PolicyWTF: Winging the Pandemic
This section looks at egregious public policies. Policies that make you go: WTF, Did that really happen?
One of the things we often say around here is how difficult it is to craft public policy. The process requires diligence in collating evidence, intellectual integrity in comparing the options and trade-offs, anticipating the unintended, planning for implementation, mapping the stakeholders and communicating to all of them. You know the drill.
Importantly, a lot of these decisions have to be taken when the future is unknown and there’s uncertainty all around. Your assumptions could be off the mark or unforeseen events could derail your plans. You cannot do much when you are dealing with ‘unknown-unknowns’. You have to opt for the best policy course while dealing with the ‘epistemological fog’.
This is one of the reasons why we don’t do a post-mortem of a policy decision with the benefit of hindsight. We call out a policyWTF the moment we think we have spotted one. And then go back to it as the future unfolds in line with what we had anticipated or differently.
But if I do have to analyse a policy response of the past, I follow what I refer to as the ‘retrospective case study’ method. It is a simple tool dealing with only the ‘knowns’ and I will use it to analyse India’s Covid-19 response. As India deals with a second wave with its healthcare infrastructure struggling to keep pace, the question that everyone is asking is how did we get here?
Maybe this tool will help us with few plausible answers.
Here’s the case study
Imagine you are in mid-March 2020. There are a handful of Covid-19 cases in the country. You have to put an emergency response plan. Like I mentioned before we will only deal with the ‘knowns’ at the time of response (March 2020) to avoid hindsight bias. So what are the knowns?
About the virus. You know the virus is infective (R0 is high) and the cases rise exponentially as already seen in Italy, Spain, USA, UK etc. The healthcare systems in these countries weren’t prepared for it. They buckled under the load. The ultimate cure is prevention. And the best tool for prevention is a vaccine. You know there are research efforts on in USA, UK and China. It is clear any vaccine will take atleast a year to be available for commercial use. This is a wildly optimistic scenario. You also know there’s a drug (Remdesivir) that has moved to phase 3 trials as a cure for Covid-19 infection. Lastly, almost every expert warns there could be more than one wave of infections as has happened with Coronavirus pandemics in the past. The virus mutates and not always to a less virulent version. So, it is likely this pandemic will see a few waves with mutants before vaccines or herd immunity brings it under control.
About India. You also know the challenges unique to India. The healthcare infrastructure is woefully inadequate. It ranks in the bottom quartile globally on hospital beds, doctors or paramedical staff on a per capita basis. The population is much larger with dense, cloistered urban clusters that are ideal for the spread of the virus. You also know its relative strengths. People comply with government orders. It is the vaccine factory of the world. And the elected government is strong and stable with an extremely popular PM.
For a moment keep the economic impact of decisions or the fiscal position of the government aside. Just focus on the health and well-being of the citizens. Based on the knowns that are available with you at that moment, what will you do?
I guess the simple policy response would have been:
- A lockdown to slow down the spread and to prepare the healthcare infrastructure to manage the eventual waves. This would mean creating additional capacity for hospitalisation, procuring testing kits, ventilators, oxygen cylinders and training people on paramedical activities during the lockdown.
- An ongoing effort at stockpiling the above once lockdown is lifted to manage the peak caseloads. A measurable set of metrics to assure the state and union governments about the inventory of these items on an ongoing basis. Continuing to be in this semi-permanent state of readiness till most Indians are vaccinated and herd immunity is achieved. Remember there are always subsequent waves as the past has shown.
- Advance Purchase Commitments for various vaccines candidates that are going to be in play. Maybe a similar arrangement for stocking up Remdesivir. This is critical given India’s population. Securing the supply of vaccines is the key. And then an initial plan for inoculating about a billion Indians in less than a year whenever the vaccine is ready. This is a non-trivial exercise.
I would say that’s probably it. This is the most you could have done a year back. Everything else was unknown. It is possible the whole thing could have blown over and all the preparations would have been in vain. Or things would have turned out worse than we imagined. Indians might have been careful and followed all protocols. Or not. The virus might have taken a toll on the seniors. Or not. Winters might have been worse. Or not. We would have a single wave. Or four. Or more. Who knew?
You could have only done so much then.
How have we done a year down the line on them as a second wave rampages its way through India?
What We Did
First, we locked down in a way that created another humanitarian crisis. That apart we used the lockdown to build some additional healthcare capacity to manage the rise in cases. After some policy missteps, we got our act together on temporary Covid care centres, PPE and testing kits, ventilators and masks. But that was about it. We didn’t have a measurable metric to track the inventory of the key items to assure us to manage any future peaks or waves. It was never enough but we managed this time. Soon we ran through the inventory and barely replenished them. No one knew because no one was tracking. We are world champions in winging it (or jugaad as we have mythologised it) and we thought we had gotten over the pandemic with it. Till the second wave arrived and we were back where we started. No testing kits, oxygen cylinders, ventilators and an overburdened healthcare workforce.
Second, like on many other occasions in the past, we declared premature victory. One of the abiding memories of my childhood is Javagal Srinath and Venkatapathy Raju dancing in celebrations mid-pitch instead of running the three runs that would have tied a World Cup (1992) game against Australia. They thought the ball had sailed over the ropes. What’s more, the fielder, the ever-reliable Steve Waugh, dropped the catch and gave us a fighting chance to run the three runs. Waugh rocketed a throw back to Boon and Raju, predictably, fell short of the crease while going for the third run. No providence wasn’t sufficient for our overconfidence.
We were hitting daily global peaks in August and September. We came through that period relatively unscathed. The mortality rates remained low for reasons unknown. It was providence much like Steve Waugh dropping the catch. But we started celebrating our victory like we had done something special to beat the virus. The case count went down as mysteriously as they had gone up. We declared we had herd immunity. We started hero-worshipping. And we were out and about. To complete the circle on cricket, we even had two T20 matches with over 60,000 in attendance in March played out at the Narendra Modi stadium. That bookended our premature celebrations.
Third, and this is a cliché that has held over time: other countries follow evidence-based policy making; in India we have policy-based evidence making. We have a phalanx of experts, op-ed writers and intellectuals who justify every policy decision with evidence collated after the fact. For the past few months, we have seen numerous articles that suggested we had done almost everything right in handling the pandemic based on retrospective evidence at that point in time. Unfortunately, the wheel turned and reading them today is a stark reminder of intellectual bankruptcy in India. There were no questions asked about our vaccine readiness. Did we secure them in advance? Are we making sure we have a supply of vaccines to inoculate most Indians as early as possible? Is the government really ‘donating’ vaccines in the numbers mentioned in media to other countries? Are we being careful about the virus mutants? The questions could have been many.
None of this was discussed in depth. Instead, we were preening about how ‘Indian vaccines’ and the PM were saving the world from Corona. We appropriated Covishield as ‘Indian vaccine’ and it almost seemed like India had run Operation Warp Speed to fast-track vaccine development for the world. Last weekend the Ken covered India’s vaccine policy with depth and insight. The contrast between the US and the Indian policy response couldn’t have been starker.
So, here we are today. In the middle of a second wave for which we seem to be worse prepared than the first. We can blame people for being irresponsible and letting their guards down. Or we can wheel out data to blame the state governments we don’t favour for this wave. Or we can say nobody could have seen this coming. None of this is going to change the reality on the ground. You know the truth.
But then the truth is the first casualty during a crisis in India.
PS: Even as we write this edition, the government gifts us another policyWTF: a price cap on Remdesivir — a drug that’s in high demand and short supply. You all already know what to anticipate next.
PPS: This is the birth centenary year of Sahir Ludhianvi, one of our greatest poets and lyricists. In Guru Dutt’s Pyaasa (1957) he wrote these immortal words which seem apt for the current times:
यहाँ इक खिलौना है इसां की हस्ती
ये बस्ती हैं मुर्दा परस्तों की बस्ती
यहाँ पर तो जीवन से है मौत सस्ती
ये दुनिया अगर मिल भी जाए तो क्या है?
Read the full edition here.
Disclaimer: Views expressed on Anticipating the Unintended are those of the authors’ and do not represent Takshashila Institution’s recommendations.