A man carrying a sack walks past a graffiti of a healthcare worker during a lockdown to slow the spread of COVID-19 in Mumbai, June 2020. Photo: Reuters/Francis Mascarenhas
New Delhi: It’s been more than two years since India registered its first case of COVID-19. There have been attempts since to document the Union and state governments’ response to this crisis, including in the form of news reports and editorials.
One important part of the country’s response was the amount of misinformation in public dialogue. It often misled people towards subpar or outright false treatments, vexed conversations between people and experts, and undermined the effectiveness of the public health response. Overtime, misinformation and disinformation also muddled our memories of the pandemic.
A new book, Covid-19: A View From the Margins, is an effort to – among other things – perform some honest record-keeping. As one of the two editors of the book, Yogesh Jain, has written, the compilation of 37 essays “is a fight for memory against forgetfulness”.
The 37 essays, spanning 650 pages, have been authored by journalists, doctors, academicians, activists and bureaucrats. Together, they cover India’s COVID-19 response and its failures, especially during the two big waves (in 2020 and early 2021). The book also devotes a lot of space to the social impact of the pandemic in India – including the rights of migrants, access to food, digital literacy and the role of courts.
The Wire Science spoke to one of the two editors of the book, Yogesh Jain. (The other editor is Sarah Nabia, who is studying public health at Johns Hopkins University, Maryland.) Jain is a paediatrician and a founder of the Jan Swasthya Sahyog, a group that has been serving the healthcare needs of people in rural Chhattisgarh for two decades.
The interview is presented in full below. The questions are in bold; additions and modifications, for clarity, are in square brackets.
What went into conceptualising the book? What was the specific need for this book, especially since others were documenting the pandemic through writing, reporting, etc.?
The idea came up in late 2020, when we were coming out of an intense ‘webinar period’. There were two types of voices: people in power were speaking through the national media, and there were some independent experts doing the talks. But the reporting itself was not analytical and was event-based. Plus, it seemed disparate and scattered if we compared the impact on the people on the margins in states like states Chhattisgarh and Odisha. The pandemic shall pass but it was incumbent upon us to retain the memory of the pandemic for the history of the people.
Ed. Yogesh Jain and Sarah Nabia
Manohar Publishers & Distributors, January 2022
While we can dwell more on the argument that the reporting was not analytical, do you think the bigger objective of the book was to record what was happening in the states?
It was one of the axes. The others were people living on margins belonging to various social groups and social classes.
There are some chapters on how prioritising COVID over other illnesses affected people suffering from tuberculosis, non-communicable diseases and mental health problems, and others requiring surgeries, etc. What would you say is the key message in these chapters?
The health systems failed. There used to be talks of resilience of our health systems. But the system would have proven to be resilient if it had [simultaneously] served people suffering from tuberculosis, cancer, etc. When restrictions are placed on the movement of people, you have to use the power of the community to ensure drugs reach these people and tide over the pandemic crisis. We really failed.
People with hypertension and diabetes didn’t get drugs and they died or their case worsened. Minor cancers became advanced cancers.
One of the important aspects of India’s COVID-19 story is undercounting COVID. There is unequivocal data to indicate this happened – but this issue hasn’t found mention in the book. Why?
It is there in one of the chapters on epidemiology of the disease, but a detailed comment is missing. Yes, it is not of high quality. The authors have prematurely said that there was not enough data [on excess deaths] and hence the escape.
The future course of the pandemic will depend on variants and hence genome sequencing is very important. This topic has also not found much space in the book…
The INSACOG fiasco has been commented upon in one of the chapters, but yes, it could have been more detailed. I had the urge to make it comprehensive from a margins point of view and therefore had to hold back my horses.
The book captures India’s non-COVID health as well as social impacts. Which of these two types do you think was more profound?
The latter clearly. That was more basic in a sense. I was very particular about the fact that any contention [made about the social impacts] had to be backed up with facts and figures [so that they are captured correctly].
What is the most important part of the book?
Difficult to answer but I would say, in terms of possible impact on planning for the future, the last section – ‘Notes from the Fields’ – is likely to be more impactful. If waves come up or a future pandemic comes up, every chapter [in this section] has a lesson to narrate, including the legal chapter, in which the author talks about the Disaster Management Act 2005 and the Epidemic Diseases Act 1897.
How is this book likely to help policymakers?
There were some good examples of some states doing very well – the way they balanced various aspects. That is still of value. Particularly Kerala, Tamil Nadu Karnataka and Odisha.
You mean both COVID and non-COVID management?
Both, yes. Kerala was good in communitisation – in handling the migrant workers, providing food, tests, etc. Tamil Nadu did good in procurement [of medical equipment]. The Tamil Nadu Medical Service Cooperation got the cheapest rates.
Karnataka had a good technical body [to support COVID care]. Odisha had a good community health worker programme.
The second most important message is that you can’t allow a larger health system to be cannibalised by any future pandemic. You have to ensure [availability of services] across the various disease-specific programmes. You just can’t afford to parasitise or cannibalise other health systems if a pandemic strikes again.
Third, and most importantly, successive governments have been fond of privatisation of various services, not just health but food, education and transport, too. Without good public systems, no unequal society can manage a pandemic. This was a lesson that one has learnt from the pandemic.
COVID-19 served a rude reminder that no country in the world could provide healthcare to all its people through a privatised system.
Anything else that you would like to highlight?
As many as 50% of, or more, contributors of this book are women. That was one important thing. A couple of bureaucrats had promised to write for us. They had written their chapters but their respective state governments did not allow them to go ahead.
Lastly, the book was a fight for memory against forgetfulness. This too shall pass, but if we don’t remember, then we tend to commit the same mistakes in future.