The third wave we once had to brace for, as Alvin Tofler warned in his 1980 book, was the Information Age. It was expected to shift power, reshape society and weaken the nation-state. The irony of the one India might have to confront is how ill-informed our preparation has been so far. Data on the current second wave of covid is sketchy. So long as our daily infection count is constrained by testing capacity, a crest cannot be sighted reliably. There has been a dip, but more discernibly so in the ratio of signal to noise. Last week, the government’s principal scientific advisor K. VijayRaghavan warned that a third wave was “inevitable” at some stage after this one subsides, only to retract this forecast shortly after by saying it may not happen if “strong measures” are taken. Given the complexity of our crisis, with variants of Sars-CoV-2 clouding the calculus, nothing can be said with certainty. Yet, high likelihood or low, a third wave ahead or just ripples here and there, we should act with alacrity and devote bulky resources to healthcare. At warp speed. Our central bank has opened a monetary window to spur private-sector action. But it is the Centre that must invest the biggest chunk, and by far.
The Union budget should be revised for a mega fiscal response, one so large that it marks an inflection point in India’s annual healthcare spending. At under 2% of our gross domestic product, it is way too little. For funds, if global bonds need to be floated, or shares in central state-run enterprises have to be pledged with the Reserve Bank of India (RBI), let us go ahead. Set strongly in motion, the apparatus of the state can work faster than the easing of credit. It speaks well of RBI’s alertness that it opened a ₹50,000 crore window last week for banks to avail money at a rate below inflation and lend it cheaply to private hospitals, vaccine makers, importers of vital supplies, etc. If loan approvals are quick, this could help plug some shortfalls of vaccines and life-sustainers like oxygen, and let well-rated service providers ramp up their capacities. However, no matter how large the sums and low the interest burden, we cannot expect such loan advances to either squash the current wave or prepare us adequately for another, should it come. That’s a job for the state, a role that partly underpins its legitimacy. The creation of health centres, provision of piped oxygen and augmentation of other support facilities should be the front-end of an all-out thrust down our national infrastructure pipeline. The scale and pace required for this might imply a diversion of money, materials and manpower from projects that are not mission-critical. New Delhi’s Central Vista project, for instance, can be put on hold without any loss to the nation.
Of course, an expansion of health services cannot be achieved just by virtue of buildings, beds, cylinders and so on. We also need doctors, nurses and paramedics, all of whom take time to train, by the multitude. The government has fast-tracked the induction of those in their final stages of training. This is welcome. But if the need arises for medical squads from abroad, India should put its rhetoric of self-reliance aside to let them in, as with foreign aid. All said, we must get cracking on an upshift in healthcare of a huge order of magnitude. For too long have we let citizens fend for themselves, by and large. Like war, a pandemic is a test of relevance for the nation-state. And India’s fiscal tools should not go idle.
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