“In March 2020 when WHO announced this was a pandemic, the general response in India was that we have better immunity, and so on. We were living in denial,” says Chinmay Tumbe in this conversation with Charles Assisi. “We muddled ourselves with all sorts of crazy hypotheses.”
Tumbe is an economic historian and researcher, and the author of The Age of Pandemics. He also teaches at IIM Ahmedabad.
“The collective memory of pandemics that had ripped India [the 1918 influenza, cholera, plague]—in 1920 life expectancy was in the 20s—that entire memory had been lost,” Tumbe adds.
In this conversation, Tumbe talks about the parallels between those past epidemics that India suffered and the current coronavirus pandemic—and the lessons we have not learnt from our own history even as we are confronted with our biggest health crisis in a hundred years.
He talks about
- why a lack of consensus on Covid protocols among the medical fraternity is not necessarily a negative thing. Protocols evolve as you learn more about how an infection is transmitted, he says.
- why public policy lags behind science (it’s about demand and supply, he says).
- how pandemics impact labour migration—and what is different today. And also what it means for urban centres, the rural economy and urbanisation. (“No country has gone from poor to rich without a process of urbanisation. India is one of the slowest urbanising countries in the world.”)
- the political fallout and how this will lead to a new crop of political leaders at the grassroots—who may well emerge on the national stage in a few years. (“A part of any pandemic is serendipity, luck and bad luck; but a part of it is also management and how are you responding to the crisis.”)
Highlights from the conversation
(Edited for brevity and clarity)
One clear takeaway from your book is how much India was impacted by pandemics in the past. And how pandemics impacted other parts of the world as well—Europe in the 14th century when one-third of the people died. How did people in Europe pick themselves up and work to revamp their public infrastructure over time? What happened in India in spite of taking the worst of it all over the centuries?
The root, from the Black Death to what happened in the 17th and 18th century, was the Enlightenment. It created a scientific outlook towards the world. It was a culture which respected curiosity. It is not a coincidence that the vaccines today are coming from the same universities that were involved in the Enlightenment.
Having said that, Western medical systems were not more advanced than Ayurveda, Unani, or Siddha until the late 19th century. When cholera struck in 1817, everybody was clueless. But by 1900 there was a clear difference. People like John Snow tried to systematically understand the transmission [that cholera is water-borne and not because of miasma or impure air]; they didn’t take established paradigms as sacred.
Why did a John Snow not come up in India or China? I believe it is that spirit of curiosity. And the leeway to push the borders.
In India [when the coronavirus pandemic hit us], we picked up this hygiene hypothesis. Because we grew up in really bad surroundings, it gave us this amazing immunity and that’s why we can survive corona much easier. [We forgot that] 40 million Indians died between 1817 and 1920 at a time when our hygiene standards were not that great.
That natural immunity argument had no scientific basis. And that’s come to haunt us today, because the second wave came with complacency based on such loose ideas.
This would never happen in the US and Europe, unless you went through a scientific explanation of what causes mortality to be more. If they can’t explain something, they’ll say we don’t know.
It’s not that America is a less religious country. But there is a certain respect accorded to scientists and their work.
The Black Death was so traumatic for Europe that it lingered through the centuries in their collective consciousness. During the plague in Bombay, British officials would refer to the plague in London 300 years earlier. Whereas when we are confronted with our biggest health crisis in a hundred years, there seems to be no public memory that we had gone through a similar experience in the 19th and early 20th century.
So, the storing of memory has been much more systematic in Europe.
The inflection point in Europe happened in the 19th century with the development of bacteriology. Once they could identify the cause of infection—with that came vaccines, medicines, and the idea of public health.
What do you make of the lack of consensus among the medical fraternity on the Covid protocols?
You cannot contain a pandemic unless you understand how it is transmitted.
Take cholera. It took years for Indian officials to accept that it was waterborne. And they had a reason for continuing to believe that it was airborne, because there was a seasonal aspect to cholera outbreaks. It happened in certain regions in certain months—and so [they thought] there was a climatic factor behind the outbreaks. And the latest research on cholera suggests that there might be a hint of truth to that.
Coming back to the coronavirus. When there’s a new pandemic, there’s a lot of uncertainty. You try different things hoping that some of it might be right. The science of mask wearing has been established over the last one year. But other protocols are evolving; there’s a process of learning on what works and what does not.
And with all the unprecedented global research on the coronavirus—though we still do not know a lot—what we know now in one year is substantially more than what we knew about any previous pandemic. For cholera it took three-four decades to find out it is waterborne.
Why does public policy lag behind science?
As a trained economist I tend to look at it in terms of demand and supply. With cholera, on the demand side, were people looking at it as an act of god and therefore there was no demand for state intervention [in public health]? On the supply side, was there funds and state capacity?
In Calcutta, for instance, piped water was installed in 1869 and cholera mortality rates came down. But they did this only in the elite neighbourhoods where the British lived. Extending piped water to the rest of the city took much longer. You can see that the supply came because of the massive demand from the British elite.
It also has to do with who is listening to the ones making a case for [public health systems]. For example [there was this medical officer who was talking about clean water systems to end cholera in India] but his seniors were steeped in the idea that cholera is airborne and were not listening to him. But among those who were listening was the Maharaja of Travancore. And that’s the root of why Kerala has a good public health system.
One fundamental lament of freedom fighters was that the British were [investing] in public health systems back in England, but not in India. But then what happened after 1947? Because then the British excuse disappears. And there [it is about] continuously underfunded health [systems]. Piped water to villages is not just about cholera, but a whole variety of waterborne diseases. Even after 70 years of Independence progress is so slow. And it has to do with both demand and supply. It is a story of systematic neglect in matters of public health.
Evidence suggests a direct link between religious gatherings and outbreak of diseases. But in contemporary India—be it the Tablighi Jamaat or the Kumbh Mela—clearly, these lessons were lost.
It is an erasure of public memory. Take the Kumbh Mela or the Haj. [If you look at] the history of the Kumbh Mela, it has been continuously linked with epidemics for so long—and just because we haven’t had a serious outbreak in the last 30-40 years doesn’t mean it doesn’t have a history of that.
People should also know that in the past Kumbh Melas have been suspended. And in the 1930s and 40s it was compulsory for pilgrims to get a cholera vaccination certificate.
This year Kumbh Mela and any large gatherings [religious or otherwise] should have been banned.
Maharashtra did in fact ban the Pandharpur Yatra—and this the second year in a row. Public health policies need to take people into confidence. The Maharashtra government sat down with the people who organise the Yatra and religious leaders and explained the gravity of the situation. When people realise that not having the Yatra will save lives, you will have support [for the ban].
The Haj has been scaled down dramatically too.
In the hypothetical situation that the second wave didn’t happen, it would have still been irresponsible to hold such a large gathering. When you are seeing a second wave around the world you have to take precautionary steps.
You make a point around migration—how people in Jessore, the centre for indigo processing, moved elsewhere when cholera struck. What happens to a cluster when migrant labour leaves? What happens to the place a migrant goes “home” to? Today even middle class people are leaving cities like Mumbai, Delhi, and Bangalore for tier 2 cities.
In a pandemic, people will go back home. This has particular salience in India because India’s economy runs hugely on circular migrant labour. This is a huge difference we see in India versus China. In China, in the last 20 years, both men and women migrated in large numbers to the cities. In India, historically and even today, more men move to cities than women for work. So you have a whole class of single male migrants in our cities, who are separated from their families. Especially in cities like Delhi, Mumbai and Surat, a huge part comes from rural India. These cities are qualitatively quite different from cities like Bangalore, Hyderabad, Chennai and Pune which have drawn a lot of IT or urban to urban migration.
Now, in places like Delhi, Mumbai, Surat, in a health crisis, migrant labour has an incentive to go back and be with their families. This is what happened in 2020 and we saw all those unfortunate images of people walking home because public transport was shut down in the lockdown.
But, as past pandemics show, labour will also come back once the health crisis settles, because of higher wages and better livelihood in the big cities.
There was debate last year that [the reverse migration] was an opportunity to invest in those areas so people don’t have to migrate to cities. But that fact is, the places people migrate from [UP, Bihar, West Bengal] are quite dense, so it is impossible to create too many job opportunities in the agriculture sector there. So, I see rural to urban migration as inevitable. Even MGNREGA works for a particular class of people; by design it is for the absolutely poor. The bulk of the migrant labour returning home will not take up a MGNREGA job. While there was an uptick in MGNREGA jobs, it is impossible to create job opportunities in places like UP, Bihar and West Bengal in just three-four months. I’ve been studying this from a historical perspective. And these regions have been sending out people in search of a job for a hundred years.
There is also a cultural logic to these migrations. You are expected to move out and explore the world, work for 10-20 years—and then return home. Very few migrants from UP, Bihar actually settle down in the cities.
Of course, this impacts the economy in the source region too, because they thrive on migrant remittances. We think of Kerala as the classic remittance economy, with migrants sending back money from the Gulf. But that’s happening in Rajasthan, UP, Bihar as well—where migrants to the cities are sending back money. So last year, not only did industries in Delhi and Mumbai shut down, but the rural economy also collapsed.
This year we’ve seen a much lower migrant exodus and that’s because employers, especially in construction, have stepped in [and are paying more to get labour back]. That’s the learning that’s happened.
The other difference between 2020 and 2021 is that the pandemic has reached rural areas.
Now the other question [on whether the middle class, especially with remote work] will move [permanently] to Tier 2 cities. It’s a possibility. But the long arc of history shows that human beings love urban congregations. You would think that the IT industry should be the least clustered industry in the world because you can always connect with anyone in the world through your IT system. But the fact is, it is the most clustered industry in the world. You have Silicon Valley, Bangalore and those clusters in Israel.
People say the difference now is good bandwidth connectivity. But I don’t think that’s enough of a reason for people to fundamentally start rethinking urban conglomeration.
Is it desirable to have an urban policy strategy that reduces the pressure on big cities? That can happen only if you invest a lot in the amenities in smaller towns. The Catch-22 here is that these small cities might then become big cities. The logic for an urban conglomeration from an economics point of view is so powerful.
The big problem in India is not big cities versus small cities, but that we don’t have enough rural to urban migration happening in the first place. China has a hundred large cities; we have four or five that are absorbing a lot of that. We need more large cities to absorb the rural to urban migration, which is only going to increase in the coming years. That’s the larger story. No country has gone from poor to rich without a process of urbanisation. India is one of the slowest urbanising countries in the world.
You touched upon the political churn that happens. The emergence of people such as Gandhi, Tilak and Sardar Vallabhai Patel among others. How does this happen? Is it possible to imagine such political shifts in the contemporary world?
First of all, there ought to be a movement for better public health.
The second wave is going to have a political fallout. A part of any pandemic is serendipity, luck and bad luck; but a part of it is also management and how are you responding to the crisis. How much of the loss [of human life] is attributable to the government, both centre and states? We need to demand accountability. But you also need a new class of leaders.
This is India’s largest crisis since Partition, in terms of the sheer death toll and the economic contraction. This is going to bring forth a new crop of leaders at the grassroots level, who will grow up 20 years down the line to lead the country.
You make the observation that “pandemic management almost always involves the dispersal of crowds and some curtailment of religious freedoms and civil liberties, which is a political issue, as the British discovered in India in the 19th century.” In India today, how real is the possibility that civil liberties are clamped down upon?
You have to have some restrictions. But how much power do you give to the police? There is also an over-exertion of power [with the cops smashing street vendors’ carts]. That is why you need independent checks to see that the Epidemic Diseases Act is not being misused.
At the end of the day it’s about how we as a society respond. I would say that in Taiwan or Singapore, if the law says don’t go out after 6 pm, people respect it.
Before and after the first wave, people were sceptical of these policies. The second wave [in India] has been so devastating that people are more likely to respect the restrictions. But overall, this is a back and forth game between the government and the public.
To deal with this, we need better communication of the risk of the pandemic. And if you see your local politician at an election rally, then who is going to respect any restrictions? The demonstration effect of political leadership is important.
For me, the last one month has been a replay of 1918 [Spanish Flu]—the first wave was mild, the second wave was devastating, the bodies floating in the Ganga, though not as many as in 1918… We’ve seen it once before and simply did not take the possibility of a second wave. We muddled ourselves with all sorts of crazy hypotheses—some sort of exceptionalism and triumphalism had creeped into the system. [We got] swayed by a self-serving logic. Politician after politician from the ruling dispensation are telling us that things are not good but it’s much worse in the US, or Britain, or Germany. But the fact is, if you compare 200 countries in the world, India is in the bottom half of the list in both reported Covid deaths per capita and economic contraction. On lives and livelihood. Even in the first wave, we had the worst Covid death rate in South Asia. We fooled ourselves with benchmarking with one or two countries. And the Economic Survey of India is an example of this—it has a chart which shows India as the best performing country among 19 countries; but if you look at 200 countries, we are in the bottom half.
The first thing is we have to admit that we have a long way to go [to being a superpower]. We have such woeful medical and health infrastructure. Jobs are a fundamental crisis right now. Take it year by year [and focus on these gaps].
And it starts with demanding accountability for course correction to happen, and for us to go beyond marketing gimmicks.