The negligent and irrational response of the Modi regime

Bus station chaos during India's first lockdown

“At all levels, various authorities are working in sync to ensure COVID-19 does not spread. No stone is being left unturned to ensure people are healthy.” This is what the Indian Prime Minister Modi tweeted on March 16, 2020. At this moment India is caught in a perfect storm of crisis, facing its worst public health catastrophe since independence in 1948, with devastating consequences for the livelihood of more than a billion Indian people.

India: the giant awakes!

If we believe what bourgeois propaganda tells us in the past years then India, a country with about 1.35 billion inhabitants, is one of the most successful countries of the last thirty years. Thanks to trade liberalisation and the lifting of import licences (de-licensing), the nation’s annual GDP growth rate reached a robust growth of 6 to 7 % per year between 1991 and 2016. In the same period, it has doubled its share of world GDP. Between 2005 and 2015, the economy grew at double-digit figures, making India the fastest growing economy in the G-20. As icing on the cake, India succeeded in displacing the United Kingdom, the former coloniser, as the sixth largest economy in the world in 2017.

Moreover, the country seems to have become richer every year: “The number of households in India with disposable incomes of more than US $10,000 has risen twentyfold in twenty-five years. The Indian household savings rates also tripled between 2005 and 2015, with many more households having a significant disposable income. During the eight-year period between 2004 and 2012, the middle class doubled in size from 300 million to 600 million. In 2015, fewer than 19 % of Indians lived below the poverty line.” [1] Between 1990 and 2019 life expectancy in India has risen from 59.6 years in 1990 to 70.8 years in 2019.

As proof of this growing prosperity and wealth, India has stepped up its space programme. “Although India’s space program began as early as the 1960s, it has gained new prominence under Prime Minister Narendra Modi.” (Washington Post, 12-07-2019). In 2014, India put a satellite in orbit around Mars, and became the fourth national space agency to actually land on the ‘red planet’. In March 2019, India carried out a successful test by firing a satellite into space. According to Modi, India can now call itself a real space power and is working towards a manned space mission in 2022. India's space programme is making giant leaps to the moon, Mars and beyond.

For the bourgeois of India, the question is crystal clear: the next decade belongs to India!

On the base of all these developments it could be argued that India would easily be able to create the conditions and the instruments to face the pandemic that broke out in the first months of 2020. Nothing is further from the truth! Despite the steady growth of the economy, despite the increase in prosperity, despite the huge technological advances, the management of the Covid-19 pandemic has been a disaster, failing to prevent millions of infections and making a total mess of steering Indian society through this pandemic storm. The declaration of the first national lockdown was made with little or no serious planning and vast numbers of seasonal workers, forced to head back to their villages, were given absolutely no support – neither food nor adequate transport, leading to chaotic scenes on India’s roads and bus stations. Since then, the profound inadequacies of India’s health system have been starkly revealed, making it clear that India’s dizzying growth has brought minimum benefits to the majority of the working class and the most oppressed social strata.

The failing public health system         

For its 1.35 billion people India has fewer than 15,000 state hospitals and only one hospital bed for every 2000 people, one of the lowest ratios in the world. The ratio of intensive care (UCI) beds in public hospitals is one to 37,500 people. Of the currently functioning health centres, only 10% are operating as per Indian Public Health Standards (IPHS). Many of these centres are even lacking basic services such as electricity or running water. [2]

India’s public health units are also severely deficient in hospital staff. The country has only one doctor in the public health system for every 11,082 people. In the public sector none of the institutions manage to meet the World Health Organisation recommendation of 1:1000 doctors to population. India has a shortage of an estimated 600,000 doctors and 2 million nurses. Furthermore, more than 50 % of the doctors have no or an insufficient qualification. Low salaries and poor working conditions in public hospitals have led around 100,000 doctors to emigrate.

In state hospitals treatment is supposed to be largely free. Nevertheless, patients end up buying consumables and medicines from private pharmacies because the hospitals simply don’t have enough in stock. Also, illegal payments have to be made sometimes to bribe doctors and nurses. State hospitals "are poorly staffed. They have employees who sometimes don't show up. You may have to bribe every employee at every level of the system”, says Ravi Ramamurti, director of the Center for Emerging Markets at Northeastern University.

The private medical care factories

India has one of the most privatised health systems in the world. Total private infrastructure accounts for 62% of India’s entire health infrastructure - an estimated 43,487 private hospitals versus 25,778 public ones. Even if the healthcare in the public hospitals is largely free, more than two-third of the population goes to private hospitals. The poor quality of service in public hospitals, the long queues and in some cases the absence of the required specialists force people to visit private hospitals and medical centres for treatments.

The private healthcare system in India is largely unregulated, opaque and often unscrupulous, overcharging patients for unnecessary treatment. In private hospitals average medical expenditure per hospitalisation case is as much as seven times higher than in public hospitals. Because 86% of India’s rural population and 81% of its urban population have no health insurance, they have to pay for this from their own pockets, which means very frequently they have to get themselves into debt.

At the same time medical tourism has become big business and is rapidly expanding. The country is home to some of Asia's top hospitals and medical tourists come to these centres from as far as the United States. Top hospitals offer a whole range of healthcare services. Advanced facilities, doctors trained in western countries, a growing compliance on international quality standards and of course low-cost treatment make India an ideal destination for half a million medical tourists a year. 

Indian capitalism is putting out red carpets for these tourists, dazzled by their dollars. It is vigorously promoting medical tourism by providing tax concessions. Since 2015 it has also created a special medical visa that lasts up to one whole year, which can be given for specific purposes to foreign tourists coming to India for medical treatment. Medical tourism is a slap in the face for all Indian people who cannot afford decent medical treatment.

No wonder that the state stimulates the trend toward privatisation of health care, as an analysis by the Centre for Budget Governance and Accountability (CBGA) in 2019 states. “Despite an evident need for investing in building and strengthening the public health system, the trajectory of health policy in India is unapologetically shifting towards an insurance-based model of healthcare, which essentially strengthens the private healthcare industry.” [3]

Nearly two-third of the medical system has been turned into a business with the use of marketing tactics and a race to achieve the maximum profits. According to T. Sundararaman, former executive director of the National Health Systems Resource Centre (NHSRC) one thing is certain: “the neglect of a robust public-health system in favour of privatised, insurance-led healthcare has weakened India’s ability to deal with a national health emergency. India’s weakened public health infrastructure is unprepared for the Covid-19 pandemic.”

Serious warnings about infectious diseases

India has always been a hospitable environment for infectious diseases. And the coronavirus has proved to be no exception. While many parts of the world have also controlled infectious diseases through immunisation and better medical care, India still struggle to manage these epidemics.

In April 2017 a study of the Centre for Disease Dynamics, Economics and Policy (CDDEP) in Washington already concluded that South Asian nations, including India, are “vulnerable” to emerging infectious diseases and their level of preparedness is “inadequate” to protect public health. The highly pathogenic avian influenza (HPAI) virus A/H5N1, which was introduced to the subcontinent through wild birds, has since become endemic across large parts of northeast India. Inadequate surveillance and uneven health system capacity may accelerate the spread of these kinds of emerging infectious diseases, putting millions of lives at risk.

On top of that India has some of the most severe issues with infectious diseases on the planet. In the country the number of cases of the top three Soil-Transmitted Helminthes (a parasitic worm) totals more than 280 million cases. (20-08-2016) Communicable diseases like pneumonia and tuberculosis accounted for over 46 per cent of preventable deaths in children aged 5-14 years in 2016. Death rates from these communicable diseases were nearly 20 times higher in India than in China, and 10 times higher than in Brazil and Mexico. (14-03-2019)

And what has the Modi government done since this study? Nothing substantial. Despite the warnings public spending on health has been stuck at around 1.2% of GDP for close to 15 years. In 2017 the Government of India made a commitment to raise public spending on health to 2.5% of GDP by 2025 (“Modicare”). But there is so far no sign of any significant increase in health spending by the government, ranking India to the lowest countries in the world in public health spending: in contrast to Thailand ($166 per capita), Sri Lanka ($63) and Indonesia ($38), India only spends $16 per capita.

When the first case of Covid-19 infection was reported in India, on January 27, 2020, private hospitals refused to treat Covid-19 patients on a massive scale, while they have the best facilities; the biggest part of the ventilators is in the private hospitals. And according to Poonam Muttreja, Executive Director, Population Foundation of India, a Delhi-based NGO, private hospitals hold almost 65% of available ventilators, and are only handling 10% of the critical load of Covid-19 patients. (26 June 2020) It is clear that the already abysmal health care system and its workforce were completely unprepared for this massive increase in Covid-19 cases.

For months there was a severe lack of testing.

Despite significant testing capacity in both public and private laboratories, India was slow to provide testing. Testing in the early days of the epidemic was limited to a few public laboratories. As of June 1, 2020, many experts have noted that testing capacity is still drastically insufficient for the needs of the population. Daily Covid-19 tests per 1,000 people are only 0.08 in India compared with 1.16 in the United States and 1.02 in Italy (30-05-2020). India’s Covid-19 testing rate is among the lowest in the world and falling.

Results of India's first nationwide study of prevailing coronavirus infections, conducted by scientists from the Indian Council of Medical Research, found for every confirmed case detected in May, authorities were missing more than 100 others. The study showed that 6.4 million people were likely infected already. The virus had already spread to India's villages, straining fragile health systems. The study confirms that India's limited and restrictive testing masked the actual toll. It actually found antibodies in people who lived in districts that hadn't yet reported cases!

In August India tried to step up its testing, almost doubling the number of tests conducted during the month of August. The country’s current testing policy aims to track and test all contacts of at least 80% of new Covid-19 cases. However, India still has one of the lowest rates of testing per capita in the world. Only about 82 of every 100,000 people in India are being tested per day, according to Johns Hopkins University -- compared to about 284 in the US and 329 in the United Kingdom.

The low levels of testing manifest India’s inadequate health infrastructure and the weak capacity of public health systems to track and scale-up rapid testing in the community.

The bourgeoisie willingly downplays the number of infections. The data of the government is full of gaps since it has failed to accurately record the deaths of its own citizens for years. In the beginning of September India's reported mortality rate was surprisingly low, apparently standing at 1.7%. For context, the same rate was about 3% in the US, 11.7% in the UK, and 12.6% in Italy (Johns Hopkins University). Antibody tests suggested that India might also be under-counting infections at least by a factor of 50, which means that the true number of infections in September could be more than 60 million, as opposed to 4.4 million Covid-19 cases being reported by the state’s institutions.

The spread of the virus: growing chaos in healthcare

When the number of infections started to rise, after the national lockdown was lifted in the middle of May 2020, the medical sector was soon overwhelmed and a general chaos, first in June-July and still more in September-October, could not be avoided.

In June 2020, when “only” 298,000 Covid-19 cases and 8,500 deaths were registered, there were already reports of people who “are dying due to the non-availability of medical treatment. It has also become very difficult to get admission in hospitals. There is also a serious shortage of oxygen facilities and ventilators. The worst victims are the poorest, as it is extremely difficult for them to get admitted into the hospitals.” [4]

In the same month it was the public health-care system in Mumbai, epicentre of India’s worsening coronavirus outbreak, which was overwhelmed as Covid-19 patients poured in and hospital staff worked around the clock. Patients were asked to sleep on the floor until beds opened up. Medical care for non-coronavirus patients had basically been shut off due to a lack of resources. Patients were dying all over the place because hospitals refused to give them the required treatment.

India TV, in its programme on 10 June 2020, showed videos which indicated the pathetic condition of the patients admitted to hospital and the deplorable condition of the wards. Patients were in the wards together with dead bodies. Cadavers were also seen in the lobby and waiting area. The living were not supplied with oxygen or any other support; no saline drips were shown with the beds and there was no one to attend to the sick and dying. This was the condition of the Government Hospital of Delhi with the capacity of 2,000 beds.

India's public health system on the verge of collapse

At the beginning of August, the pandemic spread seemed to be successfully contained, with cases slowly subsiding. But very rapidly there was a resurgence of the virus across the country and in mid-September a second spike in Covid-19 cases put the health care system really at risk. Some parts actually tended to collapse under the pressure of the surge of the Covid-19 cases.

• Data from the local government's hospital occupancy app, Delhi Corona, showed there were no ICU beds with ventilators available to coronavirus patients in eight of the capital's 11 top private hospitals, even as the total coronavirus cases here surged above the 200.000. (20-09-2020)
• In Mumbai doctors had to wait for oxygen every day. “Every day, we are worried if the oxygen will arrive or not. If they - the supplier of oxygen - had arrived even a couple of hours late, we could have lost five or six patients.” (Ravindra Khade Patil, a doctor who manages two private hospitals in Mumbai, 16-09-2020).
• At the beginning of November 2020 hospital beds in Delhi were filling up again illustrating the advent of another crisis. At least 66 % ICU beds with ventilators were occupied. India's largest public Covid-19 hospital tended to crumble under the weight of soaring coronavirus cases, with only 6 per cent ventilator beds vacant in the hospital (07-11-2020)

A surge in Covid-19 cases has overwhelmed India’s health system. Above all the government hospitals faced a very heavy caseload of severely ill patients, with only a few beds and very few ventilators available. Reports mentioned Covid-19 patients dying in a hospital in central Madhya Pradesh state because of a lack of adequate oxygen.

The appalling conditions of the healthcare workers

“The working conditions for doctors are abhorrent too; both in government and private hospitals. Doctors are overworked, without proper sleep, food or water. They are staying away from their homes for days and months. Even after working in these circumstances, they become the victims of violence at the hands of the aggressive relatives of some patients. The worst part is that doctors can’t even protest or strike against their lot, as the lives of millions depend on them”. (In Defence of Marxism, 12 August 2020)

During the pandemic the working conditions for the healthcare workers have seriously deteriorated. They were obliged to work day and night in an already overworked and overburdened infrastructure. They have been denied wages and protective equipment, muzzled, persecuted, and made to work overtime. Doctors and nurses are being overworked without proper Personal Protection Equipment (PPE), putting their lives at risk. PPE shortages forced doctors to use raincoats and motorbike helmets.

Due to insufficient safety measures the “heroes of the nation” in India have been contracting the virus at an alarming rate. At the beginning of September already 80,000 health care workers tested positive. Of these infected workers more than 600 have died in the meantime. At the beginning of October, 2,500 doctors were infected with the disease and 515 of them died. The recording of the number of health care workers who have contracted the coronavirus and died is done by the Indian Medical Association since the Modi government completely disregards this task.

At different moments Indian healthcare workers have been protesting against extremely harsh work schedules without any leave or are simply being forced to work under unsafe and hostile conditions. Despite their courageous efforts, their commitment and combativity, most of these protests remained isolated and didn’t see their demands being met by the authorities who threatened the hospital workers with dismissal.

The fight against the attacks on human lives

In the autumn India was going through a new wave of infections. But, while several countries in the world have decided on a second nationwide lockdown, a joint statement from different health institutions said that the lockdown in India should be discontinued. Even in October a committee of experts, appointed by the Department of Science and Technology, advised the central government not to impose fresh lockdowns. Since a full flowering of the pandemic might lead to the healthcare system being overwhelmed and labour power being decimated, a more rational bourgeoisie might aim for a strict lock-down. But not the Modi regime.

The government of India, an obvious manifestation of populism, is permanently in denial about the gravity of the situation and encourages the use of traditional remedies against the Covid-19 virus [5]. In April the government set up a task force for scientific validation of Ayurveda and in October the Indian health ministry begun to recommend medicine based on Ayurveda. In the concrete practice of everyday life however such a policy is based on the ideology of herd immunity, with all the resulting horrors for the population in general and the working class in particular.

Herd immunity is not an official policy of Modi’s control of the virus, but there are several experts and institutions who openly speculated about the herd immunity option:

• A sero-prevalence study, done by the Indian Council of Medical Research (ICMR), suggests that most regions in India may be inching towards acquiring “involuntary” herd immunity against Covid-19.

• The daily Covid-19 cases are beginning to decline but certain parts of the country have started attaining herd immunity, experts said on India Today TV. (31-10-2020)

“Whether they do this with a deliberate policy, laissez-faire, wishful thinking or a combination of those and others” [6], without a vaccine such strategies will cost the lives of millions of people in India alone. “This is not a question of the defence of one scientific theory against another” [Ibid], but a question of denouncing every policy that does not prioritise human lives. In order to avoid doing that, the bourgeois is making sure that people will die like flies. It is the responsibility of communist minorities, as the most conscious elements within the working class, to take up a firm position against any attack, generated by capitalism, on the lives of human beings.

Dennis, 2020-12-18

[1] “The Middle Class in India: From 1947 to the Present and Beyond”; Spring 2018; https://www.asianstudies.org/publications/eaa/archives/the-middle-class-...)

[2] Source: “Modinomics = Corporatonomics Part IV: Modi’s Budgets and the Social Sectors: Health”, Janata Weekly, 02-06-2019; https://janataweekly.org/modinomics-corporatonomics-part-iv-modis-budget...

[3] https://www.cbgaindia.org/wp-content/uploads/2019/02/Numbers-That-Count-...

[4] https://www.bodhi-project.be/blog/covid-19-in-india-13. In many cases hospitals in Delhi and Mumbai refused to admit critically ill Covid-19 patients.

[5] The latest expression of this tendency is the decision of the Central Council of Indian Medicine (CCIM) to allow Ayurvedic traditional medicine doctors to conduct certain surgical procedures after the completion of their 3-year PG course, provoking a nationwide protest by  doctors in India.

[6] “The British government's "Herd Immunity" policy is not science but the abandonment of the most sick and vulnerable”; https://en.internationalism.org/content/16848/british-governments-herd-i...