Without free vaccination, majority of Indians could miss vaccine: Oxfam India’s Amitabh Behar

Courtesy Amitabh Behar
31 January, 2021

COVID-19 and the pandemic-induced lockdown exacerbated the already existing social inequalities in India and widened the gap in access to education, health and livelihoods—that is the key finding of a report released by Oxfam India, a non-profit, on 25 January. Titled “The Inequality Virus,” the report examined the unequal impact of COVID-19 and the lockdown on the “haves and have-nots.” It highlighted the disproportionate impact of the virus on marginalised communities such as Dalits, Adivasis, and women.

The report emphasised that while the “majority of India suffered,” and 1,70,000 people lost their jobs every hour in the month of April 2020, India’s wealthiest increased their wealth. “India’s 100 billionaires have seen their fortunes increase by Rs 12,97,822 crores since March 2020, enough to give every one of the 138 million poorest Indian people a cheque for Rs 94,045 each,” the report said. It added that it would take an unskilled worker 10,000 years to make what industrialist Mukesh Ambani made in an hour during the pandemic and three years to make what he made in a second. It further elaborated that what Ambani earned during the pandemic would keep 40 crore informal workers that are at risk of falling into poverty due to COVID-19 above the poverty line for at least 5 months. Highlighting the stark inequality in the country, the report noted that the increase in wealth of the top 11 billionaires of India during the pandemic could sustain the Mahatma Gandhi National Rural Employment Guarantee Scheme, or the health ministry for 10 years. It added that if India’s top 11 billionaires are taxed at just one percent on the increase in their wealth during the pandemic, it will be enough to increase the allocation of the Pradhan Mantri Bhartiya Janaushadhi Pariyojana, a scheme to provide affordable medicines to the poor and marginalised, by 140 times.

The report examined the impact of COVID-19 and the lockdown in three specific areas—education, health and livelihood. “Till the end of October, the number of students affected by the closure of educational institutions stands at over 32 crores,” the report said, “Of those, 84 percent reside in rural areas and 70 percent attend government schools.” Oxfam India’s survey across five states also found that “close to 40 percent of teachers in government schools fear that prolonged school closure might lead to a third of the students not returning once schools reopen.” The reported noted, “It is likely that a higher rate of drop-out will be witnessed among Dalits, Adivasis and Muslims. Many of them will become victims of child labour and child marriage.”

The report further highlighted that the switch to online education excluded the vast majority of Indians who do not have access to technology. “Out of the poorest 20 percent households in India, only 2.7 percent have access to a computer and 8.9 percent to internet facilities,” it said.” On the health front, the report noted that it has been difficult for most Indians to follow the pandemic’s social distancing norms. It emphasised that the spread of disease “was swift among poor communities, often living in crammed areas with poor sanitation and using shared common facilities such as toilets and water points.”

Analysing the access to non-COVID health services in rural areas, it noted that the “disruption of health services” during the lockdown was “significantly higher” in rural India compared to urban areas. “This can be attributed to the closure of all primary health centres and deployment of the staff on COVID-19 duties in rural areas, which already has comparatively sparse health infrastructure and human resource availability compared to its urban counterparts.”

The report continued, “On the one hand, the rural, poor and vulnerable population is left without many alternatives for addressing their non-COVID-19 related health needs while the rich can afford private health care and online consultations. On the other hand, those who managed to access healthcare found that the cost of treatment, the price of medicines and other indirect costs had increased manifold while supplies declined.”

The report also assessed the pandemic and lockdown’s impact on the livelihoods of informal workers and women. It concluded that informal workers were the worst hit. “Out of a total 122 million who lost their jobs 75 percent, which accounts for 92 million jobs, were lost in the informal sector,” the report said. “These workers are engaged in small businesses and casual labour and are at a high risk of being pushed into poverty.”

It further noted that 17 million women lost their jobs in April 2020. The report estimated that the increase in unemployment of women can result in a loss to India’s GDP of about eight percent or $218 billion. It added that women have borne the burden of the pandemic in terms of both paid and unpaid work. “Women have been working longer hours and simultaneously managing the daily chores of the household, the educational needs of the children and care for all members of the family,” the report said. It also analysed the rise in violence against women during the lockdown. “As of November 30, 2020, cases of domestic violence stand at 4,687 in 2020 compared to 2,960 in 2019—a 58% rise,” it said.

The report further commented on the India’s “unprepared” public health infrastructure. “The experience of the pandemic has highlighted consequences of chronic neglect of the public healthcare systems, particularly for people living in poverty,” it said. “Underfunded and weak public health systems lack the capacity to effectively control the spread of the virus, or to provide appropriate and timely healthcare for everyone who needs it. India has the world’s fourth lowest health budget in terms of its share of government expenditure. This has resulted in a fragile, weak and understaffed public healthcare system where people pay 58.7 percent of their total health expenditure out of pocket. Despite this, only half the population has access to even the most basic healthcare services.”

Finally, in a section titled “Inadequate government help,” the report analysed the government’s response to the pandemic.Despite the adverse impact that the lockdown has had on informal, migrant workers and the economy, studies show that the relief packages have been miniscule. Additional expenditure of the government in the first relief package announced was only 0.5 percent of the GDP and the total additional public spending promised by all the relief measures announced by the end of May 2020 amounted to only around 1 percent of the GDP. Much of it has not reached the intended beneficiaries.”

In conclusion, the report pointed to the way forward in recovering from the pandemic and reducing inequality. It suggested that the COVID-19 crisis should be “a turning point in the taxation of the richest individuals and big corporations.” It added, “Progressive taxation of the richest members of the society must be the cornerstone of any equitable recovery from the crisis.”

In an email interview earlier this month, Amrita Singh, an editorial fellow at The Caravan, spoke to Amitabh Behar, the chief executive officer of Oxfam India about the report’s findings. “The main takeaway for the government is that we need more investments in people-centric sectors of health, education, livelihood and agriculture,” he said. “Strengthening these sectors will make our country more resilient, more equipped to handle adverse circumstances.”

Amrita Singh: Could you briefly explain the key highlight of the report?
Amitabh Behar: The key finding is that the pandemic-induced lockdown has exacerbated the already existing inequalities in India. The rich individuals and corporates could recover easily from the economic crisis whereas the poor and the marginalised have been hit the hardest and are still dealing with the fallout of loss of income and livelihood. The impact of the pandemic on health, livelihood and access to education has been uneven, hitting India’s women, poor and marginalised groups the most.

AS: A section of the report focuses on the experience of marginalised communities during the pandemic. Could you elaborate on Oxfam India’s findings on the pandemic’s impact on these communities and the systemic inequalities it points to?
AB: The experiences of different groups of people in the pandemic has been defined by their caste, class, religious and gender identities. Therefore, the experience of a rich person with the ability to effectively socially distance while also continuing to work remotely is vastly different from a person living in an urban slum who lost his livelihood due to the nature of his work. Also, it is often the socially marginalised that are the poorest. Therefore, Dalits, Adivasis, Muslims and women have been hit the hardest during this pandemic.

Experts estimate that out-of-school rates will double in a year. Moreover, the likelihood of dropout increases with the decreasing wealth quintile. As such, it is likely that a higher rate of drop-out will be witnessed among Dalits, Adivasis and Muslims. The closure of government schools has disrupted the mid-day meal scheme which covers 120 million children in 1.26 million schools. Around 77.8 percent of ST [Scheduled Tribe] and 69.4 percent of SC [Scheduled Caste] children are in government institutions many of whom depend on MDM for their nutritional intake. This risks exacerbating malnutrition among vulnerable populations, mainly Dalits and Adivasis.

 While elites could afford to stay indoors, overlapping vulnerabilities, deprivations with regards to water, sanitation and cooking fuel among the poor have placed millions at risk. Only six percent of the poorest 20 percent has access to non-shared sources of improved sanitation, compared to 93.4 percent of the top 20 percent. 37.2 percent of SC households and 25.9 percent of ST households have access to non-shared sanitation facilities, compared to 65.7 percent for the general population. Around 46 percent of the lower income group have resorted to borrowing money to run their household due to job loss. 

AS: Some of the figures pertaining to the Scheduled Caste and Scheduled Tribe communities, especially on their access to education during the pandemic are particularly stark. For instance, the report notes that “Fifty-two percent of adolescent girls surveyed by Praxis (75 percent of whom were from SC/ST categories) reported that their time spent on studies significantly decreased due to lack of technical facilities, fights at home and domestic violence.” It adds that 96 percent of ST and 96.2 percent of SC households whose children are in school lack access to a computer. Would it be fair to say that children of these communities have been the worst hit by the pandemic? 
AB: In a society, individuals belonging to different social groups have vastly different starting points in life. Access to opportunities as health and education has therefore been unequal among different groups. Marginalised groups as Dalits, Muslims and Adivasis have historically been denied opportunities at life which would eventually have led to better outcomes. In crisis times, it is often the marginalised that are hit the hardest. In this pandemic, children had to move their education online. Data shows that a large proportion of SC and ST communities have lesser access to technology in comparison to the general population. Similarly, the rural population, and rural females to be specific, have lesser access to technology than urban residents. As such, the effect of the shift to online education has definitely been more on socially marginalised, rural and female population. 

AS: The report recommends ensuring “safe and equitable reopening of educational institutions.” Given the state of the economy and the pandemic, how do you think this can be practically implemented in India? 
AB: The [report] stresses that the short-term disruption in education risks permanent drop-out and the likelihood of drop-out increases with the decreasing wealth quintile. Therefore, continuation of classes through creative means is significant to avoid drop-outs, especially for the poor and marginalised children with no access to technology. Mohalla classes, which are mini classrooms with small groups of students, have been set up by the community in certain parts of Chhattisgarh and Haryana, which are cost-effective and safe. It ensures continued education for children who don’t have a phone and an internet. The government should encourage offline modes of education at the community level which would also deliver entitlements as mid-day meals, textbooks and uniforms. Schools should reopen for small groups of students; school staff should be oriented on the possibility of vulnerable children discontinuing school and ways of bringing them back to classes.

AS: The report states that “unemployment for women rose by 15 percent from a pre-lockdown level of 18 percent.” It notes that this increase in unemployment of women can result in a loss to India’s GDP of about 8 percent or USD 218 billion. It also points to an increase in cases of domestic violence during the pandemic. On a policy level, what gaps do you think have led to women being disproportionately affected by the pandemic? How can these gaps be fixed?
AB: One major gap is the lack of a gender lens at each level of policy-making. A gender-neutral policy is essentially gender blind. We need more women representation in policy-making. At the policy level, gendered social norms should be effectively addressed.

If we take the increase in cases of domestic violence, the introduction of filing of cases through WhatsApp was a huge feat as it gave the victim an easier outlet to report. But we need to create more safe spaces for women and girls and centres at each hospital and clinic to help women in distress. Police apathy during the pandemic has been reported by many women. We need to find ways to make gender-sensitive policies as well as sensitise the implementers. Our policies need to think of women and girls at each step right from conceptualisation to implementation.

AS: What do you think of the government’s pandemic response with respect to marginalised communities? 
AB: The effect of the pandemic has been uneven. Dalit, tribal [communities] and women are affected the most in comparison to their upper caste and male counterpart. So, a uniform and blanket response for the entire population cannot mitigate the effect of the pandemic on these vulnerable groups. Government’s assistance and packages need to prioritise the needs of these vulnerable groups.  

AS: In terms of health and sanitation, the report mentions that, “It is the poor and marginalized groups that have been exposed and are vulnerable to the virus the most while the rich could conveniently protect themselves.” Could you elaborate on this? 
AB: The rich have a greater ability to social distance than the poor and marginalised groups. Low-income groups live in packed colonies with an average of five people living in a one or two-bedroom house that usually has only one washroom. In such a scenario, if one of them contracts the virus, it becomes very difficult isolate oneself. Moreover, working from home is also a privilege, which the poor do not enjoy. They either lost their job or had to go back to work with other workers where, again, social distance becomes a tedious task. Hence, the vulnerability to the virus is more for the poor.

AS: The report points out that “as many as ten states have passed ordinances and regulations that would dilute the existing labour laws and their application.” Policy commentators have argued that these steps were necessary to revive the economy—what do you make of this argument? 
AB: The argument for dilution of labour laws has been that longer working hours will increase the production and growth in the short term. However, research suggests that this does not guarantee an increase in productivity. There are blue-collar workers who are mostly informal and daily-wage labourers who have to work longer hours with low wages in premises that lack clean drinking water, sanitation, medical and other occupational safety measures. India has 170 million blue-collar workers. So, production and growth of the economy at the cost of quality life and rights of labour is not acceptable. 

 AS: The report also notes that India “does not report case data disaggregated by socio-economic or social categories making it difficult to gauge the distribution of the disease amongst various communities.” Why do you think this is the case? Could you speak to the significance of having such data?
AB: Data has been a huge issue for India. Usually, the constraint is the fact that the country’s population is huge, and data collection is, hence, not an easy task. I think we need to build mechanisms for enumeration of the population because macro indicators do not tell the whole story. We see, for instance, that the black community is more affected by COVID in the United States. We do not, however, know if that’s the case for the marginalised communities of India. We can only design effective policies when we know the exact problems in the country. Only with adequate information about the disproportionate effect of the virus, our policies will be able to address the issue.

 AS: The report mentioned that the government did take steps to “make COVID-19 services affordable.” However, it adds, the moves did not likely benefit large sections of marginalised communities. Could you elaborate on the data that shows this? 
AB: The rates of health services and facilities increased manifold in the initial months of the pandemic making it difficult for even the middle-class to afford them. For instance, one of the super-specialty hospitals in Delhi set the cost for an ICU [intensive care unit] with ventilator at Rs 72,500 a day. This eventually led the government to cap the rates of COVID-19 tests and treatments. It was also included under the Ayushman Bharat [insurance] scheme. But the scheme only covers the below poverty line population leaving out the uninsured poor and the middle class who still won’t be able to afford treatment at a private hospital even after the capping of prices.

 AS: Based on Oxfam India’s findings on the availability of health services for marginalised communities, what do you think will be their experience with respect to getting vaccinated? 
AB: The government is yet to officially commit to ensuring free vaccination for all. The government procurement price for Covishield is Rs 200 [for the] first 100 million doses and Rs 1,000 thereafter at private outlets, and Rs 295 per dose for Covaxin. Even at this subsidised price, the costs are prohibitive for the majority of India given that casual workers earn less than Rs 150 per day. Without a commitment to free vaccination, we would see the majority of Indians missing out on the vaccine. Secondly, even after many years, we are not able to fulfil the basic health requirements for the marginalised communities, especially those living in hard-to-reach areas, which might be the case for vaccination as well.

AS: While the Oxfam India report has alarming findings about the government’s pandemic response, a recent India Today “Mood of the Nation” opinion poll said that 78 percent of the people surveyed were satisfied with the prime minister’s handling of the pandemic. Why do you think that is?
AB: While people may be dissatisfied with their experiences during the pandemic, they do not blame the PM for the same. We need to, however, advocate for factoring the unequal impact of this pandemic. While a larger focus is given to stabilising the macroeconomic indicators, restoring livelihoods of a large segment of population through providing wage [or] self-employment has to be supplemented as a demand-side intervention. This is lacking in the present set of actions. Multiple factors and multiple people have contributed to the pandemic response and it would be critical to ensure that everyone works to address inequality.

AS: While your report mentioned inadequate government aid, several government officials have also portrayed the government’s handling of the pandemic as a success story. What do you think should be the main takeaway for the government from the pandemic? 
AB: While government released a package equal to 10 percent of GDP, most of the announcements were related to loan guarantee and non-budgetary measures. Actual fiscal cost of the government support during the pandemic was only one percent of GDP.

The main takeaway for the government is that we need more investments in people-centric sectors of health, education, livelihood and agriculture. Strengthening these sectors will make our country more resilient, more equipped to handle adverse circumstances.

AS: Oxfam India has time and again asked governments to increase the tax imposed on its wealthiest citizens. What is the urgency of this demand and why do you think the Indian government has failed to pay heed to it?
AB: Oxfam has been advocating for re-introducing wealth tax in India for quite some time now. This is because 50 percent of the current tax revenue comes from indirect taxes, which is contributed by the entire population irrespective of their income group. However, 75 percent of India’s wealth is concentrated in the hands of just one percent of the population. Our estimates suggest that if India’s top 11 billionaires are taxed at just one percent on the increase in their wealth during the pandemic, the government can pay the wages of the nine lakh ASHA [Accredited Social Health Activist] workers in the country for five years. These are the frontline workers in our fight against COVID.

From a macro point of view, the government provides tax exemptions to wealthy corporations and individuals to boost the economy. However, at the micro level, it is the poor and marginalised that get disproportionately affected by this. During unprecedented times such as this, when the poor do not have a safety net but have to pay indirect taxes in the essential items and commodities they consume, it becomes imperative that we look for alternate sources of revenue generation.

This interview has been edited and condensed.