Importance Of Free Ration Supplies During Covid-19: Lessons From The 1918 Spanish Flu

A short piece titled “The Pandemic of Influenza in India in 1918” published in The Lancet in December 1923, carried an account by Dr E S Phipson, health officer of Simla. He mentioned the relatively low stock of food, subnormal rainfall and high prices as key reasons contributing to the genesis of the 1918 pandemic.

India lost more than 12 million people to the Spanish flu, a staggering 5 per cent of the total population. The British government, at the best of the times, was unconcerned about developing basic healthcare and humanitarian facilities for the Indians living as its subjects. In the worst of times during the Spanish flu pandemic, the government was conspicuous by its glaring and shameful absence.

Given that Mumbai, then Bombay, was a key port of entry for India, especially for the soldiers returning from World War II in Europe, the Bombay Presidency was amongst the worst hit. Another city that bore the brunt of the pandemic was Karachi, which was a key trans-shipment port in those times like Bombay.

Historian Mridula Ramanna delivered a detailed talk on the experience of the Bombay Presidency during this epidemic on YouTube in May 2020. She remarked - “For every 1,000 persons living between the ages of 20 and 40, 62 men and 79 women died. Mortality was estimated at 1,086,758 for the months of June to December 1918, taking an excess of total mortality over the mean of the previous five years. The peak was reached in October”.

These details have also been addressed by Phillips Howard and David Killingray in their edited 2003 book, “The Spanish Influenza Epidemic of 1918–19: New Perspectives”. Essays in this book cover one of the lesser-known issues which made this pandemic deadly – the short supply of food grains.

During the war years, food grains produced in India were being used for the British troops in the field in Europe. Export of food grains was commonplace, and this practice did not stop until late in the pandemic. The Indian leaders raised this issue with the British government, and the export of wheat only stopped in 1918.

Given the wartime, there was no possibility of importing food grains either. Not that the British government was working on any such plans, but even if it did, the supply chains around the world were distorted and pressed into service of hundreds of global battlefields.

This situation was further complicated by a famine in all provinces that got hit by the pandemic. British Indian provinces of Bengal, Bombay, Central Provinces, Punjab, Rajputana and United Provinces all saw the incidence of famine. This made the poor availability of food grains much worse. Food inflation skyrocketed around the country, depriving poor Indians of basic supplies, let alone nutrition.

Historians like Ramanna and others have identified this lack of access to food as a key issue during the Spanish flu. The poorer section of the society was much worse hit by the pandemic, as hungry Indians succumbed in droves to the debilitating pandemic. Even without access to healthcare and medical facilities, millions of Indians could have survived were they sleeping on a full stomach.

Why is this important today? India has been through bad times in the current outbreak of the global Covid-19 pandemic. There have been several issues of state capacity on the healthcare side, where India, like most other countries, has struggled to deal with the peak case load and the peak mortality rate. But one thing that did not garner any attention – because it has been managed well – is access to food supplies.

The Prime Minister Gareeb Kalyan Anna Yojana (PMGKAY) was announced by the Modi government on 26 March 2020. This was immediately after India’s first lockdown was announced earlier that week. The programme was launched initially for three months, from April to June 2020, with an outlay of Rs. 170,000 crore on not just food security but a range of other support measures. Later, the food support programme was extended till November with an additional outlay of Rs. 90,000 crores.

This programme entitled every beneficiary to get 5 kg wheat or rice and 1 kg of preferred pulses for free every month. The programme covered all beneficiaries of the National Food Security Act, which covers almost three-fourths of the entire rural population and half of the total urban population. Overall, about 800 million Indians are eligible beneficiaries under the National Food Security Act, which is implemented through the public distribution system. The PMGKAY entitlement was over and above the existing monthly entitlement under the National Food Security Act.

This programme ensured that migrant labour and other poor sections of the society did not face hunger pangs. When the second wave of the pandemic reared its head, the PMGKAY was reinstituted for May and June 2021 at a total outlay of Rs. 26,000 crores. The programme has since been extended until November 2021, which would be the fourth phase of the initiative. The Ministry of Consumer Affairs, Food and Public Distribution is managing India’s food security in these difficult times.

An important lesson that India learnt from the devastating, high-mortality 1918 Spanish flu pandemic was that while the virus itself was deadly, a combination of famine, drought, hunger and malnutrition made the situation much worse. The weakened immunity of poor Indians became a key factor in how the virus impacted society.

This is one aspect of managing the Covid-19 pandemic, where India has done commendably well drawing upon the historical experience.