit (2020). For example, changing rainfall patterns can affect ongoing agricultural output and interact with desertification and salination of soil due to excess groundwater harvesting and excessive application of chemical fertilizers. This can worsen the crisis of falling incomes from agriculture, amidst waves of farmer suicides. Sea level rise threatens to affect India’s substantial coastal population. If this triggers mass migration, the social, economic and political disruption could be substantial.

The COVID pandemic exposed the vulnerability of India’s policy framework and brought attention to the need for urgent reforms. India must prioritize equity and address widening economic inequality. India needs to address the debt vulnerabilities of middle- and low-income populations, strengthen healthcare infrastructure and increase spending on public health and education. Across the board, a shift towards sustainable practices is essential to build a resilient economy and tackle the environmental emergencies triggered by climate change. This has the potential to create an array of ‘green jobs’ that can tackle the unemployment crisis while promoting sustainability.

India can draw numerous lessons from its successful policies during the pandemic. It showed that it had the capacity to roll out quick and decisive actions such as testing and contact tracing and a massive vaccination exercise. The challenge is to maintain vigil, through a continued institutional COVID response system, proactive research and updating of medicines and treatment protocols, and a stronger emphasis on income, good jobs, housing and health. Given civil society’s role, it is imperative to strengthen social cohesion too. Instead of highlighting that India had fewer COVID-related deaths compared to some developed countries, the government needs to focus on doing even better for India. In that way, India can build back better and create a more resilient and equitable society.