An Inevitable Crisis

Access to health care — or the lack thereof — depends on the extent to which health care services are affordable, of acceptable quality, and physically accessible. The Indian constitution guarantees access to health care for all citizens. However, an institutionally weak and resource-starved public health care system has meant that India’s private health care sector is responsible for the majority of inpatient and outpatient care.

The largely unregulated private sector is unreliable in terms of quality of services. In addition, the costly out-of-pocket payments drive vulnerable sections of the population that mostly lack insurance further into poverty. Just as the wealthiest 10 percent of India’s population holds 77 percent of the national wealth, similar levels of inequality govern access to an acceptable standard of health care during the pandemic.

Predictably, public and private hospitals ran out of beds very quickly during the second wave of the pandemic in India’s congested urban centers, where social distancing and sanitation are the preserve of the privileged few. Without a centralized coordination system, oxygen producers in the east of the country have struggled to match the medical oxygen needs of the hardest-hit regions in northern and western India. This led to the heartbreaking scenes of patients dying, often at the doorsteps of hospitals that were not equipped to deal with the surge.

Of course, the poorest inhabitants of India’s cities are the worst affected. They are the ones most exposed to the risk of contracting the virus and least able to pay for necessary medical care. In rural India, the majority of the population also lacks access to adequate health services, and the spread of the pandemic has gone unchecked and underreported.

Policy Failures

A public-health crisis was therefore entirely predictable, but Modi’s Bharatiya Janata Party (BJP) government didn’t approach the pandemic from this standpoint. It was mainly preoccupied with containing any potential challenge to Modi’s leadership, which was already reeling from a series of policy failures.

As the pandemic began, Modi’s credentials as a prime minister who could preside over economic growth and development that was free of corruption and beneficial to the ordinary citizen seemed to be in question. India was experiencing the worst economic downturn in three decades.

Modi’s headline economic initiative had produced uneven results. The demonetization of five-hundred- and one-thousand-rupee banknotes was supposed to curb the circulation of fake bills, black money, and terrorist funding. But the government’s implementation of the policy was haphazard. In the short term, it resulted in a severe shortage of cash, a rise in unemployment, and a significant decline in income and economic activity.

As the pandemic unfolded, the Modi government’s economic policies came under scrutiny again when it passed new farm laws in September 2020. The laws open up the agricultural industry to major corporate players and leave small farmers exposed to market forces. Six state governments have voted against the new federal bills. There has been a nationwide strike and farmers from nearby states have regularly marched to New Delhi since November of last year to protest the new laws.

Modi’s tenure has also been marked by religious strife as he seeks to bolster his Hindu nationalist credentials. We have seen an increase in anti-Muslim violence, government policies curbing the slaughter of cattle, the Citizenship Amendment Act of 2019 that limits the access of Muslims to citizenship, as well as the revocation of Kashmir’s special status in the constitution. The government has clamped down severely on opposition to these measures, especially in the Kashmir Valley, where it shut down the internet, cell phones, landlines, and cable TV for days.

Modi’s PR Campaign

With few policy successes to speak of, Modi mounted a sustained effort to build up his public image during the pandemic. He declared March 22, 2020, to be a people’s curfew, encouraging citizens to bang pots and pans at 5 PM that day in support of frontline health care workers. On April 9 last year, he asked citizens to light candles and lamps at 9 PM for nine minutes in solidarity against the pandemic. These campaigns had little effect on the outbreak, but they received widespread support from prominent public figures on social media, with many hailing Modi’s leadership in a time of crisis.

When Modi ordered a national lockdown with four hours’ notice, it had a devastating impact on the vulnerable population of urban and rural areas. The BJP boasted that the lockdown received a score of 100 on the Stringency Index, citing this as evidence of Modi’s effective crisis management. However, this measure of “stringency” had very little to do with the efficacy of policies against the spread of the virus.

Modi and his allies have depicted the fight against the pandemic as a personal struggle for the Indian leader. When his government set up the Prime Minister’s Citizen Assistance and Relief in Emergency Situations Fund in March 2020, many people questioned the rationale behind it. After all, there was still unused money left over in the long-established Prime Minister’s National Relief Fund. But one clear advantage of the new fund was that its title could be abbreviated to “PM CARES,” symbolizing Modi’s direct involvement. It was also a way for pro-Modi corporate donors to channel funds they had already allocated to corporate social responsibility, or CSR.

The BJP has framed the ongoing vaccination drive as a personal victory for Modi. In contrast with other countries, where vaccination certificates bear the logo of the national health and disease control authorities, India’s certificates have an image of the prime minister with the message “Together, India will defeat COVID-19.”

Many observers have blamed the recent spike on the Kumbh Mela, a religious gathering held in Haridwar in the state of Uttar Pradesh, which saw millions of people gathering on the banks of the River Ganges. Conducted without any precautionary measures, it may have well been the world’s single largest super-spreader event. Allowing the festival to take place was a political decision in a BJP-led state: it was meant to show that India was now in the endgame of the pandemic.

Against the advice of public-health officials, assembly elections also went ahead in several states during March and April. The large campaign rallies and long polling lines resulted in an immediate surge of infections. In West Bengal, where the BJP was anxious to overthrow the ruling Trinamool Congress (TMC) government, Modi flooded the state with the ruling party’s resources. While the BJP eventually lost the West Bengal contest, the party’s rallies contributed to the highest-ever infection numbers in the state.

Modi and his Hindu nationalist government have also faced criticism globally. Many consider his handling of the second wave to be a severe failure of leadership and foresight. But the BJP was still more concerned with censoring criticism on social media platforms than addressing the ongoing public-health crisis.

The vast human cost of the pandemic was painfully evident when hundreds of bodies washed up on the banks of the Ganges. While this tragedy was unfolding, the Central Bureau of Investigation (CBI) arrested four leaders of the TMC on May 17 in Kolkata in connection with a highly publicized corruption case.

The timing of the arrests led many to suspect that Modi is deploying federal institutions against the BJP’s rivals. TMC cadres protested in violation of the lockdown and attacked the local offices of the CBI.

At present, Modi is also pushing on with the Central Vista Project, a $2.8 billion redevelopment plan that is meant to revamp the central administrative area of the national capital. His government has respond to criticism by claiming that the project will “ensure readiness of the country in terms of progressive infrastructure and public facilities.”

While Modi’s administration has invoked the Essential Services Act to allow laborers to work on the project in New Delhi, it previously neglected to do so in order to secure supplies of medical oxygen during a shortage. It is once again evident that the pandemic in India is a public-health crisis that is also inseparable from the country’s political struggles.