By Sudhir K Arora
For too long, “National Security” in India has been seen through the narrow prism of a one-track mindset. A look at the National Security Council (which advises the PM and the Cabinet Committee on Security) shows that National Security and matters strategic are seen to be solely the realm of Defence (and when Maoist/terrorist turbulence arises – Home), keeping in mind External Affairs and Finance considerations. Thus, it presumes that as long as national borders are defended, and the ‘enemy within’ is neutralised, the nation is secure. The ‘Health Security’ of 135 crore citizens of the country has never been seen as a vital sub-set of ‘National Security’.
In recent years, we have finally seen effective action upon the ‘Food Security’ and ‘Energy Security’ aspects. The former has met basic nutritional needs of a vast majority of the poorest and the, latter, given the emphasis on renewable energy, has also been a step towards ‘Environmental Security’.
The Covid-19 pandemic has shown how we in India have been totally remiss in not incorporating ‘Health Security’ as a vital component of overall ‘national security’.
An examination of health crises that have killed at least 40 million people across the globe since World War II shows that (a) pandemics are hitting the world with increasing frequency, and (b) these are caused by genetically mutating viruses. The killer waves have ranged from Asian flu to HIV/AIDS (the major killer and an ongoing pandemic) to the current Covid-19, which originated from Wuhan, China.
This pandemic has wreaked havoc on a colossal scale both in India and the world in terms of massive human suffering and economic upheaval – the likes of which have never been seen in living memory. And it is not over yet. The second wave has broken upon us like a tsunami, showing up the absolute lack of comprehension about the nature of the beast. Intense ‘fire-fighting’ and desperate rear-guard actions characterise our response, with the virus always two steps ahead.
However, dwelling upon “did it have to be like this” is of use only if it leads to a structural re-think on the wider concept of India’s national security and the centrality of public health, especially in the light of pandemics and epidemics which are now appearing with increasing regularity.
The Centrality of ‘Health Security’
India is slated to be the most populous country in the world around year 2030. The so-called demographic dividend we pride ourselves on is a reality only if the people are healthy (and educated). It is then they can contribute both to themselves and to the nation.
The very high mobility of people today due to global inter-dependency of economies means that it does not take long for an outbreak in one corner of the world to quickly spread to all parts of the globe. Covid-19 has conclusively shown that. Science still does not have the ability to predict an outbreak, and with each being genetically different, it takes time to evolve a specific defence. Thus, the only bulwark against being ravaged is emphasis on ‘Health Security’ as vital to National Security. The health insurance schemes of state governments and the centre cannot make up for the reality that for a vast majority of the population, adequate facilities are not there or are not accessible. For most, a hospital stay is a harrowing experience.
India lags behind in health infrastructure. Statistics of hospital beds or trained doctors and nursing staff per million of the population are stark reminders that not enough has been done since Independence to address this. The progress of late may have picked up, say in the number of AIIMS-level institutions in the last 7 years, but the fact that we are nowhere near required levels is only stating the obvious.
Health Policy and Strategy Confusion
A major reason for the current situation is that ‘Health’ in India is a State subject in the Seventh Schedule of the Constitution, though there is a Ministry of Health and Family Welfare at the Centre. The ability to respond to national health crises is thus constrained by the fact that both the Centre and the States have their own bureaucratic labyrinth to actuate policy. Obviously, States will have a narrower orientation. Given the abysmal budgetary allocations for health by cash-strapped States, there seems to be a deliberate ceding of space to large corporate hospitals which now dot every metro city and state capital. This by itself would not have been ‘bad’ if the governments had concentrated upon building real capacity in Tier II and Tier III cities/towns so that proper health services were available throughout the length and breadth of the country and people could be treated nearer to homes and not being constantly ‘referred’ to metros. Paradoxically, despite ‘health’ being a state subject, it is the Centre that is the major player. Yet, there seems little synergy between the centre, the states, and bodies like the Indian Medical Council. It beggars the imagination that a captive plant for a vital, life-saving input like oxygen is not mandatory for, say, 200+ bed hospitals. Especially when the capital cost is said to be less than Rs 2-3 crores!
And now we come to strategy. Health needs to be shifted to the Concurrent List. This was also recently suggested by the Chairman of the Fifteenth Finance Commission, NK Singh. The role and reach of the Centre and States must be defined and a Centre-State Health Coordination Council (like the GST Council) set up as a standing body to assess priorities, set goals, monitor allocations and programmes. The country should have been spared the demoralising spectacle of state governments approaching the higher judiciary to force the Centre to commit to urgently needed aid and supplies (as if lines of communication between Centre and states did not exist). This Council must also strategise upon future challenges – that the severity of the 2nd wave of the present pandemic was not anticipated is no excuse. In defence and national security, as in corporate boardrooms, strategy evolves from ‘war-gaming’ – envisaging all scenarios, however remote, and then formulating plans that could best address possible/plausible challenges. The lethality of the second wave of the Spanish Flu in 1919 is a known fact (it even had a third wave, as has now been belatedly predicted for us). Also, there has to be a concept of ‘strategic reserve’. We must immediately start ramping up stocks of vital, critical equipment and medicines in the same way as petroleum products and ammunition are stockpiled as strategic reserves. Certain levels of stocks of ‘life-and-death’ items need to ‘mothballed’, to be replenished regularly for immediate release in the event of a national emergency. These stocks and their location must be known to the state response teams in the event of a national disaster.
Finally, another disturbing fact is staring us in the face – experts say that in the present and foreseeable future, conventional wars are less likely and ‘Non-Contact Warfare’ may be the weapon of choice of technologically-savvy aggressive nations. Biological warfare is one such form of aggression and is no longer just in the realm of science fiction. Are we at all geared up for such an eventuality?
Last year, even the richest countries of the world grievously suffered as we are suffering today. This despite their having top class health infrastructure which crumbled when faced by the ferocity of this virus. Presently, our healthcare system is under immense strain, just about held up by the indomitable spirit of our healthcare and frontline warriors and all those known and those unsung who have stepped in selflessly to help their suffering fellow Indians. The befitting tribute to these heroes, and the thousands sadly lost, would be the formulation of a ‘National Health Security Policy’ as a vital component of ‘National Security’, with defined goals, a clear strategy, and a time bound action plan so that our response to the next wave or the next pandemic is not a repeat of our 1962 war experience – fighting at high altitude wearing cotton uniforms, using World War 2 vintage rifles against a remorseless foe.