Under the federal structure of the Indian Constitution, healthcare belongs to the state list. Yet, India’s current response to the Covid-19 crisis appears to be disproportionately driven by the Narendra Modi-led Union government, which has been formulating nationwide policies such as lockdowns, transporting migrants and coronavirus testing criteria.
India is uniquely positioned to follow different models of Covid-19 response, but it is being pushed toward uniformity and standardisation.
The Modi government has in fact gone beyond recommending policies. It has asserted its control by reprimanding states that are viewed as being insufficiently compliant with its directives. It has sent inter-ministerial teams to West Bengal, Madhya Pradesh, Maharashtra, Tamil Nadu and Telangana to file compliance reports. It has even warned the government of Kerala, arguably a state that has performed better than most industrial countries in handling the coronavirus crisis, about premature relaxation of the centrally formulated lockdown criteria.
This centralised approach is a mistake. Even more damagingly, the increasingly strident command and control stance taken by the Modi government puts at risk some of the natural advantages gifted to India by its size and its federal constitutional structure.
Dealing with a previously unknown problem inevitably requires making guesses, working on hunches and drawing from related experiences, while being guided by as much technical information as is available. It is natural in such situations for authorities to make mistakes in their initial responses simply because there is no certainty regarding the correct response.
The ongoing pandemic falls into precisely this situation. We don’t know the true infection and mortality rates from the coronavirus. The scientific community remains unsure whether the virus spreads mainly through large globules of mucosalivary droplets emitted through coughing, or through smaller particles that float through air like aerosols, or through contaminated surfaces. We don’t even know the minimum infectious dose that is needed to get infected. Without these crucial pieces of information, devising a response to the crisis is like shooting in the dark.
Covid-hit world embraced variety
Not surprisingly, countries have adopted different approaches to fight the coronavirus. While India imposed a nationwide lockdown, and has twice extended it, some like Sweden placed restrictions on visiting old-age homes and some schools, but not much else. Belarus has no restrictions at all. The UK started the Swedish way but then switched to a lockdown where people could step out of their homes for “very limited purposes”. Other countries have adopted intermediate strategies of shutting down most inessential businesses and educational institutions but not a complete lockdown of people inside their homes.
The variety of policies on view are actually good from a global perspective because they increase the chances of uncovering the “best” approach. An example is the policy on face masks. Asian countries embraced face masks very early while in the US and other Western countries, there was advice against it, at least initially. The relative success of the Asian approach has now seen the world moving towards embracing face masks. Another example is the contrast between the limited social restrictions imposed by Sweden to the more stringent lockdowns imposed by its neighbours Denmark and Norway. The variation in outcomes in these countries will potentially provide us insights as to the more effective approach.
We are seeing multiple approaches to devising a cure as well. Different teams across the world are trying to develop a vaccine. Clinical trials of different drugs to treat the virus are currently underway in many countries. Multiple randomised controlled trials at the same time allow us to uncover the efficacy of alternative treatments in the shortest amount of time while exposing the least number of people to potentially ineffective treatments. The world as a whole will gain from whoever comes up with a treatment first.
One size can’t fit all of India
Experimenting with different approaches within a country is often not possible due to limitations of size. However, in a large country like India, with a population equal to 130 Swedens combined, it is possible for different states to try different approaches. This has three advantages.
First, ground conditions in India differ massively across states. It is fanciful to imagine that a uniform containment policy will be simultaneously appropriate for Ladakh (population density of 4.6 persons/sq km), Arunachal Pradesh (density 14.9 persons/sq km) and Kerala (900 persons/sq km), not to mention the variations in their temperature, climate, topography and administrative capacity.
Second, India also has the gift of a federal constitution. One of the greatest strengths of a federal system is that it encourages policy experimentation by constituent states. This generates faster learning since we gain knowledge simultaneously from a variety of experiments rather than from only one experiment at a time. This principle applies to economic policies as much as it does to health policies. The United States is an example of the benefits of a federal structure. Best practices are recognised quickly and spread widely as states compete for people and businesses.
Third, giving states the freedom to devise their own policies would also mean that state governments, and not the Centre, will be judged by the outcomes. At the moment, policies are being devised at the Centre and implemented by the states. This leaves plenty of room for finger-pointing, which is never a good outcome in democracies.
For decentralisation to work, however, states need adequate financial resources. The banning of alcohol sales during the ongoing lockdown has deprived most of them of a key source of revenue. It is indicative of the loss that several states such as Delhi, Andhra Pradesh and Haryana quickly decided to levy additional tax on alcohol the moment the Modi government relaxed its sale last week. While the states’ share of GST revenues are already in arrears for the period since December 2019, the finance ministry also reportedly slashed their share in central taxes by nearly 18 per cent in April.
In addition, the Centre’s financial package of Rs 15,000 crore for states and Union Territories has been ridiculously small to be of any help to them. Lastly, corporate social responsibility (CSR) benefits given to the PM CARES fund have not been extended to contributions to the state and chief minister’s relief funds. All of these disadvantages need to be redressed quickly.
The coronavirus pandemic is a cooperative fight. India needs to let those who are closest to the battle decide on policies on lockdowns, determination of restriction zones, testing criteria and contact tracing. The Modi government should focus more on coordination problems across states. The size of India and its federalist Constitution are strengths. The current centrist approach is threatening to waste both.
Amartya Lahiri is Royal Bank Faculty Research Professor, Vancouver School of Economics, University of British Columbia, Canada.