Dispatch #38: Weekend Linkfest
Here is a curated list of a few good articles from the world of policy, politics and development
“There comes a time in the life of every regime when it loses its iqbal, that elusive yet unique mix of moral wholesomeness, political nobility and administrative authoritativeness. A healthy quantum of iqbal enables a ruler to elicit obedience, demand respect from citizens and subjects for his or her rules and firmans; such a ruler does not need to rely on coercion as the first option. A regime that loses its iqbal may remain in office but its moral raison d’etre stands disintegrated.
The Shahenshah and Shah arrangement reached that point of no return when the honourable prime minister and his equally honourable home minister were wallowing in political shabbiness in West Bengal while the second coronavirus surge was ravaging millions and millions of helpless and hapless Indians. From now on, only unhappy choices confront the nation as the prime ministerial overlordship has not yet run its course.”
“Financial resources are limited, and therefore policies are also limited. If we were to exclude some of the more eccentric policy decisions that Prime Minister Modi’s government has taken as one-off events, such as demonetisation, broadly speaking, they have continued with what came before them because there is not much space and because, at the cost of repetition, there is no Hindutva economic ideology.
Where Hindutva has manifested itself fully is where it was always intended to manifest: against minorities, and especially against Muslims. This is evident with its most recent examples.”
3) In a Covid-19 war room in Mumbai, the pandemic feels interminable – but key lessons have been learnt:
“One of the key learnings from the early months of the pandemic for the city’s civic body, Brihanmumbai Municipal Corporation, has been that strict triaging of patients is essential to ensure the best use of resources. ‘Triage’ is the process of determining the priority of patients’ treatments by the severity of their condition or likelihood of recovery with and without treatment. The primary job of the Covid-19 war rooms, one in each of the 24 wards of Mumbai, is that of triaging. Here is how it works.
An all-Mumbai BMC bed tracker dashboard provides realtime updates of bed availability across hospitals and Jumbo covid facilities under various classifications: patients who are Covid-19-positive, further broken down into those who require oxygen and those who don’t; suspected Covid-19 patients, also broken down into those who require oxygen and those who don’t; patients needing admission to Intensive Care Units, paediatric ICU, neonatal ICU; pregnant women; those needing dialysis, and so on. These categories are further broken down, facility wise. Each facility is tasked with updating the numbers in real time.
The war room staff are primarily BMC school teachers, many of whom come from as far as Palghar, Vasai and Virar, mobilised for Covid-19 duty. They are supported by data entry operators and doctors. The teachers call each person on the list and record all details including oxygen saturation levels, symptoms, comorbidities, vaccine status and the type of house they live in. The last data point helps in deciding if home isolation is indeed feasible, Jadhav said.
The doctors in the war room use this data to begin triaging and liaising with hospitals and Covid-19 facilities within their ward. In case of bed unavailability in the ward, the doctors contact other ward war rooms using the information displayed on the dashboard. Ambulances are then dispatched to move the patients for whom the doctors have recommended hospital admission.”
“The Union government has insisted that the State governments should purchase the vaccines at Rs 400/dose and meet the costs from State budgets. Let us take the size of India’s population in 2020 at 138 crore. Let us also assume that about 30 per cent of the population falls below the age of 18 years, and hence need not be vaccinated. Thus, India must vaccinate about 96.6 crore persons. At the rate of two doses per person, India needs about 193.2 crore doses. Let us also assume that the central government would anyway vaccinate 30 crore people free of cost, as it appears to have promised. Thus, deducting 60 crore doses from the target, what remains is 133.2 crore doses. At Rs 400/dose, the total cost for the State governments comes to Rs 53,280 crore.
For individual State governments, the aggregate amount they must spend to purchase vaccines from vaccine producers are surely unaffordable. State governments are already burdened with significant additional expenses to address the pandemic. They also face falling revenues and curbs on additional borrowing. Even if they borrow, States pay higher interest rates than if the centre borrows. On the other hand, for the central government, Rs 53,280 crore is an insignificant amount over a financial year, constituting just 0.26 per cent of the GDP. It would be most desirable if the central government directly spends this amount for the entire Indian population.”
“Let’s try and understand this issue in a little more detail, through the example of hand sanitizers. When covid first started spreading early last year, hand sanitizers disappeared from the market and were being sold in black. This was because demand far outstripped supply. Nevertheless, seeing the high price of sanitizers, many entrepreneurs entered the business, and soon the supply problem was solved, and prices became reasonable. So, the free market worked and it worked well.
But in the case of vaccines, new entrepreneurs cannot just enter the market, and start producing the vaccine and thus, ensure that the price of the vaccine doesn’t shoot up in the next few months. This does not mean that the private sector should not be involved in the vaccination. They should be, simply because the population needs to be vaccinated as quickly as possible.
Given that, there is need for a credible competitor who ensures that vaccine prices in the private market don’t go through the roof. Who can this credible competitor be? The central government. This could have been done by ensuring that the vaccine against covid-19 continues to be administered for free at government vaccination centres. This would have ensured that private players priced their vaccines at a reasonable price and did not end up making supernormal profits.”
“Imagine there are two sets of people in India. The first consists of those who are better off and can afford to stay back or work from home. This lot is also less likely to cause infection to others. The second set is mostly blue-collar workers, small traders, vendors and agriculturists. The nature of their work — on the shop floor or in the field — makes them naturally prone to infect others. It follows, then, that society gains from first vaccinating the latter, as they have a higher negative externality. The irony is that the section more prone to infecting others would also be low-income people, who cannot ordinarily afford the vaccine. Under these circumstances, when the market is allowed to deliver vaccines, those with higher incomes — and even prepared to pay more than what the manufacturers are currently charging — will have better access. The market will ignore those with lower purchasing power, despite them having a higher probability of spreading the disease. In fact, the bigger the income difference between the two segments, the greater will be the extent of market failure from simultaneous over-provisioning and under-provisioning.”
7) India’s decision to liberalise vaccine sales likely to push up prices – and block access to millions:
“There is an additional reason the Union government appears to changed its vaccine policy. As mentioned earlier, all data show that the Union government was guilty of poor planning in anticipating the demand and supply of vaccines.
Several state governments have criticised the Union government for its inability to adequately plan the smooth flow of vaccine supplies. Public opinion about the Union government has already soured.
On its part, the Union government appears to have anticipated that vaccine supplies would not improve even by May and that it would increasingly become a subject of ridicule in the eyes of the state governments and the public. Prime Minister Narendra Modi clearly wanted to avoid this. Thus, Monday’s decisions were also a disingenuous attempt to deflect criticism from the Union government.
By asking the states to directly procure 50% of India’s vaccine production, the Union government can shrug off all responsibility for future vaccine shortages and transfer the blame on to state governments if they fail to procure stocks.”
“So far, only one of the vaccine manufacturers, Serum Institute of India (SII), which is making the Oxford/AstraZeneca vaccine (Covidshield in India) has declared its price – ₹400 per dose for state governments and ₹600 per dose for supply to private hospitals. Other vaccines, which include Covaxin made by Bharat Biotech, and those that will be imported or their Indian-made versions will be rolled out, could change the price in the days to come. Taking the SII price as the benchmark for now, vaccination people between 18 and 44 years of age could range anywhere between ₹47,500 crore to ₹71,500 crore, depending on whether the SII vaccine is procured at ?400 per dose or ?600 dose. Where does this number come from? The total population of 18-44-year-old age-group in India is expected to be 594.6 million, according to the report of the government’s Technical Group on Population Projections. This report also gives the statewise break-up of the 18-44 population. This number, when multiplied by ₹800 or ₹1200 (for two doses of Covidshield) gives the total cost of ₹47,566 crore or ₹7,1349 crore. Uttar Pradesh, the state with the largest population of 18-44 year olds will have to spend between ₹7,970 crore to ₹11,960 crore for vaccinations. For smaller states such as Himachal Pradesh and Uttarakhand this number will be in the range of ₹400- ₹625 crore respectively.”
“Officially, India’s daily oxygen production capacity is 7,127 MT and its medical oxygen requirement has increased by 76 per cent in 10 days — from 3,842 MT on April 12 to 6,785 MT on April 22. On paper, that leaves the country with a few hundred metric tonnes still to spare, but state after state has been complaining of acute shortage.
Until 2019, before the pandemic hit the country, India required just 750-800 MT liquid medical oxygen (LMO), the rest was for industrial use. Since April 18 this year, industrial supply has been completely disrupted. Among India’s big oxygen manufacturers are Inox Air Products, Linde India, Goyal M G Gases, National Oxygen Ltd and Taiyo Nippon Sanso Corporation.
An Inox official claims the company meets around 60 per cent of the country’s LMO demand, manufacturing 2,000 MT per day and supplying to 800 hospitals. The company has 550 transport tankers and 600 drivers, who, the official says, have been on the road 24×7.
LMO is manufactured in large plants using cryogenic distillation techniques to compress atmospheric air, feed it into distillation columns and get liquid oxygen. It has 99.5 per cent purity. This process, an industry expert said, can take two-and-a-half days for lakhs of litres.
The liquid oxygen is filled into jumbo tankers for storage, from where special cryogenic tankers, that maintain temperatures of -180 degrees Celsius, travel hundreds of kilometres to smaller distributors in the hinterland.
The distributors convert liquid oxygen into gaseous form, compress it, feed it into cylinders and transport them to their final destination: hospitals. Some stock is sold to local vendors, who supply to home patients. Officials say that with longer distances to cover, end-to-end transport takes anywhere between five and 10 hours.
Government data show India has 1,172 oxygen cryogenic tankers for road transport. The tankers served the purpose well until before the pandemic, but now they are scarce and take painfully long to cover hundreds of kilometres.”
“The India Task Force of the Lancet Covid-19 Commission last week published a report titled “Managing India’s Second COVID-19 Wave: Urgent Steps” which, among many other suggestions, recommended that the country aim for administering at least 5 million doses a day. Lest anyone rushes to dismiss the report as foreign interference, as the present government is wont to do, all members of the Task Force are eminent Indian or India-origin experts, including senior civil servants from central and state governments.
Against this target, India’s progress, notwithstanding repeated claims in press releases from the health ministry trumpeting the “world’s largest vaccination programme”, has been disappointingly lacklustre. The Tika Utsav that the prime minister suggested in his virtual conference with chief ministers on April 8 to review the Covid situation appears to have had little or no effect.
As of April 22, according to official sources in the health ministry, India’s vaccination programme has delivered 135 million doses; 20 million people have had two doses, including 12 million healthcare and other frontline workers and 8 million people over 45.”