On Sunday, India became the first country to record over 80,000 new cases in 24 hours. The severity of this record is only somewhat cushioned by the fact that it continues to report the lowest fatality rate, which stands at 1.76%. During the early stages of the pandemic, when the breadth of the situation had not been fully ascertained, experts applauded India for its expedited and proactive response. However, since then, several criticisms, such as unfathomably low testing rates, have been hurled at Indian policymakers. Numerous factors, such as population demographics and medical capabilities, have contributed to the successes and the failures of the Indian COVID-19 response. Another such factor, which not only impacted the country’s response but will also impact the post-pandemic recovery, is of centre-state cooperation in countering this unprecedented outbreak.
While the Indian constitution doesn’t explicitly call itself a “federation,” it does refer to India as a “Union of States”, which perhaps indicates that power is skewed in favour of the centre, as compared to federal governments like the United States (US), where the majority of policymaking authority is dispersed to individual states. This centre-state dynamic has impacted India’s approach to curbing the spread of COVID-19, wherein balancing state and central powers to formulate an effective and sustainable health policy has become a severe challenge. Given that just five states—Maharashtra, Andhra Pradesh, Karnataka, Uttar Pradesh and Tamil Nadu—accounted for 56% of the new cases on Wednesday, it has become abundantly clear that India needs to have a cooperative and collaborated policy that is formulated in consultation with the representatives of the states and union territories. However, given the challenges posed by India’s federalist model, it is evident that this approach must be adaptable to the unique circumstances in different states.
The question of where the power to make policies on such outbreaks lies is not clear in Indian laws. On the one hand, the Indian constitution grants the decision-making power for matters related to public health to states. Further, the Epidemic Diseases Act provides states with a broader array of powers as compared to central authorities. However, on the other hand, controlling the spread of “infectious or contagious diseases” features in the “concurrent list”. In such a scenario, while both states and central authorities have the power to enact policy, in case of a conflict, the centre’s decision prevails. Hence, while legal and policy experts admit that state governments are best suited to assess and consequently enact policies on health issues, the centre retains an overarching power to veto and overrule any decision by the state. This power of the central government is further strengthened by its use of the National Disaster Management Act, which favours the centre’s dominance in formulating a response, which in turn provides a legal justification for the nation-wide implementation of the lockdown.
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Admittedly, having a more robust centre does have its benefits. For instance, Indian authorities were quick to implement nation-wide travel advisories and restrictions. They were also credited for their swift implementation of contact-tracing and surveillance. Further, Indian policymakers were also able to influence a whole host of other industries to put forth a coordinated response—such as the agriculture sector, which traditionally falls within the states’ domain—to provide relief and aid. However, the shortcomings of a top-down approach severely outweigh its benefits.
When the lockdown was implemented on March 24, several critics expressed concern over the blanket application of identical restrictions across all states. At that time, the country had reported merely 500 cases and ten deaths. Moreover, only 6,500 samples had been tested across the country. This abrupt shift brought economic activities across the country to a complete standstill. While certain states such as Maharashtra saw a monumental surge in cases during the lockdown, other states, such as those in the northeast, were forced to deal with a severe economic blow, even in the absence of a significant threat to public health within their borders. Had there been a differentiated approach to this issue, wherein the nature of the lockdown was dependent on the extent of the outbreak in each state, states could have continued their economic activities at least until the first case was reported. Hence, instead of imposing a strict curfew-like lockdown across the country, different states could have adopted more regionally appropriate policies to enforce social-distancing restrictions that would be proportionate to the threat to public health in their area, such as restricting inter-state travel.
The impact of the universalised approach is now becoming evident. Since June 8, in a bid to revive the economy and restart industries, the government has started to “unlock” the country, even as most states are witnessing a huge surge in cases. In states where the outbreak was previously quite minimal, this surge can be attributed to the sudden and mass influx of migrant workers returning from hard-hit industrial states such as Maharashtra, Tamil Nadu and Karnataka. A report submitted to the Supreme Court suggested that, from May to June, around 10 million migrant workers returned to Odisha, Bihar and Jharkhand. The receiving states, which were financially vulnerable even before being struck by the lockdown, are now faced with an additional challenge of securing the health and safety of a large number of unemployed migrants. This, again, is a consequence of the lack of coordination between the centre and the state. The decision to start trains to permit the return of migrant workers to their domicile states was a knee-jerk reaction by the central authorities, who were facing pressures to act on the plight of these workers. Instead, had the lockdown been imposed in consultation with the states, a gradual yet expedited return of the migrants could have been arranged from the onset. Accordingly, states would have been better prepared to receive these workers and ensure the availability of quarantine facilities, establish mechanisms for contact-tracing, and make provisions for healthcare facilities and equipment to deal with a more manageable increase in cases. However, now, states face an odd dilemma, wherein restarting economic activities has become a need for survival, even as the cases are reaching unprecedented numbers and the outbreak approaches its peak. Hence, this sense of normalcy returns at the most inopportune time, with the public health situation is nearing its worst. It appears that the unlock phase has been brought about by financial necessity rather than readiness, potentially overburdening an already overworked and understaffed healthcare system and further weakening the economies of states that are already vulnerable.
Further, even as states are now being granted with more powers to shape their own COVID-19 approach, the impact of the top-down approach adopted during early stages of the lockdown has hampered their ability to successfully formulate their own policies. For instance, during the early stages of the outbreak, the centre adopted a policy that allowed the centre’s disaster management funds to benefit from corporate social responsibility contributions. However, this same privilege was denied to states. Consequently, with the erosion of their financial capital, state governments also saw a deterioration in their financial power. While the central government, during the financial reforms introduced in May, has formulated a policy to assist states in their economic losses by increasing the borrowing limit from 3% to 5%, this leeway does not come without caveats. Out of the 2% that has been increased, merely 0.5 % is unconditional. To utilise an extra 1%, the states will have to dedicate the borrowed amount towards reducing unemployment, reforming policies for the power sector and urban development. Finally, the remaining 0.5% can only be utilised upon achieving a particular amount of success in the abovementioned issues. By implementing such a reward-based policy, the central government has misused the vulnerability of the states’ economies to penetrate the states’ policymaking.
While the issues that stem from a centre-driven policy are evident, the extreme opposite end of the spectrum is not a suitable alternative either. For instance, the European Union (EU) saw a weak central response during the peak of the outbreak. Consequently, several member states were found struggling to cope with the public health emergency, with no assistance from the EU or its member states. Countries like Spain and Italy bore the brunt of the inability of the EU to coordinate a centralised response. Meanwhile, other federal countries, like Germany, saw the successful top-down implementation of a coordinated national policy. Admittedly, the inward-looking policy of the more prosperous and more powerful states may have successfully saved themselves from facing the worst during the outbreak. However, their indifference towards countries like Italy and Spain has severely impacted the economic recovery of the EU. Further, even in the US, the failure of the federal government to impose nation-wide restrictions to implement social distancing policies and impose lockdowns led to several states refusing to adopt policies to curb the outbreak, eventually causing the uncontrollable spread of COVID-19.
Therefore, for such pandemics, a careful balance between the two poles of federalism must be struck in order to empower local authorities to take stock of their economic and health concerns and ensure a differentiated approach depending on the ground realities in each individual state. This, however, must be guided by central policies that direct states’ actions on the issue to ensure a cooperative and collaborated approach. Such an approach would draw parallels with Germany’s approach, where a strong central policy was strictly implemented in consultation with provincial authorities; this was instrumental in the success of the country’s COVID-19 response. This can also prevent a US-like situation where the ignorance or negligence of state policymakers causes an unchecked spread of the outbreak. Yes, hindsight is 20/20, but the ongoing crisis has made it clear that amending outdated laws that govern the centre-state dynamics for disease control and management is the need of the hour. However, will strong centres be willing to surrender powers to opposition-led states and states be willing to give up their autonomy to the federal government, or will political motives and ambitions overpower the need for sweeping changes in policies on public health?