Narendra Modi has cultivated a reputation for making dramatic decisions to respond to India’s complex policy challenges. Addressing the nation on primetime television about coronavirus on March 24, the prime minister was true to form.

India then had just about 550 confirmed infections, and many Indians believed their repeated exposure to a wide range of germs would enable their immune systems to ward off the virus. But Mr Modi warned coronavirus had “rendered even the most developed countries of the world helpless”. India’s recent socio-economic progress, he warned, would be set back decades unless it could “break the chain of infection”.

With that, Mr Modi ordered India’s 1.4bn people into one of the world’s most stringent lockdowns, warning them not to step out of their homes — “whatever happens” — for the next 21 days. “We must accept that this is the only way before us,” he said of strictures that took effect less than four hours later, at the stroke of midnight.

The draconian lockdown — imposed with no warning, no planning and no transparency into the policy deliberations or scientific advice behind it — fit perfectly with the prime minister’s highly-personalised, muscular leadership style. Virtually all economic activity — including logistics, manufacturing, public transport and most healthcare — did come to a near total standstill. Around 140m vulnerable workers were thrust into crisis as their earnings collapsed.

Yet for all the human suffering and economic damage it inflicted, India’s lockdown failed to flatten — or even slightly bend — the country’s coronavirus curve. With limited testing capacity and restrictive testing policies, authorities struggled to identify infected patients and trace their contacts. Fears of being hauled off to squalid public hospitals or quarantine centres meant that many who became infected were reluctant to come forward. New cases rose steadily.

More than 32,000 people have died from coronavirus in India. Health experts say the official death toll is almost certainly undercounted
More than 32,000 people have died from coronavirus in India. Health experts say the official death toll is almost certainly undercounted © Yawar Nazir/Getty

Under pressure in the following weeks to resuscitate the collapsing economy and give desperate workers a chance to earn again, Mr Modi then changed tack. On May 12, as confirmed infections rose to around 71,000, Indians were told to learn to live with the virus, and get back to business.

“Corona will remain part of our lives for a long time,” he said in a national televised address. “But we cannot allow our lives to be confined only around corona.”

But two months on, India is still facing severe disruptions to normal life, as the virus circulates ever more widely — a deepening crisis that experts warn could hamper the country’s development for years to come.

Today, India has recorded more than 1.4m confirmed coronavirus infections — the world’s third biggest caseload after the US and Brazil. New infections are rising to new all-time highs almost every day — exceeding 49,000 on Thursday. Fatalities too are on an upward trend, with more than 32,000 deaths in total.

Chart 1 showing India’s new caseload drives surge in global Covid-19 infections.  Daily new cases (seven-day rolling average)

The true magnitude of India’s pandemic — and its death toll — is likely far higher. India has one of the lowest testing rates of any major economy, due both to continued limited capacity — especially in small towns and rural areas where the virus is now spreading — but also political pressure to limit testing to keep the official case count low.

Health experts warn of the need for more effective containment. Ashish Jha, director of the Harvard Global Health Institute, says India’s new infections could soon be rising by 100,000 a day — an alarming spectre given its overstretched health system.

“The virus is probably much more widespread than what the statistics show,” Prof Jha told the FT. “I am deeply worried that in the days and weeks ahead, hospitals are going to really get strained, and people are going to start dying in much large numbers. Deaths will rise, and I worry they will rise sharply.”

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Lack of control

Failure to control the pathogen will also cast a shadow over India’s economic prospects, with the gloomy scenario Mr Modi foretold in March seeming evermore likely. Tech and industrial hubs like Bangalore, Pune, Chennai and Aurangabad, and entire states like Bihar, are undergoing new localised lockdowns, while the populous state of Uttar Pradesh and nearby Punjab impose stifling “weekend lockdowns”.

Some of India’s rural migrant workers are reluctant to return to work in the cities
Some of India’s rural migrant workers are reluctant to return to work in the cities © Prashanth Vishwanathan/Bloomberg

Even without official restrictions, many urban Indians are too fearful to step out of their homes. Rural migrants are wary of returning to urban workplaces. Small businesses have reopened only to shut down again as employees were infected. Reopening schools — closed since early March — isn’t even a topic of public discourse. Welfare schemes — like mid-day meals and vaccinations — have been disrupted, as resources are diverted to the pandemic.

“I don’t think today there is any ambition to actually get rid of the virus,” says prominent businessman Naushad Forbes, chairman of engineering company Forbes Marshall, and a past president of the Confederation of Indian Industry. “Today it’s very much control, contain and ensure we have the right kind of health capabilities so we can limit morbidity.”

All this will extract a heavy toll on an economy that was already struggling to regain momentum after a protracted slowdown. Nomura, the Japanese investment bank, forecast that India’s gross domestic product will contract by 6.1 per cent this year, while HSBC expects a dip of 7.2 per cent. Domestic rating agency ICRA is gloomier, projecting a 9.5 per cent contraction.

Chart showing new confirmed cases of Covid-19 in India. Daily new cases (seven-day rolling average)

“The pace of normalisation is far more uneven than what one would have assumed,” says Aurodeep Nandi, a Nomura economist. “People have started getting more risk averse. Unless you solve the health crisis, the economic crisis will not solve itself.”

Nor will the pain end quickly. Economists warn that the pandemic has created new financial stresses that will weigh on India’s growth potential for years. Strained public finances are deteriorating further, with analysts forecasting the combined central and state deficit could rise to 12 per cent of GDP. Banks, which have struggled for several years to reduce non-performing loans, face a new wave of stressed assets. Lay-offs are increasing, and may accelerate further once a bank moratorium on debt repayments expires at the end of August.

“India’s potential rate of growth certainly has come down and these issues will remain in the system for several years,” says Sunil Kumar Sinha, principal economist of India Ratings & Research.

In a televised address India’s prime minister Narendra Modi told the nation: ‘we cannot allow our lives to be confined only around corona’
In a televised address India’s prime minister Narendra Modi told the nation: ‘we cannot allow our lives to be confined only around corona’ © PIB/AFP/Getty

Despite this gloomy outlook, Mr Modi’s government — with its sophisticated public communication tools — has persuaded many Indians that Mr Modi’s leadership has enabled them to fare far better than many richer, more advanced nations.

As evidence, New Delhi cites India’s low number of deaths compared to its population, and low case-to-fatality ratio. “The whole world is witnessing how one of the most successful battles against Covid-19 is being fought here,” Amit Shah, the home minister, said recently at a public forum.

But public health experts say India’s official death toll is almost certainly undercounted — and that such statistics mean a lot less in a situation where the number of new infections is rising rapidly. Harvard’s Prof Jha also fears that New Delhi’s tendency to minimise the magnitude of the current threat — or simply divert public attention — could backfire, encouraging people to let down their guard as the virus becomes more widespread.

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Experts have suggested that India’s lockdown was imposed too early in the pandemic, at a time when infections were narrowly concentrated
Experts have suggested that India’s lockdown was imposed too early in the pandemic, at a time when infections were narrowly concentrated © T. Narayan/Bloomberg

“Politicians have often tried to approach this disease like a political campaign — you are just trying to win the day and win the news cycle,” he says. “But downplaying the virus is actually a really harmful strategy because you can confuse people about what their action should be.”

Modi’s management

With new infections surging and the economy wilting, the focus is inevitably returning to the government’s initial response to the pandemic and the rushed decision in March to shut down the country.

For some observers, the lockdown strategy was driven as much by Mr Modi’s political persona — and his desire to demonstrate that he was the man in charge — as it was by a clear scientific and public health analysis of the problem.

Authorities in the then-hardest hit regions of Maharashtra state and the capital city, New Delhi, had already imposed curfews as local cases rose. Some public health experts say Mr Modi shut down the whole country to assert his leadership over India’s pandemic response.

The shutdown reflected Mr Modi’s impulse to rely on the might of the state to enforce shock-and-awe tactics — and discipline what his ruling Hindu nationalist Bharatiya Janata party sees as a wayward society — rather than mobilise India’s extensive network of grassroots community organisations and civil society groups in a campaign to educate people about the virus.

“Big dramatic action — the world’s biggest lockdown — fits the pattern of the prime minister’s thinking about how to deal with the problem,” says Dr T Jacob John, former head of the department of virology and microbiology at Christian Medical College (Vellore).

The lockdown reaffirmed Mr Modi’s stature in the eyes of many middle-class Indians, who saw it as a reflection of his courage and willingness to act decisively against a looming threat. Business owners were less impressed, feeling the magnitude of the disruption was avoidable.

When India entered lockdown many migrant workers desperately scrambled for transport back to their villages
When India entered lockdown many migrant workers desperately scrambled for transport back to their villages © Yawar Nazir/Getty

But lockdown failed to deliver the promised results. In mimicking tactics adopted from authoritarian China, and rich European countries, the government failed to account for the gritty realities of urban India, where millions live in crowded slums sharing toilets and water taps with hundreds of others, or depend on daily wages for that evening’s meal.

“Police cannot do public health,” says former health secretary K Sujatha Rao, who worked extensively on India’s successful Aids control programme. “It cannot be done by force. It has to be done through persuasion.”

Locking down too early?

As India’s poorest desperately scrambled for food and transport back to their villages, fertile conditions were created for the virus to spread.

“You cannot just give an order and everything will be resolved,” says Dr Smarajit Jana, former head of the Aids control program. “Any good public health policy must consider the context of the country in question — the population density, the socio-economic context and the way people live.”

In its lockdown policy, the government failed to account for the gritty realities of urban India, where millions live in close quarters
In its lockdown policy, the government failed to account for the gritty realities of urban India, where millions live in close quarters © Divyakant Solanki/EPA-EFE/Shutterstock

Dr Harsh Vardhan, India’s health minister; Dr Vinod Paul, the paediatrician who has been one of Mr Modi’s key advisers on the pandemic; and Dr Balaram Bhargava, the cardiologist who leads the Indian Council for Medical Research, did not respond to requests for interviews about India’s coronavirus strategy.

However, Swapan Dasgupta, an MP close to Mr Modi, says the premier acted on “conventional wisdom”, after Italy, Spain, France and the UK — where health systems were already under heavy pressure — imposed controls on their citizens.

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“It was imagined that if you have 18 or 21 days of very intensive lockdown, you’ll be able to get over this problem,” Mr Dasgupta said. “That was the conventional wisdom — or speculative wisdom. The thinking was, if you are able to stop this at this point, you will be able to get rid of it for the future.”

Residents of Mumbai show their appreciation of healthcare workers
Residents of Mumbai show their appreciation of healthcare workers © Rafiq Maqbool/AP

Dr John believes India’s lockdown was “mistimed”. It was imposed too early in the epidemic, when case numbers were still too low, he says, and when the infections were so narrowly concentrated that it did not require such draconian action across vast swaths of the country that had no cases at the time.

Today, he says the virus is circulating more widely than ever, yet there is little effort to warn people, or any aggressive campaign to promote correct and comprehensive mask wearing, which he believes is critical to reduce and slow the spread of the pathogen.

“The lockdown instilled fear and when the lockdown was lifted the fear is gone, and the virus is hitting everybody,” says Dr John. “It’s the crying wolf story . . . When the wolf really came, nobody cared.”

New Delhi accused of ‘unrealistic hope’ over Covid-19 vaccine

Narendra Modi has taken a strong personal interest in India’s quest to develop its own coronavirus vaccine, chairing several meetings of a high-level government task force on the issue.

But a recent Indian Council for Medical Research letter declaring that it — in collaboration with a Hyderabad-based pharmaceutical company, Bharat Biotech — would launch a coronavirus vaccine “for public health use latest by August 15, 2020 on completion of all clinical trials” sent shockwaves across India.

To scientists and public health experts, the tone and details of the letter — sent on July 2 to hospitals chosen to participate in clinical trials and then leaked on social media — suggested intense political pressure on researchers to rush through the development of an indigenous vaccine, compromising the rigorous scientific process intended to prove it was safe and effective. August 15 is Indian Independence Day, when the prime minister traditionally addresses the nation from New Delhi’s Red Fort.

First-phase trials had not even started when the letter was written. “This is one of the top priority projects which is being monitored by the topmost levels of government,” the letter said. “Kindly note that non-compliance will be viewed very seriously.”

Amid the furore, the Indian Academy of Sciences publicly denounced the proposed vaccine launch date as “unreasonable and without precedent”, accusing the ICMR of raising “unrealistic hope and expectations in the mind of our citizens”.

The ICMR countered by emphasising the importance of an indigenous vaccine, and insisting it was acting “in accordance with globally accepted norms” for fast-tracking vaccines in a situation of a pandemic. It said the leaked letter — ordering trial sites to “fast track approvals” and choose subjects within five days — was merely intended to “cut red tape”.

India has a well-established vaccine industry, which supplies Unicef and Gavi, the UN-backed alliance, with many of the inoculations used in low-income countries.

The Serum Institute of India — the world’s largest vaccine manufacturer — has tied up with AstraZeneca, and will produce hundreds of millions of doses of the vaccine candidate the pharmaceutical company is developing with Oxford university if it is proven effective.

Via Financial Times