The second wave of the Covid-19 pandemic buckled the country for many weeks. We may have passed the peak, but are still struggling with rising infection rates in many parts of the country, a severe vaccine shortage, and a rocky road to ‘vaccines for all’.
With our health systems tested to their seams and thousands of lives lost in a struggle to reach hospitals or access oxygen, what is more daunting is the complete absence of lessons learnt from Covid response during the first wave. The country has failed to acknowledge and correct biases in the first wave’s response against people based on their class, gender, caste, and geographic location.
Instead, the state’s response to the second wave only exacerbates these exclusions.
We outline three kinds of biases that surfaced during the first wave and continue to remain unaddressed during this wave: bias against the marginalised, an urban bias and a technological bias.
Economist Jayati Ghosh analysed how response strategy during the first wave of the Covid-19 crisis utterly neglected the plight of people from marginalised sections of society. She underlined that the policy actions — ranging from lockdowns to economic relief packages — were devised with a parochial view, relying on limited sources of information. Reference points for policymaking were starkly ignorant of ground realities.
The second wave has seen hardly any systematic relief measures and the effects of the first wave on workers’ incomes, nutrition in rural areas etc. are only likely to deteriorate further. Lockdowns at the local or regional level, that too without adequate social welfare support systems, are still the method of choice for containing infections.
Mobile Vaani, our participatory media platform, receives updates from users and volunteers every day about the absence of job opportunities (especially among daily wage workers), dwindling savings because daily wage workers are not able to go out to earn, and consequently, struggles to buy provisions for food. The government is considering financial relief packages (even if primarily for small and medium enterprises and not social welfare), but as the second wave has shown, delays have literally cost lives.
The second wave has also significantly affected rural areas, something that did not happen in 2020. The health infrastructure in most of these regions is still not equipped enough to address this. Voice reports on Mobile Vaani from people in Rohtas in Bihar and Jhajjar in Haryana, for instance, underline the poor status of health facilities in the hinterlands; local health services are either unable to help, do not have oxygen facilities or worse, are closed. Some people manage to get to hospitals in peri-urban areas after many hassles, but they may still struggle to access the care they need.
For several weeks into the second wave, the entire emergency response system was biased towards urban centres and responding to the present rather than looking ahead. The needs of the more ‘visible’ urban patients were highlighted, with most media reports and images primarily emerging from urban areas. Reports of exclusions from smaller cities did not, and still do not, make headlines. As a result, there have been substantial delays in government reactions to some of these exclusions.
For instance, the rule that all hospitals require online payments for amounts greater than Rs 2 lakhs was amended retrospectively after many patients had already witnessed hardships in distressing times. Alternative policy responses have simply been ignored, such as involving community-based institutions such as Panchayat Raj Institutions (PRIs) or Self-Help Groups (SHGs) to ensure inclusion of marginalised communities in the Covid-19 response relief strategy — a response highlighted by our research, too. The state did not act quickly to ensure that citizens in rural areas do not miss out due to the inequitable nature of our response systems.
There has been no learning from last year when relief efforts relying significantly on technology led to widespread exclusions — be it direct benefit transfers for social welfare or the Arogya Setu app for awareness and infection monitoring of people. These solutions seemed to assume that everyone in India owned a smartphone and knew how to use it well and that therefore, these solutions could be used efficiently for a range of health and financial support services.
However, in the second wave, the state has continued to devise more tech-reliant, exclusionary solutions. The vaccination drive being reliant on registration on the Co-WIN website is the latest in this series of gaffes.
Notwithstanding the expectation that every eligible citizen has access to the internet or a smartphone, expecting people across age, gender, class and geographic locations to be comfortable enough with using smartphones to go online, enter their phone number and get an OTP, then select the correct district or enter the correct PIN code for their location and figure out how to choose a vaccination centre seems mind boggling.
These steps are near-impossible not just for someone in a rural area, who might not be literate or own a smartphone, but also for older adults, people with disabilities and other marginalised groups due to their gender identity. The option of in-person registration was not open earlier for the ‘non-internet’ population.
Recently, walk-in vaccine appointments have been approved for all above 18, even if not implemented yet due to a drastic vaccine shortage. But even this requires an extra trip to the primary healthcare centre that can be far and inaccessible for many, especially in remote or rural areas, and where availability of vaccines is not guaranteed anyway (which is even the case in urban areas). And there are understandable fears of overcrowding.
We see this in other domains as well, sometimes even in citizen-led efforts. Several states initiated live online dashboards to help people track the availability of hospital beds. Yet, unlike in places such as New Delhi, the information in other states was often not updated as quickly as the facilities ran out, and was anyway unavailable for those who could not access the internet.
Civil society stepped in admirably —and significantly — to support patients and their families, initially in the metros and eventually in Tier-II and Tier-III cities as well. But their reliance on social media channels and innovative tech setups such as live ChatBot, SOS sheets and Sprinkler tools restrict their reach again to those who are online.
Additionally, those working on these platforms have been unable to effectively gather information from smaller towns and districts. With little recourse, those from cities who are not comfortable (or don’t know about) accessing online platforms or those from smaller towns and villages queue up outside hospitals in desperation. It is the state’s responsibility to provide updated and relevant information to those in need. The state has the wherewithal to provide a consolidated, yet detailed overview of hospital beds, oxygen availability etc., but given the state’s absence for a long time, especially in rural areas, civil society has had to step in.
In pushing for ‘efficient’ and apparently ‘unbiased’ technology, these skewed solutions only work for those who are readily identifiable to the state as victims (and sadly, to parts of civil society as well), often ignoring those in rural and semi-urban areas or people affected by the digital divide who may not be able to use these technologies. It is likely that those devising the solutions feel more connected to others like them.
With many of these ‘problem-solvers’ being based in the cities, it seems only natural that their solutions cater to ‘people like them’ — urban, educated, tech-savvy and the upper- or middle-class. Instead, rural areas and those who are not quite familiar with the whizzing use of smartphones are a part of the ‘other world’, an invisible world.
Barring a few efforts, the reach of rural-centric support systems has been extremely limited and hardly responsive to the scale of the problems.
It is unfortunate that nearly after a year of tackling a pandemic, the state has allowed obvious biases to affect its response to the second wave. The voices of academics, social scientists, those in the development sector and of the people themselves have gone unheeded. The response towards marginalised populations of the country lacked empathy back then and still do. Rural infrastructure has not been ramped up, technologies that disempower continue to be used, and solutions are drawn up without appreciating the diversity of the conditions of the people in the country.
The state needs to begin with acknowledging that these biases exist, only then will it lead to solutions such as implementing systems to provide home care in rural areas, using assisted technology solutions to reach out to those who are not tech-savvy or do not have advanced gadgets, and building offline channels to provide cash transfers and entitlements to the poor as they battle the pandemic without any safety nets.
A state that does not listen and correct its approach immediately runs the risk of putting its citizens through tremendous difficulty — in this case, more waves of the pandemic in the near future.
About the authors:
Rohan S Katepallewar is a development sector professional with more than nine years of experience in the government, corporate, and public interest agency fields. He believes that appropriate technology, which is bottom-up and contextual, can create an equalising force in society. At Gram Vaani, he leads partnership-related efforts and manages innovative programs and research for livelihood security, social security, and gender justice for marginalised and low-income communities.
Vani Viswanathan is a development communications professional with more than 10 years of experience in storytelling and campaign management for nonprofits and corporates. She is especially interested in the areas of gender and sexuality and their role in development and access to human rights. At Gram Vaani, she highlights stories of people in India’s heartlands and urban low-income communities through long-form writing and social media.