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The Financial Express

Covid pandemic: a case of failure of governance

| Updated: December 14, 2022 21:26:21


A health worker is pushing the jab to a school student in Dhaka in 2021. The decision to give vaccines free of charge was very helpful in vaccinating a large number of people in Bangladesh. 	—FE File Photo A health worker is pushing the jab to a school student in Dhaka in 2021. The decision to give vaccines free of charge was very helpful in vaccinating a large number of people in Bangladesh. —FE File Photo

Unarguably, the Covid-19 pandemic that ran amok for two years in untrammelled fury was a Black Swan, an unprecedented rare event with disastrous consequences for human lives and their livelihood across the world. It took a death toll of 6.6 million worldwide,  out of the total of 630 million infected as of November, 2022 (worldometer.com). Though globally the SARS-CoV-2 ( the technical name given to the pandemic) has  vastly diminished in scale after the application of vaccine shots, the virus, mutating stealthily, continues to  strike at random in various parts of the world, with varying degrees of severity. On December 2, 2022 only 12 cases of infections were reported in Bangladesh while, at the other end of the spectrum, the number was 71000 per day in China, till the end of November. While vaccines are being given as booster in countries like Bangladesh to sustain the immunity of people, China imposed total lockdown of entire cities across the length and breadth of the country in a desperate attempt at containing the spread of the virus through social distancing.

Dr Anthony Faucci, the celebrated American epidemiologist who incurred the wrath of former President Donald Trump with his candid remarks about the severity of the pandemic, has termed these measures taken by Chinese authorities as 'draconian'. The ruthless manner in which China has tried to stifle protests by large crowds for days together in cities under lockdowns evoked sharp criticisms from global leaders and western media. In the face of growing protests and civil disturbances within the country and bad publicity for the regime that these have engendered abroad, the Chinese authorities climbed down on December 2 from the harsh measures taken in pursuance of their zero-covid policy.  Whatever the 'easing of restrictions' announced may mean in practice, the very act of backpedalling by Chinese authorities indicate a sort of coming of age by the hitherto totalitarian state. It will, however, be an exaggerated hope, even an hubris, to see in this softening of attitude the first green shoot of democracy in the ironclad system or the initial stirring of liberalism in the mindset of its rulers. But the very decision to make some concessions to the demands of the protesting public is an acknowledgement of accountability to people. It is a significant step towards improving governance on the basis of people's consent and promising to promote public welfare as perceived by them. This is a landmark event, to say the least.

Capitulation by Chinese authorities to popular demand over Covid restrictions should not make countries with democracies cock-a- hoop, forgetting their own poor record of governance as starkly seen during the pandemic. Nor should the failure of governance at global level in monitoring the evolution of an epidemic into a pandemic be glossed over, making only China the scapegoat. It is unexceptionable that the incidence of pandemic and the havoc it wreaked in almost all countries for nearly two years was because of poor governance in the realm of public health at national and global levels. The World Health Organization (WHO) and all the national governments except Russia, China and Cuba ( all extant and past communist countries) miserably failed to prevent the Covid-19 virus from getting out of control and becoming  the grim reaper that it turned into, taking advantage of lack of preparations and inadequate  resources. When a post-mortem ( it may be premature now, with China making headlines) of the pandemic is made to find out where humanity was found wanting it cannot but be seen that  poor governance  was front and centre, before the beginning of the catastrophe and  many months after.

Among the institutions forged and established after the second world war to constitute a new world order  and governance of the same, the WHO is one, with its head quarters in Geneva and representative offices in almost all member countries (150), besides six regional offices. According to an official handout, it is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing the health trends in different countries. It is obvious that in respect of the subject of this column, the last is the most important and relevant and the discussion below concentrates on this.

According to the notification in its web site: 'On 30 January, 2020, WHO Director declared the Covid-19 outbreak a public health emergency of international concern. The declaration is WHO's highest level of alarm -- a rallying call to all countries to immediately take notice. The notification in the website continues on this issue and states. Around the world, people were hungry for clear, accurate and useful information. Starting with our first Disease Outbreak News at the beginning of January, WHO has met the demand, releasing over 200 daily situation reports, followed by nearly 40 weekly epidemiological and operational updates. WHO updates its Covid-19 dashboard daily to provide a real-time snapshot of the pandemic.'

The important matter to note here is the first appearance of the virus in infections and the time taken to provide information on this to all member countries by WHO. According to Chinese sources the virus infected people in Wuhan as early as November, 2019. There is thus a time gap of two months between this period and the date when WHO declared the outbreak of the disease as 'public health emergency of international concern'. President Trump was so annoyed with WHO for this delay that he accused the organisation of being complicit with China in suppressing the outbreak of the disease, his disenchantment leading to his subsequent decision to withdraw from the organisation. An impulsive move, no doubt but quite understandable, putting WHO on the mat. Equally serious is the delay by WHO in declaring the virus infections in a growing number of countries as a pandemic. The American news TV channel CNN beat WHO to this declaration, a delay that gave additional fodder to its critics and detractors.

Prof Adam Tooze of Columbia university has explained this 'failure'  by describing the unenviable situation in which WHO finds itself when faced with a public health crisis: for the two years 2018-2019 the WHO's approved program budget was no more than US$ 4.4 billion, less than that of a single big city hospital. The WHO's funding is cobbled together from  a hodgepodge of sources, including national governments, world Bank, private charities, and big pharma. Altogether, WHO can muster no more than 30 per cent per year in spending for every person in the planet. So, paucity of fund is a serious bottleneck for WHO's smooth functioning. It is the first obstacle to its practising 'good governance'. But a more serious problem of governance stems from the sources of funding itself-- conflict of interests. As Prof Tooze explains: "In its efforts to co ordinate a global public health response, it is caught between the fear of antagonising states by labelling them  as sources of infection, its professional desire to take early and decisive action, and the backlash it will face if it triggers what turn out to be costly and unnecessary limitations  on movement and trade".( Adam Tooze, Shutdown-- How Covid Shook the World Economy,2021). It is clear from this explanation that being hamstrung by political considerations WHO's record in 'governance' has not been exemplary, particularly when monitoring and reporting outbreak of virus infections like SARS, MERS and Covd-19. Added to the financial constraints and political compulsion is the built in inertia of a bureaucratic organisation that WHO is. It is small wonder that its performance before and in the early stages of Covid-19 pandemic left much to be desired, exposing it to widespread criticism. If the world community expects it to deliver to the maximum of its potential capacity, the handicaps under which it smarts should be minimised, if they cannot be removed altogether.

Coming to regional blocs of nations, the Covid pandemic showed that collective solidarity espoused in normal times fall apart in the face of emergencies when national interests trump over collective co-operation. European countries visited by the pandemic found themselves left alone by other member states of the European Union (EU) where national interests took precedence. Italy, the first among the EU countries to be overrun by the virus received no help from member states, either in terms of trained staff or equipments and medicines. In the initial stage of the pandemic individual countries jealously guarded whatever resources they had, ignoring the moral obligation to help the  more needful ones. This, too, was a failure of global governance, albeit an informal one.

CHINESE CASE: Coming to national level, the failure of governance by almost all countries in coping with the public health emergency posed by Covid pandemic becomes all the more glaring. In China, where the SARS-Covid-2 virus first appeared in November 2019 through infections of people in Wuhan city of Hubei province, the initial reaction of party officials was to ignore and then play it down when doctors reported the outbreak repeatedly. It was left to a doctor from Beijing to be alarmed enough, after a visit to Wuhan, to bring the matter to the notice of Chinese premier who in turn informed President XI. On January 2, President XI addressed a televised meeting organised by the State Council, calling the new virus to be taken seriously. The juggernaut of communist party was activated immediately, with provincial and local authorities taking unprecedented measures of lockdowns, social distancing, isolation of the infected and compulsory testing. While the entire city of Wuhan, the ground zero, and Hubei province were put under total lockdowns, people in other cities were required to observe social distancing and to wear masks in public. There were sporadic protests by members of the public over prolonged lockdowns and strict restrictions but these were put down without much publicity. On January 22, 202O the Chinese leadership opted for a countrywide  shutdown, and on January 25, 2020,  a publicly broadcast meeting of senior leaders in Beijing set the giant party-state machine into action, percolating down to local councils. On February 24, 2020, WHO hailed China's virus control efforts as an exemplary and declared that the moment of maximum danger had passed. Later, the outside world also acknowledged the success of Chinese government in containing the spread of the virus infection, attributing it to the power of an authoritarian state that does not care much for human rights. What was left unsaid because of oversight was the failure of the communist party authorities at local level to act promptly, either on their own or in consultation with higher ups in Beijing. The centralised decision making in a vast country like China inevitably entails delay which can be very costly, as it was in this instance. Rather than being a strength of an authoritarian state, this decision making process is also a hindrance to good governance. Moreover, not being accountable to the people and transparent, sudden decisions by the party, requiring immediate compliance, is liable to stoke public resentment, sometimes boiling over in open protests and demonstrations, as has been the case, mildly in 2020 and with vehemence in recent days.

As regards the recent lockdowns in almost all cities across China that have seen violent protests and at least 10 deaths, the reason why of all countries in the world China has faced a renewed outbreak of Covid virus infections after the pandemic has passed  the peak and flattened need to be discussed to find an answer. The dramatic fall in Covid-19 infections throughout the world has been due to the discovery of anti-viral vaccines  within one year of the outbreak of the pandemic, an unprecedented achievement of scientists. United Kingdom (UK)'s Oxford University, Russia, China, Pfizar pharma of America and a few others have been the pioneers in discovering the magic bullet of vaccines in record time. China, out of nationalistic feelings, has refused to use western vaccines and has exclusively relied on its own home-grown vaccines. Vaccines made in the west are based on the formula of mRNA which has proved to be very effective in immunising people. Chinese vaccines, on the other hand, use inactivated or killed virus as the main ingredient. According to Politico, a think tank, Chinese vaccines are not very effective in immunisation against Omicron and its sub-variants. In addition to this handicap, the rate of vaccination of people above 65 years, especially with underlying conditions, has been less than the national average. As recently reported by BBC, quoting China's National Health Commission,  59 per cent people in this age cohort were given one shot of Chinese vaccine. Only half of that age group got two shots of the vaccine and 20 per cent two shots plus a booster dose. Analysts think infections of this age group has been largely responsible for the recent surge in Covid-19  infections in China leading to prolonged lockdowns, strict social distancing, isolation,  quarantine and almost daily PCR testing, all of which, separately or singly, have given rise to public fury and violent protests all over  the country. It remains to be seen how the authorities balance the need to contain the spread of the virus and meet the demands for freedom of movement. It is, however, apparent that to the previous governance failure, through convoluted decision making, has been added the political factor of refusing to use more effective vaccines made in western laboratories. This short-sighted and narrowly nationalistic mindset of decision makers in China is also a failure of governance.

USA, UK & BANGLADESH: Among the democratic countries, America under President Trump stood apart in its government's outright denial of the pandemic in the beginning. Starting from February when the virus travelled across the country infecting more people, he pooh-poohed the idea of a new virus saying it was the normal seasonal flu. When forced to acknowledge it as a new and lethal virus he tried to demean it with the designation of 'Chinese virus', as if that sobriquet attenuated its virulence. A good deal of valuable time was thus lost in denial and inane rhetoric while the deadly virus continued to take its toll in human lives. With very little help coming from the Federal government, state governments struggled to cope with growing number of Covid patients. The hospitals with their limited staff and meagre resources found themselves struggling. Even elementary items like surgical masks, personal protective equipment (PPE) and oxygen cylinders were found in short supply, not to speak of ICU equipments. With hospitals running out of beds, playgrounds and gymnasiums were converted into makeshift hospitals, while the dead were dumped into mass graves unseen by near and dear ones. The utter lack of preparedness to cope with an emergency situation in a country like America came as a shock to many. It was significant that among the stricken and the dead the large majority were old and minorities, groups not at all or inadequately covered by health   insurance. Obama Health Care, a piece of legislation that would have brought more people under insurance, making health care affordable to the low income group  and the poor, was kept hanging in the balance by the Conservative legislators. The death toll in America resulting from the pandemic has been the highest in the world and this unenviable distinction earned by the richest country in the world can only be ascribed to indifferent governance by conservatives for whom a big role of government, even in an emergency, is an anathema.

In the UK with a more benign government policy towards public welfare, the handling of the health emergency arising from the pandemic should have been different. But shockingly, the UK was also found with its pants down, as unprepared to cope with the Covid virus as America. Like America, the same shortage of beds, medical staff, equipment for ICU, medical oxygen, masks and PPE were acute throughout the health system. The reason for this shortages can be found by the surreptitious erosion of the socialised health care system by incremental intrusion of market based hospital management that looks down upon unused resources, beds, equipments, staff, whatever. Had the NHS in its pristine form been allowed to exist, it would have risen to the occasion with much less stress and strain and most important of all, with less number of deaths.

In Bangladesh, the government did not at first take the pandemic with the seriousness that it deserved. The returnees from Italy, the most affected country in Europe, were not put in quarantines on arrival and allowed to go home with advice to observe home isolation. It was the height of naiveté to expect joyous returnees rejoining their families to observe home isolation. Many of them were already infected and soon after arrival they fell ill, spreading the infection among others.

To ensure social isolation,  at first a month long 'holiday' was declared which was taken literally by people, many of whom started going to rail stations, bus terminals and steamer ghats only to find that there was no transport available. In the absence of clear cut instructions about keeping indoors, people loitered around and made public spectacle of doing forced 'up and down' exercises, with hands touching both ears as penance for flouting social isolation or for forgetting to wear masks. For the first few weeks, the situation outdoors was simply chaotic. It was also pathetic as poor and low income people found themselves without money to buy essentials like food and medicine. The stimulus package, announced later, for the poor took time to reach their hands as there were formalities like enlisting of names to be completed. As regards patients with Covid infections, treatment in dedicated hospitals was costly and they faced the same shortages of basic items like medical oxygen, ICU equipments etc as in developed countries. Thousands of posts of doctors and nurses being vacant, government hospitals faced shortages of staff at a time when demand for their services soared. The sorry state of affairs in hospitals starkly revealed the weakness,  deficiencies and irregularities in the health care system. The pandemic also brought into sharp focus the Cinderella-like treatment meted out to health sector in annual budgets. In this otherwise gloomy atmosphere the only silver lining was the dedication of nurses and doctors who worked day and night for months together at the risk of their own lives. The short sightedness of the government's decision to buy vaccine from an Indian company through a local company in lieu of dividing the order for vaccines among a number of suppliers became apparent when the Indian supplier failed to deliver in time. Though vaccines were bought later from other sources the immunisation drive was delayed. But it must be said that the decision to give vaccines free of charge was very helpful in vaccinating a large number of people, many of whom would have remained uncovered.

END NOTE: To sum up, the governance of handling the Covid emergency has been a mixed one, with good, bad and moderate degrees at play in different stages of the pandemic. This holds true, more or less, of all countries irrespective of their political dispensation and economic standing. From this point of view, the pandemic has been a leveller.

 

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