Editorials - 29-05-2021

With an exponential rise in infections, Chennai quickly became a COVID-19 hotspot during the second wave.Serena Josephine M.reports on how the situation was stabilised before it could spiral out of control

With the phones ringing off the hook and the queues of the sick becoming longer, S. Sangavi and S. Ramachandran knew better than to put their tired feet up. In their 12-hour shifts, the duo — an emergency medical technician and an ambulance pilot attached to the 108 ambulance network — took on multiple trips in Chennai, ferrying at least 10 patients diagnosed with COVID-19 to nearby government hospitals each day.

Though both Sangavi and Ramachandran, staff of the Vadapalani Depot ambulance, have been handling COVID-19 patients from the start of the pandemic, they soon realised that the unrelenting second wave of infections was unlike the first. With each passing day, they slowly got accustomed to the long queues of ambulances and longer waiting hours outside government hospitals, hoping fervently that the patient on board would get a bed. “It took us at least an hour or two to get a patient into the hospital ward. It became extremely difficult to get an oxygen-supported bed in the last two months,” Sangavi says. At times, their shift extended to as long as 15 hours. “There was no time to eat,” Ramachandran says.

As they set out to pick up a patient, either from home or from a screening centre, they would go beyond their defined roles. “Many fear the sight of an ambulance in front of their homes. So, we would call them earlier, tell them not to be afraid, and assure them that it is going to be fine,” Sangavi says.

Even as one patient was admitted, it would be time to pick up the next. “It was like working at the warfront,” says Mohamed Bilal, regional manager, GVK EMRI, which operates the 108 ambulances. “We (the Chennai team) have been on our toes since March. Each ambulance has had to cater to 20 cases a day, doing multiple trips day and night. From May 1 to 24, we handled 9,579 COVID-19 patients in Chennai alone.”

The task was far from easy. With many ambulances held up outside hospitals, the team had to ensure that the vehicles reached the patients on time. “Once a call is received, the average response time for a COVID-19 ambulance in Chennai is 10 minutes 25 seconds, while the average turnaround time is 1 to 1.5 hours,” he says.

Scramble for beds

Chennai turned into a COVID-19 hotspot in the blink of an eye. The second wave resulted in an exponential rise in the active case load. Since the beginning of the pandemic, 2.36 lakh cases had been reported in the city, as of March 5, 2021. When the State’s daily case count crossed 500 marking the beginning of the second wave, more than 2.50 lakh persons were infected in a span of just two and a half months in Chennai.

The rapid rise in cases and the fast deterioration of patients put great strain on major hospitals. Hospitals ran out of beds even as the demand for oxygen-supported and intensive care unit (ICU) beds surged. Chandru (name changed), a resident of Sithalapakkam, was one of the affected. “My father tested positive for COVID-19, and we managed to get a normal bed at a private hospital on May 14. But his oxygen saturation level dropped from 92 to 85, and nothing helped. He required ventilatory support, but no beds were available at the hospital. We had to shift him to another facility,” he says.

After frantic and unsuccessful attempts to get him a 108 ambulance, Chandru managed to take his father, 74, to the Rajiv Gandhi Government General Hospital (RGGGH) in an ambulance of the private hospital with oxygen support. “We waited in the ambulance. We managed to get an ICU bed only four hours later. The treatment could not save my father,” he says. While the wait and the death of his father was agonising, the number of deaths around him as they waited numbed him.

Over two months, the city saw hundreds of such cases. There were desperate hunts for beds, heartbreaking moments of watching loved ones gasp for breath while waiting in ambulances and private vehicles, and serpentine queues outside counters to pick up vials of Remdesivir. Meanwhile, hospital authorities spent sleepless nights waiting for oxygen trucks to arrive.

“The numbers were huge this time,” says E. Theranirajan, dean of RGGGH, one of the largest hospitals for COVID-19. Since mid-March, RGGGH has treated 12,000 patients with COVID-19. “The 72 beds in the zero-delay ward were just not enough. So, we increased the number to 238 to immediately attend to patients who were brought in ambulances and required oxygen support, as well as to ease the ambulance lines outside the hospital. We had a maximum of 250 ambulances bringing in patients in one day, 40% of which were from the private sector,” Dr Theranirajan says.

From April 24 to May 10, the hospital saw its per day oxygen requirement soaring to 40-45 metric tonnes a day. With beds in all seven floors of Tower-3 filled up, Dr Theranirajan and his team started to open COVID-19 wards in other blocks. The number of beds quickly rose from 1,618 to 2,050, with the number of oxygen beds increasing from 817 to 1,522 from May 5 until now.

“In the first wave, the maximum number of in-patients we saw in a day was 1,083. This time, it was 1,658. We had over 1,600 in-patients for 15 continuous days. What made the second wave different from the first was the number of people requiring oxygen. We had 1,300 patients on oxygen therapy at a given point in time this year,” he says.

The hospitals faced several challenges: decongesting ambulances on campus, starting treatment on time, stabilising patients being wheeled in, and even adding space for the dead.

The doctors knew that they had to think differently. So, a team of three doctors along with technicians was deployed to triage patients waiting in ambulances and a respiratory care team was sent to assess every patient’s oxygen needs and provide appropriate dosage, he says.

The surge in cases

The first wave peaked on June 30, 2020 in Chennai, when 2,393 daily cases were reported. They gradually declined after that and were lower than 1,000 a day by mid-October. On February 19, 2021, Chennai saw just 136 cases.

By then, the State was preparing for the Assembly elections and all the COVID-19 control measures taken during the first wave in Chennai and other places were scaled down considerably.

The early signs of a resurgence in cases were noticed in the first week of March. Cases began to go up marginally. By the first week of April, when the State went to the polls, the number of daily reported cases had crossed 1,000. The number continued to rise sharply and on May 2, when the election results brought a change of government, the cases crossed the 6,000-mark.

More than crowding during elections or other factors, the sudden increase was primarily due to the mutant strains of SARS-CoV-2, says Alby John Varghese, Deputy Commissioner (Health), Greater Chennai Corporation (GCC).

P. Ganeshkumar, Scientist D, Indian Council of Medical Research-National Institute of Epidemiology, Chennai, says the new variants of the virus, poor adherence to COVID-19-appropriate behavior such as wearing masks and maintaining physical distancing, and not seeking early care for COVID-19-like symptoms were the major factors for the rise in cases. “New variants of the virus circulating in the population contributed to the higher transmissibility of the infection in the second wave. This led to higher case load compared to the first wave,” he says.

The seroprevalence study conducted during the first wave showed that 44.2% of the population in Tondiarpet and 34.4% in Royapuram, two of the worst-affected zones, had been exposed to the virus. “One would have thought that the second wave would not affect these zones much. But there was a large number of cases here as well, which is likely because of the new strains. We did not expect it to be this infectious with more people becoming sick and requiring hospitalisation,” Dr Varghese says. Analysis of zone-wise data showed that while the cases were comparatively lower in these two zones than the others during the second wave, the two nevertheless remained significantly affected.

The spread was more aggressive in the southern and central regions than the northern regions this time. While the northern zone accounted for 34% of all cases in the first wave, it accounted for only 28% in the second wave.

By the time the new government was sworn in on May 7, it was becoming impossible for many patients to get oxygen-supported or ICU beds in hospitals. Social media was flooded with requests for beds or oxygen. It appeared as if the city was heading towards the crisis faced earlier in Delhi and Bengaluru.

“We had two main challenges in the city,” says J. Radhakrishnan, Health Secretary. “People threw the Standard Operating Procedures (SOPs) to the wind. When cases surged, the situation put the oxygen and ICU bed capacity to test. Despite having the best hospitals in both the government and private sector, this was a big challenge,” he says.

Rise in fatalities

The deaths due to COVID-19 kept rising in the city. A government doctor, on condition of anonymity, said it was agonising to see young persons succumb to the infection, primarily due to respiratory failure. “Some were brought dead to hospitals,” he says.

The crisis began to take a huge toll on healthcare workers. “It was very stressful. Some of my friends from other departments who were posted on COVID-19 duty had to take sedatives to sleep as they had never seen so many people dying around them,” says a PG student.

On May 12, when Chennai recorded 7,564 daily COVID-19 cases, the highest since the start of the pandemic, Dilli Rajan, the caretaker of Velangadu crematorium, stood beside a hearse, directing his seven assistants to work late into the night to cremate the bodies. Several hearses had lined up at the crematorium. Prior to COVID-19, cremations were held only till 6 p.m. “During the first wave, the number of cremations decreased from eight to two a day at our crematorium. During the second wave, the number increased to 32 a day,” says Dilli Rajan, who lost his aunt during the pandemic. The situation was similar in most of the 41 crematoriums in Chennai. GCC data show an increase from 150 death registrations a day to more than 350 a day during the second wave.

Since the last week of March, the city has reported more than 3,300 deaths, almost close to the total deaths reported during the first wave till October 2020. However, the case fatality rate has remained low compared to the first wave. While it was around 1.8% during the first wave, it is currently 1.4%.

“Under-reporting of deaths continues. Very sick patients are not subjected to RT-PCR testing. They succumb to the infection and those deaths are not counted as COVID-19 deaths. This is also true of patients with suspected symptoms of COVID-19,” an official says.

Non-COVID-19 deaths have also increased by 300% in many crematoriums, which is a major cause of concern for public health officials. One of the reasons for the rise in the number of deaths during the second wave in Chennai has been the crowding of tertiary care government hospitals by patients who do not require higher-level medical care. With limited number of beds in government and private tertiary care hospitals, many patients who required emergency care were unable to get admitted to hospitals.

The turnaround

The situation, however, was controlled and stabilised through multi-pronged community-level strategies before it spiralled out of control. The State government imposed a complete lockdown on May 10. While this was aimed at curbing the rapid spread of infection, it also gave the much-needed breather for hospitals and time to scale up the infrastructure.

Door-to-door fever surveillance to proactively identify cases at an early stage was ramped up and so were screening centres for triaging, and telecounselling centres. While these measures existed during the first wave, new ones were added to tackle the second surge. Two hundred and fifty-one car ambulances with oxygen support were introduced to address the shortage of ambulances and ensure zero-delay transfers to hospitals.

Another key initiative was field triaging. With the 13 screening centres located in different parts of the city proving inadequate to handle the surge, field triaging was introduced. Two hundred and fifty-one teams, each comprising a doctor and two nurses, were formed.

“The field triaging team visits every person who tests positive at their doorstep. If further examination or hospitalisation is needed, the person is taken to a nearby facility. Else, they are asked to isolate at home. Further follow-ups are done through the telecounselling centres,” Dr Varghese says. Every patient in home isolation is called at least once a day by the telecounselling centres, where final year MBBS students along with doctors are deployed.

More than 12,000 fever survey workers have been deployed to visit every household to identify people with COVID-19 symptoms. This is in addition to around 400 fever survey camps across the city, mainly focusing on hotspot areas. A group of volunteers called ‘Friends of COVID Citizen Under Surveillance’ was deployed to assist those under home isolation. The members provided groceries and monitored adherence to rules.

Apart from these measures, the Medical and Family Welfare Department worked on increasing the bed capacity and set up a Unified Command Centre (UCC) for bed allocation and oxygen monitoring, which was later converted to the State’s war room for COVID-19.

From the day it was set up as a UCC on April 30 till May 25, more than 60,000 calls were received requesting beds and oxygen support. An official working at the UCC says that while the UCC was able to fulfil only 30% of the requests in the initial days, it has been able to fulfil more than 60% of the requests in the past one week.

Dr Varghese also says technology was used both for administrative purposes (for efficient monitoring and deployment of resources) and for the public. An example is the GCC VidMed application. Given the difficulties for many to visit a doctor or a hospital, the app was launched to enable patients to consult doctors online.

“While we deployed technology, we were also conscious about technology not becoming a barrier for those from underprivileged backgrounds to seek help. So, we had helpline numbers, proactively called those under home quarantine and also ensured visits by field staff,” he says.

By now, a ‘Chennai Model’ had emerged. Prime Minister Narendra Modi mentioned that he wanted other cities to emulate some features of this model. GCC Commissioner Gagandeep Singh Bedi says the Chennai Model of COVID-19 prevention and case management has become more effective because it is “community driven”.

“We have 200 mobile teams, 10 mobile units, 42 static centres, and 140 urban primary health centres carrying out doorstep COVID-19 testing with a turnaround time of 24 hours,” he says.

All laboratories have to report results to residents through the single-window system adopted by the GCC, for better coordination. The civic body has “established oxygen centres, promoted a symptomatic case management system irrespective of the test results, accelerated vaccination services for the elderly, disabled and non-ambulatory elderly, and hired FOCUS volunteers for helping residents who are in home isolation,” Bedi adds.

GCC’s Deputy Commissioner (Works) Meghanath Reddy says the second wave was managed through several micro-targeted interventions. “We constituted 30 zonal enforcement teams to enforce lockdown SOPs. We launched 100 mask kiosks to distribute seven lakh reusable masks,” he says.

Ramping up facilities

Amid the raging pandemic, government hospitals continued to ramp up infrastructure. They needed more beds, oxygen points, oxygen supply and manpower to handle the rising number of patients. “There are 6,500 oxygen-supported beds in institutions under the Directorate of Medical Education in the city. We have oxygen centres with 2,500 beds. There are 20 COVID-19 Health Centres with 3,085 beds and 24 COVID-19 Care Centres in 24 places with 16,000 beds,” says R. Narayana Babu, Director of Medical Education.

In the meantime, vaccination has started to pick up in Chennai. While Tamil Nadu’s overall performance on vaccination leaves much to be desired, Chennai has done significantly well compared to most other cities with around 70% of the elderly receiving at least one dose of the vaccine.

GCC plans to vaccinate at least 50,000 persons a day from the present 23,000 once the vaccine supply improves. Till date, the city has achieved a coverage of approximately 19 lakh (two doses).

Cases fall in city, rise in districts

Cases have begun to show a declining trend in Chennai, dropping from a peak of 7,772 cases on May 12 to 2,762 cases on May 28. The burden of cases in Tamil Nadu is shifting to the rural areas.

Chennai accounted for 25% of the 30,355 cases reported in the State on May 12, while on May 26, it accounted for 10% of the 33,764 cases reported.

“Chennai has started showing a declining trend. The fall in cases with 30,000-odd tests a day is a welcome sign. But this is the time we need to be extremely careful,” Radhakrishnan says.

There is a gradual decline in the weekly percentage change in incidence and daily test positivity observed from the reported data in Chennai. Dr Ganeshkumar says, “This may indicate to us that the spread is limited. When this current trend continues, Chennai will further limit the spread of infection.”

Cases have started to rise in a number of districts. As the Health Secretary points out, “Cases are increasing in 19 districts. This included the western districts, Theni, Madurai and Tiruchi. This is definitely a cause for concern as we need to ensure that the spread does not reach rural areas. Containment and public health measures will continue with no let-up.”

With inputs from Pon Vasanth B. A. and Aloysius Xavier Lopez

If the political Opposition resolves to fight back, it is likely that the new republic will gain in the long term

Nepal is facing its severest political crisis in decades. The repeated dissolution of Parliament, from last December to May this year, is not just a manifestation of the power struggle between political parties and leaders in Nepal but also a dangerous game plan by national and international forces to dismantle the federal republican democratic Constitution and restore the old Hindu monarchical state. It is really anachronistic that the so-called Marxist-Leninist party headed by Prime Minister K.P. Sharma Oli is in collusion with Hindu monarchical forces in Nepal and the Rashtriya Swayamsevak Sangh in India. A section of the Janata Samajbadi Party (JSP) led by Mahanta Thakur and Rajendra Mahato have been lured or forced to join hands with Mr. Oli, who is notorious for his anti-Madhesh tirade till the other day.

Autocratic splash

Even when India’s political and diplomatic culture saw a departure from best past practices, it was expected that its official regime would always support multiparty democracy, progressive political action and changing fundamentals.

Contrary to this, India is being seen backing an autocratic and unconstitutional regime, surviving in ‘caretaker mode’ with the connivance of Nepal’s President Bidya Devi Bhandari and Mr. Oli. In helping an unpopular and illegitimate regime in Kathmandu, the game-plan seems to be to derail the Constitution and plunge the country into endless crisis. It is impossible to understand how this will benefit either India or Nepal, especially when the establishment in New Delhi is perceived here to be hell bent on turning Nepal into a Hindu state and scrapping federalism as well (ultimately disempowering oppressed Madhesis, Tharus, Janajatis, women and others). The statement by India’s Ministry of External Affairs, that “political developments in Nepal are the country’s internal matters” did not help too in changing the popular perception.

If the objective is to scrap the present Constitution to undo the Kalapani-Limpiadhura map episode, why throw the baby out with the bathwater? The India-Nepal boundary issue can be resolved through serious political dialogue. There should be a trade-off between the developmental aspirations of Nepal and the strategic concerns of India, in the light of changing geopolitical dynamics in the Himalayan region. India should do course correction and should not throw its weight behind an autocratic regime; it must reassure all who care for the peace and the prosperity of Nepal by reposing faith in Nepal’s democracy and due processes. Also, India must fulfil the promises it made for COVID-19 vaccines to Nepal. The glaring gap between the promises made and delivery has been a big disappointment; people should never be kept in lurch like this.

The twists and turns

It is in the public domain that the Opposition alliance in Nepal filed a petition in the Supreme Court last week demanding that the Nepali Congress’s Sher Bahadur Deuba be declared the new Prime Minister and the House of Representatives be reinstated. As many as 146 members of the dissolved House of Representatives — 61 from the Nepali Congress, 49 from the Communist Party of Nepal (Maoist Centre), 23 from the Madhav Nepal faction of the CPN-UML, 12 from a section of the JSP and one from the Rastriya Janamorcha Nepal — have signed the petition, challenging Mr. Oli and Ms. Bhandari’s House dissolution moved late on the night of May 21 and disqualified Mr. Deuba’s claim that he be appointed Prime Minister. Representing the Opposition alliance, Mr. Deuba had presented the signatures of 149 lawmakers to prove that he commanded the majority to lead a new government in this crisis phase when Nepal is witnessing an unprecedented crisis with the novel coronavirus pandemic and an abjectly poor counter-response by the Oli-occupied regime.

Without any delay in subverting constitutionally due procedures, Mr. Oli too made a ridiculous claim that he be appointed Prime Minister, while technically still being the Prime Minister, falsely claiming to have the backing of 153 lawmakers. Since the plot was scripted, he failed to name those lawmakers. After the President disqualified both claims as the most suitable possibility for Mr. Oli, he, through a dramatic midnight Cabinet meeting, recommended the House’s dissolution. The President duly obliged him and his autocratic manoeuvring that have hammered democratic principles and national interest. Alas!

For the manner in which Ms. Bhandari has acted to keep Mr. Oli in power and undermining her constitutional role as the first citizen of the country, impeachment will be the easiest exit route for her.

A graceful exit is not an idea tempting enough for her and Mr. Oli; so going in for the lawful provision of impeachment is a prerequisite to restore eroded faith in the presidential position and due processes. Ms. Bhandari’s role in public life has been questioned earlier too, as she, as the President of a new democracy, did all possible to weaken the system and make Mr. Oli a walking authority above the Constitution. Never ever was she deterred by fierce public criticism and continued her business as usual with Mr. Oli. In a press conference recently, Mr. Oli said, “Disrespect for the President is disrespect for the republican system. In a monarchy, there is a King, in a republic system, there is a President. The President is the symbol of republicanism and an attack on the dignity of the Office of the President is an attack on the republic system.” This makes things very clear. Ironically, Ms. Bhandari and Mr. Oli are two prominent figures who have consistently disrespected and abused the President’s high office for their shared political gains — and made it subservient to the executive whims and fancies.

Mr. Oli’s sudden bout of nostalgia for the long gone monarchy is not just his bid to revisit the history but is also something in progression and from the hope he has been given by his invisible handlers and friends, in both the north and the south. He is not an original thinker. He is counting on a plan to drive the country to the brink of a constitutional crisis, stay at the helm as an authoritarian caretaker Prime Minister with an unreasonably friendly President, and force the country into elections when even the next moment is uncertain. To end their Machiavellian treachery, the Opposition alliance has to rise to the occasion and make all possible efforts to foil the unholy plan.

Nepal at the crossroads

Nepal’s quest should be to redeem its lost glory, and for the first time, avail its true development potential — and stop being a ‘theatre of the absurd’ and hosting the harmful advances of neighbours involved in geostrategic rivalries. On the domestic front, an increased focus should be on homework, instead of leveraging on vulnerabilities and the making of unruly partners. In a functional democracy, statecraft is not supposed to be altruistic till it relies on progressive policy and governance — with an aim to augment the mission of ‘greater common good’.Long ago, the People’s War was over in Nepal, with a transitory accomplishment of a goal in a new republic. However, the task is still unfinished till the people-centric priorities are not driving the political agenda and action.

Despite all the flaws, Nepal should protect its democracy that is now at stake because of actions by political opportunists. Politicians such as Mr. Oli and Ms Bhandari have endangered the country’s prospects. However, an accomplished democracy like Nepal will rise again.

For sure, the road ahead is not easy and it is going to be one of struggle. If the Opposition alliance makes a resolve and fights back, it is likely that the new republic will gain in the long term.The big powers should take note of this.

Baburam Bhattarai is a former Prime Minister and Finance Minister of Nepal. Atul K. Thakur is a policy analyst, author and columnist

The COVID-19 vaccine crisis is an opportune time when companies must rethink the purpose behind their existence

The COVID-19 vaccine crisis is another tragic instance of a clash between the needs of humanity and the principles of capitalism. Capitalists insist that private producers of vaccines must make profits because that is their compensation for investing in research and production. If the prices they charge are beyond the reach of poor people, they are not morally compelled to serve them at a loss. Then, governments must step in and buy from private producers and subsidise sales to poorer people. For which, governments need revenues of course, and taxes on private companies could be a significant source. However, if private companies also press governments for lower taxes, to make their investments more attractive; and if the government is also pushed by them, on ideological grounds, to stay out of business,viz. not having any “public sector” production enterprises, governments find both their hands tied behind their backs in crises when citizens blame them for breakdowns of public services. The Indian government is facing this crisis now.

Conversion of the commons

How Will Capitalism End? Ask Wolfgang Streeck and his co-authors in their book with that title. It will end, they say, when the forces that support capitalism run out. Capitalism expands by converting “the commons” into private capital. Economists justify this on practical grounds: it is the ‘tragedy of the commons’, Garrett Hardin postulated, that people will not care for something unless they own it. This is an ongoing justification for capitalist businesses owning land and forests and water resources. Businesses convert natural capital into financial capital and use it for generating profits and more capital for themselves. Over-exploitation of the earth’s resources to produce profits has contributed to the crisis of environmental sustainability and climate change. The concept of ownership of assets for creating wealth had gone too far when slaves without human rights were used in capitalist enterprises as their economic assets until moralists objected.

Creation of monopolies

Slavery is banned by law and the earth’s resources are limited. Therefore, capitalism has moved on to convert knowledge into private property. Modern regimes of intellectual property rights (IPR) with armies of patent lawyers help capitalists to create intellectual property monopolies. Thus, people are denied the use of their own knowledge — as they are when natural products, such as neem and turmeric are patented by capitalists. Thereby, communities whose traditions produced the knowledge must pay those who stole it from them, albeit legally. The public contributes to the creation of scientific knowledge in many ways, for example through government research and development grants and subsidies, as Mariana Mazzucato explains in her book,The Value of Everything: Making and Taking in the Global Economy. In fact, large public assistance in various ways has enabled U.S. pharmaceutical companies to develop their new COVID-19 vaccines at ‘warp speed’.

India has been a spoiler in the global Trade-Related Aspects of Intellectual Property Rights (TRIPS) regime which was promoted by the World Trade Organization in 1995 for uniform global IPR rules. TRIPS is founded on the principle of “product patents”. India had a different approach to IPR based on “process patents”. Product patents allow inventors of new drugs to have exclusive rights to produce and sell them for some years. Producers can use their monopoly to fix higher prices and make more profits for recovering their investments in drug development. Thus, the quantum of production is limited by the inventor to keep prices high. On the other hand, the process patents route forced Indian producers to invent better processes for producing larger volumes at lower costs of ‘generic’ versions of the medicine. This benefited citizens of poorer countries including India. However, Indian generic drug producers became threats to the pricing power of ‘innovator’ drug producers from the West.

TRIPS does have a provision to enable governments to enforce ‘compulsory licensing’. They can demand that an innovator company must allow domestic, lower cost, producers to increase the supply of the drug in an emergency, with compensation to the inventor of course. However, western companies do not like this provision, which has been used before by the South African government, for example, to get drugs for AIDS produced by Indian low cost producers when the AIDS pandemic was raging and Africans could not pay the high prices charged by western companies. This is the provision that South Africa and India want to invoke now to enable production of the new U.S. invented COVID-19 vaccines whose prices are too high for poorer countries.

There are three stakeholders involved in a system to produce adequate volumes of affordable medicines: citizens who need the medicines, governments who must ensure they get them, and private companies who produce and sell them. If the stand of private companies is that because their business must be only business, and the public good is not their responsibility, governments must step in. They must have the means to regulate the prices and also to enhance production. However, if private companies (and the economists who support them) take the view that any interventions by governments distort the market, and go even further to say that taxes must be reduced to make their investments more attractive, governments have both hands tied behind their backs when they have to step in to help people in distress.

Public sector versus private

Many economists do not like ‘public sector’ enterprises. Whenever governments set up ‘public sector’ enterprises, such as banks, hospitals, and schools, economists can prove that these enterprises do not produce as much shareholder returns than they would if they were ‘privatised’. If they were privatised, their owners’ objectives would be primarily, if not entirely, to maximise returns to investors. In that case, public benefits are relegated to the background, or even drop right off the table. Therefore ‘private’ will always be better than ‘public’ by the limited metric of shareholder returns.

The purpose of governments is to improve the all-round well-being of all citizens; not merely to provide products to customers who can pay good prices for them, which is the means by which private enterprises meet their objective of producing profits for their investors. The COVID-19 crisis has revealed the inadequacy of capitalism to fulfil societal needs. If capitalist enterprises are not willing to fulfil public purposes, governments must create more public spirited enterprises to provide public goods equitably to all citizens. Relentless economic growth is devouring the earth that hosts humanity. With artificial intelligence algorithms in social media, capitalist enterprises are able to manipulate human minds. Their investors have become the richest people on the planet. New mRNA technologies on which some new COVID-19 vaccines are based provide the means to manipulate the composition of human bodies. Thus, capitalists can create even more wealth for themselves off human beings.

Time to reflect

Money-driven capitalist values have drifted too far from human values. Money has become the supreme measure of success in all spheres: the wealth of individuals, the size of companies, and the scales of nations’ economies. The sustainable health of complex systems — which human beings and societies are — is being lost sight of. The COVID-19 crisis will not end capitalism. But capitalism must mutate to survive. Companies must rethink the purpose for their existence. It is imperative now that more human and less money values are adopted.

Arun Maira is the author of ‘A Billion Fireflies: Critical Conversations to shape a New Post-pandemic World’

The RBI’s transfer is a much-needed buffer, but there are risks in banking on these surpluses

The Reserve Bank of India’s decision to transfer Rs. 99,122 crore of surplus to the Centre comes as a windfall to the government, at a moment when the ferocious second wave of the COVID-19 pandemic has likely upended most projections for the economy including revenue assumptions. The payout is almost double the Rs. 53,511 crore that the Finance Minister had budgeted for by way of dividend receipts, including from nationalised banks and financial institutions. That the RBI has generated a surplus that is over 73% higher than what it posted for the previous 12-month period ended June 2020, is also noteworthy when one considers that the bank just changed its accounting calendar from July-June to an April-March format by truncating its last financial year to a nine-month period. The RBI’s annual report, released on Thursday, shows that a sharp 63% contraction in expenditure was a major factor in boosting the surplus, especially as income fell by 11%. However, the biggest contributor in real terms was the Rs. 50,629 crore of exchange gain realised by the central bank from its foreign exchange transactions. The central bank, which admits to intervening in the foreign exchange market to smoothe volatility, clearly had a very busy time mopping up the record foreign direct investment inflows that exceeded $81 billion (at a gross level) in the last financial year, as well as the sizeable portfolio investments from overseas. Still, a 69% increase in exchange gain, over the preceding 12-month period, prompts the question as to whether the RBI’s foreign exchange transactions were all entirely aimed only at stabilising the rupee’s value.

Given the magnitude of economic disruption caused by the ongoing pandemic and the lack of visibility on the costs that the economy is going to have to bear in the coming months, the RBI’s transfer surely provides a much-needed buffer to the government’s finances. However, both the Centre and the central bank need to be cognisant of the risks in making a habit of banking on these surpluses to cushion the government’s coffers. After all, just two years ago, the RBI had transferred a record Rs. 1.76-lakh crore to the exchequer. While the Reserve Bank has ensured that it maintains contingency reserves at exactly 5.5% of the overall size of its balance sheet, the level of its reserves provides little wiggle room to safeguard against a sudden, unexpected financial crisis and is at the lower end of the 5.5%-6.5% band recommended by the Bimal Jalan committee. With the government facing the likelihood of overshooting its budgeted borrowing, given the higher spending needed to bolster vaccinations, health care and direct fiscal support, the RBI’s balance sheet could swell in size this year too. It would behove policymakers to remember that the central bank is ultimately the lender of last resort to the nation as a whole and can ill-afford to be less than adequately funded to meet every conceivable contingency.

The IOC is walking on the razor’s edgein its bid to conduct the Olympics in Tokyo

Not everyone is enthused about the biggest sporting event of the world, due in a couple of months in Tokyo. Less than a fortnight ago, Roger Federer spoke about the uncertainty looming over the Olympics, saying ‘athletes need a firm decision’ and that he is in two minds about the event. There are two diametrically opposite voices emerging from Japan. As the coronavirus pandemic rages across the island nation, a BBC report stated that only 1.9% of the population has been fully vaccinated while COVID-19 infections and current deaths stand at over 7,00,000 and 12,000, respectively. Hospitals are overwhelmed and fully aware of that grim context; a majority of Japanese citizens emphasised that the Olympics should either be postponed or cancelled while their collective voice found resonance through opinion polls. As a counter, local officials and the International Olympic Committee (IOC) held firm that the Games will be conducted from July 23 to August 8. The quadrennial showpiece championship originally slated for 2020 was postponed by a year during the first wave of the pandemic, and organisers believe that an event with a staggering $15.4 billion budget cannot afford another reworking of the dates.

The Olympics has always been about striving for the impossible as evident in its motto — faster, higher, stronger — which defined the Games ever since its modern version commenced at Athens in 1896. It braved past the gaps caused by the World Wars as the 1916, 1940 and 1944 events were shelved and also coped with the Cold War years when the Western and Eastern blocs took turns to boycott the 1980 and 1984 Games. But the pandemic is a bigger obstacle even while vaccination drives continue at varied speeds. People do yearn for normalcy and sport offers that illusory thrill of everything being fine with the world. Seen through that prism, the Olympics is the highest benchmark. European football, international cricket and Grand Slam tennis have all resurfaced while following COVID-19 protocols. But there are no fool-proof measures as the latest truncated Indian Premier League edition clearly revealed. Despite best practices and bio-bubbles, sportspeople are vulnerable to the virus and the Olympics with an expected attendance of 11,091 athletes, can be a logistical nightmare. The IOC is walking on the razor’s edge in its bid to conduct the Olympics in a reluctant nation, where even an event partner,Asahi Shimbundaily, sought the cancellation of the Games citing the strain on the health sector. So far, the most pessimistic of the experts have been the ones being proved right.