ANONYMOUS - OUR VOICE

Will the Taliban roll back two decades of public health progress in Afghanistan?

Since the Taliban retook Kabul this past Sunday, observers around the world have worried about what the religious group’s control will mean for Afghanistan’s women, its internal security, its education system, its religious minorities, and its citizens who aided the coalition occupation over the past two decades.
But relatively little attention has been paid to what the Taliban victory will mean for one of the <a href="https://www.theatlantic.com/international/archive/2013/10/heres-the-best-thing-the-us-has-done-in-afghanistan/280484/">nation’s biggest accomplishments</a>: the sharp decline in child and maternal mortality over the past two decades.
A <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30002-X/">study in The Lancet Global Health</a> found that between 2003 and 2015, child mortality in Afghanistan fell by 29 percent. While maternal mortality is difficult to estimate, <a href="https://gh.bmj.com/content/5/5/e002126">one data set</a> found that deaths in childbirth fell from 1,140 per 100,000 in 2005 to 638 per 100,000 in 2017, or nearly in half.
<div class="c-float-right">
<div>
<div class="c-entry-sidebar">
Twice a week, we’ll send you a roundup of the best ideas and solutions for tackling the world’s biggest challenges — and how to get better at doing good. <a data-analytics-link="related-story" data-analytics-viewport="related-story" href="https://www.vox.com/future-perfect-newsletter">Sign up here</a>.
</div>
</div>
</div>
This progress was not necessarily all generated by the US-led occupation, with aid from international organizations and Afghan-led initiatives contributing heavily; and these estimates rely on household surveys that are difficult to conduct well, especially in poor, war-torn countries with large nomadic populations, meaning they are likely off to some degree.
But regardless of their origin, these are huge gains to the country’s health, gains that represent hundreds of thousands of lives saved. It would be disastrous if they were to deteriorate, or if progress were to slow, under the new regime.
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629397848_9693_14380" data-cdata='{"asset_id":22792599,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/IETPBXuBfTRNvAdr9WX0dXHpu3A=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 320w, https://cdn.vox-cdn.com/thumbor/gEZxbeZ-ropGmFt212-hoMFuQgk=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 520w, https://cdn.vox-cdn.com/thumbor/mcrQ_jfBlVa0RtTvAu8Q_eH6hUY=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 720w, https://cdn.vox-cdn.com/thumbor/Qyzz4e6m0AnZCNWOeE7BJfsC-bI=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 920w, https://cdn.vox-cdn.com/thumbor/D5Gpoim-y-FuuYZHZmBNwGyGXNg=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 1120w, https://cdn.vox-cdn.com/thumbor/XfInSbHtOvzLc2hLKd6tGZXUFBY=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 1320w, https://cdn.vox-cdn.com/thumbor/_l5ut1kZV8BNnTkqaPgcmKo16oA=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 1520w, https://cdn.vox-cdn.com/thumbor/WKuljLoOeKN0BkO1Wl_iAoT2PLw=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 1720w, https://cdn.vox-cdn.com/thumbor/MuUlkUaRqn_Ow55J85KkgScgTFM=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 1920w" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" type="image/webp" /> <img alt="American Medics Train Afghan Nursing Students In Kabul, Afghanistan" data-upload-width="3000" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" src="https://cdn.vox-cdn.com/thumbor/0QDXBL6VR1lyW4DQQ1-UOE3Vqk8=/0x0:3000x2000/1200x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg" srcset="https://cdn.vox-cdn.com/thumbor/dUVKc2c6wohH9dFuHCkunygPsTo=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 320w, https://cdn.vox-cdn.com/thumbor/P5q6rjbuAcHfg5ZrlinnhTQVTyM=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 520w, https://cdn.vox-cdn.com/thumbor/G6_8viv7-f7luUtXDYQDm-VbWBI=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 720w, https://cdn.vox-cdn.com/thumbor/YtF33yaviRT77QK8fl8QUjxPs3M=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 920w, https://cdn.vox-cdn.com/thumbor/GkZjtKsVHza-WHJFn7LNupb5HdE=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 1120w, https://cdn.vox-cdn.com/thumbor/Txofcmqww9kwTMHTsNBHYZAXd-8=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 1320w, https://cdn.vox-cdn.com/thumbor/80jhGZsZLaMaSz02OIT8YzTqjUg=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 1520w, https://cdn.vox-cdn.com/thumbor/TMk9O8znTFfJkY9kDKIixv9uZNI=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 1720w, https://cdn.vox-cdn.com/thumbor/s8w4vxNW7hjPY6YwKyq9oq1Ph2w=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792599/113050641.jpg 1920w" /></picture>
<figcaption>Afghan doctors assist an injured Afghan National Army soldier at the Daoud Khan Military Hospital on April 23, 2011, in Kabul.</figcaption>
<cite>Majid Saeedi/Getty Images</cite></figure>
To get a sense of where this progress came from, and whether it can be maintained under Taliban rule, I spoke with Gilbert Burnham, a professor at Johns Hopkins’s Bloomberg School of Public Health who has been researching Afghanistan’s health systems and helping conduct public health surveys since 2002. A transcript of our conversation, lightly edited for length and clarity, follows.
<h4>Dylan Matthews</h4>
When you started in Afghanistan in 2002, the country had been under Taliban rule for five years and was in a state of humanitarian emergency. What was your assessment of the country’s public health compared to other places where you’d worked?
<h4>Gilbert Burnham</h4>
Without a census, which Afghanistan has never had, it is hard to plot trends. But the health status of Afghanistan had been poor before the Soviet invasion in 1978, with high infant and child mortality. During the Soviet times [1978 to 1989] and afterward, during the conflict with the mujahideen and the Taliban, there was little or no improvement. In 2002, the health status, especially of women and children, was poor by world standards and regional standards. The deaths of women from pregnancy-related causes were <a href="https://www.reuters.com/article/us-afghanistan-maternity-fb/factbox-why-are-maternal-deaths-so-high-in-afghanistan-idUSTRE7BB0FJ20111212">some of the worst in the world</a>.
<h4>Dylan Matthews</h4>
What have been the main trends in public health in Afghanistan over the last two decades?
<h4>Gilbert Burnham</h4>
The principal health indicators are still worse than the region, but many have shown a remarkable improvement. These include immunization coverage, women delivering with a skilled attendant, death rates of children, and function of hospitals. Especially impressive is the percentage of the population who have access to primary health care, though there are still many households living in isolated and distant locations, and several million nomads with little access to care.
Especially impressive has been the training of health care workers, especially with advanced skills. The number of health care workers with advanced public health training, obtained in the USA, Europe, Asia, and the region, while still insufficient, is remarkable, considering there were few if any in 2002.
<h4>Dylan Matthews</h4>
If you’re trying to explain the positive trends in child and maternal mortality in Afghanistan, what gets credit there? What kinds of aid or government programs or societal changes are responsible for that?
<h4>Gilbert Burnham</h4>
Improvement in maternal and child health was a government priority from the beginning, heavily supported by programs such as from USAID and the UN. UNICEF was always an important player.
While strengthening access to care and the quality of care and availability of vaccines is always important, other improvements in water and sanitation, roads, markets, schools, and education of women are important as well. The [US] government and supporting donors such as the World Bank were really single-minded on these maternal and child priorities, and this focus worked. While [maternal and child health in] Afghanistan is still not good compared to neighbors, the change in most public health indicators since 2002 has been quite impressive.
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629397848_918_14381" data-cdata='{"asset_id":22792767,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/ZQJ0PLddyTORrgqfQzicrUk1U4g=/0x0:2536x1690/320x0/filters:focal(0x0:2536x1690):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/dBlKy-ML4yerl_m4icWdbXnANkg=/0x0:2536x1690/520x0/filters:focal(0x0:2536x1690):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/oe103OB1QYSkbNSc_rSqm7aKauo=/0x0:2536x1690/720x0/filters:focal(0x0:2536x1690):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/E6Bv7yEnxgtnq3cGK_szoAi_MC0=/0x0:2536x1690/920x0/filters:focal(0x0:2536x1690):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/dwEFlN8v8-0BG8-n1IKF3Dg7Hl4=/0x0:2536x1690/1120x0/filters:focal(0x0:2536x1690):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/WxqTCERE0BGKt2-tNwnAG6l0vYM=/0x0:2536x1690/1320x0/filters:focal(0x0:2536x1690):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/2J63tZpmFWvq3hZPsszuBysog60=/0x0:2536x1690/1520x0/filters:focal(0x0:2536x1690):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/wslOGCXlgxjTwD0C0CXCauPC82U=/0x0:2536x1690/1720x0/filters:focal(0x0:2536x1690):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/FoRHgF52fB7Z7uYOKJY2LmetiyM=/0x0:2536x1690/1920x0/filters:focal(0x0:2536x1690):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 1920w" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" type="image/webp" /> <img alt="" data-upload-width="2536" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" src="https://cdn.vox-cdn.com/thumbor/oxLCDUa1AHu-VAKj_jGnIAKmqzA=/0x0:2536x1690/1200x0/filters:focal(0x0:2536x1690):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg" srcset="https://cdn.vox-cdn.com/thumbor/i4P69A_m4QQagwZH4dxijpoAiOI=/0x0:2536x1690/320x0/filters:focal(0x0:2536x1690):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/bDPd-29mMh2mdxAY4nvt4nJdwLQ=/0x0:2536x1690/520x0/filters:focal(0x0:2536x1690):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/lzlc5d209JrPCpFQXJoUSI3-j1w=/0x0:2536x1690/720x0/filters:focal(0x0:2536x1690):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/_Si3VbvMiopx72KMco5q-9XM-E0=/0x0:2536x1690/920x0/filters:focal(0x0:2536x1690):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/TGX7DYG7hgLVFe-_4Taq7GRVhiE=/0x0:2536x1690/1120x0/filters:focal(0x0:2536x1690):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/BZMR0FB7k5ihHtkazi1LQQ-unxk=/0x0:2536x1690/1320x0/filters:focal(0x0:2536x1690):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/SEQ99Ps1BVfNcmEwXQ_Kb7ng0GA=/0x0:2536x1690/1520x0/filters:focal(0x0:2536x1690):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/tfA0o-DWcoHuq93Y5ikGKKT94uI=/0x0:2536x1690/1720x0/filters:focal(0x0:2536x1690):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/Y5c5Gzrs6JFh5PmqDiULMMqET1Y=/0x0:2536x1690/1920x0/filters:focal(0x0:2536x1690):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22792767/GettyImages_1230706273_copy.jpg 1920w" /></picture>
<figcaption>In April, UNICEF helped launch a large-scale polio vaccination drive across Afghanistan targeting 9.9 million children.</figcaption>
<cite>Xinhua/Rohullah via Getty Images</cite></figure>
<h4>Dylan Matthews</h4>
What has happened with human resources in health care since 2002? How has manpower been boosted for doctors, nurses, and other medical personnel?
<h4>Gilbert Burnham</h4>
The numbers and quality of health care workers have substantially increased, and some extremely capable leadership has emerged. Yet more developed health systems are always a magnet for migration. Shortages of medicines and delays in salary payment can have a demoralizing effect. A very robust private health sector has been emerging, even in the smaller areas, and this was becoming a preferred source of treatment for many conditions.
<h4>Dylan Matthews</h4>
What can we expect on public health from a Taliban regime?
<h4>Gilbert Burnham</h4>
We don’t know yet. Initial promises have sounded like supporting existing programs, and there has been some outreach to international donors and aid organizations encouraging them to continue their work. But these are early days. Maintaining the emerging role of women in the health workforce will probably be a litmus test for [international] donors.
<h4>Dylan Matthews</h4>
To what extent has aid gone to service provision versus corruption? I know this is a big worry people have about the Afghan government generally; was it a big problem with health specifically?
<h4>Gilbert Burnham</h4>
Corruption is a problem for most poor countries. As they become more prosperous, this often reduces. In the health sector there are some certain areas in countries where corruption often occurs — medicines, construction, and employment of nonexistent or “ghost workers.” Although an <a href="https://tolonews.com/afghanistan/report-speaks-corruption-moph">Afghan government inquiry</a> several years ago identified several areas of corruption in the health sector, my impression is that this has not been as big a problem as in other sectors, but this is just my impression.
<h4>Dylan Matthews</h4>
If you’re looking five years into the future for Afghanistan, what would a good scenario look like? What would a bad scenario look like? What are you hoping for or fearing?
<h4>Gilbert Burnham</h4>
The best-case scenario would be a continued emphasis on the health of women and children, expansion of the developing public health sector — including nutrition, water, sanitation, and housing — and attention to the emerging problem with chronic or noncommunicable diseases.
The health workforce needs continuing support. Things can go bad if restriction of women, both as a health focus and in the workforce, occurs and ideology starts getting in the way of health programming. The health of Afghanistan cannot move forward without continuing external support, and this is likely to be required for some years to come, regardless of who is the government. A plunge back into war and instability is the very worst case imaginable for the health of the country.
 
 
source <a href="https://www.vox.com/future-perfect/2021/8/19/22631070/taliban-afghanistan-public-health-mortality-deaths">https://www.vox.com/future-perfect/2021/8/19/22631070/taliban-afghanistan-public-health-mortality-deaths</a>

vox Will the Taliban roll back two decades of public health progress in Afghanistan?

Since the Taliban retook Kabul this past Sunday, observers around the world have worried about what the religious group’s control will mean ...

Some companies are mandating vaccines — but not for front-line workers

<div><img class="ff-og-image-inserted" src="https://cdn.vox-cdn.com/thumbor/-1asnAv6_edP4kzuYNrohC093yg=/0x272:3800x2262/fit-in/1200x630/cdn.vox-cdn.com/uploads/chorus_asset/file/22788352/1323834252.jpg" /></div>
Workers at places like Walmart and McDonald’s have been on the front lines of the pandemic for months. But when it comes to the Covid-19 vaccine, their employers are treading lightly with just how far to push them.
Major brands and corporations were initially hesitant to wade into the debate over whether to mandate vaccines for their workers. Many <a href="https://www.vox.com/recode/22192545/covid-vaccine-corporations-lobby-cdc">advocated to get their employees</a> access to the vaccine as early as possible, but the hope was — as with many government and public health officials — that a significant majority of people would opt to get the shots voluntarily. That’s not what has played out in reality.
Now, with cases on the rise in many parts of the country and the <a href="https://www.vox.com/22547537/delta-coronavirus-variant-covid-19-vaccines-masks-lockdown">dangerous delta variant</a> proving to be highly contagious, “please, get a shot” messaging has become “really, get a shot” for many workers. Thus far, however, companies have been much keener to require vaccinations of white-collar workers than of front-line workers, many of whom were declared “essential” during the pandemic. This yet again drives home the divisions and inequities exposed among America’s workforce during the pandemic.
Walmart, for example, <a href="https://corporate.walmart.com/newsroom/2021/07/30/walmart-announces-covid-19-vaccination-policy-for-campus-office-associates">will require</a> all of its corporate and regional staff to be vaccinated against Covid-19 by October 4 unless they have an “approved exception,” namely, a religious or medical reason not to be vaccinated. But it isn’t asking the same of store associates and warehouse workers, to whom it is <a href="https://corporate.walmart.com/newsroom/2021/07/30/walmart-responds-to-cdc-guidance-updating-mask-policy-and-urging-vaccinations-for-associates">instead offering</a> a $150 incentive for getting vaccinated (it previously offered $75) and paid time off. McDonald’s has taken a similar approach and is <a href="https://www.wsj.com/articles/nbc-delays-office-return-as-covid-19-cases-rise-11628702724">requiring</a> its US corporate workers to be vaccinated by September 27 while offering restaurant employees at the locations it owns four hours of paid leave to get a vaccine (<a href="https://corporate.mcdonalds.com/corpmcd/franchising-overview.html">most McDonald’s locations</a> are owned by franchises and not directly by the company). <a href="https://www.reuters.com/business/att-require-management-employees-get-vaccinated-against-covid-19-2021-08-12/">AT&T</a> is mandating vaccines for managers and starting negotiations with unions about a similar rule for other workers. <a href="https://www.cnbc.com/2021/08/05/uber-ceo-on-why-vaccines-mandated-for-office-workers-but-not-drivers.html">Uber</a> and Lyft are requiring their corporate employees to get vaccinated to return to the office, but they’re not mandating shots for drivers.
From a business perspective, it’s possible these decisions make sense: It’s easier, logistically, to compel a smaller pool of corporate employees to get the Covid-19 vaccine, which they <a href="https://www.vox.com/22587443/covid-19-vaccine-refusal-hesitancy-variant-delta-cases-rate">may not be as hesitant about</a> in the first place. With a broader pool of floor workers, a vaccine mandate may be more difficult to orchestrate or enforce. Many businesses are already struggling to find workers, and they don’t want to turn anyone off.
But from a public health perspective, asking office workers to get vaccinated while having a different set of rules for employees in much higher contact with the general public (as well as other workers) does not really add up.
“The reality is that the goal of a business, the goal of a company, is not the same as public health,” said Kirsten Bibbins-Domingo, an epidemiologist at the University of California San Francisco. “A fundamental tenet in protecting public health is ensuring that those who are most vulnerable, namely front-line workers, are going to be protected.”
To be sure, some companies are obligating all their employees to get vaccinated. Disney says all of its salaried and non-union hourly workers at its US sites have to get the shot, and it’s <a href="https://wdwnt.com/2021/08/cast-member-unions-negotiating-with-disney-over-vaccination-requirement/">negotiating</a> with its unionized workers over the issue right now. Tyson Foods, which has seen severe Covid-19 outbreaks among its employees, <a href="https://www.tysonfoods.com/news/news-releases/2021/8/tyson-foods-require-covid-19-vaccinations-its-us-workforce">is requiring</a> all of its office workers to be vaccinated by October 1 and the rest of its workforce by November 1. Many state and federal workers are required to get vaccinated or get tested regularly. More employers could get tougher on their vaccine rules, especially as the pandemic rages on, frustration with the unvaccinated <a href="https://www.nbcnews.com/news/us-news/covid-cases-surge-unvaccinated-trigger-scorn-resentment-vaccinated-n1275210">grows</a>, and more companies jump on board.
“There’s probably a degree of bravery or going out on a limb for employers,” said Rebecca Dixon, executive director of the National Employment Law Project (NELP). “Maybe it’ll hit some tipping point. But right now your largest ones, Amazon and Walmart, are not mandating it for their line staff. If they were to make that call, my guess is that lots of other companies would follow suit.”
“The fact of the matter is that it’s a very touchy situation,” said Ed Egee, vice president of workforce development at the National Retail Federation. “There’s only so many levers we can pull.”
It is, by and large, legal for companies to require their workers to be vaccinated, as long as they provide accommodations for people who for certain reasons, such as their religion or a disability, cannot. (Vox’s Ian Millhiser has a full explainer on the issue <a href="https://www.vox.com/22599791/covid-vaccine-mandate-legal-joe-biden-supreme-court-jacobson-massachusetts-boss-employer">here</a>.) But just because employers can mandate vaccines doesn’t mean they are necessarily eager to, for a variety of reasons.
There are a lot of “complexities” to mandating the vaccine for workers in the field, said Kory Lundberg, a spokesperson for Walmart, in an email. “Because our office associates are a much smaller population that’s concentrated in a few geographic areas, and because most are planning to return to the office in the coming weeks, we feel it’s much more practical to move to a requirement for that group,” he said.
Walmart didn’t specify the complexities it’s worried about, but it’s not hard to make some inferences as to what those may be. The company employs 1.6 million people in the US, the vast majority of whom work at its stores and warehouses, and trying to wade through how many of those people were vaccinated, decipher exceptions, and perhaps put in place testing regimes for people who aren’t vaccinated but want to keep working would be expensive and logistically hard. A vaccine mandate for all of its workers could also spark backlash in places and among people who are more vaccine-hesitant, including employees and customers. And with many businesses complaining of a shortage specifically of low-wage workers, many companies, including Walmart, may not be eager to risk alienating any potential employees. Walmart is <a href="https://www.cnbc.com/2021/08/06/walmart-offers-bonuses-to-warehouse-workers-ahead-of-holidays.html">already offering</a> bonuses to warehouse workers to try to keep them on through the holidays.
“If you’re trying to mandate vaccines, some goodly number of workers are going to insist that they want to do something else,” Egee said.
<div class="c-float-right">
<aside><q>“The goal of a business, the goal of a company, is not the same as public health”</q></aside>
</div>
Lindsay Ryan, an employment lawyer based in California, noted that in many places, the laws around vaccines are evolving in a way that may render it tricky for national corporations to manage requirements. Montana, for example, <a href="https://www.natlawreview.com/article/montana-enacts-new-law-making-vaccination-status-protected-class-and-limiting">has made vaccination status</a> a “protected class,” meaning that with few exceptions, employers can’t discriminate against workers based on whether they’ve gotten the Covid-19 shot. “It’s a different thing to mandate it for corporate offices and headquarters where it’s easy to know the applicable laws for that jurisdiction,” she said. “They don’t want to implement a mandatory vaccine policy and [then] take it back.”
Companies with a franchise model, like McDonald’s, might not have as direct of a say in what is asked of workers who are employed directly by the franchisee and not the corporation. “In many instances, the frontline workers who people might normally associate as employees of the corporation are actually employees who are under the control of franchise owners, so the corporate policy will only apply to corporate employees,” Ryan said.
McDonald’s didn’t return a request for comment for this story on its decision process.
While it’s not the case with McDonald’s and Walmart, many companies must also deal with unions when deciphering how to approach vaccines. “If they’re there already with bargaining authority, they’ve got power. If unions have bargaining power, they can require bargaining before the employer mandates vaccines,” said Sam Estreicher, a law professor at New York University’s School of Law and director of its Center for Labor and Employment Law.
That’s what’s happening at Disney. Eric Clinton, the president of Unite Here Local 362, which represents thousands of Disney World workers in Florida, said there are a lot of “complicated details” in working out how vaccine requirements will work with unionized employees. The union and the company have to come to an agreement on what exceptions should be and how they’ll be reviewed as well as accommodations for unvaccinated people. Workers could be given a different shift, be required to wear more personal protective equipment, or wind up in a different job altogether, depending on what kind of agreement is reached.
Throughout negotiations, the union has been adamant that it backs the Covid-19 vaccine. “Our position is very clear: The vaccine is the best way to protect yourself as a front-line worker. Period,” Clinton said. “If this was a firefighters union and they didn’t get a proper suit to go into a burning building, we’d be demanding that.”
Front-line workers are among those most vulnerable to contracting and spreading Covid-19. They’re in contact with the public and often find themselves in close quarters and dealing with customers whose vaccination statuses are unknown and are often unmasked. They’re the people who, from a public health standpoint, are arguably among those most important to protect from the disease. They are also often from groups that are less likely to be vaccinated.
The <a href="https://www.vox.com/22587443/covid-19-vaccine-refusal-hesitancy-variant-delta-cases-rate">vaccination rate across the US</a> tends to be lower among low-income people and Black and Hispanic people, <a href="https://publichealth.uic.edu/news-stories/black-hispanic-americans-are-overrepresented-in-essential-jobs/">who are also likelier to be front-line and “essential” workers</a>. There is also a partisan bent to vaccinations, with Republicans generally being more hesitant than Democrats. If companies require vaccines for front-line workers, they risk alienating a group of people who, for whatever reason, tend to be more vaccine-hesitant. At the same time, if they don’t, they risk exacerbating racial, geographic, and income divides in vaccinations. Requiring shots for some but not all workers is a policy that “has the potential to really entrench some of these vaccine inequities,” warned Tara Smith, an epidemiologist at Kent State University.
According to a <a href="https://justcapital.com/news/vaccines-at-work-americans-increasingly-support-employer-vaccination-mandates/">recent survey</a> from Just Capital, which tracks corporate social responsibility, in collaboration with the Harris Poll, Americans are becoming more amenable to employer vaccine mandates, with 46 percent of respondents saying they think companies should make workers get vaccinated in an August poll compared to 36 percent who said the same in June. But there are divides: 56 percent of people making over $100,000 want worker vaccine mandates compared to 46 percent of people making under $50,000, and just 28 percent of Black respondents agree with worker mandates compared to 53 percent of Hispanic respondents and 47 percent of white respondents.
A <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-july-2021/">separate</a> Kaiser Family Foundation poll found that vaccinated adults are much likelier to say the government should recommend employer vaccine mandates than unvaccinated adults, by 68 percent to 19 percent.
In other words, some of the workers who most urgently need the vaccine are those who don’t want it, or want to be told to get it. And companies are likely well aware that is part of what they’re facing.
<div class="c-float-right">
<aside><q>Some of the workers who most urgently need the vaccine are those who don’t want it, or want to be told to get it</q></aside>
</div>
“I don’t want to say that they don’t have an interest in protecting their workers, but the primary interest of a company is keeping the company running,” Bibbins-Domingo, the University of California epidemiologist, said. “While it is always helpful when business interests align with our public health goals, businesses are not public health agencies.”
The conversation about how to compel people to get the Covid-19 vaccine is constantly evolving, including how private businesses should approach the matter. Not all worker groups and unions <a href="https://www.politico.com/news/2021/07/28/vaccine-mandates-labor-biden-501123">are in agreement</a>, nor are companies or business groups or workers themselves. But as the clock ticks and the virus continues to spread, the situation is becoming more urgent.
United for Respect, a nonprofit that advocates for retail workers’ rights, including at Walmart, has not taken an official position on mandatory vaccinations. Instead, it is <a href="https://united4respect.org/fivetosurvive/">advocating</a> for a $500 bonus for workers who get the vaccine. The Consumer Brands Association, which represents companies such as Clorox, Coca-Cola, and General Mills, says some of its members expect vaccine mandates will occur at some point, but not until the Food and Drug Administration grants full approval of the shots, which are currently under emergency use authorization. “[Consumer packaged goods] manufacturers are largely pursuing a carrot rather than a stick approach. Across the industry, substantial incentives are in place to encourage employees to get vaccinated. In the weeks and months ahead, we expect a stick approach and potential employer mandates to become more common,” said Geoff Freeman, president and CEO of the Consumer Brands Association, in a statement to Vox.
The Business Roundtable, a lobbying group that represents CEOs from major corporations, said a number of its members (which include Walmart) have decided to mandate vaccines for some or all employees, while others are still deciphering how to navigate opposition from policymakers at the state and local levels. But in light of Covid-19 spikes and infectious variants, it expects additional announcements from members.
Clinton, from Unite Here Local 362, said he’s continuing to have ongoing conversations with members who are nervous about the vaccine, but resistance isn’t as prevalent as one might think. “Are there people who are anti-vaxxers or are doing ‘my body, my choice’ type of stuff that currently work at Disney? Certainly,” he said. “There’s not as many as I thought there would be; it just turns out they’re really loud, so it feels like there are more of them.” He thinks he’s gotten about 20 calls out of some 9,000 members.
Many companies are continuing to try to nudge employees with incentives to get vaccinated by offering time off and bonuses, and bringing vaccines to work, among other measures. Egee, from the National Retail Federation, said his members have had some success with incentives, but not a ton. “It didn’t move the needle a lot — probably a few percentage points here or there,— but we’ve done everything we could,” he said.
The decision for companies to mandate vaccines for all of their workers — and not just the ones it’s easiest for them to do so far — is complicated. There are no easy answers. If they require shots for people who really don’t want to get them, they might leave those people out of a job, find themselves struggling to hire workers, or face public backlash. If they require shots for some workers and not all, they risk making vaccine inequality across the US worse or sowing discord among groups of workers.
Companies generally don’t want to take many risks that could harm their businesses. In weighing requirements around Covid-19, there’s no risk-free scenario.
 
 
source <a href="https://www.vox.com/the-goods/2021/8/19/22629327/employee-vaccine-mandate-walmart-uber-lyft">https://www.vox.com/the-goods/2021/8/19/22629327/employee-vaccine-mandate-walmart-uber-lyft</a>

vox Some companies are mandating vaccines — but not for front-line workers

Workers at places like Walmart and McDonald’s have been on the front lines of the pandemic for months. But when it comes to the Covid-19 va...

The long road to India’s unparalleled pandemic catastrophe

NEW DELHI, India — Shiv Charan Lal Gupta, the medical director of Batra Hospital in New Delhi, has seen the devastation that follows an earthquake: dead bodies strewn about, patients maimed and in desperate need of care.
None of it prepared him for the day his hospital ran out of oxygen.
It was a Saturday: May 1, 2021. <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+cases&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=~IND">The massive second wave</a> of <a href="https://www.vox.com/2021/4/24/22400986/india-coronavirus-surge-hospitals-deaths">Covid-19 cases in India</a>, driven by <a href="https://www.vox.com/22547537/delta-coronavirus-variant-covid-19-vaccines-masks-lockdown">the emerging delta variant</a>, was peaking. At Gupta’s 500-bed private hospital, 80 percent of beds were reserved for Covid patients. Oxygen use was up to four times higher than normal, and the hospital’s reserves were dwindling. The local government had taken over the oxygen supply during the emergency, and Gupta pleaded with officials for more. Nurses tried to reassure panicking patients and their loved ones, who had learned from social media reports that the hospital was running out of air.
Finally, government officials gave Gupta some news: More oxygen was coming, but not for at least 90 more minutes.
It came too late.
The oxygen in Gupta’s hospital was exhausted before reinforcements arrived. For about 10 minutes, there was no air for patients struggling to breathe. And in that brief lapse, 12 people died.
A friend and colleague of 30 years, a senior gastroenterologist, was among the dead. Gupta called it the worst day of his life.
“I was a broken man that day,” he said. “In the aftermath of an earthquake, we would deal with injured or dead people. But here we had people who were alive, who we were treating, and they were dying. I have never felt this helpless in my life.”
<div class="c-wide-block">
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629394435_7078_14384" data-cdata='{"asset_id":22790284,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/xzamU1dhuaGHSbMYHNfNowq1lsg=/0x0:3248x2165/320x0/filters:focal(0x0:3248x2165):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/abdl2GkVlJvLkYspbfVBng3yqD4=/0x0:3248x2165/520x0/filters:focal(0x0:3248x2165):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/AE2nyCVpx8vQSsoSMGJ5OA_RT7o=/0x0:3248x2165/720x0/filters:focal(0x0:3248x2165):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/T1CLfDGqYwyRPxIX0SYXoS24G3k=/0x0:3248x2165/920x0/filters:focal(0x0:3248x2165):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/GzHziOaZFDjhQ_6OJ8UA5wizQmk=/0x0:3248x2165/1120x0/filters:focal(0x0:3248x2165):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/eisB_WTWazcEM2BB_SLvlz4jDEw=/0x0:3248x2165/1320x0/filters:focal(0x0:3248x2165):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/07c3ipez8idiNhbTyOpyOPJXLjY=/0x0:3248x2165/1520x0/filters:focal(0x0:3248x2165):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/GkZ_OL8UfsucJZj6X1vlEkKpdoI=/0x0:3248x2165/1720x0/filters:focal(0x0:3248x2165):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/NEi-MSZ_FOn1I7wS3RoA7B9hxdo=/0x0:3248x2165/1920x0/filters:focal(0x0:3248x2165):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 1920w" sizes="90vw" type="image/webp" /> <img alt="" data-upload-width="3248" sizes="90vw" src="https://cdn.vox-cdn.com/thumbor/AB6LLpSWO1UpGlOedemIaOD2-E0=/0x0:3248x2165/1200x0/filters:focal(0x0:3248x2165):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg" srcset="https://cdn.vox-cdn.com/thumbor/v-1WTK7r76qva13_rz3j-FGUzvs=/0x0:3248x2165/320x0/filters:focal(0x0:3248x2165):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/1KwfWDgZL6LvVrVG8AmxAmEjAaQ=/0x0:3248x2165/520x0/filters:focal(0x0:3248x2165):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/aOOXL9Ujua9bHe6vovplD1C5LIQ=/0x0:3248x2165/720x0/filters:focal(0x0:3248x2165):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/NoxVGou6-95NMYNBH_QMS8eN70I=/0x0:3248x2165/920x0/filters:focal(0x0:3248x2165):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/jpahcYn5RhGz7hICnjE5A8gOpJY=/0x0:3248x2165/1120x0/filters:focal(0x0:3248x2165):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/EvMAzwbOzYoBSFIUpP1YzqXHGL8=/0x0:3248x2165/1320x0/filters:focal(0x0:3248x2165):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/whlhZBTg-rfIIgVYJjHJ_3uG4Lc=/0x0:3248x2165/1520x0/filters:focal(0x0:3248x2165):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/CumF9mID5hgNNVgsey6ePfVj5zg=/0x0:3248x2165/1720x0/filters:focal(0x0:3248x2165):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/ib-x77-OCkQSB8Hbjy7sERspXSA=/0x0:3248x2165/1920x0/filters:focal(0x0:3248x2165):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790284/VOX_7048_copy.jpg 1920w" /></picture>
<figcaption>Dr. Shiv Charan Lal Gupta (second from right) visits a patient at Batra Hospital in Delhi. During the peak of the second wave, he lost 12 Covid-19 patients, including a colleague, after oxygen ran out in the hospital.</figcaption>
</figure>
<div class="c-image-grid">
<div class="c-image-grid__item">
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629394435_3587_14385" data-cdata='{"asset_id":22790297,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/GNzOkAD2zilTja7iszigYP9QYeI=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 320w, https://cdn.vox-cdn.com/thumbor/g90lCX6FuI7hxRdE4sUSNSKFNvM=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 520w, https://cdn.vox-cdn.com/thumbor/N_V88VfVI2YY_oJ75S0Mi_n1i1U=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 720w, https://cdn.vox-cdn.com/thumbor/Q4nIzFOVwB4OVsh3nROM97n30ME=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 920w, https://cdn.vox-cdn.com/thumbor/hJvziDeKATzeciuSRTjL1t4nqCo=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 1120w, https://cdn.vox-cdn.com/thumbor/Jo93VHINBPv0tVPYKicfEY3XyYs=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 1320w, https://cdn.vox-cdn.com/thumbor/aO8gbvoaulr3e3J47IUeIRloFXY=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 1520w, https://cdn.vox-cdn.com/thumbor/WQIRJ_9EAU04bZUnre56mFbF46w=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 1720w, https://cdn.vox-cdn.com/thumbor/1oC7RpZid2GxfKNsugtgeND1fTc=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 1920w" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" type="image/webp" /> <img alt="" data-upload-width="3000" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" src="https://cdn.vox-cdn.com/thumbor/qFiGf73JqtJGBbk91sqVdDIcpV0=/0x0:3000x2000/1200x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg" srcset="https://cdn.vox-cdn.com/thumbor/zvbwVz9aQVXPUuMnMpmeuESJMfU=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 320w, https://cdn.vox-cdn.com/thumbor/DJijTZfa_xJ7LTPEU_jeojYbCMk=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 520w, https://cdn.vox-cdn.com/thumbor/-hjtb-zgj0dU2R2wm2eHI9IL_Xg=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 720w, https://cdn.vox-cdn.com/thumbor/n66U2vxZkpjasl6y9GcLduwjByM=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 920w, https://cdn.vox-cdn.com/thumbor/T2yIr9I5A7f_5icumDFdQ_DtteI=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 1120w, https://cdn.vox-cdn.com/thumbor/k9xuecmiRxNIa0MfUOv4-nWC6NA=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 1320w, https://cdn.vox-cdn.com/thumbor/fza3SFpqI2HtnOk7CrfvkBpSEM4=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 1520w, https://cdn.vox-cdn.com/thumbor/zui4pR45AjaXjYTG6bRwdoRdyfw=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 1720w, https://cdn.vox-cdn.com/thumbor/9_5sid0ZNogHC6odNqINNFmpovk=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790297/GettyImages_1232646573.jpg 1920w" /></picture>
<figcaption>Relatives of a Covid-19 victim mourn outside Batra Hospital on May 1.</figcaption>
<cite>Amal KS/Hindustan Times via Getty Images</cite></figure>
</div>
<div class="c-image-grid__item">
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629394435_462_14386" data-cdata='{"asset_id":22790386,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/naB-g2mLc0ySSyb19Z0FNjkD9zo=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/YvDOOMdFYdHfv_Y7K3gtdwcuj6I=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/8eO6FeRD5R2-iyd3Jau899vEOZ0=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/CsOgCWQ9SvL5AqrE0_SgWQlhYvQ=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/g7SmOj5PEanlAWKgHOo2zUHciVM=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/2rKRzbByv2oD5hSCWpE7MKl34ts=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/s6cCyeZmU02evDyb13kAbR_BEko=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/pqmuJcR9p1iOED45DTH39T72Kbg=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/_vko1vR2SOJvriDs_L-JLqaKNbo=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 1920w" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" type="image/webp" /> <img alt="" data-upload-width="3000" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" src="https://cdn.vox-cdn.com/thumbor/mchGEfbQgxBEbV095M6gfMHEvUo=/0x0:3000x2000/1200x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg" srcset="https://cdn.vox-cdn.com/thumbor/aHUvNXLKJkEhIr-SsLfFmTbfpxw=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/HRBtatcUWA8GpVDapoGFZhSEEAQ=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/1FmTyO00bUyX_pHdUu8O-A6maUM=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/NsHk-YnvKdVUY90di1D9AqSrK_4=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/c5oT1f3r4uAKj2kBrwXi19gyVAg=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/SvrA5kqAKljA1PWYRWpY03ag-TU=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/_8iK8dEdnshjaxi6YuLvXJ91J1w=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/_v-pUYl_RzNub3hD9v-DsiWoEHY=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/q7FI1jXfwiwdruxLnfna4yX09XU=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790386/GettyImages_1232646479_copy.jpg 1920w" /></picture>
<figcaption>An oxygen tanker leaves after replenishing supplies at Batra Hospital on May 1.</figcaption>
<cite>Amal KS/Hindustan Times via Getty Images</cite></figure>
</div>
</div>
</div>
Gupta was witnessing firsthand the collapse of India’s health system, buckling under the pressure of a pandemic. Across the country, patients were dying because hospitals ran out of oxygen.
“Every hospital loses patients. But if patients die because there is no oxygen, that is wrong,” said Gupta, a former legislator with the ruling Bharatiya Janata Party (BJP).
Long before an unprecedented wave of infections and death began this spring, there were warning signs that India’s chronically underfunded health system would struggle against the deadly new virus.
<a href="https://www.commonwealthfund.org/international-health-policy-center/countries/india">Less than 40 percent of Indians</a> have health coverage. The country spends <a href="https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=CN-TH-BR-VN-ID-NG-IN-CO">a smaller share of its GDP</a> on health care than most of its economic peers. The country’s health outcomes, such as <a href="https://www.oecd.org/officialdocuments/publicdisplaydocumentpdf/?cote=ECO/WKP(2015)2&docLanguage=En">life expectancy</a> and <a href="https://data.worldbank.org/indicator/SP.DYN.IMRT.IN?locations=CN-TH-BR-VN-ID-CO-IN">infant mortality</a>, trail accordingly. Indians pay <a href="https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?locations=CN-TH-BR-VN-ID-NG-IN-CO">a higher share</a> of the country’s health care expenditures out of their own pockets.
Indian experts say this reality reflects the government’s failure to invest in a sustainable health system for the world’s largest democracy.
As a result, when Covid-19 hit, there were not enough hospitals, particularly in the rural parts of the country. There were not enough doctors or nurses. Overworked community health volunteers were stretched beyond their limits. The system was so overloaded that some patients died before finding out the results of their Covid-19 test.
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629394435_9855_14387" data-cdata='{"asset_id":22790996,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/sKxuLwah0Dl_9znRWiBRarcDJRk=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/r-C5Ynfh-Yw4kzBbjInzO3zVT1s=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/AsftTvSfT_4MZqjLdmykw6Tu-7A=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/3UJYle7tlfGsIhp9aDZRBgf9UeM=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/gx411upSeZRLOiuxDzAoMOov4Yo=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/f36JAT843k2hwEIn2lOBz5qaNEk=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/4hmc3hScVMjTLNmGqAE0wMFhJB0=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/dR8JsXIjayrR0sEQbBnzrDljGOw=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/x-jsGt9ISUqlK4ij6tLOnsZYb0c=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 1920w" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" type="image/webp" /> <img alt="" data-upload-width="3000" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" src="https://cdn.vox-cdn.com/thumbor/ZVHkRf6x5lTEwrB9U1yoXDDVePs=/0x0:3000x2000/1200x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg" srcset="https://cdn.vox-cdn.com/thumbor/Jc5p6Q30rSLgjFOSnCiSREHhICM=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/8z6U6JJ7vp1mxuXDmEpiJR75990=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/m09u4cxwZiALoPCZZXFT8HtSdKM=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/n2LDIAV2YqXHdg9dMDY7WsErxyw=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/KETnkZB0l14WQXFJhfEOpx8FE1k=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/JmNV0x-EkBPy_BG-NSKb3IQ5Ys0=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/Svj8_761FzB8kAl4Sak0HqWb1xg=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/7cD5K-2jO7NkIOfaild8pI7c3R8=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/RfqjINIxGfOPrtzx0VmAhfxjxs4=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22790996/GettyImages_1233168611_copy.jpg 1920w" /></picture>
<figcaption>Colleagues pay tribute to a friend who died of Covid-19 complications in Assam, India, on May 29.</figcaption>
<cite>David Talukdar/NurPhoto via Getty Images</cite></figure>
The toll has been enormous: <a href="https://covid19.who.int/region/searo/country/in">The more than 430,000 official deaths</a> from Covid-19 are believed to be a serious undercount. The actual number of deaths <a href="https://www.reuters.com/world/india/indias-30093-new-covid-19-cases-are-lowest-daily-figure-4-mths-2021-07-20/">may be as high as</a> 3 million to 5 million. A recent antibody study suggested <a href="https://indianexpress.com/article/explained/explained-icmr-covid-fourth-serosurvey-findings-7413949/">more than half of India’s people</a> have contracted Covid-19.
India’s failures parallel those in other countries both rich and poor. A decentralized health system dependent on private industry pushed much of the cost of medical care onto individuals and families, exposing deep disparities between the haves and have-nots — a familiar narrative in the US. As in other developing economies, including Brazil and Colombia, systemic failures and insufficiencies resulted in overwhelmed hospitals and patients left to die without care.
But in sheer magnitude, no Covid-19 catastrophe matches India’s.
Indian leaders have known for years their health system needed improvement. Prime Minister Narendra Modi, who came to power with the BJP in 2014 on a Hindu nationalist platform, tried to reform it. In 2018, his administration established a new health insurance program that would cover hospital services for more than one-third of Indians, targeted to lower-income groups. But that program has <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3797792">struggled</a> to meet its goals.
“Now a country that aspires to be a global leader is seeing people die because they can’t get oxygen,” Rama Baru, who studies India health policy at Jawaharlal Nehru University, told Vox. “I feel quite shocked. We’ve never had a time in our history when we lost our humanness.”
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629394435_5357_14388" data-cdata='{"asset_id":22791021,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/ZUsaQnAtR9TejbZfcAWZ3-9qD9U=/0x0:2444x3667/320x0/filters:focal(0x0:2444x3667):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/2fydS2jQabRJDTcD3FTEhgXmx-k=/0x0:2444x3667/520x0/filters:focal(0x0:2444x3667):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/MdvA4baQNmfUMGeK4QGiAp8Q_E4=/0x0:2444x3667/720x0/filters:focal(0x0:2444x3667):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/xCYt17sUGLq0XmLSbaFhQO69dLY=/0x0:2444x3667/920x0/filters:focal(0x0:2444x3667):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/wgr38a7yXnE0_7h_IcovE4jBUXw=/0x0:2444x3667/1120x0/filters:focal(0x0:2444x3667):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/rdJzDK5AXSXhGXULUzbzQ5gS5es=/0x0:2444x3667/1320x0/filters:focal(0x0:2444x3667):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/GDqxDc_EFvmsnLzLjhYFeyojzCw=/0x0:2444x3667/1520x0/filters:focal(0x0:2444x3667):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/AQBMz6aUgtwKQhEXBGIzFyVpU44=/0x0:2444x3667/1720x0/filters:focal(0x0:2444x3667):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/HNn0o8lxcC6EzodwTDKzF5I8Lvo=/0x0:2444x3667/1920x0/filters:focal(0x0:2444x3667):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 1920w" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" type="image/webp" /> <img alt="" data-upload-width="2444" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" src="https://cdn.vox-cdn.com/thumbor/9lb0ePeiGpi0DHYmpEcJoSDVrsA=/0x0:2444x3667/1200x0/filters:focal(0x0:2444x3667):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg" srcset="https://cdn.vox-cdn.com/thumbor/PTF6Ul6rUFUmxB2OQV8XrnSprrI=/0x0:2444x3667/320x0/filters:focal(0x0:2444x3667):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/P8gjYJqdifCATD-SJh9esmhnwWM=/0x0:2444x3667/520x0/filters:focal(0x0:2444x3667):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/qmzpVMk4uG5uH3jMisIzwVSqwYQ=/0x0:2444x3667/720x0/filters:focal(0x0:2444x3667):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/SxTACBCs6BY9zHnUtrJ2MhgrwNY=/0x0:2444x3667/920x0/filters:focal(0x0:2444x3667):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/9Kc8hL1JZkbVG36bgYz8pklaO4I=/0x0:2444x3667/1120x0/filters:focal(0x0:2444x3667):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/4m61Bb0ukK2XfLKxxy2d2ZRX5Do=/0x0:2444x3667/1320x0/filters:focal(0x0:2444x3667):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/sCcEpZuyiM5tu4oxes1UsCoRQ5E=/0x0:2444x3667/1520x0/filters:focal(0x0:2444x3667):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/P2JfArTdhfBml9tNQP16ovL28ms=/0x0:2444x3667/1720x0/filters:focal(0x0:2444x3667):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/FYifpSCuhdwUIPk9e2Mm0xzK96w=/0x0:2444x3667/1920x0/filters:focal(0x0:2444x3667):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791021/AP21119569334186_copy.jpg 1920w" /></picture>
<figcaption>Funeral pyres of victims of Covid-19 burn at a makeshift crematorium in Delhi on April 24.</figcaption>
<cite>Altaf Qadri/AP</cite></figure>
When India broke from British rule in 1947, its new constitution established health as a human right: “The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties,” the document, ratified in 1949, reads.
Responsibility was delegated to the 28 states and territories that now comprise the Indian Union. States, not the national government, would fund the hospitals where people could get care and cover the cost of providing those services.
But states immediately struggled to deliver on that promise.
In part, India had been set up to fail. After centuries of economic exploitation, the country was left destitute. India had accounted for <a href="https://www.livemint.com/news/india/a-short-history-of-indian-economy-1947-2019-tryst-with-destiny-other-stories-1565801528109.html">almost one-quarter of the world’s economy</a> in 1700; by 1952, it represented less than 4 percent. Money was scarce.
But even as the Indian economy exploded in recent decades, the country spent less on health care than other large emerging markets. Brazil <a href="https://data.worldbank.org/indicator/SH.XPD.GHED.PP.CD?locations=CN-TH-BR-VN-ID-NG-IN-CO">spends</a> eight times as much public funding per person on health care as India does. Nearby Thailand spends seven times as much.
“Within their income class, they’re low,” Cheryl Cashin, who studies health system development at the nonprofit research group Results for Development, said of India. “They’re not following the normal pathway as countries become wealthier.”
The lack of funding is due in part to the challenges facing a country pulling itself out of deep poverty. But some experts also blame the national government for failing to provide more support to the states. The result is that a parallel, private health care system has emerged, where prices vary considerably and most expenses are paid out of pocket.
<div class="c-wide-block">
<div class="c-image-grid">
<div class="c-image-grid__item">
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629394435_6857_14389" data-cdata='{"asset_id":22791066,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/L8GzE6u7koKyGiK8ury3t4FJ-A8=/0x0:3000x2001/320x0/filters:focal(0x0:3000x2001):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/SLzsQoOmGHHTa0udtC-omAubAXk=/0x0:3000x2001/520x0/filters:focal(0x0:3000x2001):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/tCAq6X2EuzXp5crnbr6JKUinHXI=/0x0:3000x2001/720x0/filters:focal(0x0:3000x2001):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/Z79DOiawXI4jm8rL5S-NC9BJESk=/0x0:3000x2001/920x0/filters:focal(0x0:3000x2001):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/GxoOt5jkioPifaiMzPGsUbBKqco=/0x0:3000x2001/1120x0/filters:focal(0x0:3000x2001):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/hW2nPT2j8J7VAZp_LOfUvk2WrN4=/0x0:3000x2001/1320x0/filters:focal(0x0:3000x2001):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/tseJ8pgpy9bE05E-Z0XhSmQ5OiQ=/0x0:3000x2001/1520x0/filters:focal(0x0:3000x2001):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/vFOw55cXyJzEo16G_5625JMaa-U=/0x0:3000x2001/1720x0/filters:focal(0x0:3000x2001):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/yZ8AEYlUkblt76aqrlV_RwQY868=/0x0:3000x2001/1920x0/filters:focal(0x0:3000x2001):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 1920w" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" type="image/webp" /> <img alt="" data-upload-width="3000" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" src="https://cdn.vox-cdn.com/thumbor/MyfMOa7dnL2sqJv2IAjgkxvold0=/0x0:3000x2001/1200x0/filters:focal(0x0:3000x2001):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg" srcset="https://cdn.vox-cdn.com/thumbor/YyoqnMwDwnKsHf_Mre659ka0rzo=/0x0:3000x2001/320x0/filters:focal(0x0:3000x2001):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/oKWm-Uedu6-vObaZwl65sS2h_L8=/0x0:3000x2001/520x0/filters:focal(0x0:3000x2001):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/Bh_dXa0N-b7Ah4ANmM_Rgh5gsik=/0x0:3000x2001/720x0/filters:focal(0x0:3000x2001):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/LAlrbF1biA8OQmiq74HbHi-1eIM=/0x0:3000x2001/920x0/filters:focal(0x0:3000x2001):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/CRDeu9KVxpUj6HjqWu8dCFvEcQw=/0x0:3000x2001/1120x0/filters:focal(0x0:3000x2001):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/edA17Ej6rHMMY8KpygYEwxSYXnc=/0x0:3000x2001/1320x0/filters:focal(0x0:3000x2001):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/UjQTwQGl1CFJXlT303LkYCG4cRo=/0x0:3000x2001/1520x0/filters:focal(0x0:3000x2001):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/QjFEWqdcFAeqmeSQDilZb6IE9_c=/0x0:3000x2001/1720x0/filters:focal(0x0:3000x2001):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/Pw33MqAidBmMC-6qavx1qRR_GL4=/0x0:3000x2001/1920x0/filters:focal(0x0:3000x2001):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791066/VOX_6932_copy.jpg 1920w" /></picture>
<figcaption>The waiting room outside the emergency ward of Civil Hospital in Gurgaon, a public hospital run under the jurisdiction of the Haryana Department of Health.</figcaption>
</figure>
</div>
<div class="c-image-grid__item">
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629394435_5955_14390" data-cdata='{"asset_id":22791067,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/DK2x0b1OHriDW5vbeHoyLMmT9s4=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/tkJUnMndTU-JJPYD1S-LpQ-DA6I=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/5pPMVL7w4YPiIMp-WMZ_XfnbJRk=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/FOf6abW1WYJAO6TVUBU0F7mzhLY=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/wfvV0PddzYGVIGy0YU6Arzvanqg=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/NlGNuNNCw29WEZklJqjYDUJpic0=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/8qUzQiDHOt595oL9jUyqmL6vITI=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/suKPlhkq2JjDePyOYNFdtEdf9do=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/ZuuHzMV8J5Cip9I_tpBhUD3orpA=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 1920w" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" type="image/webp" /> <img alt="" data-upload-width="3000" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" src="https://cdn.vox-cdn.com/thumbor/mxY4taHGwODczhucOAeZMvNb5lg=/0x0:3000x2000/1200x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg" srcset="https://cdn.vox-cdn.com/thumbor/Q9sjV9YqmuQ7B_PDPFuuNSx6k2U=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/b3ZLiCaEf-bD-jy_0BSLnmgCwLA=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/aTQ1axtGyB_BfYgGPCxJRNVeg2U=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/NB_Q028_sEwgqYf2xaV2LCQT-U4=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/4rFMYTNnQtlKsw3GJZl3H-sXok4=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/puxt7hqdxJpOH1MDOod_6uwoRIg=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/WJdgg2TzN7VvQJdgJAE7R_dHoa0=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/oodMJ3lS0sXJ6J-xOXnICNoCHc4=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/9bqWB6RpzA-TRSIvEYNx4HvpNjE=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791067/VOX_7188_copy.jpg 1920w" /></picture>
<figcaption>Inside the waiting room of Batra Hospital, a 500-bed private facility in Delhi.</figcaption>
</figure>
</div>
</div>
</div>
Ultimately, private insurance pays for <a href="https://www.commonwealthfund.org/international-health-policy-center/countries/india">less than 5 percent of India’s overall health expenditures</a>. Out-of-pocket spending accounts for more than 60 percent. The disparities have deepened over time: Wealthy people could seek top-quality care at for-profit private hospitals, while the less affluent were left relying on an underfunded public system.
Modi’s new health insurance program, <a href="https://www.washingtonpost.com/world/asia_pacific/india-launches-modicare-the-worlds-biggest-government-health-program/2018/09/21/46c275d6-bb6e-11e8-adb8-01125416c102_story.html">established in 2018</a>, was supposed to fix that. But <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3797792">a 2021 review</a> published by Duke University researchers found the program has seen mixed results. Many eligible people in poorer states are still unaware it exists. Its record in providing financial protection to its beneficiaries was “mixed,” in part because it covered only hospital care.
During the pandemic, an analysis by Jeevan Raksha, a public-private partnership from the Public Health Foundation of India and the management consulting firm Proxima, <a href="https://assets.researchsquare.com/files/rs-703175/v1/92a5e29e-059f-49cc-b8f8-61276b190e3e.pdf?c=1628857699">found</a> the program covered less than 1 percent of all Covid-19 tests and 14 percent of all related hospitalization costs in India during the second coronavirus wave.
India’s health care infrastructure has also languished. The Modi administration set a goal of opening or upgrading 150,000 primary care clinics across the country but <a href="https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/1-5-lakh-ayushman-bharat-health-wellness-centres-to-be-set-up-by-2022-survey/articleshow/73807346.cms?from=mdr">had only gotten to a fraction of that number</a> when Covid-19 struck.
“Covid exposed the deep fault lines,” said Indrani Gupta, who leads health policy research at the Institute for Economic Growth in Delhi. “Dysfunctional health systems can never cope with pandemics and epidemics efficiently.”
<div class="c-wide-block">
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629394435_2518_14391" data-cdata='{"asset_id":22791117,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/JXWsht_GEPtVLrPlwdT2msI-k_M=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/-0rTWzCOSLQMLab4Ahpl2WkfjF0=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/XgB4iDc3P8UqAurjhossttZYXhY=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/SPeaWbWge4tVHfORv4Mpkpu2_-A=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/6v1u_vkw5Nn1hjQoj7rwOM8e7-8=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/Dzh3Y8iIbL3AgpVjz8oOdDUTWRs=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/h8MpPu4t42puq802MMeMpzhOuZ8=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/Mf7-iv9N99JwypuroO7l93hIi88=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/BJ6SyVml4E9feYXHRX3SmJj6HFQ=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 1920w" sizes="90vw" type="image/webp" /> <img alt="" data-upload-width="3000" sizes="90vw" src="https://cdn.vox-cdn.com/thumbor/O3fka6QdM0dRt-RaorU_EUPDKYU=/0x0:3000x2000/1200x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg" srcset="https://cdn.vox-cdn.com/thumbor/Qo8dkPyUla98u9wdM1TBKcjYWsk=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/Z__qwrImLztFz3hjM-1M6WlHZVM=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/Mh57nmbw-Xm-mgipyqNEVOsP3ho=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/O72UYO5qgVBtEhiYZpEtaWVE4Ik=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/j56rX5utnph1rgouR_SNQhqT8z0=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/uuzzn6ImpaOai3BNIhZ2WqMqJuc=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/sHTrN_bZO6JZ6RqXJZckm2008Rc=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/ZQtt8ZibgBYk6U20zfJ7lXxqM44=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/Yl3SSYAmCmtFyQ4hswVZvFGWVis=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791117/VOX_7430_copy.jpg 1920w" /></picture>
<figcaption>The private Artemis Hospital in suburban Gurgaon offers 400-plus beds and state-of-the-art medical care.</figcaption>
</figure>
</div>
During the pandemic, the failure of India’s health system was total. Providers were left ill-equipped to handle the surge of patients. And even the people who did get care often faced unaffordable medical expenses.
“It was an unprecedented situation,” Sandip Datta, assistant professor at the Delhi School of Economics, said. “The health infrastructure we have, both public and private combined, was not adequate to serve everyone who was getting infected.”
In many areas, there are fewer doctors and nurses per capita than is recommended by the World Health Organization. When hospitals ran out of lifesaving supplies, they were blamed and, in a few cases, even attacked.
On his second day working at a Covid-19 care center in Assam’s Hojai district, Seuj Kumar Senapati began treating a patient who had come in with a fever and mild cough; when he checked on the patient later, they were unresponsive. A mob of 30 people chased the young doctor around the hospital, eventually catching and assaulting him.
“I didn’t even get a chance to do anything to revive the patient,” Senapati told Vox.
As major medical centers and clinics were being overwhelmed, India relied on its community health workforce — accredited social health activists, commonly known as ASHAs — to be the vanguard of the Covid response.
ASHAs are quasi-volunteers who receive nominal compensation to raise public health awareness in their villages and neighborhoods. The Indian government created the corps in 2005, as doctors and nurses moved to the emerging private health care sector.
While they confronted Covid-19 this year, those volunteers were often left on their own when they themselves got sick.
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629394435_2133_14392" data-cdata='{"asset_id":22791135,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/Dfol3Y1buuYFr_-ztdaR7nf0Z40=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/ovjjOmWhSArKYogP4XxEPnj1Vuk=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/Ayzc7Zea3A0Gka7PlPJ-Dw2aFnE=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/SW3rsPTIpwfUdrksChxYFwPOe4E=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/HsKztjNvF67xRpKLFTqLLJSZaxI=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/X0CwZmOSGNVKhRY_z0gMezIUdIs=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/bcxt2fuWp1jWlLMXuyNvdu_PaEc=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/tJC4O-FcaDsfgjMh5e1vWzDymWQ=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/TCCbCWgnNJ66WeyX9SZXxGtX3W0=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 1920w" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" type="image/webp" /> <img alt="" data-upload-width="3000" sizes="(min-width: 1221px) 846px, (min-width: 880px) calc(100vw - 334px), 100vw" src="https://cdn.vox-cdn.com/thumbor/mLbeVaGQKmc4zO4hAhfSD5JERz8=/0x0:3000x2000/1200x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg" srcset="https://cdn.vox-cdn.com/thumbor/p-lLQD47RBOrBEzXle_5yx6CBRY=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/vOs1BmoZv2bQmEeH9zMa-yp6woo=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/poeMNSj8sRMJOmuxKu_jNsc87Uw=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/q3StdKK2M3ZueDEXnu0TlbeLobY=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/8FgXr6WtlKpN3u2tHa-y5vsNTCA=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/qZ51eqSL0Cx74XS1l1gXorYmtm4=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/o5B7eqJ16hQ7WsuEKzLOArfhyzQ=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/KRsFPqdHiJt8bcvJ-FzU_gM8e3E=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/HOoveC-n1XVVwRlsLz_06UrzpBM=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791135/VOX_6920_copy.jpg 1920w" /></picture>
<figcaption>Poonam Sharma, an ASHA, or accredited social health activist, makes her daily rounds at Tigra Village, near Delhi. Sharma’s bonus pay for Covid-related work expired last fall, long before the surge in spring 2021.</figcaption>
</figure>
Sangeeta Kamble had been working for months as an ASHA in her rural village of Yellapur, near India’s western coast, when she came down with Covid-19 in March 2021. Her husband and son were soon sick, too, and her husband, who has diabetes and two partially amputated legs, quickly deteriorated.
She called the doctor at a nearby government hospital — a 30-minute drive away in the town of Shirala — but no beds were available. They visited two other hospitals before finally getting a bed at a government medical college late in the night.
“Despite helping people during the pandemic, there was no bed for front-line workers like me,” Kamble, 34, said.
Her husband pulled through after two weeks in the hospital with oxygen support, and his care at a public facility was covered by the government. But his family, who are uninsured, have been on their own as he deals with post-infection complications. Kamble does tailoring work on the side, to bring in some extra income.
“But that’s not nearly enough to pay for his medicines,” she said.
Poonam Sharma, an ASHA in Tigra Village, located near New Delhi, has been working seven days a week for the past year, up to 10 hours a day, all for about $50 US every month; bonus pay for Covid-related work expired in the fall, long before the surge.
Sharma, 42, knows of three ASHAs who died of Covid-19 in the region. She said their families had still not received the generous life insurance payout that the government had pledged to provide — equivalent to nearly $70,000.
“No one cared for their families,” she said.
No part of India’s health system has gone unscathed in the pandemic; even patients with private insurance have struggled to pay the bills. Because private health insurance in the country is so unregulated, some plans did not even cover Covid-19 care unless individuals or employers purchased it as an added benefit.
Isha Nagpal has health insurance through her job at a TV network, but when her father was hospitalized for months after a case of Covid-19 and ensuing complications, she faced more than $20,000 in medical bills that her insurer had not paid.
“I couldn’t argue with them at that point because I was just seeing so many patients dying every day in the ICU,” Nagpal told Vox. “But the hospital just went on overcharging us.”
Nagpal covered the costs through donations, with help from the nonprofit group Mutual Aid India, and through her personal savings.
For many in India, such a financial setback is life-altering: “There are studies that suggest that poor people are falling into the poverty trap only because of health care expenditure,” Datta, the economist, said. “They may be barely above the poverty level, but because of expenditure on sudden disease, they are again falling back into poverty.”
Those are the symptoms of a broken health system. But Indian health policy experts appear skeptical this would be a moment for reform in their country.
“This is an opportunity to strengthen the public health system,” Baru said. “But we don’t see that happening.”
As the Indian economy grows, more money will inevitably go to health care. It’s part of the natural life cycle of any health system. But that alone may not fix the problem.
<div class="c-wide-block">
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629394435_1841_14393" data-cdata='{"asset_id":22791162,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/htKVadldKK7brPcwfzYQqbZrwi4=/0x0:3313x2209/320x0/filters:focal(0x0:3313x2209):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/LkLipVT8dKJ5lLOCUbhuDokE9KA=/0x0:3313x2209/520x0/filters:focal(0x0:3313x2209):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/2ZS3dOdGM_42bLvVyIZPS9F8xus=/0x0:3313x2209/720x0/filters:focal(0x0:3313x2209):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/06p2tdG8j5W8SyYoqpc1dX79u-o=/0x0:3313x2209/920x0/filters:focal(0x0:3313x2209):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/lh3Ic6oKSMMfX0Oo2LD37dkiYec=/0x0:3313x2209/1120x0/filters:focal(0x0:3313x2209):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/amIYgnGxQgMp0hHFrVMLEzBl2hs=/0x0:3313x2209/1320x0/filters:focal(0x0:3313x2209):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/kixynQLu3GSj1XdBEijW8Vrqw_k=/0x0:3313x2209/1520x0/filters:focal(0x0:3313x2209):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/ovu4YiG8EtlXmsV9jIeT5ys5wRg=/0x0:3313x2209/1720x0/filters:focal(0x0:3313x2209):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/iUKvo1kfr0EfSiOBvuKpksgbY04=/0x0:3313x2209/1920x0/filters:focal(0x0:3313x2209):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 1920w" sizes="90vw" type="image/webp" /> <img alt="" data-upload-width="3313" sizes="90vw" src="https://cdn.vox-cdn.com/thumbor/p-JfClxGlp1z10qe-V6rpbY2KeM=/0x0:3313x2209/1200x0/filters:focal(0x0:3313x2209):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg" srcset="https://cdn.vox-cdn.com/thumbor/UOLgS2S4TFoZ_dVkF_YogIYcHL4=/0x0:3313x2209/320x0/filters:focal(0x0:3313x2209):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/TFfh9MiHQ79SVhfzgjCFsLFswW8=/0x0:3313x2209/520x0/filters:focal(0x0:3313x2209):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/fEUIPuN3Za8VEgjYM54BmZgJlvo=/0x0:3313x2209/720x0/filters:focal(0x0:3313x2209):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/3RjX4P3X9VdSQt0nHrJRh1q9XYs=/0x0:3313x2209/920x0/filters:focal(0x0:3313x2209):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/PHI91USDZ_uk46xmVQj2_bc-19s=/0x0:3313x2209/1120x0/filters:focal(0x0:3313x2209):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/ST_Yrg6KtEbYJDj844qgnh8T3Xo=/0x0:3313x2209/1320x0/filters:focal(0x0:3313x2209):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/VFouU-LqlZP-m-GDd1OSR6p56Ek=/0x0:3313x2209/1520x0/filters:focal(0x0:3313x2209):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/NHuG-Abw1ZEyMex2n6WHmz_AuKw=/0x0:3313x2209/1720x0/filters:focal(0x0:3313x2209):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/cxGg3HznjdojpDyN3X8RWnVQS9I=/0x0:3313x2209/1920x0/filters:focal(0x0:3313x2209):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791162/VOX_6641_copy.jpg 1920w" /></picture>
<figcaption>Nonprofits often step in to fill a need when the government cannot provide easy access to health care.</figcaption>
</figure>
<figure class="e-image"><picture class="c-picture" data-cid="site/picture_element-1629394435_9135_14394" data-cdata='{"asset_id":22791159,"ratio":"*"}'><source srcset="https://cdn.vox-cdn.com/thumbor/GwP2DpG09QhdcrKmdmzcCM69K2w=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/K8Gi5Ogcc5dFqhKfhwjkz-YlHzw=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/wrNfcnQA1rjS_JZAQjlCf7WAFLw=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/Z9LjM1FpUstzYNXG0Hv24XdDit8=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/hnvD2ZH7wsJBLJteX582EtrsSxM=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/uhmgMJNq8ESpmPL2s5iKPPZp9yI=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/xt9Hpszc94uSbY53ESmxD3olK80=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/I9Hjt60xfOqHTdXC7KZoV-uIt7A=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/L6DxfcWTvKNIz-jLiog5acNl7z0=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 1920w" sizes="90vw" type="image/webp" /> <img alt="" data-upload-width="3000" sizes="90vw" src="https://cdn.vox-cdn.com/thumbor/Z9FQ4CcNIBeF9u2FGUekmfUEIB4=/0x0:3000x2000/1200x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg" srcset="https://cdn.vox-cdn.com/thumbor/1-3cn3lcSdEmNbNQAk1rrTOcrhY=/0x0:3000x2000/320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 320w, https://cdn.vox-cdn.com/thumbor/zM0N4HTsEMw0DmLR4TPiR3Gi3io=/0x0:3000x2000/520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 520w, https://cdn.vox-cdn.com/thumbor/vrtUT-Np6dfmDaQ_dCf34MuJOcc=/0x0:3000x2000/720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 720w, https://cdn.vox-cdn.com/thumbor/HEGX2_tmokX8ex5orcroZYYtRKI=/0x0:3000x2000/920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 920w, https://cdn.vox-cdn.com/thumbor/x1iur79Dgabh-2KiWk6wLjPaJRw=/0x0:3000x2000/1120x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 1120w, https://cdn.vox-cdn.com/thumbor/hiqwAPPrBosg4nPOzd7BrMJuGk0=/0x0:3000x2000/1320x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 1320w, https://cdn.vox-cdn.com/thumbor/KBc2peKpcglnHW6D0pXa67YK1uM=/0x0:3000x2000/1520x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 1520w, https://cdn.vox-cdn.com/thumbor/NeWgeEvBYKPk4HT2Gow76EhwHAs=/0x0:3000x2000/1720x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 1720w, https://cdn.vox-cdn.com/thumbor/INRaYvUG71FUwtFntn1Y3umjscE=/0x0:3000x2000/1920x0/filters:focal(0x0:3000x2000):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/22791159/VOX_6582_copy.jpg 1920w" /></picture>
<figcaption>A Covid-19 vaccination drive organized by the nonprofit Swasti at Hasanpur Village in Haryana, targeting street laborers and informal workers.</figcaption>
</figure>
</div>
The Indian health system is highly decentralized. It’s largely deregulated, and it pushes a high portion of costs on to patients. That tends to lead to worse outcomes and deeper disparities, in part because powerful industry actors oppose reform.
Baru described the rise of what she calls the “medical-industrial complex” in India. The national government has generally been more interested in accommodating the private sector than in solidifying the public health system.
There was “a capture of policy by the private sector,” she said. “The voice for the need for a public health sector was rather weak.”
In the United States, the influence of the private sector has made fixing the structural problems of the health system extremely difficult. Obvious problems remain intractable. India runs the risk of following the same path.
Shiv Charan Lal Gupta is clear on what went wrong when he lost his friend and 11 other patients, when he heard stories about bodies being dumped in the Ganges River, and when he witnessed his country’s health system’s effective collapse.
“What was the problem?” Gupta said. “There was hardly any structure.”
The pandemic exposed the woeful insufficiencies in the core pieces of the Indian health system. The right to health enshrined in the constitution exists more in theory than in practice. The pieces are there, but they are not good enough in their current form.
The past year has been one trauma after another. Gupta wants change.
“If these systems are actually put in place,” he said, “the problem will be solved.”
Pamposh Raina is a New Delhi-based journalist. Makepeace Sitlhou is a journalist based in Guwahati.
<a href="http://www.smitasharma.com/">Smita Sharma</a> is an independent photojournalist based in Delhi.
 
 
source <a href="https://www.vox.com/coronavirus-covid19/22628806/india-covid-19-cases-deaths-delta-variant">https://www.vox.com/coronavirus-covid19/22628806/india-covid-19-cases-deaths-delta-variant</a>

vox The long road to India’s unparalleled pandemic catastrophe

NEW DELHI, India — Shiv Charan Lal Gupta, the medical director of Batra Hospital in New Delhi, has seen the devastation that follows an eart...

Police Investigating "Active Bomb Threat" Near US Capitol

<div class="ins_instory_dv">
<div class="ins_instory_dv_cont"><img alt="Police Investigating 'Active Bomb Threat' Near US Capitol" src="https://i.ndtvimg.com/i/2015-11/us-capitol-police-bomb-squad-afp_650x400_41447904744.jpg" title="Police Investigating 'Active Bomb Threat' Near US Capitol" /></div>
Both the Senate and House of Representatives are currently on recess (File)
</div>
Washington:
Police said Thursday a suspicious vehicle near the US Capitol building and Library of Congress was being investigated for possible explosives and that people were told to leave the area.
"The USCP is responding to a suspicious vehicle near the Library of Congress," the US Capitol Police said on its Twitter feed. "This is an active bomb threat investigation."
Both the Senate and House of Representatives are currently on recess, but staffers are working in the Capitol complex.
(This story has not been edited by NDTV staff and is auto-generated from a syndicated feed.)
 
 
source <a href="https://www.ndtv.com/world-news/police-investigating-active-bomb-threat-near-us-capitol-2514339">https://www.ndtv.com/world-news/police-investigating-active-bomb-threat-near-us-capitol-2514339</a>

news world Police Investigating "Active Bomb Threat" Near US Capitol

Both the Senate and House of Representatives are currently on recess (File) Washington: Police said Thursday a suspicious vehicle near ...

Afghan Woman News Anchor Barred From Work After Taliban Takeover

<div class="ins_instory_dv">
<div class="ins_instory_dv_cont"><img alt="Afghan Woman News Anchor Barred From Work After Taliban Takeover" src="https://c.ndtvimg.com/2021-08/tqldtdnk_afghan-news-anchor-twitter_625x300_19_August_21.jpeg" title="Afghan Woman News Anchor Barred From Work After Taliban Takeover" /></div>
Shabnam Dawran worked as a journalist for six years for state-owned RTA
</div>
Kabul:
An Afghan woman journalist has said she was barred from working at her TV station after the Taliban took control of the country, and pleaded for help in a video posted online.
Wearing a hijab and showing her office card, well-known news anchor Shabnam Dawran said "our lives are under threat" in the clip on social media.
Under the Taliban's regime from 1996 to 2001, women were excluded from public life, girls could not attend school, entertainment was banned and brutal punishments were imposed.
Female journalists have also been targeted by the militants in a wave of assassinations in recent months leading up to their takeover of the country.
However, since seizing power in a lightning offensive the Taliban have claimed women will have rights, including to education and work, and that the media will be independent and free.
One Taliban official even sat down for a one-on-one interview with a woman journalist on TV to press the point.
But Dawran, who has worked as a journalist for six years in Afghanistan for state-owned broadcaster RTA, said this week she was barred from entering her office while male colleagues were allowed in.
"I didn't give up after the change of system and went to attend my office, but unluckily I was not allowed despite showing my office card," she said in the video.
"The male employees, those with office cards were allowed to enter the office but I was told that I couldn't continue my duty because the system has been changed."
Dawran then pleads with viewers, saying: "Those who are listening to me, if the world hears me, then please help us as our lives are under threat."
Among those to share the footage was Miraqa Popal, an editor at Tolo News, a 24-hour channel in Afghanistan.
"Taliban didn't allow my ex-colleague here in @TOLOnews and famous anchor of the State-owned @rtapashto Shabnam Dawran to start her work today," Popal wrote in a tweet on Wednesday that was shared thousands of times.
In a tweet on Tuesday, Popal posted a picture of a woman news presenter on Tolo, with the caption: "We resumed our broadcast with female anchors today."
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)
 
 
source <a href="https://www.ndtv.com/world-news/afghan-woman-news-anchor-barred-from-work-after-taliban-takeover-2514332">https://www.ndtv.com/world-news/afghan-woman-news-anchor-barred-from-work-after-taliban-takeover-2514332</a>

news world Afghan Woman News Anchor Barred From Work After Taliban Takeover

Shabnam Dawran worked as a journalist for six years for state-owned RTA Kabul: An Afghan woman journalist has said she was barred from ...

Anti-Taliban Forces Massing North Of Kabul, Russia Says

<div class="ins_instory_dv">
<div class="ins_instory_dv_cont"><img alt="Anti-Taliban Forces Massing North Of Kabul, Russia Says" src="https://c.ndtvimg.com/2021-08/72e3rr2_taliban-terrorists-afp-650_625x300_17_August_21.jpg" title="Anti-Taliban Forces Massing North Of Kabul, Russia Says" /></div>
Afghanistan: The Kremlin has in recent years reached out to the Taliban. (File)
</div>
Moscow:
Russian Foreign Minister Sergei Lavrov said Thursday that armed resistance to the Taliban is forming in Afghanistan's Panjshir Valley, led by deposed vice-president Amrullah Saleh and Ahmad Massoud, the son of anti-Taliban fighter.
"The Taliban doesn't control the whole territory of Afghanistan," Lavrov told reporters at a press conference in Moscow following a meeting with his Libyan counterpart.
"There are reports of the situation in the Panjshir Valley where the resistance of Afghanistan's vice president Mr Saleh and Ahmad Massoud is concentrated," he said.
Lavrov also reiterated his call for an inclusive dialogue involving all political players in Afghanistan for the formation of a "representative government".
The Panjshir Valley northeast of Kabul is Afghanistan's last remaining holdout, known for its natural defences.
According to images shared on social media, Saleh and Massoud, the son of Northern Alliance leader Ahmed Shah Massoud, are pulling together a guerrilla movement to take on the Taliban.
Moscow has been cautiously optimistic about the new leadership in Kabul and is seeking contact with the terrorists in an effort to avoid instability spilling over to neighbouring ex-Soviet states.
While the United States and other countries rushed to evacuate their citizens from Kabul, Russia said its embassy will continue to function.
Russian foreign ministry spokeswoman Maria Zakharova told reporters on Thursday that the Taliban are "actively restoring order" and have demonstrated their "intent to dialogue".
She said at her weekly press briefing that the terrorist group -- known for its severe treatment of women -- is "ready to take into account the interest of citizens, including... women's rights".
Earlier this week, Russia's ambassador to Afghanistan Dmitry Zhirnov met with the Taliban in Kabul, hailing on state television a "positive and constructive" meeting.
The Kremlin has in recent years reached out to the Taliban -- which is banned as an "extremist" group in Russia -- and hosted its representatives in Moscow several times, most recently last month.
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)
 
 
source <a href="https://www.ndtv.com/world-news/afghanistan-anti-taliban-forces-massing-north-of-kabul-russia-says-2514320">https://www.ndtv.com/world-news/afghanistan-anti-taliban-forces-massing-north-of-kabul-russia-says-2514320</a>

news world Anti-Taliban Forces Massing North Of Kabul, Russia Says

Afghanistan: The Kremlin has in recent years reached out to the Taliban. (File) Moscow: Russian Foreign Minister Sergei Lavrov said Thu...