The above given cartoon by Satish Acharya has been shared a lot many times of late.
While it wants to make a more specific point about the relative underfunding of healthcare when compared to the defence forces, I believe this aspect is only a symptom of a broader malaise which has been uncovered by the Covid-19 crisis. The policies and outlooks which drive the world today, are deeply influenced by the challenges the world faced in the 20th century- mainly colonialism, the 2 World Wars and the prolonged Cold War. It is only to be expected, as most of the leaders of consequence across the world are in their 60s or 70s and the bureaucracy which advises them, is even more archaic, not in age but in mindset- as bureaucrats as a breed tend to prioritise stability and status quo. Unfortunately, the world has undergone a sea change, with deepening roots of globalisation and is interlinked to an unprecedented level and as the world has changed, so have its problems.
We saw 2 full-fledged and prolonged conflicts involving almost the entire world within a span of 20 years, but after that very rarely have we seen a prolonged conflict between 2 countries of comparable strength, leave alone the whole world. What did follow the Second World War was a multi-decade Cold War where blocks on both sides of the spectrum pumped in billions of dollars (and roubles if you may:-p) into preparing for an Armageddon which never happened. While one can argue the war was avoided to a large extent because of the deterrent capabilities of either side, it becomes difficult to fathom the need to stockpile enough nukes to destroy the whole planet several times over. Now the same machinery is turning to be woefully inadequate when faced with a challenge like the Coronavirus pandemic since it is simply not tuned to deal with it. I am no policy-planner or geostrategic expert myself, but these are some of the ways I think we could modify our outlook-
Some of the most developed countries in the world ran out of personal protective equipment and intensive care infrastructure when struck with the Covid-19 pandemic. While no one can deny the fact that healthcare as a sector remains underfunded, even if healthcare was abundantly funded, there was no way any hospital in the most developed part of the world would have had enough ventilators to combat the peak of the pandemic. This is because of the simple fact that no hospital needs such a large number of ventilators on a day to day basis and since intensive care equipment is expensive to procure and maintain, it does not make a lot of sense to stockpile such equipment.
So, a better question to ask is how can an enhanced funding to healthcare be utilised in the most optimal manner? The simplest answer is to strengthen the preventive and promotive aspects of healthcare on one hand and training more healthcare personnel right from community healthcare workers to specialist doctors.
A more comprehensive approach would be to adequately fund R&D activities in the domain of health. To draw comparison, we get tremendously better computers today at a fraction of what a bulky slow machine used to cost 20-30 years ago. A similar revolution is yet elusive in healthcare. With the advent of generics, some drugs surely have become cheaper, mass produced and affordable, but most other equipment remains prohibitively expensive. Part of the reason for this is the fact that any product related to healthcare faces much more stringent quality control and requires prolonged trials before it gets regulatory approval and even after the approval, you can be asked to pay millions in compensation if something were to go wrong. Moreover, with the developed world becoming besotted with non-communicable diseases like diabetes, hypertension and cancer, antibiotics and other drugs for infectious diseases are hardly being discovered on one hand and resistance to existent antibiotics is burgeoning by the day.
This is where governments across the world can step in and finance R&D activities to incentivise the development of state-of-the-art lifesaving drugs and technology which can be mass produced at affordable price-points. Imagine if it was a public entity which held the patents and production of intensive care equipment like ventilators in today’s time, it could have easily ramped up production by transferring technology to other players without having to worry about losing out on recovering the money it had to invest to develop the technology in the first place. Moreover, each country could cater to its own specialised needs and not have to rely on the profitability assessments of an MNC executive sitting in New York, London or Beijing. The other aspect which is in need of urgent attention is the record and data-keeping at healthcare establishments ranging from a sub-centre in the village to the most sophisticated hospitals. There is a requirement for IT enabled platforms at every health facility to ensure each case that a doctor or health-worker sees is uploaded to a centralised server where algorithms exist to monitor and warn about any abnormal rise in a particular illness. The Integrated Disease Surveillance Program (IDSP) is a good start in this aspect, but has a lot of scope for improvement.
I do not argue that governments need to stop funding the armed forces or significantly cut down on this expenditure. But much like healthcare, there can be improvement in the way the funds are to be utilised. Of all the funds allotted to the armed forces in India, almost 60% are spent purely on manpower (salary, pensions etc) and a much smaller fraction is spent on modernisation .
This is another arena in which we need to come out of the 20th century mindset which valued large standing armies; the era of trench warfare is far behind us. More than a prolonged war where you can overwhelm the enemy by sheer numbers, what matters now is a leaner but technologically superior force which can give you a quick victory in a short but intense battle. Human life is valued more today, than at any point in history and no country can afford to fight a war where large numbers of its own soldiers make the supreme sacrifice, examples are America’s disastrous involvements in recent times from Vietnam to Iraq. What then could be the rationale of spending most of your budget into manpower?
A pressing need is to cut down on the manpower and invest more and more in technologies like unmanned combat vehicles, protective equipment for soldiers etc. Technology can make a single solider more efficient than 10 under-equipped soldiers and technology does not need to be paid a pension once it retires. So be it health or military, both can do with an aggressive outlay towards R&D.
The Covid-19 pandemic has shown more than anything else, how much a 20th Century framework of the UN and its allied organisations is incapable of dealing with today’s world. Serious questions have been raised about WHO’s competence and stance vis-à-vis China. The UNSC itself remains a body which favours certain nations with a veto power simply because they were on the right (read winning) side in World War 2 and ignores much more capable and humane powers like India, Japan, Germany etc. It also shows, like there exists a framework to keep a check on countries’ nuclear activities, there is a pressing need for a similar organisation to keep monitoring health related outbreaks all over the world and stop relying on data provided by the respective governments whose own interests may not align with that of the world at large.
In a globalized world, where millions fly from one corner to another, a local outbreak of one province could be the global pandemic of tomorrow. Imagine if WHO had its own researchers and epidemiologists monitoring the situation in Wuhan in the early days of the Covid-19 outbreak and had power to alert governments across the world to take preventive measures, the world would be so much better off today. Instead, the archaic mechanism of the WHO had no alternative but take the Chinese word at face value and come out looking like fools after announcing that there is no man-to-man spread of Covid-19. Any modifications to the power structure of the WHO and allied agencies must provide the due recognition to non-aggressive, humane and responsible powers like India, Japan etc. In a nutshell, if the world takes it as a timely warning, the entire Covid-19 pandemic has the potential to become the classical churning of the oceans (‘samudra-manthan’) which yields a whole lot of good (‘amrit’) in the end.