Harsh Vardhan: The Good Doctor Goes

Dr Harsh Vardhan left the Union Health Ministry following a cabinet reshuffle on 7 July, as quietly as he arrived. It was a departure without fuss, remonstration, or coverage, exactly as is warranted by a senior member of the Bharatiya Janata Party (BJP). Yet it took many by surprise.

Grapevines had been buzzing furiously from a week before, that a few big names would be dropped from the Narendra Modi cabinet. Raucous speculation centred primarily on Ravi Shankar Prasad and Prakash Javadekar; although that turned out to be right, few thought that Harsh Vardhan too, would join the exit list.

As Union Health Minister, this quiet, non-controversial, self-effacing politician from the national capital had spent 18 torrid months in the hot seat, leading a bruising fight against the Wuhan virus. From January 2020, when the Chinese menace first reared its fearful head, through the first wave, a winter lull, and a horrific second wave in 2021, it was Harsh Vardhan who stoutly held the fort.

Commentators were quick to arrive at the conclusion that Harsh Vardhan’s forfeiture of a place in the central cabinet was formal admission of his complicity in failing to tackle the second wave with requisite alacrity. Others said that he was being set up as the fall guy, to take the heat off the central government, before a fresh election season arrived in six months.

Naturally then, it behooves us to assess the extent to which such perceptions are true, or not, by reviewing both policy and operational aspects.

On the policy front, the Ministry of Health and Family Welfare (MoHFW) website lists a paper trail of advisories, showing how the Union government responded to the crisis. It includes specifications for making testing kits, protocols to be followed in various environments, and a number of demi-official letters to the states, by both the Cabinet Secretary and the Home Secretary, on the “dos and don’ts” devised by the Health Ministry.

A second important feature was the establishment of expert bodies to guide the fight against the Wuhan virus. Those chosen represented the best medical advice on offer in the country, and as on date, much of their advice remains the uncontested yardstick for tackling this epidemic. The luminaries included, inter alia, Dr Randeep Guleria, Dr Balram Bhargava, and the now-retired Dr Gangakhedkar.

The third, and strategically most important initiative, was the decision to invest risk and resources in two vaccine development programmes. Let it not be forgotten that if, today, Bharat Biotech’s Covaxin is being touted as perhaps the most effective vaccine globally, the virus strain used to manufacture this vaccine was provided by the Indian Council of Medical Research (ICMR). That initiative was driven by the Union Health Ministry.

A fourth aspect is the pre-planning for medical oxygen. As it now transpires, the Union government had already allocated ample funds to states and Union Territories to generate storage capacity for oxygen, well before anyone even envisaged a second wave.

A fifth aspect is the nature and quality of our politics. Be it the first nationwide lockdown or subsequent ones, the migrant issue, testing, vaccines, relaxations, travel restrictions, or epidemic-appropriate behaviour in public spaces, at every step, the solitary constant was a persistent effort, by select political forces to run down advisories and irresponsibly advocate the exact opposite, with nary a thought on how such actions might hamper collective efforts to contain the epidemic and exorcise it.

In such a badly vitiated atmosphere, is it a wonder that the situation deteriorated to worse levels than otherwise, if these forces had behaved conscientiously?

And yet, for all that, the biggest questions invariably centre round culpability for the second wave. Could it have been predicted? Could it have been prevented? Could it have been managed better?

Quite frankly, that’s tough to answer. From March 2020, this writer was intimately involved in epidemic data analysis and monitoring. Plotting testing levels, positivities, and a host of other parameters, became an elaborate daily ritual, because it was clear from the start that this crisis was too important to be left to politicians.

Dozens of articles were churned out, warning various states about where they were going wrong, or what to do, or what to expect. Most of the predictions came true. And yet, this writer missed the second wave by three whole weeks.

It is only in late-January, or very early-February, that realisation dawned of what was coming; and even then, it was not till May, when a laborious, district-by-district analysis led to the sinking finding, that the second wave actually began in early January 2021, when the UK variant (as it was then called) found generous reproductive space amidst the so-called farmers protests then raging in North India.

So yes, the signs were there, but there was so much scatter within the district level data, that it would have taken an eagle to spot the genesis of the second wave, as it was happening.

In which case, if Harsh Vardhan is wrong, then so is everyone else who was studying the data, including this writer. The honourable thing to do, then, would be for all to share the blame together — the Centre, the states, the scientists, and the analysts.

Still, accountability is everything in a democracy, so if someone is indeed to be held responsible for the second wave, then propriety and morality deem that the buck has to stop at the Union Health Minister’s door.

Nonetheless, it would be grossly unfair to hold him solely responsible, since the onus of gauging and containing the crisis in an efficient, cost-effective manner with minimal loss to life and livelihood, rests as much with the states, if not more, as with the Centre. After all, no matter who points a finger at whom, health is, was, and shall remain, a state subject.

It is this truth which was conveniently swept under the rug during both waves, and it is this truth which informs that, whatever the central government did by way of drafting advisories, taking key decisions of travel restrictions, developing vaccines, or providing economic, medical, and material relief, at the end of the day, the operational duties and responsibility of physically grappling with the virus lay with the states.

Testing, tracing, isolation and treatment were never a central function during the course of this epidemic, but the sole remit of the states.

And that is where India was let down the most. Be it the triggering of the migrant crisis, the impromptu assembly of hordes outside Bandra and Mumbra railway stations, the egregious hesitancy displayed in tracking, testing, and isolating the Tablighi Jamaat super spreaders, or the incessant, openly politically-motivated protests against the farm bills, all of which increased virus transmission and worsened the situation exponentially, the responsibility lay with the states and not the Centre.

In spite of these, it is brutally ironic that it is Harsh Vardhan who has to go, instead of our best chief ministers, and flagrantly incompetent state health ministers, who couldn’t trap a dead virus in a month of Sundays.

Truly, what else explains the fact that the cumulative positivity in Kerala still hasn’t come down to requisite levels, after it crossed above 5 per cent in September 2020, 10 long months ago.

Or, that the daily case count in Maharashtra has yet to drop below 2,000 since May 2020 (14 long months ago).

Or, that the mortality rates in Punjab are around twice the national average.

Or, that the Delhi government publicly stated that they had sufficient stocks of oxygen, just days before a cataclysmic oxygen shortage hit the state?

It’s a long list, filled also, with the names of so many who need not have died. Thus, on the operational front, and in light of available evidence, it is difficult to heap much blame on Harsh Vardhan.

The ultimate irony though, is that the same week as Harsh Vardhan tendered his resignation, the Center for Public Policy (CCP) at the Indian Institute of Management, Bangalore, extended an invitation to K K Shailaja, to, hold your breath, give a lecture on ‘Policy Implications of the Pandemic: Learnings from Managing Covid-19’.

According to Professor M S Sriram of the CCP, this invitation apparently ties in with the institute’s aims of improving the delivery of public services across the country.

What great wisdom Shailaja Teacher has to offer on controlling epidemics (she was the Health Minister of Kerala till two months ago), when the TPR in Kerala has been at over 10 per cent for months on end now, where the daily case count is a third of the national total, and where it has been essential one unbroken wave from the time when she was in charge, is truly a question for the ages. And what profound learnings on epidemic management the CCP hopes to gain from Shailaja Teacher, they will surely elucidate.

So, in conclusion, it appears that fate has been rather harsh on Dr Harsh Vardhan. Since the actual reasons for his departure remain unknown, the best we can say is that he took one for the team.

A quiet man, who served to the best of his ability during uniquely trying times, yet one who left with his honour intact. Still, if karma is anything to go by, this may not be adieu, but only à bientôt. Pound to a penny, he’ll be back in an executive role again before long. See you soon, Doc.