Policy solutions to strengthen India’s response to Covid-19
India is now over 50 days into a stringent national lockdown. With cases continuing to rise and a WHO envoy predicting a peak in end-July, the country is in a tight spot. On the one hand, economists have argued that a continued lockdown will severely damage the economy and harm the poor. On the other, public health experts have struck a note of caution over a potential second wave of infections if the lockdown is lifted too soon.
In this fog-like situation, there are only difficult choices ahead for policymakers. Many have urged the government to focus on evidence-based decision-making. Unfortunately the unreliability of public health data in India makes that difficult in practice. In fact, when officials used quantitative models to indicate that the epidemic curve was flattening, the rate of positive cases rose instead. Not to mention, the wide variance in public health capacity among local and state governments, who are the first responders in this crisis.
Nevertheless, contrasting state responses offer useful lessons that can help the central government fine-tune its national response to the evolving pandemic. These include:
- A track-II dialogue between state health ministers
Many have attributed East Asia’s success in containing Covid-19 to the region’s past brush with SARS. India’s recent encounter with an even more lethal virus is frequently overlooked. The Nipah virus hit Kerala in 2018 — and had a frighteningly high case fatality rate of 88.8%. The learnings from that outbreak moulded the state’s response to Covid-19. Kerala’s strategy — which included clear public communication, home visits by healthcare workers to check symptoms and aggressive contact tracing by volunteers — helped flatten the state’s curve, despite its relatively low testing rate.
Rather than replicating the East Asian model of containment, India needs to utilise low-cost public health methods that have proven effective in the country, especially in Kerala. This can be achieved by bringing state health ministers together in a track-II dialogue — commonly used in foreign policy as a form of “backchannel diplomacy”. The goal is to allow state and local public health officials to share their experience and learnings in a non-political setting.
Ideally this forum should be headed by K.K. Shailaja, Kerala’s Minister of Health and Social Welfare. She’s the only elected official with experience in fighting a virus. In fact, Karnataka’s health minister recently held a video conference with Ms. Shailaja to learn about Kerala’s Covid-19 strategy. These informal interactions must be institutionalised by the centre to co-ordinate states’ response to the crisis. As the virus spreads throughout the country, less-affected states can be better prepared by learning from Kerala.
2. Devolve financial capacity and decision-making to states
The Covid-19 pandemic has confirmed that “a chain is as strong as its weakest link”. Bearing that in mind, it is concerning that states are under acute financial stress despite being at the forefront of India’s fight against Covid-19. With their primary sources of funding choked off during a lockdown, states must receive adequate fiscal support from the centre or be allowed to borrow beyond prescribed limits to ensure they don’t compromise on their public health response. Kerala’s Finance Minister Thomas Isaac signed off on the state’s entire annual medical supplies budget in just a single day!
It also needs to be noted that India’s states are at different points on their epidemic curve, so a one size fits all approach is unlikely to work. States like Maharashtra and Gujarat, which are closer to their peak, may need to institute more stringent quarantine measures than those like Kerala, who have flattened their curve. Based on the large variance in states’ public health infrastructure and capacity, decisions on opening up lockdown restrictions need to be localised rather than centralized.
There are also huge variances in policy-making capacity between the centre and states. As India re-opens its economy, the top-heavy concentration of technical knowledge needs to be dispersed to the local level. The centre can achieve this by deputing public health officials from the Niti Aayog and ICMR to work for state and local governments for the duration of this pandemic.
3. Leverage incentives and behavioural insights to re-start the economy
The success of India’s early national lockdown in potentially slowing the spread of infections has led to the propagation of a false dichotomy about the need for a total economic shutdown to protect public health. In reality, there is enough evidence about the virus that can help policymakers take a balanced approach in re-opening the economy without sacrificing public health. These include:
· Lifting lockdown restrictions for people under the age of 55, who comprise much of the workforce.
· Permitting e-commerce companies to operate throughout the country and deliver non-essentials, so as to enable contactless deliveries.
· Increasing the frequency of public buses and trains to reduce overcrowding.
· Providing incentives to companies that operate during off-peak hours.
· Installing free public wi-fi to encourage people to work and stay at home.
· Frequent testing in high risk occupations like healthcare, transport and policing.
While a lockdown is a blunt but effective policy instrument, it causes significant social and economic damage. Bureaucrats need to use incentives and behavioural science perspectives, rather than a command and control approach. They need to become much more agile to maintain the delicate balance between public health and the economy over the next year. Now is the time to let innovative solutions and a decentralized approach prevail.
