Part 11 | COVID19, Governance and the PM

We have some additional contextual realities relevant to India
A healthcare worker checks the nasal swab taken for COVID-19 testing at Jammu railway station on Sunday April 18, 2021. GK File/Mir Imran
A healthcare worker checks the nasal swab taken for COVID-19 testing at Jammu railway station on Sunday April 18, 2021. GK File/Mir Imran

But the "The global HIV/AIDS epidemic is a long-term event whose impact unfolds over many decades rather than months."  The critical lessons learnt on HIV pandemic by the middle of the first decade  of this Millennium were: "We observe a more rapid spread of health problems as a consequence of (1) an expanding worldwide mobility (for example, infectious diseases) as well as (2) the globalization of consumption habits as a result of global advertising and cultural densification (for example, smoking, changing patterns of food consumption). HIV/AIDS is seen as a global threat that is comparable to epidemics such as the plague and cholera in the nineteenth century; and new, hitherto unknown diseases like Ebola and SARS are interpreted as examples of new global challenges to health. One reaction to these relatively new threats through infectious diseases is the renegotiation of the International Health Regulations, which coordinate restrictions on travel and the exchange of goods, cooperation in surveillance, and research in emergency situations

The defence mechanisms of antimicrobials (antibiotics and antiviral, antiparasitic and antifungal drugs) are weakening due to overuse by the middle and upper classes and incomplete therapies by the poorer segments of the population, as well as by widespread use of antibiotics in animal feed. The development of multi-drug resistant strains has become a serious problem in the treatment of tuberculosis and malaria, in particular as research on antimicrobials has slowed down considerably since the 1970s).

The more rapid spread of drugs and medical technology from rich countries to – in principle – all corners of the earth has the potential to improve global health in general, but also leads increasingly to ethical problems as it makes the selectivity of health care related to income more and more obvious.

In the face of the debt crisis and structural adjustment programmes, 'health', like other social programmes, was no longer seen as a primary focus of development cooperation. In most countries, resources were insufficient for the health needs of the poor, and many developing country governments were desperately seeking funds to uphold a minimum of social services. The crisis of the primary health care strategy became visible in the 1980s, when even the most fundamental services (preventive measures, vaccines, pregnancy) were increasingly underfunded. This can be seen as an element of the crisis of state-dominated cooperation in international health.

Linked to these processes, the supporters of comprehensive systems of primary health care also lost ground within the WHO in the 1980s and 1990s, with the organization refusing to take a strong position in support of grassroots strategies to develop local health care (which were frequently backed by civil society organizations.

The liberalization of international trade and the reduced scope of national regulatory tools decreased the control of national societies over the production of and access to medical drugs, health equipment, and – with the General Agreement on Trade in Services (GATS) – to some degree also over the supply of health services.

Since the mid-1990s, there has been a mounting preoccupation with the vicious circle of rising poverty and growing vulnerability to health problems in large parts of what is becoming an increasingly global society. Social exclusion is also a health concern and a starting-point for the spread of epidemics beyond the limits of slums and marginalized societies as well as a serious problem for the provision of health-related services.

Governments of OECD countries show growing concerns because of the increased transborder spread of health problems and infectious diseases in addition to the possible political and economic instabilities related to the high prevalence of poverty-related diseases (like HIV/AIDS in some world regions). Thus, in the 1990s, health played an increasingly important role at the G7/G8 meetings."

But the world still faces two major challenges: (i) the vaccine for HIV is still awaited. (ii) The Global Health Governance framework is still incomplete. This global framework is particularly significant in the case of pandemics. Unfortunately, the COVID19 emerged in this background. Unlike the HIV, the COVID19 has nothing to do with the behavioural indulgence of the person being infected; it infects unknowingly all irrespective of affluence or poverty or place of residence. However, the COVID19 demands convergence between Science and Politics more than ever in order to fight it meaningfully. Quite contrary to this requirement, the intervention needs to the present pandemic and as arising from the scientists have been so conflictual. Science still suffers from what Kiell Andersson highlighted in 2008 in the book titled Transparency and Accountability in Science and Politics: "The main force behind the on-going disintegration of scientific identity is commercialization. This is not a new factor, of course. Partnerships between science and industry seem quite rational and reasonable. Knowledge-seeking science needs money to be invested in research. The aim of industry is to develop products for profit, but it needs a sound base of knowledge for this to be done. In other words, science and industry need each other and they have complementary interests. As the costs of basic science and clinical research have increased, and as public funds have proved insufficient to cover the cost increase, universities have become more dependent on industry money. Furthermore, politicians have encouraged scientists in academia to collaborate more closely with business and industry for the sake of economic development. Even if these trends are not new, something changed dramatically during the 1980s that made academia and industry come closer together. The emerging biotechnology industry, based as it was on new techniques developed from molecular and genetic biology, became the driving force behind this development. Since then the meaning of science, to seek the truth as a public good, has been gradually distorted by a drive to find profitable technologies." This period has also been coupled by two political movements: A. Legal Democracy – "The idea of legal democracy is the minimisation of the role of the state and the granting of the fullest possible scope to market forces. Individual freedom and free choice have the highest priority and this can best be achieved by the market. The dynamic market is the perfect mechanism for determining not just individual but also collective choice. As a consequence, the role of the state is limited to providing a legal system to protect the individual from violent force and to secure his properties…………The legal democratic system cannot offer awareness and accountability in societal decision-making." B. The competing paradigm to this is Participatory democracy: "the main characteristic of participative democracy (in its broadest sense thus including deliberation and discussion) is a focus on process as much as results. More participation increases the legitimacy of societal decisions. In contrast to the traditional theory of democracy, which emphasises voting as the central institution, participative democracy theorists argue that legitimate lawmaking can only arise from the public deliberation of the citizenry. Participation is not only good for the society as a whole, but also for individual citizens who are rewarded by self fulfilment through participation and deliberation. Proper rules for deliberation will also bring justice and more equality between groups in society. Another strength of deliberative democratic models, according to their proponents, is that they tend, more than any other model, to generate ideal conditions of impartiality, rationality and knowledge of the relevant facts…….The idea of participatory democracy seems, however, too idealistic ……..We simply lack the knowledge needed to find the appropriate procedures to make it work."

In addition to these complexities, we also have the additional contextual realities relevant to India. First, there is the multi-level political structure under which we have to take decision and implement interventions; it is not a case of taking a decision and getting it implemented from the Prime Minister's Office. There are multiple layers from which information has to be filtered and a final decision is ultimately taken; we have a federal structure in governance. Second, in the case of COVID19, the stakeholders are multiple – the politicians, the citizens, the medical professionals (multiples), local governance agencies and what not. Third, the scale in terms of size – depth and spread – is tremendously huge in the demographic and the geographic senses in India.

Our Prime Minister, in the light of these complexities, has attempted to address the needs of the nation to adequately face the challenges caused by the pandemic. Unlike in political engagements in the case of Assembly/Parliamentary elections, he has fully digested the need for action rather than vocabulary in the public domain; this is why we see the PM in his very unusual approach of speaking less on pandemics this time. This does by no means imply that he is unconcerned, but speaks volumes of his commitment to what Robert Dahl emphasised to establish Political Equality: "Among adults no persons are so definitely better qualified than others to govern that they should be entrusted with complete and final authority over the government of the state."  Time is now for all the stakeholders (including vocal journalists) and the inhuman profit-seekers in medicines and oxygen supplies to rise to the occasion for collective social responsibility.

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