 Along with Newsclick, the Constitution Conduct Group is another collaborator in this series. The Constitution Conduct Group is a really fine group of former civil servants of which two members are here in the panel, Sijata and Kesha. Ramani will say a brief welcome on behalf of the Constitution Conduct Group. Hi everyone, I am Ramani. I am a member of the Constitutional Conduct Group. And the Constitutional Conduct Group was formed about three years back because a number of former civil servants felt that there had been and has been a steady erosion of constitutional values over the past many years, amplified in the past few years. The group today has about, has exactly 173 members. We have issued over the past three years, 26 letters and four organized for conclaves as well. The idea being to bring to the notice of those in power are increasing discontent at the type of sort of situations that are coming about in the country. We've also had deliberations with constitutional bodies like the Election Commission to bring about electoral reforms, not with too much. As far as the current webinar series is concerned, Constitutional Conduct Group is very happy to be associated with this series because it has great topical relevance. And it is of course a matter of life and death literally for everyone on the globe today. There are four areas I feel that the Constitutional Conduct Group is concerned with and I'm sure the webinar series over time will be touching on each of these areas. The first of course is the most important one that we're taking up today, the related to health. And it is a fact that even seven weeks after the lockdown started, we don't seem to be seeing any light at the end of the tunnel. So obviously we need to pause and sort of reassess what exactly has gone wrong with the strategy. The second is the very critical issue of livelihoods and we have seen the heart-rending scenes of whatever has gone on over the past month and a half. Both in terms of migrant labor as well as disadvantaged sections of the population all over the country in slums and in villages. The fourth is I think something that we need to take up over time that is the dignity of the individual and the issues relating to liberty. And I think this is going to get more and more critical over time. Three areas suggest themselves immediately. One we are already seeing that is related to the movement of migrant labor from where they are currently located to their villages and to their hometowns. The second has been the issue of labor laws, which again we find are becoming more and more restrictive. The intention being obviously to give a sort of completely ignore labor rights working class rights in order to ensure that production goes on stream. It seems to be the only concern. And the third is the issue of surveillance, which I think is going to assume increasing importance in times to come. The fourth issue is one which is I think critical, which has not been touched adequately, which is related to federalism. Although the state governments are tasked with the job of tackling the pandemic, there has been no real involvement with them in terms of making finances available to them, listening to them in terms of the strategies they wish to adopt. There has been a one-size-fits-all type of approach from above. And I think this is again an issue which needs to be discussed in far greater detail if we need to come out with this pandemic. I think the issues we discussed today and in the coming series are both the COVID as well as the post COVID era. And we need to look at issues that are going to affect us even when we seem to have the pandemic under control because I think a number of these issues are going to remain with us. And these are going to apply across geographies. So we are not going to be sort of insulated from the impact of other countries what happens elsewhere. I'm really grateful to Ramani for having laid out, you know, very richly, you know, the context not just of this particular discussion but of the entire... I think the issues are so important that we'll probably have them every few days very quickly back-to-back to be able to bring together thinking on how the governments are and should be responding from the perspective of people who are most disadvantaged. Finally, before launching into the discussion, I invite my very dear colleague from volunteers, leads the media and communication work in the Karwa. A very fine filmmaker and writer Natasha Badwa to kindly introduce the panelists and then be diving. Hello everybody. All speakers today are outstanding examples of public health professionals or administrators who have worked for equitable and just health systems in various ways. And it's really our privilege to have all of you together at the same time. As I said, psychiatrist and researcher is the Pershing Square Professor of Global Health in the Blavatnik Institute's Department of Global Health and Social Medicine at the Harvard Medical School. Keshav Desiraju has a distinguished career as an IS officer, crowned by his memorable term as Secretary Health, Government of India. He's chairperson of the Population Foundation of India and on the boards of CES as well as Banyan Chennai. He's worked with homeless women with mental health challenges. Sujata Rao, equally distinguished former civil servant and also former Secretary Health, Government of India is a feisty and outspoken commentator on public health issues. How many contributions include the ever first ever national program for non-communicable disease and a national policy for the use of antibiotics. Vandana Prasad is a community pediatrician and public health specialist, founder and secretary of the Public Health Resource Network, EHRN and joint convener of the Jan Swasthianan. She leads management of malnutrition and also advises CES time to time with the homeless. Sujata Rao is a noted people's science leader. He has led the state health resource center in Chhattisgarh for 10 years and as director of the Public Health Network Resource Center, he has also been the department of public health at TIS because Bajkai is a leading public health scholar and a voice for equity in the center for social medicine, JNU. With this, I welcome all of you to start the discussion. Thank you so much, Natasha. And once again, I think I'm extremely grateful that all of you have gathered. I think it's a token of how much we are concerned about which direction, as you know, as a concern of, as Bramini said, a literal question of life and death for millions of people in India and around the world. The choices that we make are efficiently. I wanted to underline right at the very beginning that this entire discussion and in fact the entire series is a series of discussions which are primarily and very avowalery partisan. Partisan in the sense that these are on the side of people who are most disappointed. So everything that we want we are discussing. More or less is following perhaps the talisman that Mahatma Gandhi had left for us a few months before he was assassinated. When you are in confusion and doubt, remember the most vulnerable person, the weakest, the most disadvantaged person that you know, and think whether what we are doing is making sense to her. And I think that that is primarily what we are trying to do in this discussion and in everyone that follows. Is it making sense to that most vulnerable person. And, and, and I wanted to also say that disadvantages of many times. In the context of the urban world, even more sharply, but I think also with the rural poor, we could look at disadvantage in, in at least three kinds of axes. The first is, you know, the disband economic disadvantage disadvantage of livelihood and income. So people whose employment is, you know, who are I have uncertain employment have paid very low wages, work in unsafe conditions have no security, etc. So I think that's one kind of disadvantage. Very importantly, there's a second access of disadvantage. And that is of the kind of habitation that you live in. So homeless people, people living in shanties, living in, you know, under plastic sheets, etc. It's important to remember them because when, when the whole prescription is around social distancing and washing your hands regularly, I mean, it's just so extraordinary that we keep talking about it to people who live, you know, perhaps in a in a six, 10 people in a six by eight or 10 by 10 shanty and you're asking them to spend 40 days cooped up in that space and and to wash your hands when you when 150 people share a common toilet. So, so you're, you're, you can be occupationally and economically disadvantage, you can be disadvantage in relation to your living conditions. And there's a third access of disadvantage that I request this entire conversation and series to bear in mind, which is social disadvantage. So disadvantage, you know, as a single woman headed house sold children without care, people of Dalit and Adivasi communities, Muslim communities, which are particularly targeted today. So social disadvantages of age of gender of sexuality and so on. And, and very often, very sadly, all of these three kinds of disadvantages overlap one upon the other. So the occupationally disadvantaged can also be socially disadvantage can also be, and it's quite likely to be a disadvantage in terms of habitation and habitat. And when all of these pile together in the lead lead to even greater vulnerability disadvantage, or let us use the much clearer term, disposition and oppression. And I think that it is from the perspective of all of these people of disadvantage that our conversation today will make the data sense. When we were planning this session, a victim, but in particular, said, let us be forward looking. And by all means, let us think for the future, whatever has happened, when we go from here. And, and that will be really the focus of our discussion. But I think that briefly, just one round of discussion, one round of observations from all of you on with a stringent lockdown in principle as an idea. And in the way it was executed. The execution was usually faulty, but was the idea itself correct. Was it the only or the best public health option in order to fight the pandemic. This is a country where vast populations have no short income, no food without work, do not live in conditions where social distancing and intense sanitation are possible. And if, if not, what, what could we have done differently. As I said, this will be just one round of looking at where we have reached so far, and from hence, and the rest of the discussion will be forward looking. The format of zoom is a little complicated about, you know, we're not exactly sitting down the table and so you don't know who's who's wanting to speak so one way is to just since everybody's videos are honest to put up your hand. But I think this first round, I'll just go in the same sequence, more or less as Natasha introduced your and maybe you could give your response to this first question. And, and then we could go on to other things. And so the job, maybe start with you. So thanks harsh and thank you. What a great opportunity to be with so many friends, old friends and hopefully the new ones as well that I'm making on this webinar. Thank you for inviting me harsh. I think it's first of all important to understand what is the purpose. What is the objective of a lockdown. It's quite simply to enforce physical distancing to slow the spread of the epidemic. It's very important that this is absolutely understood the lockdown achieves nothing else. It does not achieve the elimination of the virus, and it does not achieve the eradication of the epidemic. It doesn't do any of those and I think this is a basic fundamental fact that we have to actually start with. And so then the next question is, are there other ways in which we could have slowed the epidemic and done physical distancing that are equitable and practical in our context that really to me is the fundamental question. And I think there are many ways. Obviously, the horse is bolted the train has left the station in some respects I mean it's now easy to look back in hindsight as what we could have done. And that's why I feel that we should be forward looking but since you've asked this question. If I was in charge I would have done things in a very different way. First and foremost, I would have planned the lockdown. I would have given the country enough time to plan for what is going to happen. I would have allowed public transportation to continue so that people could actually get home. My 86 year old father is trapped alone in his apartment in Bombay. There is no way I can get him to come to live with me or for me to go live with him. I think this is simply cruel. And of course, this is my class of society. I can't even begin to imagine how harrowing it is for people who are living on the bread line. The second thing I would have done is that I would have done it in a staggered way. I would have definitely used some form of physical distancing or lockdown policies in those areas where there were clusters of high transmission. That is a very good epidemic management policy, but I would not have imposed a total lockdown on 1.3 billion people. I don't think there was any reason to do it when it was done then. I think there was certainly reason to do planned and staggered physical distancing. The third thing I would have done is I would have implemented right at the outset a very clearly defined proper strategy for case identification. And harsh here again, I think another issue that we should really consider is the heavy focus on top heavy medicine and technology here. You know, it's all about PCR diagnostics and intensive care, but actually India's greatest public health success. And I speak amongst people like Sujata and Keshav and they can speak for themselves here. I was just finishing. I was just saying that I wish our communication had been a little bit more balanced, that it would have really invoked our solidarity with one another rather than to invoke our fear of one another. And I think it's the fear element which I feel was misplaced. We should have really invoked the support element. Keshav, over to you. Everything becomes absolutely correct. Lockdown was clearly not thought through. We will talk more about the sole business of people thrown out of work and trying to get home. Clearly, those were aspects that no one thought about. But I think we should also remember that at the time when lockdown was announced, which was 24, 25 March, when I frankly I don't think anybody in government had any information. And it seemed to at that point of time, it probably seemed to them that that was the best they could do to control the spread of the epidemic. Not knowing, not having enough information and really not knowing what else to do. I think we have to admit that one way or the other. Lockdown has, in many parts of India, control the spread of infection. Unfortunately, we squandered the time we saved. We did not use the time we gained in either strengthening hospitals or in increasing the pace of testing or in more carefully identifying which areas were more susceptible, what Vikram was talking about the clusters. Chennai where I live, there are contradictory messages coming out all the time. Many, many relaxations have been introduced, but we have a very large number of what they call areas of containment, red zones even now. And no one really seems to know what the correct thing to do is. So the limited point I wanted to make was, I think Vikram did not really get to what else could they have done around 24, 25 March, when they didn't know too much other than the fact that infection had entered the country. I think it may be useful to spend some time looking at that. Thank you. Thanks so much. Sujatha, may you come in now please. Thanks, Harsh for inviting me. You know, there's not much that we can differ with what Vikram and Keshav have said. It was totally unplanned. I think that's an accepted fact of the matter. But you know, even if it was unplanned, lockdown, once they announced it, they should have gone the full hog and done the entire strategy properly, which meant really that that was a time given to them to expand access to testing, to isolating those who are infected, quarantining them and doing a massive information campaign of do's and don'ts and what, and you know, generating community understanding of what we are informed. None of these things were done. And we wasted so much time in trying to just go on and on putting up ventilators and ICUs and so on, which is the last bit of the whole epidemic. And even today, if you see Bombay, which is in such a mess, the most of the time is going and putting out these open air quarantines in that Mahalakshmi and so on. Not, not understanding that on 7th June you have the rains coming in. And then what happens to all these temporary facilities. So I think there is a, and what has really appalled me is the way the Ministry of Health has been sidelined, the way the technocrats of ICMR took over, the way they constituted committees with no epidemiologists involved. They were one or two from NIE and so on. But then the chair is the DGICMR. So you can, you cannot really expect Ganga Kedkar and all to come up with anything different. And you know, we have enough experience in this country and a large number of epidemiologists who have been directly involved with both the HIV and the polio programs and HIV in particular. And as I keep watching this whole epidemic evolve, every moment I could see what's going to happen next, only because of my engagement with HIV, it just tells so many lessons to teach all that memory, all that knowledge is available, and it was not used. And that's a very big tragedy, I feel. Now I really don't know what has happened in Delhi that they just simply sidelined all this and went on to, you know, aims clinicians taking over the entire program and set aside public health specialists. So that's something that I've been very disturbed about because we've made one mistake after another unplanned. Now even the exit, of course, we've come to that later on, I suppose. But the way we are trying to also continue with the lockdown seems so lacking in strategy. My last point I'd like to make at this stage is I was amazed that there is no uniform guidelines for testing strategies. So every state does its own bit. Kerala did one set of actions, which they've proved to be very efficacious. Telangana has no strategy at all. So it's a chief minister who decides there's no information available to anyone. So he decides that today's symptomatic might be tested next day and symptomatic might be tested. So one doesn't know what's going on. There's no testing strategy in Bombay, as we've seen from the media. Every day commissioner comes up with his own understanding of what kind of testing strategies to follow. So the whole issue of testing itself is a mess, even today after so many days, that I find very, very strange, not to talk of the fact that we still don't have adequate kids. And you know, I remember in March, mid-March itself, when I used to be called to the TV and so on, we were all shouting, testing has to increase. If you remember, there was a time when we were doing five tests per million. And it was, it was so evidently ridiculous. And it took so long, almost over 10 days or 10, 15 days for ICMR to get out of its denial and expand the testing strategy. They kept on saying that their strategy was the best and that we should stick to travel history and those related to those having had travel history. The second is, they still continue to deny community transmission, where there's so much evidence available that there is a community transmission on and we still don't have a strategies on how to deal with a community transmission-led epidemic. So I think, you know, this continued confusion at the top is something that's very disturbing and extremely worrying as far as I can see the way the epidemic is going. We are making far too many mistakes and it's going to have a lot of implications for us, not to talk of the social cost, the economic cost of the lockdown and so on. And that we will come to later. We know it's evident, but just the technical aspect of being able to contain the epidemic. And lastly, I'd like to point out that as Vikram said, lockdown has a specific purpose of slowing the epidemic, containing it within a manageable boundary and all and so on. But it clearly hasn't bent the curve as I keep on saying. It just slowed down for sure. But the RO is still very high. We haven't really achieved much of a success anywhere except in Kerala. And so I think there is, you know, lockdown in my opinion, and we reviewed later, seems to have been a failure. We have paid too much of a social cost for not much, that much of a gain. But having said that, I still do believe that maybe the lockdown, if planned well after a week from April 1, with everything planned properly, would have had its dividends for sure. And a much better outcome than what we have today. Thank you so much, Sujatha. I think that was also very comprehensive. For the remaining panelists on this first point, I, you know, what could we have done differently? Suppose you were the Minister of Health and what would you have done differently is something that we could also focus on. So Vandana, next. Thanks, Harsh, for inviting me. And I mean, just a small disclaimer, I'm no longer a joint convener of Jan Swastavyan, but I work very closely with Jan Swastavyan, also the right to food campaign. I also want to mention the medical support group that's been really working, you know, crazily, really so hard to be able to facilitate health care to people living in slums in various cities and even in rural areas. I just want to do want to mention that. You know, I think we're a panel of fairly like-minded persons and we're going to mostly agree with each other and hold to each other's views. I think Vikram has already highlighted what he might have done differently quite well. I mean, it's a case of bringing granularity. It's a case of timing. Timing is critical. Just one second, friends. Can I just request everyone to unmute when we're not speaking because it makes it easier. The organizers can also help. Shiran, if you could kindly mute the other speakers. But one thing, one point that I do want to make, Harsh, is that, you know, it's not just from the equity, ethics, humanitarian livelihoods point of view. What we have actually done is bad public health. And I think that it's critical to be able to frame it in that way at least by public health experts. It's bad public health to not think of social determinants, to not think of equity, to not think of medical conditions that are not necessarily, you know, directly related to an infection by the COVID virus, but very certainly related or causing morbidities and mortalities because of the response that we have created. So I think that we must very surely keep this within the public health domain and not be tempted into thinking of these things as collateral damage and so on. And in terms of data alone, many people are now making the same points in mainstream editorials. Vikram has, you know, brought out a paper we ourselves are trying to publish one. We are placing data on COVID-19 deaths practically by the hour. Where is the data on heart attacks, you know, that have not received, and we are seeing this. I'm seeing this on a daily basis thanks to this support group that I'm associated with the maternal mortalities and so on and so forth, which only the media is picking up on and activist groups. And the government should be, you know, totally held accountable to letting us know about all that as well and taking that into account. In fact, I mean, that should not have happened in the first place. But now that these things are happening, you must moderate your response, keeping all this evidence and this data in mind the distress deaths are part of that hunger is part of public health. I mean, lack of food is part of public health. So I mean, that's one central point that I wanted to make. I feel that, you know, this, this is this grand gesture, you know, with with very little thinking to is very, very symptomatic this current government we've seen it before, less dramatic, you know, outcomes and impact, but it's just really the same thing lack of planning. I think that one point that was made is very important to understand that we've, we've transposed a public health problem into a policing problem into a law and order problem. And I think that that is very, very important to a understand and to fight to resist. Because really, there's no way that this, this pandemic can be sorted out in that particular manner. I also want to say that it's not that there is no decentralization, it's a wrong kind of decentralization is a classic case of decentralization without building capacities and providing support. So somebody did mention that there's no devolution of finances to the state governments that's very, very important. Secondly, as Vikram also pointed out that the state leaders and even the RW is, I mean, what they have done is actually increase the stringency of the lockdown. Every, I mean, in Uttar Pradesh, they've increased the stringency of the lockdown. RWs have gone a step further to do even what central government is not recommending simply because they do not understand the objectives of the lockdown and nobody is bothered to, you know, make sure that they understand that. So when we say we must decentralize like Kerala, but you know, Kerala has a long history of decentralized governance that works well because of the capacities it has. So I think we need proper decentralization. Let us learn some lessons from this whole thing. This thing is not going to go away soon. We're going to be seeing a whole lot of I think mortality creeping up. I'm going to stop maybe come back later at some point but I also want to just place one, you know, paradox or something that I'm struggling to understand, which is why Britain, why the UK has suffered the way it has. I think it's worth analyzing. They have a very strong public health system. They also have very strong social systems. I've been, you know, a part of that in some sense. And they have, you know, a community that is not as variegated as our own. And yet, look at the mortality is there is it something to a demographic, whatever it is. It's, you know, something to think about. I also feel that we, we must not underestimate the, the, you know, the nature of this pandemic and we cannot also play it down. It is a very in the best of circumstances we are in a very, very difficult situation in the world and in this country in particular. Thanks so much. I think, Sundar, could you come in with your observations about what how you assess what has happened so far. Yeah, I think most of it has said, and Madan has just made the point about policing versus public health. And I think that's a very, very central issue. And I've not got too much to add. Let me just make one just an observation. Suppose we had allowed all the migrants who wanted to go to go back home the day the week before the lockdown on March 14, we had 100 cases, even if we say 1000 cases, the spread would have been of 100 cases. Now, when you lock them in, you have actually incubated the whole infection within those quarantine centers, which has no sense of quarantine in them. And now you're letting out 60,000 people we are actually going to have. Just think of it. If we had actually let them go the disease, the stage of the spread it was. So somewhere the ethical principle that people have a right to return to the family. The more you frighten them that you may die. There is an epidemic. The more you want to get back to your family between the basic understanding of ethics and between a basic value and rights and public health that actually makes a lot of connection. We sort of missed that. The other surprising paradoxes. I just want to draw your attention to two paradoxes. One is, we have a system. We built it up after the swine flu, but we had started it before the integrated disease surveillance program. You know what happened to it. Its last report goes up on the February 1st week. It has been reporting weekly from 2010. In the last report it faithfully and brilliantly reports the first three COVID cases of India and then go silent. No further reports are put up. No further information. And I believe it's not just not put up. It's not even on flow. So you have built a system at some effort, particularly for managing epidemics. And when the epidemic coming, the first thing you do is let go of it. And similar thing we do with the public hospitals. You have top line public hospitals, which actually provide a huge amount of care, which are willing to run despite because they have the notion of public services where many other hospitals are now. But what do you do? You actually empty them out and keep the beds empty in anticipation of an epidemic that should arise. So when we say we created one lakh additional beds. We've only repurposed existing beds and reduced the total amount of care available within the public sector in effective terms. Because unlike the other places where new hospitals came overnight, over here what you actually did was repurpose essential. So you use it for residual care. Before you had a minimal package. Now you say, okay, COVID-19 nobody will handle. I'll handle this. But what I am handling now, let somebody else take care of. So our, the point I'm making is this, the health system preparedness for which the country sacrificed so much, the migrants have satisfied families and business. It actually not only did not happen. It took a bizarre turn, at least on these two areas. One is the disease surveillance program. It's been disrupted by the epidemic instead of actively being built up by and the second is on the whole area of the public care that was there. So this whole repurposing of central public hospitals without any substitute arrangement has been actually not the way that health systems preparedness was conceived. These are serious issues and I'll stop with this the rest. Actually I endorse they have already said some of those issues. Thanks so much and finally because you have anything to add. I think the next question I'll go to reverse so that you know because I think a lot has been said so I will go in a reverse direction so that you all have more to say on the second question and so on. But because is there anything that you want to add to what has already been said. Yes, I wish to add just a little bit. Many thanks for having me on this discussion. See, among, I mean, beyond just being appallingly planned, I think the way and manner of imposition of lockdown was very, very criminal. You see, none of the consequences which followed. They were not unforeseeable. We had all the information about the conditions of living of our people about the size of informal sector workforce and all and unmindful of all those things. The lockdown was implemented. So I think it had a very pronounced class bias in the manner it was carried through. Secondly, one lasting impact of that lockdown had has been that it has confounded our strategies to combat this pandemic by portraying the it's probably the worst victims of this pandemic as the criminals or as the most dangerous ones. Remember how police treated these migrant workers, the latte charges and all those kind of things. Then we had minorities getting targeted and all that. So, and this is all carried on the way in decisions as recently as that one state government deciding we will not let these migrant workers go. So this, all of this, you know, it ultimately fits into this jigsaw saw puzzle lockdown has not just been carried out badly, but it has confounded our strategies it has confounded what needs to be done and all. And I think the result is that those who ought to have been treated as victims of the pandemic are now being criminalized, less they fall sick or something. So we have reduced human beings to be treated as vectors of the disease. And it was very, very evidently visible. I think this is something. It's not just that, you know, okay, it was done. It was done. It was a mistake and all it wasn't really that way. And this thinking continues to cast a shadow on what the government is doing as of today. It was a absolutely wonderful conversation. I really wish our policymakers find the time to listen to people like you. And, and I think that I, for one, learned a great deal about, you know, what needs to be done and I think that it calls for our best trends in these final words you spoke about perseverance, spoke about alliance and community. Reliance on states on hope on on kindness and I think above all on solidarity that we are all in all in all of this we are there together and and the suffering of, you know, the suffering of that last person should be suffering that I I, I, I, I, I, I, I would trade against and fight against. And I think that let's, let's, let's continue to, to have these conversations and continue to strive as, as we pass through this terrifying and defining time in our lives. So thank you all of you, once again.