Different Strokes in the Second Wave

A doctor drags an oxygen cylinder at CWG village Covid-19 Care Centre near Akshardham, in New Delhi
In many ways, the second ongoing surge in the Covid-19 cases of infection in India is different from the first one witnessed between April and September 2020. An obvious difference is that the second wave is far more virulent in terms of the infection rate, though the trajectory for the death tally so far appears to have been mercifully dissimilar to that seen during the first wave.


The peak during the first wave was reached by the middle of September 2020 with the reported number of cases of around 98,000 and a death tally of 1,290. The infection level then took about five-and-a-half months to reach the peak. Just as the slow rise to the peak, the pace of decline in the number of cases was also slow as it took about four-and-a-half months to settle down at less than 10,000 cases.


The second wave has been substantially more rapid, though the pace was relatively slow in the beginning. From about 9,000 cases with a death tally of less than 100 by the middle of February 2021, the number of reported cases rose to over 26,000 and the death tally went up to about 120 by the middle of March 2021. But from there on, the rise was sharp. The number of cases went up to about 200,000 cases and the death tally inched up to about 1,200 by the middle of April 2021. The Covid-19 case load reported for India on April 26 was 352,991 and the death tally was 2,812..


Although it is too early to say, the correlation between the number of reported cases and the death tally so far in the second wave has been a little different from what was seen during the first wave. It is possible that the death rate may be actually higher if one takes into account the likely under-reporting of numbers or it may climb up suddenly in the next fortnight, given the overloaded health care infrastructure. But the sharp difference in this respect between the first wave and the second wave stands out as of now. Going by what happened in the first wave, the daily death tally in the second wave so far is fortunately much less.


The sharp rise in the pace of infections in the second surge has also exposed the serious weaknesses in the healthcare infrastructure in the country. Shortages of oxygen, ICU beds and ventilators have surfaced alarmingly in almost all hospitals handling Covid cases. The first wave too had seen shortages of medical facilities and equipment, but obviously not of the same magnitude. Now, the capacity of governments at the Centre and the states is fully stretched and the authorities are making sincere efforts, though a little belatedly. A question that epidemiologists should answer is if the first wave took over four-five months to peak and took a similar period of time to decline, would the second wave, which is rising rapidly, decline at the same rapid pace?


Enter the states


The bigger difference between the first wave and the second wave of Covid-19 is in the way the Union government has responded to the resurgence of the pandemic. The Centre has scaled down its role in some areas of the battle against the disease.


Unlike during the first wave, the Centre is allowing the states to decide on what kind of restrictions they should enforce to prevent the rapid rise in the infection rate in the second wave. There are only suggestions from the Union government on the need for enforcing lockdowns only in limited areas of the state, afflicted by the disease, instead of bringing the entire state under its purview.


But states are now free to decide on adopting such measures. They were earlier complaining about how the Union government had centralised such decision making during the first wave. Now the Centre has given them those powers, but at a time when the second wave has been more rapid, virulent and more difficult to manage.


The ball is now squarely in the court of the states. The blame for messing up with the lockdown enforcement or executing it well will be on the states and that at a time when the challenge of the pandemic is far more daunting. Even for oxygen availability, the states have been pushed to running from pillar to post, even though the Centre has chipped in with its efforts to augment such critical supplies.


Shift in vaccination policy


In the rollout of the vaccines too, the Centre has curtailed its role by deciding to vaccinate only those people above 45 years, health-care workers and front-line workers. The states have been left to their own devices to manage the vaccine rollout for all those between 18 and 44 years, which, mind you, account for about 44 per cent of India’s total population.


Consider the change. In the early days of the pandemic, the Centre was talking about playing a key role in the rollout of the vaccination programme. The country, after all, was then the vaccine-factory of the world. Indeed, it took the initiative to provide vaccination to all the front-line workers, health-care workers and those above the age of 45 years.


Things will change from May 1. While the Centre will continue to provide vaccination for those above the age of 45 years, the states will be asked to take the responsibility of vaccinating those between 18 and 44 years. According to an estimate made in a Hindustan Times report, the cost of vaccinating this group – about 595 million Indians – could range between Rs 47,566 crore and Rs 71,349 crore, depending on the price at which they eventually procure those vaccines from Serum Institute and Bharat Biotech.


In the new policy, to be effective from May 1, 50 per cent of the vaccines produced would be routed through the Centre and the remaining half would be available for the states and the private hospitals including the open market. Of course, the Centre has clarified that it would continue to supply vaccines to the states and union territories from its 50 per cent quota, depending on the need of the state for vaccination. It is likely that the Centre might help a state, which fails to procure the vaccines it needs to administer to its residents. So, the role of the Centre in the vaccination programme has now become more discretionary as far as the states’ needs are concerned.


Centre’s Budget for vaccination


The Union government had provided for Rs 35,000 crore for Covid-19 vaccination during 2021-22. In her Budget speech on February 1, 2021, Finance Minister Nirmala Sitharaman had said: “I have provided Rs 35,000 crores for Covid-19 vaccine in BE 2021-22. I am committed to provide further funds if required.” Assuming that it had contracted Covishield at Rs 150 per dose and each individual received two doses, the Budgeted  amount of Rs 35,000 crore would have been adequate to vaccinate a little over 1.1 billion people.


Obviously, the Centre’s cost of procuring the vaccines has gone up, leading to a shift in its policy, even though it had earlier shown its inclination to increase its vaccine budget over and above what was already budgeted for. The shift in the policy, however, would mean that the states would have to vaccinate almost double the number of people that the Centre would do and at a higher cost. And the Centre may save some money allocated for the vaccination budget.


Vaccination politics


Of course, there are many states that have already announced that they would offer the vaccines to their residents free. As many as seven states have made such an announcement. This includes Bihar, where a partner of the ruling alliance (the Bharatiya Janata Party or BJP) had made a promise in its poll manifesto that free vaccines would be provided to the people. The alliance won the elections and will now have to fulfil that poll promise, even though the promise itself had raised an ethical controversy.


In the ongoing West Bengal elections, the BJP made no such promise in the manifesto, but its state unit has announced in the middle of the poll that if voted to power, it would make vaccines free in the state. The BJP promise was in response to a similar pledge made earlier by Trinamool Congress, which at present is the ruling party in the state. Vaccines have unfortunately entered electoral politics.


In such a situation, it is unlikely that any state government would be able to levy vaccination charges on its residents. In other words, an additional fiscal burden on the states will be imposed and its size would be in the range of Rs 47,000-71,000 crore. The states are already fiscally stressed. On top of that, the Centre expects the states to reach a fiscal deficit target of 3 per cent of GDP in just three years by 2023-24. In contrast, the Centre has set for itself a more relaxed deficit target of 4.5 per cent of GDP and that too after five years by 2025-26.


Treating the states with care


What is the way out? It is important that more attention is paid to building the states’ fiscal capacity. The responsibility for this should be borne not just by the states but also by the Centre. Fiscally weak states would be a problem for both the Centre in managing the national economy and the Reserve Bank of India (RBI) in managing the inflation situation. States too should be given a similar relaxation in the timeline for achieving fiscal consolidation as the Centre has given to itself.


Equally important will be to delink vaccination from electoral or any other politics. The Centre could consider negotiating with the RBI in facilitating a special borrowing window for the states, which they could use for funding their vaccination programme.


Finally, there is an urgent need for building institutional capacity to address the Covid-19 situation in the country. India has several globally renowned epidemiologists and virologists. But most of them are only heard and seen on various media platforms. The Centre could take the initiative to build a body of experts consisting of top-class Indian scientists, who could enhance the government’s knowledge capacity in understanding the pattern of the virus spread and take early preventive steps. If ever public-private partnership was needed to succeed, it is in this area. And, the government would do well to listen to these experts.

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