OpinionGuest's View

India’s COVID-19 emergency, geopolitics, and healthcare policy

By Seithikurippu R. Pandi-Perumal

 Synopsis

 The author contends that politicians and the media (local and foreign) are both to culpable for playing a risky game during the COVID-19 outbreak and during vaccination in India during its second wave. Several journalists found to be engaged in unethical behaviour, such as disseminating misinformation, disinformation, mal-information, and alternative facts. According to reports, disaster stressors may be a significant element that exacerbates the harmful consequences of excessive social media use on mental health. Prolonged exposure to tragedy on social media can have a negative impact, perhaps leading to poor mental health outcomes such as affect dysregulation.Leading medical journals also published flawed editorials without proper investigation. The author further argues that India’s COVID-19 healthcare emergency may look like the proverbial duck, swim like a duck, and quack like a duck, it is NOT the duck it has been made out to be.

 The second wave of India’s coronavirus disease (COVID-19) crisis has received global attention. Though India struggles to cope, fight, and monitor the pandemic, friendly nations are voicing their appreciation and solidarity, lending a helping hand, and constantly pouring required medical supplies to get the situation under control. All these countries have been fighting with us against an invisible enemy, the contagious virus, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).

COVID-19 emergency and India’s geopolitical landscape

According to recent UN data India boasts an estimated population of 1,391,494,040, 17.7% of the total world population. Dealing with a pandemic emergency in any country is very much challenging.However, for India it is much more challenging due to its large population count, but also because of its peculiar and complicated living conditions (e.g. residential crowding and joint family), its varied religious ceremonial traditions, its disparities in wealth and literacy, and especially its internal political animosities (both internal and external neighbors), dealing with a pandemic becomes considerably more challenging than it is elsewhere, which the westerners find difficult to comprehend. Several areas including Uttar Pradesh, Bihar, which are India’s larger states, with a population greater than that of several European Union countries combined, have been hardest hit. Despite many multi-faceted problems, India has managed to do a better job of controlling COVID-19 than has Europe.

However, both the politicians and media to be blamed for playing a dangerous game. During the early vaccination period, in addition to lack of planning, failure to develop adequate infrastructure by the states, the opposition parties raised doubts about vaccination and spread rumors against the safety and efficacy of vaccines1. This led to the wastage of vaccines in India. This is followed by booking of hospital beds for patients who are not infected with corona, artificially inflating the shot supply of medicine and medical supplies, including stealing and hoarding of cylinders of oxygen, the elixir of life2, and artificially created a scarcity of beds by illegally booking and selling in the black market with the help of middlemen, and did politics for profits on dead bodies3,4. This list can go on. None of the media questioned the earlier government for the lack of proper healthcare infrastructure development in the last 50 years. If this was not Mr. Modi, how they would have dealt with such a situation, is still a matter of debate.

In the current crisis, however, the implementation part will be crucial yet challenging, not just for Mr. Modi’s government, any government for that matter. Failure of leadership doesn’t mean the failure of the ruling party but must include the opposition party as well. Fail to foresee, lack of adequate planning, and an under-invested public health system all point to the fact that adequate healthcare budget must have been allotted to meet the demand in the past, now, and in the future including a random Force Majeure. Keep on developing hospitals will not solve the problem as there is no quick fix to the problem. However, long-term planning is needed to develop necessary healthcare infrastructure based on a gap analysis with a defined timeframe to develop such facilities was much crucial. It is merely a failure of the system as a whole and its public policy which needs a total revamp. But it is not the failure of the current government in power yet blamed them, which needs to be highlighted and recorded here. But this is what is happening now. The current misinformation will also heap disgrace on the opposition parties.

In India, it is nothing new for the mainstream legacy media to go few strides too far. While India continues on the path of recovery, the Indian media, the fourth pillar of Indian democracy, are continued to misrepresent the cause of India’s current struggle. Rather than instilling hope or sharing honest and unbiased opinions and offering scientific views is not a primary agenda for many such agencies who work for inducements. Is this right, or should the media be blamed for fabricating or misreporting narratives? Is it appropriate, during a global healthcare crisis, to impose regulations or censor news sources and other media networks to prevent impediments and complications in the war against the pandemic and the breakdown of public order in politically and economically fragile countries? Or does it expose flaws, expose incompetence, and impair or tarnish the reputation of the ruling government? If censorship, at what level? Along this line, one might raise several troubling concerns.

Media coverage and mental health

Because of fierce competition, they often distort the truth to improve their Television rating point (TRP). Among others, discredit vaccine, its safety and efficacy, misinformation on the second wave, challenging COVID-19 related death statistics, and dangerously sharing false information on social media platforms. In addition, they also reported sensational stories (e.g. ICU, death, morgue, burning pyre, cremation, lack of beds, equipment, drugs, and people cry in desperate situations). They fail to highlight the successes, the many COVID-19 patients who are expertly treated and cured. The majority of media outlets are aligned with leftist and pseudo-liberal opposition parties whose job is to humiliate the government even if it also means shaming their country in the eyes of the world.

These journalists often resort to unethical practices such as sharing misinformation, disinformation, mal-information, and alternative facts. These so-called ‘Kumbh Mela’ or ‘Cremation’ journalists, selling their cremation photos to the highest bidder5.These selective false narrative reporting journalistic behaviors instill terror in a populace still insecure due to the pandemic and the many physical and mental health consequences6.They instill a media frenzy and cause confusion, panic, and fear in the minds of people by resorting to mis-infodemic and dis-infodemic. This paints a negative picture to foreign news agencies, who have different agenda of their own. These media and the public are guided by incompetentpoliticians and celebrities who have massive social media followers, who may or may not have the complete picture of what is going on in the country, still provide wrong information, which eventually influences people’s social behavior.

It has been reported that the disaster stressor could be a contributing factor that exacerbates the negative effects of excessive social media use on mental health.7,8Furthermore, prolonged exposure to tragedy on social media can cause detrimental impact, which may lead to poor mental health outcomes including affect dysregulation.8According to Zhao and Zhou, while the disaster stressor acted as a moderator, negative affect acted as a mediator. Hence, future strategies to improve mental wellbeing should take into account both disaster stressors and negative effect.8

The isolation, distant socializing, and quarantine during the long duration of this pandemic outbreak also took a toll on physical and mental health in humans of all age groups.9 Mental health conditions include but are not limited to, loneliness, psychological stress, trigger affect, anxiety, depression, sleep disturbances, suicides, and suicidal ideation, substance use and abuse (e.g. alcohol consumption), and post-traumatic stress disorders all reported in the medical literature This will have a long-term consequence in the months and years to come. According to the Centers for Disease Control and Prevention (2021),10and the COVID-19 infection had a disproportionately negative effect on chronic medical conditions and exacerbated pre-existing medical conditions. Similarly, patients with pre-existing mental dysfunctions will also suffer considerably as a result of the risk for relapse/regression, inadequate mental health care as a result of COVID-19, and increased psychiatric morbidity through various neural pathways.11 Overall, the quality of life is also impaired for all. COVID-19 impacted people at a personal, family, community, and population level. The daily routine, as well as the work pattern, also changes drastically.

Mixing politics and medicine: a deadly combination

A recent audio interview on “India’s COVID-19 crisis” that was published by the New England Journal of Medicine (May 6, 2021) also had inaccuracies in terms of numbers.12Dr. Zarir F. Udwadia of Mumbai commented that about 3.5 million pilgrims participated in Kumbh Mela 2021 and less than 5% of the people vaccinated. The only issue was the former was less and the latter was more.

On a similar note, the medical journal the Lancet (May 08, 2021) also published a flawed and biased editorial entitled, “India’s COVID-19 emergency,” which also received worldwide publicity and severe criticisms from several fronts.13 As a neutral political analyst, any rational person wants the best possible solution to the pandemic, but they are acutely aware of the flaws of the political, print, television, and social media responses. This is being misinterpreted as facts by international newspapers and has also misled reputable medical journals. Thelancet editorial echoed various issues that are currently prevailingin India that invited widespread publicity in social media platforms from the public and politicians.14,15,16,17,18It was, however, an unfounded, under-researched, unscientific, contrived tale and outright lie, akin to a pseudo-liberal/leftist assertion that fails to comprehend the genuine problem at the grassroots level. It went quick to criticize Mr. Narendra Modi, no matter if he spends sleepless nights (or not) trying to get the pandemic under control or not before one walks in his shoes and realizes how monumental the job can be. If all countries lined up to help for a social cause or to reciprocate the help that they received from India, it was because of hispolitical goodwill and humanitarian action.

Coming to the Lancet editorial per se, it is a deplorable, politically biased opinion, and missed the point in every aspect. In a large democracy such as India, a biased editorial from a prestigious journal will only fuel the fire. The knowledge gained from the editorial in question will only transform society to the worst. Not every scientist agrees with everything that was said in the editorial. Lancet might have the highest standard in imparting and disseminating medical knowledge and improve the livelihood of people. They should continue to do it. However, using words such as “own up to its mistakes”, “provide responsible leadership,” are not based on facts and I think it sailed into uncharted territory. On the similar note, I am not sure if the Lancet would write a firing editorial addressing the issues surrounding the Euro2020 and the possible spread of infection. Even the WHO expressed concern about it.

It is easy to critique or advice from the outside. But the ground reality is very different. Not everything is what it appears to be. One shouldn’t overlook these socio-political issues when making false accusations. Despite overwhelming media negativity and political animosities internally, India is making headway, in very difficult circumstances, in dealing with its second COVID-19 wave.

What happens next will, of course, be crucial. The healthcare budget and infrastructure in India will need shoring up and public health policy will need revamping by a course correction.

Although anyone would agree that science and politics cannot be separated; but the evaluation should be unbiased and must include all variables. If not, in the interest of the public, medical journals are best at discussing science, not politics. A bunch of scientists sitting in an office who compelled to pen their thoughts cannot,however, debateor dictate how to run a countryin a pandemic crisis when we don’t know how the fabric of the system work at the ground level. By the way, until otherwise, they haven’t seen issues at close quarters and broader perspective, who are they to criticize?

Conclusions

Despite these complicated issues, the number of COVID-19 tests and vaccinations is steadily on the rise. India has the infrastructure, the scientific knowledge, and the technical know-how to combat this pandemic. Besides skills in allopathic medicine, India has vast indigenous knowledge (e.g. Naturopathy, Ayurveda, Siddha, etc.) which, in rural areas as well as in cities, provides healing at affordable prices. Compared to many developed countries, India ranks high in COVID-19 control, concerning case numbers, test numbers, critical case numbers, deaths per million, and vaccination coverage.19 India deserves to be commended for its handling of the pandemic thus far. Aside from a neglected healthcare system [total healthcare expenditures in India (including private and governmental] is 3.6 percent of GDP), the rise in COVID-19 cases and deaths is the result of insufficient policy responses and a scientifically illiterate attitude. However, a pandemic of this magnitude necessitates massive healthcare infrastructure and resources.Although India’s COVID-19 healthcare emergency may look like the proverbial duck, swim like a duck, and quack like a duck, it is NOT the duck it has been made out to be.

 Mr. Pandi-Perumal is a Canadian Indian scientist, specializing in the areas of Mental Health, Public Health, and Global Health. He can be reached at [email protected]

 

References

 https://ourworldindata.org/covid-vaccinations(accessed on 06/18/2021)

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