The Asia-Pacific Journal | Japan Focus Volume 19 | Issue 1 | Number 3 | Article ID 5527 | Jan 01, 2021

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The Coronavirus Pandemic: India in Global Perspective

Ramesh Thakur, Deepak Nayyar

Abstract: This article analyzes the impactof the coronavirus epidemic in India afterfirst situating it in the wider internationalcontext. It begins with a global perspectiveon the spread of the pandemic thatcorrelates more with geography,demography and seasonality thanlockdown stringency and sequencing. Theresponses of governments have damagedeconomies, lost livelihoods, worsenedhealthcare-access and learning-outcomes,while curbing rights and freedoms ofcitizens. In India, the draconian lockdowndealt a crippling blow to the economywhich has hurt the poor badly but couldnot ‘flatten the curve’. The inadequate andinappropriate policy response has madethe task of economic recovery even moredifficult. Yet, the crisis also opens possibleopportunities for India to enhance itsglobal role and profile.

Keywords: Covid-19, India, lockdowns,lives, livelihoods, economic contraction,unemployment, immunities, liberties.

A novel coronavirus emerged from the wetmarkets of Wuhan China in late 2019 byhopping across from animals to humans.Initially endorsing Chinese official claims thatthere was no evidence of human-humantransmission, it wasn’t until 11 March 2020that the World Health Organization (WHO)declared a pandemic. The rest of the world atfirst thought this was a local problem for China,

and then was shocked at the brutality of thelockdown clamped on Wuhan by the authoritiesto quarantine the infection cluster. But soonthe virus caught the highways and byways ofglobalization to quickly encircle the world.Other countries realized their hospital systemscould be overwhelmed unless they flattened thecurve of the virus to drastically slow down thesurge of new infections. In particular, nocountry had the requisite number of beds in itsintensive care units (ICUs) to manage patientloads under worst-case scenarios. At this pointChina’s response began to be reinterpreted asbrutally effective, not just brutal, and perhapswor thy o f emula t ion because o f i t sdemonstrable success. This despite the factthat China’s claimed success based on officialfigures is highly implausible, as SebastianRushworth, a practising physician in aStockholm hospital, points out in one of hisexcellent blog posts (3 January).

The virus response spectrum has spanned fourpossible policy approaches: “let it rip” donothing; flatten the curve; communitysuppression that aims to stop person-persontransmission within a territorially demarcatedcommunity; and elimination. Belarus,Nicaragua and Tanzania may have gotten awaywith the f i rst , but no ser ious expertrecommends it. Elimination is not possibleeither, as it would require local, national andglobal eradication. Like other respiratoryinfections, coronaviruses keep circulating,albeit with progressively decreasing virulencein subsequent waves as part of the naturalevolution of the virus curve. In an average year,around 3mn people die of flu and pneumonia inthe world despite the availability of vaccines.Similarly, it is extremely unlikely we will ever

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get to a zero level of Covid risk. Instead, thekey question is to decide on the level we arewilling to accept relative to the damage done tosociety and the economy by mitigationstrategies. This is ultimately a politicalquestion, not one to be decided by healthbureaucrats and doctors. Dr. Mike Ryan, headof the WHO Emergencies Programme, at theyear’s final press conference on 28 December,said Covid-19 is likely to become endemic inthe global population. Vaccinations do notguarantee that infectious diseases will beeradicated. Instead, societies would do betterto focus on getting back to full strength, ratherthan on the “moonshot of eradication.”

Consequently, the responses of mostgovernments divide between the second andthird options. Social distancing is intended onlyto contain infection transmission, not suppressinfections and related fatalities. At some stage,however, many countries seemed to quietlyswitch from flattening the curve to protect thehealth system, to the more ambitious strategyof community suppression, which had theperverse if unintended effect of slowing theattainment of herd immunity; and even, as inthe case of New Zealand, move towarderadication by closing off the country until aneffective vaccine was available and actingaggressively to suppress any outbreak ofinfection in the community until then.

While this was successfully done in the case ofsmallpox, with a virus it may be a dangerouslydelusional ambition. In the early 1950s, anestimated 50mn cases of smallpox occurred inthe world each year, millions of whom died.Thanks to WHO’s initiative and efforts, it waseradicated by 1980 after an eleven-year effortat a total cost of around $300mn. Governmentsand people may be over-estimating the impactof the Covid-19 vaccines. Based on earlyreports, the Covid-19 vaccines approved formass manufacture will help to reduce theseverity of symptoms but may not save lives,guarantee immunity to infection or prevent

transmission. Their efficacy for subgroups,especially the elderly, is unknown, as is theirshort and long-term side effects.

“Herd immunity” – where “the chain ofcontagiousness toward the vulnerable” isbroken when enough of the population hasacquired immunity to an infection – is verycontroversial. An important part of theexplanation for the public distaste concerningthe concept of herd immunity lies in scientists’remoteness from the public relations nuancesof a technical term that they, the scientists,understand to be value neutral. To the generalpublic it carries connotations of relegatinghuman beings to the status of cattle. We willsubstitute “population immunity” to mean thesame. The pharmaceutical intervention route topopulation immunity is through vaccines whichis common and uncontroversial. Indeed,typically it is the ‘anti-vaxxers’ (people opposedto vaccinations) who are derided as sciencedeniers. The natural route to populationimmunity is through T-cell-based immunity andantibodies that could permit a gradual butcontrolled spread of the virus withoutoverwhelming the health system. The reasonmost governments shied away from the herdstrategy was the assumption that this requirestwo-thirds of the population to be infected.With the initial alarming fatality rates reportedfrom China, the horrific scale of lives thiswould have sacrificed was unacceptable.

However, more recently researchers havebegun to suggest that the immunity thresholdcould be much lower because fatality rates arelower than initially projected by the fear-generating models. Major news media –Guardian, BBC, New York Times – have finallybegun to take note. One team looked at humangenomic datasets for possible explanations forthe strikingly lower rates of Covid-19 infectionsand mortality in East Asia that has been thegeographic origin of several moderncoronavirus epidemics. Their results, publishedon 16 November 2020, suggest that ancient

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coronavirus-like epidemics drove adaptations inEast Asia between 25,000-5,000 years ago.

We believe, but do not develop the argumenthere, that the fate of this virus is going to bedetermined by two variables: what fraction ofthe population acquires immunity throughvaccination and infection, includingasymptomatic infection; and what proportion ofthe population already has some form ofresistance to it. Thus, in our view, allgovernments should respond to coronaviruswith effective risk management, instead ofreacting in panicked haste with misconceivedpolicies. With respect to India, we argue thatsaving lives and preserving livelihoods aresymbiotically entwined. Together they shapethe wellbeing of people and it is for thegovernment to reconcile these objectivesinstead of letting it be posed as a false either-orchoice. We further argue that the draconianand prolonged lockdown dealt a crippling blowto the Ind ian economy and p laced adisproportionate burden on the poor, while thegrossly inadequate response of the governmentto mitigate the harsh impacts on the people andthe economy has made the task of post-pandemic recovery even more difficult.

The Global Context

The focus of this article is on India. Beforediscussing India, however, it is useful tosummarize the global context of Covid-19 witheight observations.

Figure 1: Population and Covid-19 casesand deaths by continent (percent of world,

1 Jan. 2021)

First, the geographic spread of the virus hasbeen strikingly uneven among continents(Figure 1) and even within them. Oceania andAfrica were the most lightly affected. Australiaand South Africa, the worst hit in the tworegions respectively, have just 35 and 489deaths per million people (DPM, figures as of 3January 2021). Only 7 of the 57 Africancountries have a mortality rate of over 100DPM. Western Europe and the Americas werethe most severely impacted. The chart,following UN regional groupings, includesCentral Asia and the Middle East in Asia, whichdistorts the latter’s overall statistics. Forexample, eight countries (Armenia, Georgia,Iran, Iraq, Israel, Jordan, Oman, Palestine) haveon average 516 DPM. In Asia minus the MiddleEast, India and the Philippines suffered themost, but still with lowly 108 and 84 againstthe world average of 236 DPM. Even on itsown, before looking at the impact of lockdownmeasures, this already indicates the folly ofgeneralizing across countries and continents.Instead, it is better to look at the specificcircumstances of each country. In Oceania,Australia’s low toll, for example, might bebetter explained by its geographical location,physical isolation, vast open spaces, low densityliving, few multigenerational households, high

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use of private cars instead of mass transit, andsociocultural practices.

Second, the cascading lockdown measuresimposed across Europe and the Americas werea radical, even experimental, departure fromthe existing orthodoxy. Until 2020, the officialWHO position was contained in an 85-pagereport in October 2019. I t prov idedrecommendations for the use of non-pharmaceutical interventions (NPIs) in futureinfluenza epidemics and pandemics “based onexisting guidance documents and the latestscientific literature.” NPIs recommended fordealing with pandemics included hand hygiene,respiratory etiquette (such as covering coughsand sneezes, using tissues and then throwingthem away), face masks for symptomaticindividuals, surface and object cleaning,increased ventilation, isolation of sickindividuals, travel advice, avoidance ofcrowding, and, for a pandemic of exceptionalseverity, workplace measures and closures andinternal travel restrictions. By contrast, borderscreenings and closures, entry and exitscreenings, quarantine of exposed individuals,and contact tracing (and, for epidemics, eveninternal travel restrictions), were notrecommended in any circumstances (p. 3, Table1).

There were two reasons for the scepticism. Forone, “sufficient evidence” exists to showineffectiveness of entry and exit screening; and“weak evidence” that travel restrictions maydelay the introduction of infections onlytemporarily and can adversely affect mitigationprograms and disrupt supply chains, whileborder closures may work for small islandnations in severe cases “but must be weighedagainst potential ly serious economicconsequences.” For another, “social distancingmeasures… can be highly disruptive, and thecost of these measures must be weighedagainst their potential impact.” The 2019 WHOconsensus report was foreshadowed in a 2006study by a team led by Thomas Inglesby,

Director of Johns Hopkins’ Bloomberg School ofPublic Health. The final paragraph of thatpaper concluded with this “overridingprinciple”: “Experience has shown thatcommunities faced with epidemics... respondbest and with the least anxiety when thenormal social functioning of the community isleast disrupted.”

What happened to overturn the existingconsensus? It was certainly not new science.There simply was no time to conduct rigorousnew studies following standard procedures,randomized clinical trials and peer reviewedpublications on the emergence, growth, curve,and retreat of the virus, let alone the bestmitigation and suppression measures to fight it.Mortality rate is the frequency of deaths withina time period relative to the size of a well-defined population: DPM is a standard metric.An infection fatality rate (IFR) is defined as theproportion of deaths relative to the prevalenceof infections within a population. IFRs fromsamples across the population includeundiagnosed, asymptomatic, and mildinfections. A case fatality rate (CFR), basedexclusively on relatively smaller groups ofmoderately to severely ill diagnosed cases atthe beginning of an outbreak, is defined as theproportion of deaths among confirmed cases ofthe disease. In the US, says Dr Ronald Brown ina peer-reviewed article, “due to misclassifyingan IFR as a CFR, the comparison turned out tobe between an adjusted coronavirus CFR of 1%and an in f luenza IFR o f 0 .1%.” Notsurprisingly, the prospect of a new disease tentimes as deadly as the average flu was alarmingand led to a cascade of disproportionateresponses.

This begs the question: have the peoples of theworld been subjected to an unethicalexperiment in contravention of the science?Before implementing mitigation measures thatincur severe costs, the onus is on proponents toformally reject the null hypothesis by justifyingclaims of life-saving benefits. Yet lockdowns

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and other mit igat ion measures wereimplemented with minimal supportingevidence. For example, Abiel Sebhatu et al.concluded that OECD countries essentiallymimicked one another’s Covid-19 restrictivepolicies: a clear demonstration of herdbehaviour by governments. Either the WHOguidance was not based in science and theepidemiologists have access to better scientificknowledge, in which case the public needs toknow the basis of their confidence over that ofthe existing WHO advice at the start of thepandemic. Or else the existing science behindthe 2019 advice was sound, in which case theclosures privileged abstract mathematicalmodelling over actual science based onobservational data and medical scholarship.

Third, rather than scientific consensus, there’sconsiderable uncertainty. The coronavirusscience has been unsettled and vigorouslycontested regarding infectiousness, lethality,transmissibility, and the effectiveness ofvarious forms of preventive practices, NPIs andpharmaceutical interventions. Should schoolsbe closed? Should masks be universallymanda ted? Shou ld i ve rmec t in andhydroxychloroquine be prescribed or prohibitedto treat the disease? Perhaps most critically,should the overriding strategy be to do nothing,or to aim for flattening the curve, stopcommunity transmission, or eradicate thevirus? In these circumstances, reasoneddiscussion of all options should be welcomedand facilitated. As a thoughtful letter to theBritish Medical Journal on 21 September fromRaj Bhopal, emeritus professor of public healthat Edinburgh University, put it, silencing andremoving sceptical and contrarian voices fromthe public space “is irresponsible at this time ofglobal crisis.”

To take but one example, the science on facemasks can be looked at for cloth/gauze versusmedical/surgical masks, healthcare workersand general populations, open spaces andclosed settings, sick and healthy people, and

laboratory experiments and randomizedcontrolled trials. In communitarian-mindedEast Asia, non-surgical masks are mostly usedby the sick to avoid infecting others, not by theh e a l t h y a s a p r o p h y l a c t i c . O x f o r dUniversity’s Centre for Evidence-BasedMedicine notes that “despite two decades ofpandemic preparedness, there is considerableuncertainty as to the value of wearing masks.”Dr Andrea Ammon, Director of the EuropeanCentre for Disease Prevention and Control,holds that wearing masks has limited utility inrestricting the spread of coronavirus, on theone hand, and could pose a potential healthhazard, on the other, if it leads to complacencywhere people think it protects them enough toignore personal hygiene and physicaldistancing.

India’s Home Minister Amit Shah at aparty rally in Midnapore, West Bengal on

19 December 2020.

In the photo, of those who are clearlyvisible, three are wearing masks properly,three have it down around their neck, andthree are completely mask-free, includingShah who has already had Covid. Not one

of them is bothering with physicaldistancing.

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Data from the Centers for Disease Control andPrevention (CDC) showed 71% of Americans“always” and 14% “often” wore a mask in thefortnight before the onset of Covid illness. TheCDC evidence is powerfully buttressed byobservational data showing that in countryafter country and in US states, caseloadssurged in autumn despite universal maskmandates – and did not surge as sharply inDenmark, Norway and Sweden, which did notmandate masks. A large Danish study in theAnnals of Internal Medicine reconfirmed thatmasks do not protect healthy people from beinginfected, as attested to earlier in the year byboth the WHO and the CDC in the US.According to an article in the New EnglandJournal of Medicine in May 2020, wearingmasks “outside health care facilities offerslittle, if any, protection from infection... Inmany cases, the desire for widespread maskingis a reflexive reaction to anxiety over thepandemic.”

Scientists disagree over the reliability of testsfor determining Covid cases. There is not evenan agreed methodology for counting Covid-19deaths, producing variable reliability ofstatistics from different countries that are nota lways measur ing the same thing. Areadjustment of the official methodology in theUK revised the total death downwards by asubstantial 10% in August. In Italy, one studyestimated that only 12% of attributed deathswere caused by Covid-19. The CDC estimatedthat until 30 December, only 6% of all USdeaths recorded as involving Covid-19 was ofpeople without any existing comorbidity. Forthe other 94%, “on average, there were 2.9additional conditions or causes per death.” InAustralia, Epidemiology Report 22 recordedonly 9% with no comorbidity in hospitaladmissions for the fortnight ending 2 August.This adds grist to the controversy mill overdying of or with Covid. Thus, we do not know ifthe vast majority or tiny fraction of ‘Covid’deaths are from the virus. The impossibledistinction distracts from a deeper reality.

Across all age groups, the ‘marginal’ risk ofdeath caused by Covid is small (see the age-segregated survival rates from the CDC givenbelow).

Fourth, by now it is clear that there is no hardevidence to prove the effectiveness oflockdowns and several reasons to question it.The trigger for the lockdown measures was theImperial College London (ICL) model of 16March which predicted up to 510,000 UK and2.2mn US deaths in “an unmitigated epidemic”(p. 7). The model described Covid-19 as “avirus with comparable lethality to H1N1influenza in 1918” (the Spanish flu). Itsassumption was that without intervention, 80%of the people would be infected and the IFRwas 0.9%. In a subsequent interview leadauthor Neil Ferguson clarified that based oninformation “gathered in recent weeks... it hasbecome increasingly clear that actually this isnot the reasonable worst case, it is the mostlikely scenario.” The ICL model has beenproven just as spectacularly wrong in its best-case scenario of a maximum of 20,000 UKdeaths over two years with school anduniversity closures, case isolation and socialdistancing, going down to 15,000 with homequarantine thrown into the mix as well (p. 14);the actual number of Covid-related deaths inthe UK was already over 70,000 by the end of2020. Similarly, responding to Nicholas Kristofof the NY Times (20 March), Fergusonpredicted a best-case scenario of 1.1mn USdeaths (against his model’s worst-case estimateof 2.2mn deaths).

There are strongly divergent views amongsoftware engineers, epidemiologists, medicalscientists, physicists, chemists, andstatisticians over the quality, reliability andpredictive utility of the ICL model. Severalmedical-scientific-epidemiological expertsquestioned the mass hysteria and the panickyresponses but were ignored, even though panicproduces bad public policy. Sweden’s chiefepidemiologist Anders Tegnell noted that

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shutting down and locking down have no“historical scientific basis.” John Ioannidis, oneof the world’s most cited scientists, called theexisting data on coronavirus infections “utterlyunreliable” and dismissed much of the earlyepidemiological modelling as “speculation andscience fiction” that had fed a “mob mentality.”In a meta-analysis published in the WHOBulletin on 15 October, Ioannidis found themedian overall IFR is 0.23%, but low and highmortality countries have IFR of 0.09% and0.57%. For people under 75 it’s 0.05%. Theglobal coronavirus IFR is thus broadlycomparable to that of flu overall, significantlylower for most of the working age population,and close to insignificant for schoolchildren.School closures cause great harm for zerohealth gain for children or even the teachers.The BBC reported (28 August) on a large UKstudy that not one otherwise healthy under-19child had died of Covid-19. The Guardianreported (20 October) worr ies f romgovernment scientific advisers that schoolclosures would leave children “scarred for life.”The story is similar in the US, said the NYTimes (22 October) and its columnist NicholasKristof (18 November).

Yet, policy invariance has not reflected thehighly age-segregated deadliness of thedisease, despite the recommendations of theGreat Barrington Declaration for “focussedprotection” that had been signed by nearly52,000 doctors and public health scientists andover 700,000 concerned citizens from aroundthe world by year’s end. Every one of the top

ten countries by Covid DPM (Table 1) hasinstituted lockdown measures. According to astudy in EClinical Medicine published byLancet: “Rapid border closures, full lockdowns,and wide-spread testing were not associatedwith Covid-19 mortality per million people.”However, “Increasing Covid-19 caseloads wereassociated with countries with higher obesity”and higher “median population age.” On USstates, another study offered two conclusions:lockdowns didn’t help to contain the spread ofthe virus and opening up didn’t hurt.Confirming that, in late December a regressionanalysis calculated the coefficient ofdetermination (R2) between NPIs and DPM tobe 0.003 for the 50 US states plus DC, meaningthat variance in NPIs has zero explanatoryutility for explaining their variance in DPM.

The lack of covariance might provide an answerto this attention-grabbing headline fromPolitico on 23 December: “Locked-downCalifornia runs out of reasons for surprisingsurge.” Despite “some of the toughestrestrictions,” California had become “one of thenation's worst epicenters for the disease,setting new records for cases, hospitalizationsand deaths.” This “has confounded leaders andhealth experts,” Victoria Colliver wrote. AsRoger Koops says: ‘Stopping humans frombeing human will not stop the virus from beinga virus!’ They should consider the possibilitythat the whole approach is flawed and theGreat Barrington Declaration’s alternativeapproach, of shielding those most at risk whileencouraging the rest to get on with their liveswith sensible individual precautions, makesmore sense. Meanwhile in San Francisco, 621people died of overdose in 2020 compared to173 with Covid-19.

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Figure 2: Stringency Indices and Covid-19DPM of Ten Selected Countries

Forget causality; there’s not even a clearcorrelation in either direction. Countries thatlocked down hard and those that did not havewidely varying mortality rates. Figure 2 mapsthe stringency index of ten selected countries.As the text below the chart notes, the five withthe tougher lockdowns for prolonged periodshave significantly higher DPM than the fivewith softer mitigation measures. In Europe andthe Americas, outcomes invariance can be seenalongside a diverse array of policy responses.All this explains why Mark Woolhouse,professor of infectious disease epidemiology atthe University of Edinburgh and a scientificadviser to PM Boris Johnson, said on 23August: “Lockdown was a panic measure and Ibelieve history will say trying to controlCovid-19 through lockdown was a monumentalmistake on a global scale, the cure was worsethan the disease.” Bhopal warns that “strikingfear into the minds of the people or punishingthem... is not advocated in any public healthstrategy or international approaches tocontrolling the pandemic.”

Fifth, it is abundantly clear that whilecoronavirus is indeed highly infectious, it’s notvery lethal. The most common symptom is nosymptoms at all, including 60% of new cases inChina. As at 2 January 2021, the total number

of cases in the world was over 84mn and 1.8mnpeople had died of Covid-related illness. Of61.5mn closed cases, 3% had died. Of 22.8mnactive cases, 99.5% were described as “mild”and only 0.5% as “serious or critical.” That is,it’s so vicious that millions must be tested toknow if they’ve had it. The CDC figures for age-segregated IFR published on 10 Septembershow that for those infected with coronavirusaged 0-19, the survival rate is 99.997%; 20-49,99.98; 50-69, 99.5; and 70+, 94.6%. At around80 years old, the average of Covid-relateddeath is near and often above the national lifeexpectancy. Not surprisingly then, Covid-19accounted for less than 3% of all causes ofglobal deaths in 2020, and even this is whenincluding everyone who has died with the virusas having died from it (Figure 3). In otherwords, the lockdown interventions representthe biggest triumph of the Henny Pennys (orChicken Littles) of the world in human history.

Source

Sixth, the massive toll in other healthoutcomes, damaged economies, lost livelihoods,curtailment of human rights and civil liberties

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became clearer with each passing month.“Flattening the epidemic curve” came at thecost of flattening economies. A spate of reportsfrom multiple intergovernmental, private sectorand civil society sources warned of dramaticdecelerations and contractions in GDP andtrade from the pre-pandemic forecasts, with aresulting ballooning of poverty. In developingcountries, the disruptions to national andglobal economic activities could reversedecades of progress for tens of millions on lifeexpectancy, hunger alleviation, infant andmaternal mortality, immunization andeducational outcomes, child labour and sextrafficking, female emancipation from forcedearly marriages, and human dignity. Hence theconclusion from a Canadian medicalpractitioner: “If lockdowns were a prescriptiondrug for Covid-19 treatment, the FDA wouldnever have approved it.”

The 6-12% range for Covid-19 deaths withoutcomorbidity (see above) means there never wasany justification for turning a national healthservice into a national coronavirus-only service.Multiple reports documented the immediateand likely long-term economic harm caused bylockdowns; the risks of deferring consultations,screenings and surgery for other medicalconditions; the impact of fear, enforcedisolation, anger, frustration, financial loss andunemployment on mental health; and the addedrisk of domestic violence. Drs. Jay Bhattacharya(Stanford), Sunetra Gupta (Oxford), CarlHeneghan (Oxford) and Martin Kulldorff(Harvard) operate a useful website calledCollateral Global as a global repository forresearch into the collateral effects of theCovid-19 lockdown measures on mental health,physical health, social health, education andthe economy.

Seventh, in earlier epidemics (when scaled upto today’s global population, Asian Flu 1956–58killed 3mn people; Hong Kong Flu 1968, 2.2mn;HIV/AIDS has killed upwards of 25mn since1981), the numbers infected and killed were

sufficient to produce a severe impact onsociety. But catastrophism on some previousepidemics proved false. In 1999, Europeanscientists suggested up to 500,000 people coulddie from the UK mad cow disease. By October2013, 177 deaths were recorded from thedisease. In 2005, the UN’s coordinator DavidNabarro warned between 5mn-150mn peoplecould die from avian flu; WHO official estimateswere 2mn–7.4mn. Only 455 people died of birdflu from 2003–2019. With the 2009 swine flu,instead of the feared 1.3% IFR, the actual ratewas 0.02%, comparable to the US 2007–09seasonal flus. In the UK, where the IFR was0.026%, against the “reasonable worst-casescenario” of 65,000 deaths, there were only457. The panicked government spent £1.2bn onflu remedies that were not needed. The WHOcame under severe criticism for having servedthe interests of “Big Pharma” in sellingunnecessary vaccines. The total worldwidedeaths was about 280,000.

In all the previous deadly pandemic episodes,governments didn’t shut down their country,destroy the economy and jeopardize their wayof life. People suffered but endured. This tooshall pass. Walter Scheidel reminds us, in anessay in Foreign Affairs, that the ICL model’shyperbole notwithstanding, SARS-CoV-2 isnowhere near as lethal as the Spanish flu thatkilled the fit and young as virulently as it didthe elderly and infirm. It infected 500mnpeople (one-third the world’s population at thetime) and killed around 50mn. Scaled up to theglobal population in 2020, that would translateto around 200mn-250mn dead today. Theerosion of liberal democratic freedoms andsense of community and fellowship is anothercomponent of the trade-off equation. Humanbeings are family- and community-orientedsocial animals. Sharing food and drink at homeor in restaurants, enjoying the cinema,watching football or cricket, appreciating aconcert or a play are not optional add-ons butfundamental to our daily life as human beings.“Social distancing” by contrast is profoundly

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anti-social and rubs against every fibre ofhuman civilization. From everything we nowknow, the elderly should be free to meet, greetand hug grandchildren under 10 to bring backjoy and cheer to the l ives of al l threegenerations of a family. On 21 October, despitea modest rise in Covid cases, Sweden lifted allremaining restrictions on over-70s. Thejustification was not economic but emotionalhealth. Health Minister Lena Hallengrenexplained: “We cannot only think aboutinfection control, we also need to think aboutpublic health.” Months of social isolation hadmeant loneliness and misery and a “decline inmental health likely to worsen the longer therecommendations remain in place.”

Finally, Japan, South Korea and Taiwan haveshown how democracies can manageepidemiological crises without rupturingsociety or sacrificing the economy: if you aresick, stay home if you can but if you must goout, wear masks in crowded settings and avoidphysical touching and proximity; the East Asianbow and Indian ‘Namaste’ are simple, elegant,cordial yet respectful alternatives to theubiquitous handshake; wash or sanitize handsfrequently; check temperatures at airports,seaports and on entry into crowded areas liketrain stations, office complexes and malls; testthose with elevated temperatures; hospitalizeserious cases and quarantine those withsymptoms at home with random inspections toensure compliance; and trace and isolate thosewith whom they have been in contact.

The Pandemic in India

The survey of the global landscape on thespread and virulence of the coronaviruspandemic and the range of interventions bygovernments underscores the importance ofstriking a balance between health, social, andeconomic policies, as well as individualfreedoms for citizens, in all their dimensions.The risk of creating mass hysteria and panic

with exaggerated reporting must be set againstthe risk of losing control by delaying publicannouncements of the true scale, gravity andurgency of a nascent epidemiologicalemergency. A government must settle on theoptimal balance between sufficiently slowingthe disease, preventing an economic meltdownand maintaining a functioning society, whilethe threat and responses evolve and the virusspreads. It is our contention that in India, PMNarendra Modi went into a lockdown far tooearly and much too hard. It was imposedwithout adequate thinking about preparationsrelating to logistics and health infrastructure,and without any planning of implementationwhich cou ld have been se lec t i ve ingeographical space and sequential in time.Such an approach caused unnecessarily brutalhardships that could have been softened with amore calibrated and targeted range ofinterventions.

As of 2 January 2021, India’s total number ofcoronavirus cases was over 10mn and deathstotalled 149,205. While this is the second andthird highest in the world after the US andBrazil, in the context of India’s massivepopulation and exceptionally high prevalence ofmany deadly illnesses, Covid-19 accounted foronly 1.6% of the 9mn all-causes annualmortality in the country. Moreover, in line withglobal experience, 69% in India wereasymptomatic in one survey conducted by theIndian Council of Medical Research.

However, India’s Covid-19 experience isanomalous in the global context for threereasons. First, its DPM is substantially belowthat of the Western countries and the worldaverage (Table 1), but higher than both theAsian and South Asian averages. Although itsmortality rate was only 103 DPM, the averageDPM o f i t s South As ian ne ighbours(Afghanistan, Bangladesh, Bhutan, Nepal,Pakistan, Sri Lanka) was just 41; and of EastAsia (China, Hong Kong, Japan, Mongolia,South Korea, Taiwan) was under 5 (14

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December 2020 figures). India’s real toll mighteven be higher. China is not the only countrywith question marks over the reliability of theirCovid data. According to a BBC report, some ofIndia’s states are undercounting Covid deaths,attributing them instead to comorbidities;others have weak health surveillance systems.There are reports of discrepancies betweenofficial tolls and counts from crematoria andburial grounds. The vast majority of Indians dieat home, with last rites performed by thefamily. The fear generated by the alarmismaround coronavirus has led to heavystigmatization. Doctors and young Muslimshave been refused burial for fear of beingcontagious. Families could be reluctant to takesick members for testing and hospitalization.Many who succumbed might be cremated orburied quietly, to avoid social stigma andostracism.

Second, in the typical seasonally fluctuatingmortality curve of the worst-affected Europeancountries like Belgium (Figure 4), deaths roseexponentially in the first month, then fellsharply although not quite as steeply over thenext two months, remained flat through to theend of September and climbed steeply again inautumn. Nobel Laureate Michael Levittpostulated a “self-flattening curve.” Indo-British Oxford Professor of TheoreticalEpidemiology Sunetra Gupta observed thatrates of infection and mortality were strikinglysimilar across countries with differentlockdown policies: they grew, stopped, turnedaround and retreated “almost like clockwork.”Europe and the US seem to offer more supportfor this thesis than for the original modellingthat predicted indefinite exponential growthwithout stringent control measures. By contrastIndia’s curve shows an initially slow and then asteady rise through to the end of Septemberfollowed by a slow descent, with little visiblecorrelation with the stringency index line thatbegan with 100 (maximum mitigationmeasures) on 25 March (Figure 4). There islittle evidence of self-flattening.

Figure 4: India stringency index and dailynew deaths; Belgium daily new deaths

Sources: 1, 2, 3

And third, other countries locked down,watched their cases and deaths fall right down,and only then eased restrictions before re-imposing some measures again for the “secondwave” in September. The discrepancy betweenthe spike in infections amid a fatalities plateauseen across Europe and the US in autumn wasstriking, although Germany seems to be farworse in the autumn compared to the spring.The rise in infection numbers could be anartefact of increased testing, high false positive

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rates in testing, with ultra-sensitive testingpossibly picking up fragments of dead virusfrom old infections. Or it might indicateimproved treatment protocols and procedures,or even that perhaps population immunity hasbeen achieved in some countries.

Although many now accept we may have tolearn to live with the virus, epidemiologists,medical scientists and public health expertsremain sharply divided over “herd immunity.”While the dominant assumption has been thatthe threshold for population immunity is60-67% [based on the formula HIT(%)=(1-1/R)x100, where HIT is the herd immunitythreshold and R is the average number of otherpeople that one infected person infects and isassumed to be 2.5-3.0], some now suggest incertain areas it could be just 20%-25%, possiblyeven lower. The complexities of real lifeshowed clearly that some people are moreinfectious and more vulnerable to coronavirusthan others, while an unknown but significantproportion are asymptomatic. As the highlysusceptible and vulnerable get depleted in theini t ia l wave, the spread of the v irusdecelerates. The spikes of the initial wave ofinfections are unlikely to be repeated insubsequent waves as the susceptible-vulnerablepopulation has decreased. Also, even if ourimmunity weakens and fades and cannotprevent us from getting infected again, it maystill reduce the severity of the disease, whichitself could become less deadly in successiveiterations. One study showed the infection ratein Mumbai slums was 57%, compared to 16% inother areas of the city. That is not surprising,because the slums lacked commensuratefatalities and physical distancing in crowdedspaces was almost impossible. The fact that asubstantially lower proportion of infectedpeople were dying with Covid in the slums thanelsewhere suggests that the threshold forachieving population (herd) immunity throughinfection might well have been significantlylower in the Mumbai slums.

India imposed total nationwide lockdown with astringency index of 100 (Figure 3) on fourhours’ notice on 25 March, without anyadvance logistical preparation to manage theconsequences. The graphic emblems of India’sharsh lockdown included shuttered stores;deserted schools and universities; closedplaygrounds and parks; beaches withoutpeople; empty markets; silent houses ofworship; bankrupt businesses; and millions ofmigrant daily-wage labourers trekking homeover hundreds of kilometres.

The harsh lockdown, at such short notice,created a humanitarian crisis of enormousproportions. The plight of migrant workers inurban India – construction workers, streetvendors, restaurant employees, deliverypersons, domestic workers, rickshaw driversand so on – was grim. Deprived of their workand dignity, uncertain about where their nextmeal would come from, stranded in megacities,in search of night shelters and open kitchensrun by state governments or charities, most ofthem were desperate to return to their homevillages. But there were no buses or trains inthe lockdown. Inter-state movements of peoplewere prohibited. Yet, thousands of migrants setout on foot, carrying their children, to walkhundreds of miles, braving the sun, theirhunger and the police. It was only two monthslater, when such a humanitarian crisis could nolonger be ignored, that the government allowedspecial trains and buses to take the strandedmigrants home.

The lockdown was meant to end on 14 April,but was extended three times until 3, 17 and 31May. The unlocking process started hesitantlyaround 8 June. In substance, however, thenear-complete lockdown continued until end-June, as several state governments continuedthe lockdown, while the embargos were liftedvery slowly elsewhere. Some restrictions werelifted on 1 July but the lockdown continued tobe stringent on the movement of people and inmany other respects. Further relaxations and

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lifting of restrictions have continued to beannounced on the 1st of each month since then.But schools, colleges, and other educationalinstitutions remain closed. Cinemas, theatres,gyms, entertainment places and bars have beenallowed to reopen but with restrictions toensure physical distancing, so that business isfar from normal. Public transport systems incities have restarted but both frequency anduse are far lower than before the pandemic.Passenger trains and domestic flights, too, areskeleton services compared with the past.International travel remains highly restricted toa few point-to-point bubble-flights. Theeconomy that had almost shut down has begunto limp forward, but it will be quite some timebefore it can walk let alone run or hum withactivity.

Figure 5: India’s leading causes of deaths2020

Source

Yet among India’s biggest killers, Covid ranks12th, well behind heart diseases, lung diseases,tuberculosis, diabetes, and traffic accidents(Figure 5). Of the 139,123 suicides in India in2019, daily wage earners (25% of theworkforce) numbered 32,563 (23.4%), risingsteadily each year to double from 12% in 2014.The unemployed made up another 10.1%. With

preliminary estimates of suicides already atover 200,000 by 12 December, we shudder tothink what the final 2020 numbers will be.More importantly, it makes no sense tointervene to combat Covid with policymeasures that increase the deaths fromsuicides that are already 43% higher than thecoronavirus toll and at risk of almost doublingfrom 2019.

India has plummeted from the world’s fastestgrowing major economy to the fastestshrinking. Its GDP contracted by 23.9% for theApril–June 2020 quarter, and by 7.5% in theJuly–September quarter. Even if the next twoquarters are better, projections suggest thatGDP will contract by about 10% in 2020–21:among the sharpest contractions in the world.

The harsh lockdown smashed the economy. Yet,migrant labourers, driven out of many cities,spread the disease deep into India’s villageheartland when they returned home. India gotthe worst of both worlds and is yet to recoveron either the disease or the economy front. Itshousing, water and sanitation realities are anightmare for any epidemic that is both highlyinfectious and lethal. Physical distancing isimpossible in slums where generations offamilies sleep in one room, eat together andshare communal water and sanitation facilities.The situation in villages differs only slightly onthe physical spread of housing.

The biggest killer in today’s world is not anyone disease or a pandemic, but poverty. Thehealth of most people is vitally dependent on ahealthy economy that gives the government thefinancial muscle to create an efficientuniversal-access public health infrastructure.The world’s bottom billion subsist in aHobbesian state of nature where life is “nasty,brutish and short.” The human and economiccosts of coronavirus wil l be far moredevastating with low state capacity, weakh e a l t h s y s t e m s , t e e m i n g s l u m s ,multigenerational housing, unclean water and

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sanitation systems, congested mass transit, andinadequate safety nets. The killer ailments thatare taking the heaviest toll are water-borneinfectious diseases, nutritional deficiencies andneonatal and maternal complications. FewWesterners realize that the biggest death tolleven from the 1918 pandemic – between one-fourth to one-third of the world total – was inIndia.

The Indian government’s relief packages weretoo little and too late. For example, the packageannounced on 12 May was insufficient toalleviate the distress in the agricultural,airlines, automobiles, hotels, restaurants andtourism sectors. Nor was it much help to thepoor and migrants in shielding them from theharsh realities of hunger without jobs, incomes,shelter or dignity. The economy was flattenedby the contraction of output on the supply sideand contraction of employment on the demandside. But government measures have focussedon the supply side while neglecting the demandside. This showed a flawed understanding ofeconomies in crisis and little recognition of thereality when a prolonged lockdown has broughtthe economy to the edge of collapse. Withoutexpansionary macroeconomic policies, there isa serious risk that the economy will go into afree-fall. In that case, the shortfalls in publicrevenues would cause the fiscal deficit toballoon without any hope of recovery. Survivalthrough the crisis was essential for the returnboth of poor households and small firms toeconomic act iv i t ies . The short - termstabilization focus should have been onhouseholds on the demand side and firms onthe supply side. In the absence of suchcorrectives, recovery, whenever it begins, ismost likely to be K-shaped, in which things getbetter only for a small proportion of thepopulation (comfort for the rich) but remainunchanged or get worse for most people(hardship for the poor).

Thus, the lockdown has produced its ownsocioeconomic version of Thucydides’

geopolitical dictum that the strong do whatthey can, the weak suffer as they must. Thevirus carriers were the wealthy, but the poorbore the burden. The privileged jet-setters whoimported the virus could work remotely fromhome and utilize the private hospitals. But thepoor they infected, who depend on daily wagesfrom manual labour and have little access todecent healthcare, were disproportionatelydevastated. The lockdown shuttered almosttwo-thirds of the economy. It stranded 25-30mnmigrants in cities far away from their homes,deprived of their work and dignity, at themercy of food and shelter provided by stategovernments or charities, often hungry andhomeless, creating an unprecedentedhumanitarian crisis. Manufacturing, mining,construction, trade, hotels and restaurants, andtransport, which account for more than 40% ofboth output and employment, were shut downcompletely. Thus, 150mn people, as much asone-third of the total workforce, who are casuallabour on daily wages or workers in informalemployment without any social protection,were deprived of their livelihoods. Much of thisburden was borne by the poor, often self-employed, who constitute 75% and 50% of ruraland urban households respectively. The impacton micro, small and medium enterprises, whichaccount for 32% of output and 24% ofemployment in India, was devastating.Healthcare for patients, except for those withCovid-19, diminished sharply in terms of bothaccess and quality. In education, learningoutcomes, which are already poor, are bound toget worse with school and university closures.

Like most strongmen, Modi has prioritized theexpansion and consolidation of state powerover the development of state capacity. India’seconomic slowdown began long before thepandemic hit and there was little to cushion itfrom the lockdown’s harsh impact. The neglectof urgently needed economic and governancereforms in order to pursue a religious agendaleft the country exposed to the exogenousshock. Democratic India used brutal tactics to

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enforce one of the world’s harshest lockdowns,for example by spraying desperate migrantworkers with chemical disinfectant.

On the one hand, the high level of trust that theIndian public has in Modi, premised on thebelief that he acts in the national interestinstead of for personal or family profit, giveshim room for tough and decisive action. On theother hand, weak capacity in turn means thatauthorities will have correspondingly greaterdifficulty in case management and contact-tracing. India has the world’s biggest pool ofpoor, illiterate, sick, hungry, underweight andstunted children, as well as of sexual assaultand domestic violence victims. Widespreadpoverty diminishes the state’s capacity toprovide adequate nutrition needs of its peopleand being malnourished makes people morevulnerable to coronavirus. The equation hasclear if uncomfortable implications for allc o u n t r i e s w i t h p o o r p u b l i c h e a l t hinfrastructure. The government has a criticaland indispensable role to play in public healthduring pandemics: prompt, accessible andaffordable universal testing, ramped uphospitals to cope with a surge in demand,accelerated supplies of protective, preventiveand therapeutic medicines and equipment, etc.Poverty hollows out state capacity to do allthis.

The long-term impacts of the lockdowns will bedeadly for the world’s poorest billion peopleover the next decade. Oxfam warns thepandemic could push another half billionpeople into poverty. The number of peoplesuffering from acute hunger could nearlydouble to 250mn from the disruptions to cropproduction and global food distribution chains.Grave and prolonged economic damage takesits own tragic toll on lost livelihoods and onlives. This is seen at its most acute and moreimmediately in developing countries whosepeople “fear hunger may kill us beforecoronavirus.” The United Nations estimates theglobal economic downturn could cause

“hundreds of thousands of additional childdeaths in 2020.” Other UN estimates show thatmore than 800,000 Indian infants died in 2019,a mortality rate of 3%. Nearly 1mn childrenunder the age of 5 years died, an even highermortality rate of 3.7%. Those figures are tentimes higher than the infant and child mortalityrates in the developed world. Most of theseIndian children died from preventable causes –nutritional deficiencies, lack of sanitation andlack of access to healthcare.

Exit from a lockdown poses a tough dilemmafor governments. It requires decision-makingunder high uncertainty and courage groundedin both conviction and confidence. The belief oforthodox economists in the strong springanalogy – the harder you push an economydown, the greater the force with which itbounces back – is an illusion. In reality, a weakspring is the more appropriate analogy for apoor economy. If pushed too hard, it maysimply remain down if its restorative forceshave been destroyed.

The impact of diseases can and does differacross countries and continents, possiblyattributable to differences in demographics,geographies, cultures and immunities. A studycovering 290 hospitals in all 30 districts of thestate of Karnataka in India was preprintedonline on 11 December. Billed as “the firstcomprehensive survey providing accurateestimates of the Covid-19 burden anywhere inthe world,” its estimated IFR was just 0.05%.India has a much younger population than richcountries, so that the proportion of vulnerablepeople older than 65 years is far lower.Countries like India which have mandatoryBCG vaccinations may be less susceptible toCovid-19 infection because the vaccine has astimulating effect on the immune system thatgoes well beyond tuberculosis. In India,universal BCG and polio vaccination ismandatory, while immune systems of peoplehave a lifelong exposure to curative andpreventive drugs for malaria. The conventional

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assumption is that vaccines create antibodiesagainst specific pathogens. But immunologistshave discovered that vaccines also stimulateinnate immune systems creating capacities tobetter resist, or fight, other kinds of pathogenstoo. This possibly exists in immune systems ofpeople in India who have antibodies that couldbe effective in resisting the virus. Similarly, thesignificant number of people who have testedpositive for Covid-19 but are asymptomaticsuggests that they have some innate T-cellmediated immunity which helps resists thevirus. Research by Indian scientists suggeststhat exposure since childhood to an extensiverange of pathogens has given Indians relativelysturdier immunity to Covid-19. Another study inthe International Journal of Infectious Diseasessuggested a similar conclusion holds for sub-Saharan Africa.

Lockdowns, combined with mass testing,contact tracing, containment zones andmandatory quarantines, can only slow down thespeed at which the infection spreads. Thismight help for temporary periods in countrieswhere public health facilities are robust, but isinadequate for large numbers when infectionspeak. India’s public health system is poor and itcould never suffice for its large population ifthe pandemic spreads. It could still be sometime before vaccines become available insufficient quantities to suffice for India’smassive population. On 2 January 2021,the expert committee of the Drug ControllerGeneral of India recommended restrictedemergency authorization for the Oxford-AstraZeneca Covishie ld and India ’sindigenously-developed Bharat Biotech’sCovaxin vaccines. Because “the initial vaccinesupply ... is likely to be very slow,” however,“for the average Indian aged less than 50 yearsand without any comorbidities, the wait for ajab is likely to extend till 2022.”

It is also essential to recognize that a lockdownis not a weapon in a war that can conquer orvanquish the microbe. The virus will be with us

for some time to come and there could be aspike in infections when the lockdown is eased,and such spikes may recur over time andacross space. India must learn to live with thisreality of an endemic equilibrium, just as it didwith pneumonia, and manage the virus as bestit can. There is also the possibility that yetanother novel virus could emerge, potentiallyreigniting a perpetual process of unfoundedfear and revolving-door lockdowns. Last but notleast, this is a wake-up call to improve socialinfrastructure on public health, which wouldsave lives lost through easily preventablecauses, for example child mortality, to bringabout significant improvements in thewellbeing of the people.

India’s potential global role

Like any crisis, the pandemic presents its ownopportunities. India has the potential to play amore prominent role in the rapidly shifting andfluid global order as a low-cost manufacturinghub of safe, reliable and inexpensive butessential medicines. As countries prepare toend overdependence on China for criticalmedical supplies, the post-Corona world willoffer India, already a leading global actor in thepharmaceutical industry, an unexpected,longer-horizon opportunity to play a larger rolein revamped global supply chains, expand itsmanufacturing base and become the pharmacyto the world. The deindustrialization that Indiahas witnessed over the past quarter century,because of unilateral trade liberalization whileabandoning industrial policy, could bereversed. The rhetoric of “Make in India” couldbe turned into real ity, i f India beganmanufacturing for world markets as largeinternational firms relocate production out ofChina.

This would require the government toformulate strategic industrial policy thatcoordinates trade, technology, fiscal, monetaryand exchange rate policies for reviving

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industrialization. It would also require massiveinvestments in physical infrastructure,particularly power, roads, transport and ports.This should be done without moaning aboutfinances, for it would serve two purposes.Government expenditure on infrastructurecreates employment and stimulates demand torevive economic growth in the short run andremoves supply constraints that wouldstimulate the economy through strongmultiplier effects in the long term.

For example, India is the largest producer ofhydroxychloroquine as the drug is commonlyused to treat malaria which is widespread inIndia, manufacturing 70% of the world’ssupply. India is also the world’s largestproducer of vaccines and has enormousexperience in implementation of massvaccination programs for smallpox, BCG, polio,etc. On 19 April Modi exhorted India to rise tothe occasion and become “the global nervecentre of … multinational supply chains in thepost Covid-19 world.” In his virtual address on26 September to the UN General Assembly’s2020 opening session, Modi proudly noted thatIndia’s pharmaceutical industry had sentessential medicines to more than 150 countries.He then promised: “As the largest vaccine-producing country of the world, I want to giveone more assurance to the global communitytoday, India’s vaccine production and deliverycapacity will be used to help all humanity infighting this crisis.” With the right industrialpolicy, some Indian pharmaceutical companies,which already have an established presence inthe wor ld market and compete wi thsubsidiaries of US and European firms in thedomestic market, could become global firms.

India could also take a lead in resisting theclimate of pandemic nationalism unleashed bythe “My Nation First” mentality. When theBrundtland Commission Report (1987) said“The Earth is one but the world is not,”hardcore realists dismissed that as theromantic notion of dreamers. Yet the serial

crises of the last few decades, from naturaldisasters to pandemics, from financialmeltdowns to terrorism, remind us that nonation can be an island, sufficient unto itself inthe modern world. The pandemic andlockdowns together posed an unprecedentedthreat both to public health and to the globaleconomy. US President Donald Trump’sdisruption of the global trading order made itcorrespondingly more difficult to organize acoordinated response to the pandemic or forthe US to provide the requisite worldleadership. The rushed retreat into “beggar-my-neighbour” responses, where Washingtontried to buy exclusive access to vaccinesproduced in Germany, forcefully demonstratedthe consequences of the crumbling architectureof the global order. ‘Sicken-thy-neighbour’policies led dozens of countries to imposerestrictions, including outright bans in somecases, on the export of critical medical supplieslike masks, medicines, ventilators anddisinfectants. Espousing nationalist rhetoricand policies, while abandoning internationalcooperat ion, aggravated the cr is is .Governments can better protect the peoplethey claim to represent by reversing theequation – ditching pandemic nationalism andembracing global cooperation instead.

Thus, the pandemic reaffirms the importance oflooking for solutions without passports toproblems without passports. The media wasflooded with predictions that the pandemic willkill globalism. The death of globalization andglobal institutions is much exaggerated. Auniversal pulling up of drawbridges behindnational moats would do collective self-harm.The positing of national sovereignty and UN-centric multilateralism as alternatives is a falsedichotomy. We need both strong state capacity,not power, at the national level and efficientand effective multilateralism for coordinatingresponses at the global level. The ethic ofcollaboration can be operationalized throughthe UN-centred mandated multilateralmachinery such as the WHO, voluntary

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international organizations like the Non-Aligned Movement, BRICS and the G20,regional intergovernmental organizations,philanthropic foundations and private sectorin i t ia t ives . India ’s potent ia l as thepharmaceutical manufacturing hub gives it theparallel scope to provide global leadership inorganizing collaborative efforts that can beinstitutionalized instead of depending on ad hocresponses with each fresh crisis.

In sum, the crisis is a sharp reminder of thelimits of unilateralism and cascadingvulnerability to external shocks in an age ofshared threats and fragility but unequalresilience. National adequacy measures mustbe supplemented with building internationalfunctional redundancy in food supplies, healthand value chains in a deliberate strategy of“risk reduction through diversification.” It is inall countries’ individual self-interest to recreatea healthy rules-based international order thatbreaks down barriers to the free flow of masks,protective gear, test kits and other medicalsupplies.

Covid-19 has demonstrated the urgentimperative to reboot the ethic of globalcooperation. Tackling a pandemic requirescross-border good governance: robustsurveillance to detect, test, isolate and treatevery serious case; unimpeded flow of medicalequipment and supplies from manufacturingorigins to affected countries; real-timeintelligence sharing and exchange of bestpractices; and an impartial, technically

competent and publicly credible internationalorganization to establish universal healthnorms. An efficient and legitimate architectureof global health governance would havedetected the emerging epidemiological threatearly, sounded the alarm and coordinated thedelivery of essential equipment and medicinesfrom point of manufacture to populationclusters in most need. There is a need for anearly-warning system to detect the emergenceof new or mutated viruses. An early Covid-19warning enables a government to react rapidlyby ramping up testing and engaging the wholepopulation in contact tracing and containment,thereby potentially reducing the economic andsocial costs of an outbreak.

The faster and more effectively that we act tocontain the spread of the virus in the world’spoorest and most populous countries, thebetter we can protect everyone. Unless largecountries such as China, India and Indonesiaare all coronavirus-free, the risk of re-infectionwill persist even in the global North and it willpose an epidemiological and economic threateverywhere, as the letter from Gordon Brown,Kevin Rudd and a large number of otherleaders and prominent public figures warned.This requires urgent investments in preventionthat also depend on international cooperation –including via the Africa, EU and US centres fordisease control and prevent ion, theInternational Monetary Fund’s emergencyfinancing and the World Bank’s emergencyhealth support.

Ramesh Thakur is Emeritus Professor of International Relations in the Crawford School ofPublic Policy, Australian National University; Senior Research Fellow, Toda Peace Institute;and Fellow of the Australian Institute of International Affairs. He is a former United NationsAssistant Secretary-General and was Foundation Director of the Balsillie School ofInternational Affairs in Waterloo, Ontario. His most recent book is Reviewing theResponsibility to Protect: Origins, Implementation and Controversies (Routledge, 2019)

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Deepak Nayyar is Emeritus Professor of Economics at Jawaharlal Nehru University, NewDelhi, and an Honorary Fellow of Balliol College, Oxford. He previously served as ChiefEconomic Adviser to the Government of India, Vice Chancellor, University of Delhi, andDistinguished University Professor of Economics at the New School for Social Research, NewYork. His latest book, Resurgent Asia: Diversity in Development, was published by OxfordUniversity Press in 2019.