Indian Express Editorial Analysis
07 May 2020

1) App for a reason-

CONTEXT:

Earlier this week, the information technology hardware manufacturers’ body, Manufacturers Association for Information Technology (MAIT), protested that the head of a company should not be penalised for staff not using the Aarogya Setu app, downvoting(register disapproval of or disagreement with) the blunt(sharp)-instrument approach to securing compliance(action or fact of complying with a wish or command).

Regardless, the authorities in Noida have made the use of Aarogya Setu mandatory, invoking Section 188 of the Indian Penal Code, which can attract a jail term of upto six months. Would companies and homes, now, have to supply smartphones to workers and employees who cannot afford them?

NO PRIOR DISCUSSION:

 

This fundamental question did not even arise, because there was no prior discussion. In the battle against coronavirus, governments should not rely too much on the might of the state. It is being waged(carried on) by a committed public, and now the people must be convinced of the trustworthiness of contact tracing apps like Aarogya Setu, which are being developed by governments, universities and corporates everywhere.

Even Apple and Google, the biggest smartphone operating system developers, are partnering to release an application program interface(API) this month, and will bake in low energy Bluetooth tracking thereafter.

(An application programming interface is a computing interface which defines interactions between multiple software intermediaries. It defines the kinds of calls or requests that can be made, how to make them, the data formats that should be used, the conventions to follow, etc.)

PRIVACY RISK:

As economies open up and normal life resumes, despite the lack of a vaccine or cure, such apps will enable governments to detect outbreaks and prevent community transmission. They will also serve as e-passes and health certificates, necessary for workers to commute.

When migrant workers are fleeing the cities for the safety of their homes, and factories, markets and supply chains are opening slow and hesitan or failing to open for want of staff, an e-pass could be the key for starting the engine of growth.

But Aarogya Setu, which depends on a critical mass of users to work meaningfully, is not being widely adopted yet. In countries experimenting with such apps, the first hurdle is trust, as people fear that rights like privacy, lost during an emergency, may not be restored after the event.

FIDICUARY AND LIABILITY?

Governments and corporations have displayed enormous bad faith with respect to data privacy in recent years, and concerns over privacy issues in the Aarogya Setu app cannot be ignored. They needn’t have developed at all if the app had been open-sourced, as countries like Germany and institutions like MIT, which take privacy very seriously, have done with the contact tracing software they are developing.

Technology apart, there is concern over statutory limits on storing user data, the fiduciaries(trustees) handling the data and their liability(responsibility) in the event of misuse.

CONCLUSION:

Could the data be used for tracking anything other than the pandemic, and who would be legally responsible if it were diverted to general surveillance?

Such concerns should not be swept aside with anodyne(not likely to cause offence or disagreement) assurances of the technical robustness(quality or condition of being strong) of systems, or with scoldings about the national interest, but publicly debated.

Only open discussion can create the public trust on which the success of Aarogya Setu depends.

Aarogya Setu e-pass could be key for opening up economy, but it will work best if there is open debate in atmosphere of trust.


2) Other healthcare fronts-


CONTEXT:

Last month, as the country framed medical protocols(rules) and mobilised its healthcare infrastructure to confront the COVID-19 pandemic, there were concerns that the needs of patients with other critical diseases could suffer in the process.

MISLEADING DATA:

On April 24, for instance, the Bombay High Court took note of reports on how a single-minded focus on confronting the pandemic had left other seriously ill people in the lurch(without assistance or support). Responding to a PIL, the court asked the Maharashtra government and the Centre to “not ignore the needs of non-COVID patients”.

Also, in April, this paper reported that states were postponing case-finding campaigns for tuberculosis (TB) because their healthcare systems were overwhelmed(filled with large numbers) with the task of dealing with the pandemic. Now, a report has cited National Health Authority data to show a sharp fall in non-COVID treatment procedures in private and government facilities.

This data is particularly worrying because it shows that the lockdown has compromised the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana’s (PMJAY) ability to reach out to critically ill patients — including those afflicted(suffering) with cancer — below the poverty line.

CHALLENGES POSED BY NCDS:

 

In the past 10 years, studies have shone a light on India’s growing non-communicable disease — cardiovascular ailments, cancer, respiratory diseases, diabetes, and mental health conditions. These diseases have added to the country’s already substantial(huge) burden of infectious diseases.

While the public health infrastructure in most parts of the country is far from adequate(sufficeint) to meet the challenges posed by this combination of NCDs and infectious diseases, the particularly poor states struggle the most during serious outbreaks.

While containing the surge of COVID-19, these states will also have to be on alert for other contagions which assume menacing(suggesting the presence of danger) proportions during the summer.

Authorities in Bihar, for instance, will have to make arrangements for the returning migrants even as they cannot afford to forget that it was about this time, last year, when Muzaffarpur and adjoining districts were gripped(involved) by an encephalitis epidemic.

 

CONSEQUENCES:

 

Slowing down other health services while the nation deals with the pandemic could lead to serious public health complications. There are already reports, for instance, that the immunisation(vaccination) drive — against a host(series) of diseases including TB, hepatitis, polio, diphtheria, measles, and rotavirus — has suffered because the community health workers, who drive this programme in the country’s rural areas, have been roped(taken) in for COVID-19 surveillance(observation).

CONCLUSION:

According to conservative estimates, at least 5 million children have missed out on vaccination. The country has had some success in the battle against the pandemic. Medical authorities would do well to ensure that this record is not marred(spoilt) by failure on other healthcare fronts.

While dealing with COVID-19, public health authorities must make sure patients of other diseases do not suffer.

 

3) PREPARE FOR LONG HAUL INDIAN-


CONTEXT:

The coronavirus pandemic has created an unprecedented(never happened before) crisis. It has spread rapidly, catching governments, local administrations and public health systems unprepared. All countries — rich or poor — have been adversely(badly) affected.

For India — a country of 1.3 billion with socio-economic disparities(inequalities), and hundreds of millions of poor, unemployed and underemployed labourers — the virus has posed critical challenges. The country has been under a total lockdown since March 25, which has now been extended to May 17.

But the virus is still spreading and the lockdown restrictions have to be extended further. On March 25, India had only 627 confirmed cases spread over 130 districts. On May 3 — the last day of phase II of the lockdown — the number of affected districts stood at 401 with 42,836 confirmed cases, now rising by over 2,000 a day.

Though the mortality(death) rate for India at 3.2 per cent is lower compared to the US, the UK and other European countries, more than 1,389 people have died and infections are doubling every 11 days.

BIPARTISAN SUPPORT:

India’s lockdown has been arguably the harshest. It was supported by all major political parties, and elected state governments of which 11 are controlled by the opposition. This bipartisan(agreement or cooperation of two political parties) consensus was made possible as containment of the virus was considered necessary.

The lockdown has helped in slowing the spread and flattening the curve. Tracking suspected cases, their contacts and testing them has been relentlessly(unstoppingly) pursued(followed). This period has also provided space for the Centre and state governments to ramp(increase) up testing facilities, and strengthen a fragile(weak) public health system for a possible post-lockdown surge(increase).

BURDEN ON GOVERNMENT HOSPITALS:

The pandemic has brought to fore(open) the glaring(serious) shortcomings of the public health system and the over-dependence on private hospitals. Over the years, there has been a tendency to favour an insurance-based private hospital model and not opt for increasing government spending to expand public healthcare facilities.

Two-thirds of hospital beds in India and almost 80 per cent of available ventilator-equipped ICU beds are in private hospitals. They are handling only 10 per cent of the COVID load. For a country with a large number of poor and socially vulnerable citizens, private healthcare is neither accessible nor affordable. Ironically, in this time of crisis, it is the government hospitals that are taking on the burden.

RESOURCES FOR PUBLIC HEALTHCARE INFRASTRUCTURE:

This pandemic should be a wake-up call for the government to allocate more resources for public healthcare infrastructure. Unfortunately, the government’s priorities are misplaced.

It is persisting with the controversial Central Vista Project which costs Rs 20,000 crore. This will also be a criminal waste of public money when there is already a paucity(scarcity) of resources to fight the pandemic. The government is withholding Dearness Allowance (DA) installments and accepting loans from the World Bank to fight the pandemic.

India needs well-equipped government hospitals and not grand buildings which will serve no public purpose.

(The objectives of the Project include upgrading Parliament's space and facilities; consolidating, rationalizing and synergizing government functioning; refurbishing and better equipping the Central Vista Avenue; strengthening cultural institutions in the Central Vista)

 

IMPACT OF LOCKDOWN:

 

The shutdown of the economy has inflicted(damaged) unbearable social and economic costs. An estimated 122 million jobs in the formal and informal sectors have been lost. The informal sector which employs 90 per cent of the workforce and the MSME’s are worst hit.

The lockdown was hastily(hurriedly) imposed by the Central government without any advance preparation or coordination. There were no consultations with the state governments. Abrupt(sudden) cancellations of trains, buses and bans on movement of all vehicles led to confusion and despair(suffering). Millions were stranded(trapped) without food and money. Untold suffering was inflicted on them.

The fallout on the large number of casual workers and migrant construction and farm labourers has been severe. Migrant labour desperate to return to their native villages were stranded and trapped in harsh conditions.

Thousands of migrant workers deprived of their livelihoods were forced to walk back to their villages. The images of men and women — many pregnant, carrying their belongings and children, the elderly and young ones, starving and crying — will remain forever frozen in our memory.

FUNDAMENTAL QUESTIONS:

The enforcement of the first lockdown without consultation with the states raises fundamental questions. India has a federal(power divided between state and centre) structure and in the constitutional scheme of things, healthcare is a State subject and contagious diseases is on Concurrent list.

Also, trade and commerce within the state and industry are State subjects. But all decisions were arbitrarily(on the basis of random choice) taken by the Centre under the National Disaster Management Authority Act of 2005. This approach has long-term implications on Centre-state relations.

WAY FORWARD:

India is staring at a prolonged(longing) recession(a period of temporary economic decline ) and massive unemployment. The financial package provided by the government is very small to make any meaningful impact. A financial package of 5 per cent of GDP is a must to revive the economy.

The government has directed industry to pay full wages to their workers. MSME’s should be given government-guaranteed finance at zero interest to enable them to pay their workers. The fiscal deficit and inflation issues can be put in abeyance until April 2021.

For the poor — 75 per cent of rural and 50 per cent of urban households — food security has to be guaranteed. Fortunately, the granaries are full with 77.5 million tonnes of buffer food grain stocks.

A phased exit from the lockdown has started. Industrial activity, movement of cargo and limited retail trade has resumed. This will help to balance the twin objectives of saving lives and livelihoods. It will also save the economy as the collateral damage is bound to be far greater if the lockdown is extended.

CONCLUSION:

The lockdown has definitely slowed the spread of the virus. It will resurface once the restrictions are eased. The virus spread, it appears now is beyond the ability(control) of state to contain by quarantining.

Ensuring personal protective equipment for doctors and healthcare workers and providing required resources and logistical support to government hospitals is essential to prepare for the next wave. India has to be prepared for a long haul(grind). A pragmatic(practical) approach is the need of the hour.