The union government chose to centralise COVID management across the country ignoring warnings from states, experts and parliamentarians. It had a year to plan a strategy. VINEET BHALLA explains why the major blame for our lack of preparation for the current wave of the pandemic lies with the union government..—-.AS India grapples with the ongoing second wave of the COVID pandemic, which has made it the worst affected country in the world, citizens are rightfully demanding accountability for why the government was so woefully unprepared in spite of having a year to prepare..In the face of anger and disenchantment, as well as trenchant criticism from foreign news media, the Bharatiya Janta Party (BJP)-led Union Government and BJP spokespersons, as well as some sections of the news media that are pliant to the ruling party's interests, have tried to deflect the blame on to state governments. They do this by taking refuge in the fact that the subject of 'public health' features in the State List of the Seventh Schedule of the Constitution of India..Notwithstanding the fact that the BJP runs the governments, either by itself or in alliance with other political parties in 17 of the 29 states in the country, and also notwithstanding that the Union Government's Ministers were only too happy to take credit for supposedly vanquishing the pandemic earlier this year, this argument is misleading because it does not take into account the heavy centralisation of India's COVID response through executive actions by the union government in the last one year..Also read: Government botches up COVID-19 response again.Centre took on pandemic management from the beginning.Last year, the initial stage of our COVID-response was marked by a national lockdown imposed unilaterally with just four hours' notice. There was no consultation with the state governments. The lockdown was imposed through powers vested in the union government by the National Disaster Management, Act, 2005..Throughout the lockdown, the Ministry of Home Affairs issued a series of guidelines for states to control the pandemic. This, even when the states are empowered to manage pandemics of this nature specifically by the Epidemic Diseases Act, 1887..Even though several jurists and commentators characterised the union government's actions as unconstitutional and unitary overreach, all of state governments acquiesced with the arrangement, essentially ceding authority to the centre..The states' ability to exercise power in this regard was further hemmed in by the incentivisation of corporate social responsibility (CSR) contributions to the controversial Prime Ministers's Citizen Assistance and Relief in Emergency Situations (PM-CARES) Fund over state specific relief funds..This was done by the decision of the Ministry of Corporate Affairs to qualify contributions made by companies to the PM CARES Fund as CSR expenditure under item no. (viii) of Schedule VII of the Companies Act..However, the same qualification was not granted to contributions made to the Chief Minister's Relief Funds or State Relief Fund for COVID-19 in place in several states..It follows that companies would prefer to put their CSR money into the PM Cares Fund rather than the state relief funds set up for the same. No wonder, then, that the PM CARES Fund received Rs. 30.76 billion within the first five days. It has now turned out that the fund is characterised as a private entity, and its account and utilisation of money is not open to public scrutiny, by virtue of not being amendable to the Right to Information (RTI) Act, 2005..Union Government had put in place empowered groups for uniform COVID response.At the beginning of the outbreak of the pandemic in March, the government set up eleven 'empowered groups' (EG), headed by government secretaries and including senior representatives from the PM's Office and the cabinet secretariat. Each of these EGs was assigned separate specific tasks dealing with different aspects of the State's response to the pandemic, ranging from medical emergency management to the availability of hospitals and medical equipment, and capacity building..In September 2020, these EGs were replaced by six larger groups. Four of them were headed by departmental secretaries, and the other two by NITI Aayog officials..Each of them had very broad mandates:.EG1 was to deal with medical infrastructure and the COVID management plan..EG2 was to ensure the availability of essential medical equipment and augmenting human resources..EG3 was to coordinate with the private sector, NGOs and international organisations for response-related activities..EG4 deals deal with economic and welfare measures..EG5 with information, communication, public awareness, public grievances and data management..EG6, with strategic issues related to COVID management, and facilitating supply chain and logistics management..It is shocking that we were caught so unprepared in spite of the presence of these EGs, formed by the union government and manned by seasoned bureaucrats, since March 2020..The only logical conclusion is that either these EGs did not work according to their mandate at all, or they were incompetent and utterly failed to see the second wave coming and prepare for it. Either way, they failed us..Monopolisation of control over oxygen and essential medical equipment.On April 2, 2020, the Union Ministry of Health and Family Welfare issued a circular to all state governments and union territories. The operative part of the circular read as follows:."[A]s per the Disaster Management Act 2005, the productions, procurement, import and distributions of essential types of equipment like a mask, PPE, gloves, ventilators etc will be done by the empowered group of the central government. [sic].The state government has to put forward their demands of crucial medical devices for COVID-19 management like personal protection equipment, N95 mask, ventilators rationally and fortnightly demand to the central government. The state governments will not go for the procurement of these essential medical types of equipment that will be done centrally by the Ministry of Health and Family Welfare and then it will distribute to states.".In other words, the government expressly barred state governments from procuring or producing essential COVID medical equipment and took upon itself the responsibility of regulating the supply of the same for all states in the country. State governments are to simply put up their demands for this equipment once every fortnight with EG2, which would assess them and distribute the equipment to states..EG2 was also granted the responsibility of procuring liquid oxygen for medical use from suppliers, private manufacturers and government entities, and their distribution to state governments as well as various central government hospitals and private hospitals. EG2 keeps account of the availability of oxygen and assign procured oxygen to states based on their needs and the prevailing situation..Thus, state governments did not have control over the supply of medical equipment or oxygen. They, therefore, were dependent on the largesse of the union government which entirely centralised its procurement and distribution. .The blame for the acute shortage of the supplies of these commodities, and the lives lost due to the same, lies solely with the union government..Also read: The Great Indian Oxygen Famine.Union government had information of the second wave well in advance.As far back as September last year, the Union Health and Family Welfare Minister Ashwini Kumar Choubey had stated on the floor of the Lok Sabha:."Pandemics caused by a new virus have the propensity to infect the human population in multiple waves, each time affecting a cohort of susceptible population. Some countries, which had initially successfully contained the COVID-19 outbreak earlier are now reporting a resurgence of cases. Government of India has advised States accordingly to upgrade health infrastructure based on the case growth trajectory in respective States/districts, besides taking stringent containment measures.".In November 2020, a Parliamentary Standing Committee on Health and Family Welfare comprising 30 Members of Parliament presented a report to the Chairman of the Rajya Sabha warning about the possibility of a second COVID wave hitting India, and cautioning about preparedness to combat the same, especially in the ensuing winter season and super spreading forthcoming festive events..In spite of these warnings, an India Today analysis of government data reveals that the number of oxygen-supported beds, intensive care unit (ICU) beds and ventilators across the country saw a drastic decrease between September last year, which was when India saw the peak of its first COVID-19 wave, and the end of January end this year. According to the analysis, in this period, the number of oxygen-supported beds fell by 36.5 percent, the number of ICU beds by a whopping 46 percent, and ventilators, by 28 percent..Also read: Timeline: How Indian Govt Ignored Warnings and Led People into COVID-19 Catastrophe.A report by Scroll.in from last month revealed that the government waited till October last year, which was after the first COVID wave, to invite bids to set up oxygen generation plants in 150 district hospitals across the country, by floating a tender online through the Central Medical Services Society, an autonomous body under the union health ministry. The health ministry later stated on social media that out of the 162 proposes oxygen plants, only 33 had been installed as of April 18..According to a report by ThePrint, about a dozen senior government officials in the central and state governments acknowledged that there was laxity on the part of the union government in responding to red flags raised by states and also to issues highlighted in internal meetings at the central level. The report quotes a senior union government official involved in COVID management admitting that data from the National Centre for Disease Control from as early as February this year had started showing the trend that the number of persons getting affected by the mutant coronavirus strain was increasing. States had also started flagging issues like shortages of bed and medical oxygen, but the centre did not respond promptly..This is supported by a report by Reuters that interviewed multiple scientists from the Indian SARS-CoV-2 Genetics Consortium, or INSACOG, in this regard. INSACOG is a forum of scientific advisers set up by the union government in late December specifically to detect genomic variants of the coronavirus that might threaten public health. As per the report, INSACOG had warned the union health ministry in early March of a new and more contagious variant of the coronavirus taking hold in the country. Shahid Jameel, the then chair of the scientific advisory group of INSACOG, expressed concern that authorities were not paying enough attention to the evidence as they set policy..In spite of all of these red flags, the national scientific taskforce on COVID-19, which is supposed to advise the union government on its response to the pandemic, did not meet even once during February and March this year. Meanwhile, election rallies in different poll-bound states in the country in March and April, as well as the Kumbh Mela in Haridwar in April, continued unabated, turning into super-spreader events..Clearly, the union government chose to ignore warning signs about the second wave, both from states, parliamentarians, as well as experts' bodies constituted by it..Also read: COVID Mishandling: Misuse of Scientists, Abuse of Science.The unmitigated disaster that is the union government's vaccine policy.In the governance mechanism for COVID vaccination constituted by the union government, a National Expert Group on Vaccine Administration for COVID-19 (NEGVAC) at the top provides guidance on all aspects of COVID-19 vaccination, including equitable distribution, procurement, financing, delivery, prioritisation of population groups and vaccine safety surveillance. Its agenda also covers regional cooperation, assisting neighbouring countries, and communication and media response. NEGVAC, set up in August 2020, is chaired by member (health), NITI Aayog, and co-chaired by the secretary of the Ministry of Health and Family Welfare. Its membership constituted representation from the relevant union and state government departments..As an interesting aside, the union government had last year batted away Right to Information Act queries seeking details about NEGVAC, with the health ministry stating that it doesn't hold information about NEGVAC, and the external affairs ministry citing national security exemption to shield the information..The most apt way to describe our national vaccination policy, as designed by NEGVAC, is that we have none. For much of last year and the beginning of this year, the union government did not provide any financial support to the only two vaccine manufacturers in the country with approved COVID vaccines, Serum Institute of India (SII) and Bharat Biotech (BB), either for their research and development or to shore up their manufacturing capacities. No advance purchase agreements were put in place with them either to ensure sufficient stock of vaccines at the beginning of this year when we began vaccinations..Also read: The Economic Costs of Not Vaccinating Everyone.Only in mid-April, when the current second wave began hitting us with fury, did the government belatedly spring into action. On April 13, it approved the Russian vaccine, Sputnik V, for emergency use in the country..On April 16, it allowed the fast-tracking of use of foreign-made vaccines that had already received clearance from the World Health Organisation or regulators in the US, UK, European Union and Japan..On April 19, it placed orders with SII and BB to supply 200 million doses and 90 million doses, respectively, to the government by July..On the same day, it decided to 'liberalise' its vaccination strategy: allowing the two vaccine makers to supply 50 percent of their production to the central government at a fixed price of Rs. 150 per dose, and sell the remaining 50 percent to the state governments or private hospitals at higher prices of their choice. States have also been directed to arrange the vaccination of those of their residents below the age of 45 by themselves..This sudden volte-face in the vaccination strategy has been criticised by several experts and opposition party leaders for leaving states to compete with each other in the free market for vaccines, not negotiating a standard rate for the vaccination of all Indian citizens, enabling super-profiteering by the vaccine manufacturers, potentially exclude millions of poor Indians from vaccination, and putting an even greater financial burden on state governments, who will have to purchase vaccine doses at rates more than double those at which the union government is procuring the same doses. This, when state governments' budgets have been hamstrung due to the pandemic and lockdowns, in response to which they have received meagre COVID-management aid amounting to only about Rs. 60 per Indian citizen..Also read: Centre's Vaccine Policy is Anti-Democratic and Unconstitutional.No wonder, then, that we are facing severe vaccine shortages, with the vaccination program for 18-44-year-olds paused in Maharashtra and Karnataka, the second dose of vaccination for citizens aged 45+ years postponed in Telangana, several vaccination centres being shut down, especially in Delhi and Mumbai. India's daily vaccination numbers have been steeply declining since last month..Government was even unprepared by pandemic last year.But then, this is the same government whose health secretary had, on February 14 last year, after a meeting with health secretaries from states and Union territories and senior officials from Ministries of Shipping, External Affairs, Civil Aviation and Tourism, publicly stated that the novel coronavirus situation in India was under control..This, when India had its first confirmed coronavirus case as early as January 30, 2020, which was also, coincidentally, when the World Health Organization declared COVID-19 a global emergency. This had been repeated on March 5, 2020, by health minister Dr. Harsh Vardhan in the Rajya Sabha. He said: "The Government is taking all necessary measures to prevent the spread of the COVID-19 in India". Dr. Vardhan also informed the nation that our preparedness and response is being regularly monitored by the Prime Minister and a Group of Ministers consisting of Minister of External Affairs, Minister of Civil Aviation and Minister of State for Home Affairs, Minister of State for Shipping and Minister of State for Health & Family Welfare, as well as being daily reviewed by him personally..In spite of our top Union Ministers and bureaucrats monitoring the situation since February 2020, we had to resort to a national lockdown with four hours' notice and no preparation. It broke the back of our economy and caused untold misery to migrant workers across the country. Then, too, as now, no one took accountability for the human costs of this brazen lack of preparedness..It seems that giving empty assurances to mask its absence of meaningful preparation to deal with adversities is a common motif that runs through the governance record of this government..Also read: Covid-19 Crisis: Lack of Key Data and Gaps in India's Preparation for Second Wave.To summarise, then, the union government hemmed down the role of state governments at the beginning of its pandemic response, took over the management of the pandemic nation-wide, monopolised the authority over the supply of essential medical supplies for combating COVID, ignored several warnings about the second wave of the pandemic from states and expert groups, and came up with an ad-hoc and arbitrary vaccination policy..While state governments are not faultless in this regard, and shouldn't be absolved of all blame, it is amply clear that the lion's share of the blame for our botched COVID response lies with the union government..(Vineet Bhalla is a Delhi-based lawyer and part of The Leaflet's staff. The views expressed are personal.)
