An Analysis of How ill-Managed the Covid Pandemic was in India

“There is absolutely no need to panic. Essential commodities, medicines, etc., would be available. Centre and various state governments will work in close coordination to ensure this. Together, we will fight Covid and create a healthier India,” read Prime Minister Narendra Modi’s tweet right after announcing an unexpected 21-day national lockdown to battle the pandemic and contain the spread of the virus on March 24, 2020.

It has been four years since this statement. Let us look back at some of the recent ones too. Two years and nine months later, during the G20 summit held in India, Modi said, “Climate change, terrorism and pandemics can be solved not by fighting each other, but only by acting together.”

Remember that this was a time when the Prime Minister stated that one of the positive impacts of India’s G20 presidency was a global shift towards a “human-centric” approach and India played the role of a catalyst in it.

During the G20 summit held in India, Modi said, “Climate change, terrorism and pandemics can be solved not by fighting each other, but only by acting together.”

It is significant to note that while the Prime Minister was singing paeans to a human-centric approach, many state governments in India engaged in forced evictions ahead of the G20 summit, which left thousands of people homeless.

This was especially true in Delhi, which undertook a big drive to hide its ‘dirty poor’ to please visiting dignitaries through evictions and erecting green walls around slums. On the other hand, 963 promotional billboards were installed in just a 12 km stretch, among which 263 had Modi’s face on them— in various sizes.

The recent decision of the Supreme Court on the electoral bonds case has opened a can of corrupt and quid pro quo worms. After the State Bank of India reluctantly shared the data on electoral bonds on the Supreme Court’s insistence, it became clear that the party in power at the Union level (i.e., the Bharatiya Janata Party), had opened its coffers to pharmaceutical companies, even those engaged in the manufacture of vaccines and other essential drugs during the pandemic.

While tall claims of a human-centric approach were being painted all across towns and cities, health and pharmaceutical companies bought electoral bonds worth ₹900 crore. As it goes with everything else in India, it was a case of the rich industrialists bugging governance by bribing the party in power. 

Even three and half years later, the government does not miss a single occasion to pat itself on the back for the management of the pandemic.

It is important to look back at the facts around the pandemic to understand how misplaced the claims about efficiency are. An investigative analysis was conducted of government circulars and notifications for Delhi to assess governmental actions and transparency during both the first and second waves of Covid.

Delhi undertook a big drive to hide its ‘dirty poor’ to please visiting dignitaries through evictions and erecting green walls around slums.

The report focused on Delhi (as it was one of the most affected cities during the pandemic) and how the Union government had ignored its role in the capital. Some of the variables that we looked at were medical protocol, patient rights, plasma therapy and vaccination.

The inclusion was done based on persistent questions asked by the public and civil society, keeping an accountable, democratic and equitable disaster action plan in mind.

India reported its first Covid case in January 2020; it was not until March 2020 that the Union and state governments started seeing Covid as a considerable health threat.

Our report focused on Delhi. Due to higher rates of tests, New Delhi reported the seventh-highest number of confirmed Covid cases in India. As of March 2024, the total number of confirmed Covid cases was 2,042,322, with 26,681 deaths and 2,015,346 recoveries.

While it is true that several other parts of India witnessed harrowing circumstances due to ineffective and insufficient public health systems, Delhi, which has a more robust health system, fared no better.

All emergencies create opportunities for profiteering and overcharging, and Covid was no exception. From the people’s point of view, the epicentre of overcharging was corporate and private hospitals. The pandemic re-exposed the scale and magnitude of India’s private sector’s accountability crisis.

When the pandemic began, several Orders and circulars about a wide range of issues related to Covid were issued by different government departments. Based on narratives from the ground and persistent questions asked by the public, seven health indicators were chosen to identify the areas on which the government focused, and how and where they could have done better.

While tall claims of a human-centric approach were being painted all across towns and cities, health and pharmaceutical companies bought electoral bonds worth ₹900 crore.

Our report found that in 2020 and 2021, most of the notifications issued by the Ministry of Health and Family Welfare (MoHFW) were related to administration and infrastructure. Out of 198 Delhi-specific health-related notifications, 166 were related to administration and infrastructure; 16 were on Covid protocol; five were related to the cost of treatment; two were on medical protocol, and two were on vaccination.

In 2020, two notifications were on patient rights. In 2021, there was not a single such notification. In 2021, three notifications were on grievance redress. There was no such notification in 2020.

The Delhi Disaster Management Authority (DDMA) released the maximum number of notifications related to Covid in 2020 and 2021. Most of the notifications issued by DDMA were related to Covid protocol.

Of the 220 Delhi-specific health-related notifications, 89 were related to the Covid protocol. Forty-seven notifications were on administration and infrastructure.

Even three and half years later, the government does not miss a single occasion to pat itself on the back for the management of the pandemic.

One notification was on vaccination and, in 2021, one notification was on medical protocol. The DDMA did not release any notification on the cost of treatment, grievance redress and patient rights. Eighty-two notifications remained out of the scope of our report and chosen health indicators. 

A majority of the notifications related to Covid issued by the Indian Council of Medical Research (ICMR) in 2020 and 2021 were related to administration and infrastructure.

Of the 38 health-related notifications, 16 were related to administration and infrastructure. One notification was on patient rights. The ICMR did not release any notification related to the cost of treatment, Covid and medical protocol, grievance redress and vaccination.

Nineteen notifications did not fall under any of the chosen health indicators.

To sum up, there were 452 notifications, among which only five were on the cost of treatment (three in 2020 and two in 2021), and three each on patient rights, grievance redress and vaccination.

While the Union and state governments did work on and respond to the issues that came before them during the pandemic, their responses were not effective. What we saw was a bureaucratisation of public health, where there was a sheer unwillingness to have public health experts on their team or to consult them, leading to irrational ways of managing the pandemic.

Delayed relief and lack of transparency

Lockdowns to battle the pandemic were difficult for everyone but governments failed to take into account how people from vulnerable communities would navigate the crisis.

All emergencies create opportunities for profiteering and overcharging, and Covid was no exception.

While the lockdowns caused inconvenience to the privileged in the form of restricted mobility, those from the vulnerable communities struggled with joblessness, loss of livelihood, no income, etc.

They struggled to keep themselves and their families afloat and ended up racking huge debts as they had no option but to rely on moneylenders in the absence of no earnings and dwindling savings.

During this time, the reverse transcription polymerase chain reaction (RT-PCR) test was made mandatory for almost everything, including visiting a hospital. The test price was not regulated until June 2020 and even when the price was regulated, it was capped at ₹2,400, an amount that was unaffordable to most of Delhi’s population.

Months later, when the rates were reduced further, media reports suggest that labs continued to charge higher rates and action has been taken against those labs.

Multiple cases of overpricing were reported from different parts of Delhi during the pandemic. The surge in demand and shortage of hospital beds, oxygen cylinders and drugs led to price hikes whereby not only medical suppliers and vendors but hospitals also took advantage of the situation.

Many hospitals in the capital breached the Delhi government’s Order capping per day package rates to ₹8,000–18,000 for Covid treatment in private hospitals, by charging as high as ₹50,000–60,000 per day.

Alarmingly, amidst the second wave, in May 2021, the Delhi High Court asked the Delhi government to revisit its hospital capping rates of ₹8,000–18,000. The reasoning had been that the Order was passed a year ago and the hospitals would incur a loss if the capped prices were not revisited.

Lockdowns to battle the pandemic were difficult for everyone but governments failed to take into account how people from vulnerable communities would navigate the crisis.

The Delhi government’s negligent attitude further came to light when it was announced that only ‘bonafide residents of Delhi’ would be allowed admission for treatments.

Although the Order was withdrawn the following day, not only did the government, which is meant to care for its people directly, violate patient rights, Delhi being a migrant state, a good number of the population would have scrambled to access proper healthcare and treatments had this Order come into effect.

Overpricing by hospitals and labs, denying treatment to non-Covid patients, etc. were a few of the many violations of patient rights in Delhi. The most acute and widespread patient rights violations reported from across the country were denial of admission to patients citing various socio-economic and medical reasons.

There was no systematic communication from the government recognising these incidents or addressing them.

With many forms of patient and human rights violations comes the need for an efficient grievance redress mechanism. The Covid pandemic glaringly exposed the issues with India’s grievance redress system.

A user-friendly redress mechanism shows the State’s commitment to deeper democratisation of administration to ensure accountability, responsibility, efficiency and welfare.

Given the magnitude and multiplicity of rights violations during the pandemic in India, it was clear that a robust grievance redress system particularly dealing with Covid-related complaints was needed.

While all government institutions have grievance cells where citizens can lodge their complaints, the process of filing a complaint is rather ambiguous and not widely known.

The interface of the grievance redress portal is not very user-friendly. Sometimes grievances are disposed of with suggestions of approaching another department, sometimes they are sent back without closure to the complainants or the agency which forwarded the complaint.

The Union government informed the Parliament that, as of January 30, 2022, 70,102 cases of Adverse Event Following Immunisation (AEFI) related to Covid vaccination and 1,013 deaths were reported.

A total of 63,315 cases of AEFI were due to Covishield, 6,757 due to Covaxin, and 30 due to Sputnik. Of the 1,013 deaths, 921 were after the administration of Covishield and 92 after Covaxin.

During the pandemic, Uttar Pradesh witnessed forest officials burning standing crops and taking land away from forest dwellers.

The MoHFW issued two circulars related to vaccination. The notification issued by the MohFW on March 18, 2021 dealt with the increase in vaccination sites and the Oorder issued on April 5, 2021 dealt with vaccination timing and centres.

No notifications were issued on reporting adverse events following Covid vaccination and the mechanism to report adverse events was not publicised by the government.

Possible outcomes, such as thrombotic thrombocytopenia as a result of AstraZeneca vaccination were not mentioned by the government and Serum Institute of India which led to people making uninformed choices.

The DDMA issued two circulars related to vaccination. The Order issued by the DDMA on June 6, 2021 dealt with vaccination centres for Covaxin. The Order dated October 8, 2021 mandated government employees and others to get vaccinated.

While the Indian government boasted about the country’s mass vaccination drives, it is worth noting that transparency was lacking in information related to vaccination.

There were no notifications on reporting adverse events following vaccinations. The mechanism to report adverse events was not publicised by the government.

There were no circulars that dealt with the constitution of committees that would probe AEFI complaints. Upon filing two separate RTIs, months apart, it was found that 27 deaths had occurred following Covid vaccination.

Of these, seven had an indirect link with the vaccination. An autocratic vaccination programme was enforced, especially among vulnerable communities in a manner that they were forced to get vaccinated to access ration.

Others reported that officials would threaten people until and unless vaccination was taken, some said they were not certain what vaccination was given to them.

What does it tell us?

One has to note that the number of notifications does not imply the government’s preparedness but suggests the issues they focused on and how they addressed people’s concerns.

The nationwide lockdown was sprung upon the unsuspecting populace almost as if the government did not trust its citizens to behave well if given the time to prepare for it.

With no indication of something of this magnitude happening, the entire country panicked and was left clueless as to how to go about their lives during the lockdown. This quickly turned Covid, a public health crisis, into a socio-economic crisis.

While everyone rushed to take care of themselves and their families during the pandemic, the poor were left unattended and were made to fend for themselves by the government.

People were isolated, harassed, and ostracised and a moral justification was given every step of the way, claiming a section of people were ‘corona spreaders’, ‘lockdown breakers’, etc. Amidst these events, the government was busy governing in the form of diluting labour laws and the like.

During the pandemic, Uttar Pradesh witnessed forest officials burning standing crops and taking land away from forest dwellers. Whereas in Delhi, goods and carts of street vendors were seized. Rampant evictions took place and even when vendors were allowed to work, they were harassed by police and municipal authorities for running their business.

Despite these horrifying visuals from the ground, the government kept claiming that the situation was ‘normal’. The facts provided in this article show how ill-prepared the government was to handle the pandemic, despite them claiming otherwise.

The last decade of governance has normalised lies, claims and injustice with no place for truth, accountability and justice. 

Looking at the magnitude of the issues, several governments made efforts towards learning from the pandemic such as in the United Kingdom, where active steps have been taken towards learning from the pandemic by setting up a Covid inquiry named The Health and Social Care Committee and Science and Technology Committee and conducting public hearings. Similarly, New Zealand established a Royal Commission of Inquiry to engage in fact-finding and preventing future pandemics.

Here in India, we have a government mechanism deliberately bypassing all means of accountability.

Read the full report here. 

 Evita Das is a New Delhi-based researcher and practitioner. 

Akshara (pseudonym) is a communications curator and researcher associated with people’s inquiry committee process.