Pandemic Policy in Developing Countries: Recommendations for India

Shruti Rajagopalan and I have written a policy brief on pandemic policy in developing countries with specific recommendations for India. The Indian context requires a different approach. Even washing hands, for example, is not easily accomplished when hundreds of millions of people do not have access to piped water or soap. India needs to control the COVID-19 pandemic better than other nations because the consequences of losing control are more severe given India’s relatively low healthcare resources, limited state capacity, and large population of poor people, many of whom are already burdened with other health issues. We make 10 recommendations:

1: Any test kit approved in China, Japan, Singapore, South Korea, Taiwan, the United States, or Western Europe should be immediately approved in India.

2: The Indian government should announce a commitment to pay any private Indian lab running coronavirus tests at least the current cost of tests run at government labs. 

3: All import tariffs and quotas on medical equipment related to the COVID-19 crisis should be immediately lifted and nullified.

4: Use mobile phones to survey, inform, and prescreen for symptoms. Direct any individual with symptoms and his or her family to a testing center, or direct mobile testing to them.

5: Keep mobile phone accounts alive even if the phone bills are not paid, and provide a subsidy for pay-as-you-go account holders who cannot afford to pay for mobile services. 

6: Requisition government schools and buildings and rent private hotel rooms, repurposing them as quarantine facilities. 

7: Rapidly scale up the production and distribution of masks and encourage everyone to wear masks. 

8: Truck in water and soap for hand washing and use existing distribution networks to provide hand sanitizers. 

9: Accept voter identification cards and AADHAAR cards for in-kind transfers at ration shops.

10: Announce a direct cash transfer of a minimum of 3000 rupees per month (equivalent to the poverty line of $1.25 a day or $38 a month) to be distributed through Jan Dhan accounts or mobile phone applications such as Paytm.

See the whole thing for more on the rationales.

Addendum: As we went to press we heard that India will lift tariffs on medical equipment. My co-author lobbied hard for this.

Comments

Any reason not to write this 6 weeks ago? Virus time beats human time every time, at least till now.

And why India? Wouldn't this easily apply to around another billion or so people in outline?

All that would require the Indian regime to actually care about its own people, yet Indian religion teaches that the powerful must have the right to enslave the people.

I am unable to understand which religion you have in mind when you refer to indian religion. Christianity is also an Indian religion!

Might be cos you are stupid then, to not be able to make such an easy inference. :)

Social Distancing didn't make the cut huh? I guess it's not as important as they make it out to be here in the US.

As explained in the paper, social distancing is simply not possible for many millions of Indians.

The explanation is pretty weak. It does not attempt to establish a minimum square ft per capita that social distancing becomes possible. while the "experts" argue that social distancing is the number 1 most effective method to contain the spread and ease up on more intensive and costly medical resources.

Social distancing has been implemented here by shutting down businesses to remove incentive for people to go out, which in a way, puts a $ amount of the cost of life. Saying that social distancing in India is impossible because the population density and large amount of population in poverty is saying that the lives of those in poverty are not worth much.

It should be the reverse, in developed nations with much more medical resources, it makes more sense to *not* social distance and keep the economy running to pay for the medical resources and export surplus resources, while nations that do not have as much resources should implement social distancing to minimize strain on their limited medical resources.

The India numbers for new C-19 cases are suspiciously low. I doubt their accuracy. Seems many countries C-19 new cases numbers, and that includes the USA's, are limited by the number of tests conducted. In other words, when more tests are conducted, the new cases jump up. It's really not an indication of actual new cases.

The low case numbers are easily explained. Little testing. The suspiciously low number of deaths is a little harder to explain. You can easily avoid being tested for COVID-19. Much harder to avoid dying from it if you are susceptible. Part of it is not counting the dead, I expect, but given India's density, poor sanitation, lack of public education, poverty, etc., I would have expected the dead to be piling up by now in a fairly conspicuous way. Something of a mystery.

They have a tradition of burning corpses, or letting them float down the Ganges.

I stand corrected. But then shouldn't we be seeing more fires, or more floating corpses? That's actually a serious question. Everything we know about how the pandemic spreads suggests that it should be spreading faster in India than elsewhere.

They also have a tradition of burning their surplus organic matter in agriculture. Thus, many fires are the base rate. Note they will burn many more corpses than they will let float down rivers. Few corpses are buried, mostly at Muslim communities.

Are people really that stupid here?

India seems to be doing OK without Alex's help.

Really? It must be the first time in the last 70 years!

Via @mims

https://twitter.com/TheKeralaPolice/status/1248219276407738368?s=19

#1 is not good advice. Tests that don't have high enough accuracy do harm rather than good. Tests ordered out of China have proven useless on multiple occasions, including currently in the UK, who bought millions of antibody tests that they aren't going to be able to use.

India is in a really difficult position, but they are better off doing as many high quality tests as they can afford, even if it's not nearly enough.

I've been a "testing is hard" guy, but I also think the math can vary on this.

"Are bad tests good?"

It has to do with expectations of compliance, right? If no one is distancing, and you can use bad tests to convince some subset of true positives to quarantine, it's a win. On the other hand, if people are distancing, and a bad test "sets them free" it's a loss.

Are you even following what has been going on? Pretty much all of this is being done. You know people in India aren't dolts. I found this vaguely insulting. Ugh.

It is okay to not get insulted by everything. Sooner or later, the Indian economy will have to open up. This virus is still going to be around. India needs to prepare for that day.

"Any test kit approved in China..."

Alex, is this a joke? Sadly, this silly recommendation completely undermines your argument.

You got it completely backwards. India is a young country by demographic. They have nuclear weapons. You keep poor people from earning enough to eat, and a populist will rise to power. Stopping people from earning their $60 per month paycheck to feed their family to make sure some 80 year olds (the average death age) kick the bucket a few months later is imoral.

The most but wrenching commentary I read on this was indeed a comment. But not here. It was a Thai man saying he has no money and no work. He is more worried about starving to death than any sickness. And EVERYONE he knows is in the same position.

You are preaching from an ivory tower. Given the risk profile of this disease, you've got it 💯% backwards.

Or maybe they should just eat 🍰?

My understanding tests are a bit like a recipe for brownies. You can 'approve' the recipe but you gotta then pull out your own eggs, butter, flour etc. If everyone is doing the same and the store runs out you're out of luck.

The tests are floundering not on approvals as much as a lack of reagents that are consumed in the testing. A diversity of approved tests might be helpful if different reagents means you could choose the test that matches what is in your supply chain, but I have a sneaky feeling many of the tests are likely to use the same reagents because life often just wants to make it that much tougher.

In the US at least I think we're beyond hope with testing. It simply is not happening unless you're very sick already so the test just acts as a confirmation you don't have regular flu. If we could develop a test to see who has acquired, hopeful, immunity because they already passed the virus we could possibly use that to minimize transmission (say by having a nursing home put all the positive patients in one area and only have staff who already passed the virus handle that part).

"2: The Indian government should announce a commitment to pay any private Indian lab running coronavirus tests at least the current cost of tests run at government labs. "

This recommendation would severely hamper India's testing regime by locking the current level of cost efficiency as government labs have been able to scramble to achieve.

Economies of scale and improved methodologies could drive this a long a way down.

And most important of all, convince the religious radicals, particularly the tablighi jamaat, to--for God's sake--forgo their religious prayers and gatherings for some time. Breaking the law wouldn't only cause further spread of the virus, but also induce extreme populism by raising further discontent with the Muslim community. Of course, this is easier said than done, for, in the case of radicals, you must provide a boatload of incentives to convince them to forgo religious activities.

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