One needs more systematic thinking about the hard choices India now faces — the trade-offs between the lockdown paralysing the economy and decimating the poor on the one hand, and on the other, lifting the lockdown thereby allowing the infection rate to soar, and taking a heavy toll on the old.

There have been systemic differences in the way different countries have been fighting the scourge of COVID-19, with different degrees of efficacy. So far, reportedly, the most successful have been South Korea, Taiwan and Singapore. The state machinery in these countries is very effective, they had prepared themselves since the SARS crisis in the early 2000’s, and were pro-active in early and mass-testing for infection. Of these, South Korea is a centralised democracy, Taiwan a more decentralised civic-participatory democracy, while Singapore is effectively an autocracy. But, all these three countries are relatively small, where mass-testing and quarantine are easier to implement.

Take in contrast the virus-fighting performance, so far, in the three largest countries of the world: China (an openly authoritarian country), India (until recently a democracy, now in an alarming state of decline), and the US (a highly flawed but functioning democracy). China had, after its mismanagement of the SARS epidemic, installed a well-designed early-warning system by which Beijing was to get immediate warnings of a contagion developing anywhere in the country. Yet, it fumbled again, this time largely because in an authoritarian system, local officials do not want to share bad news with the authorities above them. As is well-known by now, Li Wenliang, the Wuhan doctor who raised an alarm early in December (and later died of the disease in February) was reprimanded by local officials and made to “confess” that he was spreading false rumours. This made China (and the world) waste a crucial few weeks.

After that initial delay, China quickly mobilised its entire state machinery and put into action a severe quarantine system, and by most accounts, has now largely contained the incidence of the disease (though there are many who do not quite trust the officially released Chinese data). One should not, however, overlook the additional advantage China had as the world leader in manufacturing and infrastructure construction — this helped China in speedily building new hospitals and manufacturing ventilators and other medical equipment. This is an advantage which much of the world now lacks, having outsourced it to China for all these years.

 In the US, the President and the ruling party were in denial until mid-March (consistent with their anti-science and anti-expert attitude), fatally wasting several weeks of preparation, testing and tracing (A large state where many of the old people live, Florida did not get going until the beginning of April). Even in the best of times, the US private medical insurance system is messy and mired in a bureaucratic system that is oriented towards excluding people. It is largely unaffordable for the vast masses of the poor who do not have a stable job. Among rich countries, the system is among the least prepared to face a pandemic of current proportions. Testing facilities are highly inadequate, nurses are appealing to the general public for donations of hand-sewn masks, and hospitals are facing what is called the triage protocol, when one has to make cruel choices in rationing beds and medical equipment among patients of different survival probability.

The story behind the shortage of ventilators in the US points to a larger systemic issue. More than a decade ago, the Centres for Disease Control and Prevention asked the federal government to procure a large number of ventilators in preparation for future emergencies. The task of designing and making ventilators was assigned to a small company in California. However, this company was taken over by a corporate giant, which then decided, in view of its multiple product operations, to give low priority to supply the government the ventilators at the agreed low price. So the ventilator project got stalled, and hospitals have run out of them in the current crisis.

The current regime in India has, by and large, been trying to copy this American system. Government spending on health, as a percentage of GDP, is one of the lowest for a major country. Faced with the virus, India, like the US, has been woefully unprepared. India also wasted crucial weeks in February and the first two weeks of March, but not so much because of anti-science attitudes, but more because of another virus that has been afflicting our body politic — the virus of hate and intolerance.

In the third week of March came the sudden total lockdown, with hardly any notice or consultation with state governments, and without any simultaneous announcement about alternative food and shelter arrangements for the suddenly unemployed — chaos, police dandabaji, displacement and destitution followed. The financial package announced a few days after the announcement was a pittance in view of the needs, and about half of the spending announced was old outlays dressed as new.

One needs more systematic thinking about the hard choices India now faces — the trade-offs between the lockdown paralysing the economy and decimating the poor on the one hand, and on the other, lifting the lockdown thereby allowing the infection rate to soar, and taking a heavy toll on the old. In a country where the overwhelming majority of the population is young (the median age is somewhere around 26), the trade-off will be different than in the western countries where the age composition of the population is drastically different. A wide-ranging public deliberation on these tragic choices is now imperative.

This article was first published under the title ”A different hard choice” in The Indian Express

The writer is professor of graduate school at the department of economics, University of California, Berkeley

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