By: P S M Rao
It is true that the Covid-19’s potential for destruction is unprecedented, its spread has been rapid, close to 1.1 million persons infected with about 60,000 deaths – situation keeps fast-changing, and the numbers noted at the beginning of the article do not remain same till its end of writing. And the pandemic reached everywhere on earth, excepting eighteen countries which include North Korea (accusations on it or not reporting the fact notwithstanding), South Sudan, Turkmenistan, Yemen, Comoros, Kiribati, Lesotho, Marshall Islands, Micronesia, Nauru, Palau, Samoa, Sao Tome and Principe, Solomon Islands, Tajikistan, Tonga, Tuvalu and Vanuatu.
But it is true, that the advancements in science and technology have reached a stage seen never before. So, the humankind can better deal with the pandemic’s challenge than it did with the earlier menaces in history; no worries, we shall overcome.
Also, it is truer than the truth that human society will have to face bigger challenges of mass destruction, if it doesn’t learn lessons from its failures the Covid-19 has laid bare. This is not the first nor is it going to be the last pandemic on the globe.
A peek into pandemics’ history
History is replete with terrible epidemics and pandemics. An epidemic as early as 5,000 years ago killed the entire population in some regions in China; one hundred dead were found stuffed in one house in an archeological site, Hamin Mangha. A similar mass grave was found at Miaozigou in the country strengthening the assumption of the deaths en masse. Another epidemic around 430 BC in Athens was supposed to have caused the deaths of about 100,000 persons. So did the Antonine Plague killed over five million people in the Roman Empire and the Plague of Cyprian killed an estimated 5,000 people a day in Rome alone.
There are umpteen other examples like the bubonic plague decimating 10% of the world’s population; the Black Death of 1346-1353 killing half of European population and American Plagues (several of diseases the European explorers carried with them) of 16th century wiping out 90% of the local population of entire Western Hemisphere. So did the Great Plague of London of 1665-66 caused the death of 100,000 people – equal to 15% of London’s population then.
Other notable pandemics in the later centuries were: Great Plague of Marseille of 1720-1723 (100,000 deaths), Russian plague of 1770-1772 (100,000 deaths). More horrifying, the Flu pandemic of 1889-1890 claimed one million lives.
The Spanish Flu of 1918-20, the most dreadful pandemic, afflicted 500 million people, about a third of the world population and killed a large number of people, variously estimated between 50 to 100 million. Again, the Asian Flu 1957-1958 took another million human lives.
The pandemics of most recent origin include H1N1 Swine Flu of 2009-2010 (infected 1.4 billion caused 150,000 deaths at the minimum), West African Ebola 2014-16 (infected 28,600 and caused about 11,000 deaths).
The AIDS that surfaced in 1981 and it still survives, currently with about 40 million patients worldwide. It has so far killed 35 million people. We could not kill the disease yet but learn to live with it.
Modern governments’ advantages
The loss of life in the past disasters was so heavy because the governments that time lacked the 21st century’s advantages – in medical science, communication, information technologies, etc. Also, the character of the governments of ancient times was feudal where the concern of the governments is more with those who were governing than with the governed, the people; so, more suffering to the people.
Society has advanced and greatly progressed compared to those times though there are many more imperfections that may take generations to disappear. Whatever may be the ups and downs, the society moves towards greater and greater degrees of democracy whereby peoples’ pressure increases and the governments’ role to secure their welfare strengthens with the increasing pressure people build.
By the same logic, the present-day governments are undoubtedly doing much better than their counterparts in the distant past did. Yet, they are lagging in their duty; they could do much better if they had the foresight to give due importance to the health sector. The strong excuse that the pandemics put the health system under strain cannot hide the flawed health policies so far and the failures of the governments.
The Covid-19 pandemic brings these weaknesses to focus; it should be taken as an opportunity found in the threat. So, the governments should accept the truth and jump into action to strengthen their healthcare systems instead of futilely defending their failures.
The most blatant failure that has come to fore is the lack of preparedness to deal with the pandemic. Most of the countries could not arrange the procurement of ventilators, personal protective equipment (PPE) like masks and gloves and virus testing kits in the quantity required to deal with the pandemic.
Not that all the countries of the world are equally bad in facing the Covid-19 challenge. Those with a better plan and early response could contain its fast spread. India appears to be on the right track. The late starters have seen the damage of their inaction. Lessons can be learned from both sets: accept and imitate the early birds and reject and shun the methods of late starters.
Another most crucial issue that the catastrophe has brought to light is the callousness of the governments in that the policies of many of them are aimed at commercializing healthcare. Ensuring health to all and universal healthcare remained a mere slogan in a large number of countries. The health spending by some governments, although high in some countries, has been in the wrong direction; it went to help the health insurance companies more than it did to the people. The examples of health care in India and the US – the biggest and second-biggest democracies of the world – exemplify the poor state of the health sectors.
India’s ailing healthcare
In India, public spending on the health sector in recent times has been a little over 1% of GDP; much below the world’s average of 6%. The allocation in the recent 2020-21 budget of Rs. 69,000 crore, though a 10% hike over the previous year’s, was just equal to 0.30% of the anticipated GDP of Rs.2,24,89,420 crore. All the state governments put together spend another about 0.75% equivalent of the GDP. The total spend is much below 2.5 to 3% of the GDP recommended by the expert committees like that of Dr Srinadha Reddy committee.
Because of the governments’ low spending, 72% of rural and 79% of urban spells of ailment are treated in the private sector as per the 71st round National Sample Survey.
Despite governments boasting of several health schemes, a high 86% of the rural population and 82% of the urban population are not covered under any government supported health scheme.
Overall health infrastructure is inadequate. For instance, there is only one allopathic government doctor for every 10,926 people in India against the WHO’s recommended doctor-population ratio of 1:1000. As per one estimate, there is a shortage of 6,00,000 doctors and 20,00,000 nurses in the country.
The nexus between corporate hospitals, pharma companies and doctors have increased the risks and costs of healthcare to such an extent that millions of middle-class Indians descend into poverty when they fall sick; every year, more than 3.5 crore people fall below the poverty line due to illness.
Then, the study of the Institute of Health Metrics and Evaluation (IHME), has found India to be ranking low, at 158 among 195 countries, in human capital; one notch below Sudan’s 157. India’s poor quality of education and high prevalence of certain diseases were the culprits, in halting its progress.
The recently launched Pradhan Mantri Jan Arogya Yojana-Ayushman Bharat (PMJAY-Ayushman Bharat), too, cannot be a substitute for the universal healthcare. The peripheral changes to the system are not going to bring any succor to the country with over 1.3 billion population and with 70% of them without the capacity to meet the expenditure essential to life.
Healthcare, it should be noted here, is a fundamental right under Article 21, as held by the Supreme Court of India; so, the sector can no more be ignored by the democratic government.
Poor healthcare in a rich country
The world’s second-biggest democracy, the USA’s health care is no better; rather it is much worse than that of India.
The medical bills’ cost in the US is so high that they are the major cause of 60 % of the personal bankruptcies in America as per one observation.
Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care as asserted in an article in the Lancet journal. There are no plans to move to universal health care system in this country.
So, learning lessons from the Covid-19 shock, the world governments need to revise their economic policies particularly with regards to health care. They should decommercialize the health sector; take it outside the market forces doctrine. So, should they go for the universal public distribution system taking hints from the difficulties in food distribution during the pandemic, particularly to the migrant labourers. India cannot forget that the unorganized workforce accounts for more than 90% in the total and they have been hard-hit in every economic turmoil – manmade or government made. Needless to repeat, the governments claiming to be welfare states cannot leave health and education to the mercy of market forces.
Hope Covid-19 will make the governments rethink and act. People would appreciate if the government converts the threat into an opportunity but despise if it continually seeks to hide its past, present and future failure under Covid-19 menace. (The writer is a Development Economist and commentator on Economic and Social affairs and can be reached via firstname.lastname@example.org)