 For more videos on people's struggles, please subscribe to our YouTube channel. Hello and welcome to People's Dispatch. Today, March 25th, March 1 year since the Indian government led by Narendra Modi imposed a nationwide lockdown in response to the COVID-19 pandemic. This lockdown was the largest anywhere in the world in terms of its scale and also one of the strictest lockdowns experienced and witnessed anywhere across the globe. So today, we are joined by immunologist Dr. Satyajit Rath to talk about the experience in India in the last one year, what the country's response was like, what were the mistakes, what were the things it has done well, and what were the key lessons that we can take away from India's response. So Satyajit, to start with, let's bring up this point of the lockdown, how it impacted the spread of the disease. One of the things that happened was it did lead to the largest migration crisis in the country since the partition in 1947, but apart from that, what was the impact on the disease itself, on the spread of the disease? So, two issues. One, I don't think that when we talk about the disease in the pandemic, that we should ever do it in isolation. We should always do it in the context of existing inequities, injustices, specific situations and circumstances, and consequences, even if they are by-product consequences. Secondly, the question of whether a particular policy did well or ill in a pandemic is actually a very hard question to answer. There are exceptions to this. The sheer scale of foolishness in pretending that there is no COVID-19, that there is no pandemic, that there is no virus, that it's not dangerous, and so on and so forth, varieties of which have been seen in countries across the world in all continents, from Brazil to the United States, to Tanzania, to UNEVENT. Those are, of course, clearly demonstrably problematic public policies, but those excluded in policies such as lockdown, strict lockdown, graded lockdown, restrictions, physical distancing, policies, masks, no masks. In all of this, there is a tendency, all of us have this, to ascribe outcomes to something that we've done as policy. And in a spreading, unpredictable pandemic that spreads somewhat unpredictably, these connections are not necessarily reliable connections. That said, did lockdown of the kind that India had save lives? That's a question that we should address not simply in the pandemic context, but in the larger socioeconomic context. That aside, the only realistic way in which lockdowns help in public policy in a pandemic of this sort is to provide a breathing space for the state apparatus to get organized and geared up to deal with the pandemic, to deal with testing, to deal with masks, to deal with supply chains, to deal with human resource development, capacity development in all sorts of ways to begin the process of containment. So the real question is, did the pandemic, I apologize, did the lockdown lead to well executed strategies and policies of containment or not? And the answer I'm afraid is that we haven't done as well as we ought to have done. That's one kind of consequence for the lockdown. So can you talk more about that? Like you said, the intention of the lockdown should have been really equipping our facilities to deal with the spread of the disease as it did eventually spread to a large number of people. So what was that response like in terms of equipping our healthcare facilities, in terms of equipping our healthcare frontline workers who we know were lauded and applauded and everything, but were they really given the facilities to actually respond to the disease? So here's a core difference between the United States 2020 and India 2020. The United States 2020 in its government and political leadership was clearly not necessarily guided by evidence and science and rational decision. India was, that is a difference that we should not lose sight of. And yet our response as a quality, as a government was less, clearly less than adequate. So why am I saying this? That on the one hand, we had evidence in science-based policies and yet on the other hand, the response was inadequate. And in a sense, it's driven by a fairly common phenomenon in India, which is we refuse to accept and acknowledge the potential difficulties of implementation of even reasonable, rational, evidence-based policies. And since we refuse to acknowledge that they might happen, we make no provision for those problems. So let me give you examples. It's a little bit like we set up traffic lights at intersections and we are very happy. We are far less concerned about whether anybody is actually obeying traffic light signals or not. So we declared excellent policies, excellent sounding policies. We declared that there will be testing. We declared that testing will be expanded. We declared that testing will be widely available. And in all of this, we made a little good, but not enough to be adequate. For anybody who's worked in the Indian government, as well as non-government social political sphere, this is not surprising. What is surprising is that despite the magnitude of the problem, we did not soberly acknowledge potential implementation difficulties and provide for them. We didn't have the ramping up of tests to the speed and extent necessary. We certainly did not provide for the kind of community health team capacity development that was needed. To put it bluntly, I don't think we had enough people out there in neighborhood contact tracing. We built hospitals on scratch. We shut them down. We built them again. We began to license drugs without they are having been thought through. In pretty much everything, we were ostensibly formally evidence driven in our decision making. And in practice, we were far from adequate. Let me add a point to this. Our entire approach to the pandemic, and we're not alone in this, governments and communities, the world over have done this, is to pretend that it's a short term crisis. That if we only grit our teeth to put it in paternalistic government speak, if people will simply obey orders of the government and stay at home for three weeks, each and every person in the country, we will triumph over the pandemic. And fear generates a particular kind of nationalism, which in today's India is pretty easy to take recourse to anyway. All of that together meant that we were treating the pandemic, which is going to be a protracted issue of dealing with the spread of the infection, dealing with the consequences of the infection, dealing with the socioeconomic consequences of the pandemic, dealing with the lessons that it teaches us about public health care. All of this is going to be a long drawn process. Instead of acknowledging that we are in this for the long haul, we have made provisions that are short term crisis provisions. We've built 10 hospitals and we've taken them down. Then we have a surge, we've started 10 hospitals again. And we have not made commitments over the long term. We have not made them to developing healthcare manpower. We have not made them in developing our policies. We have simply been attempting to grit our teeth until the acute crisis passes. And this has been a fundamental error. And I think another point that really illustrates the government's response has been the sort of narratives that it has set. Of course, you've talked about how the policies have been scientifically backed and evidence backed, but the sort of narratives that the government has built about right at the beginning of imposing the lockdown about banging pots and pans and chanting, go, corona, go. What sort of impact does that really have on the people and in terms of how the people react to the disease? That's also I think a question we should consider. Absolutely. And I think you put it very well that on the one hand, the formal, almost bureaucratic policies of government were clearly evidence based. Yet the messaging, the narrative of the leadership, particularly the political leadership, was always a nationalist triumphalist. It was about how we can triumph over the virus. There is in reality no such perspective possible, but we can triumph over the virus. That the virus is some sort of a demon drawing on Hindu mythologies as part and parcel of a Hindu nationalist narrative. But even more than that, the notion that India was somehow exceptional, that we were not as badly off as Europe and North America, never mind that very many other places in the world as poor or much poorer than us were equally less badly off apparently. There was nothing terribly exceptional about India. But the Indian exceptionalism claims have all been with either no evidence or extremely poor evidence. And they were primarily intended as triumphal nationalism. And they pulled as narratives against the evidence based policies of the government itself. That's what led to people saying, oh, it's not a big problem for us. Oh, we have leadership of this, that and the other kind. And we are just going to triumph over it. No problem. It's also what led us to beginning to crowd the marketplace for fake remedies and immunity boosters and alternate medicine cures of all sorts, some of which were in fact supported by political leadership of the country. And all of this is this tension and trade off between what the bureaucracy struggled in its own way to do, which is evidence based policies with the limitations we've talked about, and what the political leadership across the country attempted to do, which is essentially spin it for triumphal nationalism. And when people are afraid, as anybody would be off a pandemic, to take a recourse to xenophobic nationalism is made even easier. And I think another case of this Indian exceptionalism is that there are people apparently who claim that death rates in India have been lower than the rest of the world, which is somehow baffling because India has a very dense population. So can you tell us about that, what explains that if such is the case? So in the first place, across locations, infection rates will vary, severe illness rates will vary, death rates will vary. Some of that is driven by democracy, some of it is driven by chance, some of it is driven by policy, some of which is driven by underlying socioeconomic conditions. For example, across the months of winter in Europe and North America, cases soared. These are societies that in winter tend to be indoors, to congregate indoors in heated, recirculating air. Of course infection rates will be high. India as a country, as a society, lives open air lives, even when we are indoors. We usually have doors and windows open, and sometimes our neighbors wish we had doors and windows closed. So the amount of recirculating air driven efficient spread of infection would be much less. There's all sorts of topical reasons why in patches across India we either would have infection spread, such as in the hyper-crowded urban hutman colony localities, the so-called Chukhi Jopri clusters, or we might not, such as in the open air poor village communities of India. And rather than looking at these with sober, rational attempts to understand cause and effect relationships, we converted all of this into yet one more thread of triumphalist nationalism. And did ourselves a disservice, or still do this? And another thing I wanted to ask you about is vaccinations. So it was in the beginning of this year that we began vaccinating our population. So how do you think the vaccination campaigns have progressed so far? What else do you think needs to be done? So in part because we have a government, we have had the governance. This is not a matter of this government, this is a matter of governance in the subcontinent, which even when it does plan bureaucratically reasonable policies, it does not plan for the implementation problems that are inevitably going to arise. As a consequence of that perhaps, but we as a society are used to our own version of cynicism when governments say something to us. They say, yeah, they always say these things. And I suspect that that has been one component of vaccine hesitancy in the country. The trouble was, while again the policy was quite reasonable in how it's drawn up and what it looks like on paper to be dismissive about it, its implementation and its narrative and messaging have been complicated by these triumphalist threats. So as a result, we decided that a homemade vaccine, that an India made vaccine, India developed vaccine, had worked enough for us to have evidence to bring it into widespread use when we didn't have that evidence. There was no practical need to rush this through. The only real need to do that was for what I keep calling triumphalist nationalism. All it ended up doing was adding to vaccine hesitancy in the country. Number one, number two, we did not clearly plan for the fact that over the duration that healthcare workers were to be vaccinated, since these were two dose vaccinations, that they would need to be provided second doses in a short fashion, long before that happened for the bulk of the healthcare workers, we started the above 60s and above 45 with comorbidities vaccination. The result is all of our healthcare workers are even today not vaccinated. From the 1st of April, which is not very far away, we are now going to start vaccinating above 45s with or without comorbidities. This is going to amplify the problem of the earlier, more vulnerable categories, more exposed categories being left behind. We haven't completed our healthcare worker vaccination, we will not have completed our above 60 or above 45 with comorbidities vaccination going into April. We already have long lines and unpredictable supplies and shortage of supplies to particular centers with the result that there are enormous difficulties, especially in metropolitan areas that stories are emerging from. I don't know if stories are emerging from rural areas or not, of vaccinations not being available. And as a result, it's quite clear that again, we are in the gap between what on paper in broad brush terms is a reasonable evidence-based policy and the sheer inadequacy of its implementation and of planning for its implementation. And finally, Satyajit, can you tell us some of the key lessons that India should take away from this last one year of dealing with the pandemic and of its healthcare response? So the fundamental lesson in this specific is that we need a far more effective, far more decentralized, far more empowered, far more community-based and far better funded public healthcare system than we have. This is an absolutely core issue that the pandemic has thrown up for us. There's absolutely no question about this. The second is again, what I keep pointing out, that if we as a deeply unequal society are to respond collectively, unitedly, collaboratively and soberly to crises of this sort, we need leadership and government to provide us with real information and with an acknowledgement of the kind of problems that we would have for which the government and communities would need to work together and for which governments would need to empower communities in collective and collaborative fashion without which we are never going to be able to overcome these kinds of crises without landing into what ought to have been avoidable, misery and difficulties and deaths. Thank you, Satyajit, for joining us today in this discussion and that's all the time we have. Keep watching People's Dispatch.