COVID-19: AN OPPORTUNITY TO LEARN EFFECTIVE DISASTER GOVERNANCE
Nibedita S. Ray-Bennett, Avoidable Deaths Network and University of Leicester
You are the founder of the Avoidable Deaths Network. Would you say this pandemic was an avoidable disaster? How?
The WHO announced the novel coronavirus (alias COVID-19) a pandemic on 11 March 2020. It became a disaster due to the number of deaths, coupled with national and international lockdowns, and the economic fallout thereof. A pandemic is the “worldwide spread of a new disease”, according to the WHO. Before COVID-19, the world has experienced other pandemics in the 20th and 21st Centuries, including the influenza (H1N1) of 2009, the Hong Kong Flu of 1968 and the Spanish Flu of 1918-19. Although pandemics are a rarity (as such, their probability is low risk with high impact), their occurrences are entirely unavoidable in the 21st Century. This is due to the movement of people resulting from globalisation (also known as people flows by Richard Freeman), which accelerates human-to-human transmission of viruses or pathogens, coupled with weak health systems and complex interface of humans with nature – among other things. The major impact of the pandemic is human fatalities. The pandemics of the 20th and 21st Centuries have jointly killed more than 30 million people. According to Worldometer, more than 133,359 lives have already been lost due to COVID-19. I believe that the excess deaths from pandemics are avoidable through timely and effective health care, public health interventions, and joined up disaster risk governance.
What are some lessons from your regular work that would be relevant to this situation?
Pandemic and epidemic disasters thrive where institutional cracks and vulnerabilities exist. They thrive in environments that are non-democratic and do not support early warnings. The Chinese Doctor, Li Wenliang, an ophthalmologist at the Wuhan Central Hospital tried to warn fellow medics about the novel coronavirus. Instead, he was reprimanded by security police and forced to sign a letter that accused him of ‘making false comments’. Doctor Li contracted COVID-19 and died on 30 January 2020. Reporting culture, safety culture, and transparency (among other things) are cornerstones to save lives and promote disaster preparedness. National and international organisations must invest in promoting cultures that believe in saving lives at any cost, heeding to the voices and early warnings from health workforces, and most importantly investing in developing the capacities of health systems.
Currently, national governments (including India and Bangladesh where I work) allocate less than 3% of their budgets for the health sector. The COVID-19 pandemic must act us a wake-up call for India and other low-and middle-income (including high-income) countries to invest in risk communication, health and health systems – among other things. As evident in the COVID-19 outbreak in Italy, China and the UK, the health workforce bears the burden of mortality and morbidity disproportionality. It is paramount that the lives of health workforces are saved at any cost so that the health services can continue to function with minimal disruption. Each country should work on emergency capacity for production of personal protective equipment (PPE) to avoid international competition.
I work within the United Nations’ disaster risk reduction (DRR) framework, which is currently advocated through the ‘Sendai Framework for Disaster Risk Reduction 2015-2030’. The DRR framework will be invaluable for the management and mitigation of pandemics. The operational components of DRR are: disaster risk management and disaster risk governance. Currently, COVID-19 is managed through health care provisions, public health interventions, national lockdowns, contact tracing, individual and mass testing, social distancing, isolation, and quarantines – among other measures. Both disaster risk management and disaster risk governance are currently lacking. Studying the pandemic also through the lens of disaster risk management will enable policymakers and practitioners to conduct pro-active and reflective management, rather than reactionary management. Disaster risk management of pandemics and/or epidemics will also promote the mitigation, preparedness, response and recovery cycle throughout the year, rather than reacting during an outbreak.
Disaster risk governance for epidemics or pandemics will promote coordination, communication, cooperation and collaboration between local, national, regional and international actors and organisations. Disaster risk governance will also highlight that the impact of pandemics is differentially experienced; one in which, pre-existing vulnerabilities, such as underlying health conditions, organisational vulnerabilities, and socio-economic differences (e.g. caste, class, gender, age, race, religion and locations) can potentially exacerbate the impact of pandemics. Therefore, the differential impact of the viruses can underpin disaster risk governance to mobilise finite resources to save lives, promote inter-agency collaboration in governing hazard management in everyday life, and in doing so, share the burden of deaths and disease at a minimal cost.
What could have been planned differently given the knowledge we already have about communities, their needs and capacities? In other words, if the government had consulted you, what would you have asked them to think about?
If the Government of India had consulted me, I would have advised pre-planning for the national lockdown, which would have included: identifying multiple scenarios and outcomes (intended, unintended and desirable) underpinned by the DRR’s ‘all-of-society approach’. I would have advised them to plan and then assess the plan in terms of its effect on each segment of society with preferably multiple stakeholders. This also means planning early for consultation to avoid reactionary management. The central government was able to assess the impact of the lockdown on the formal sector, but failed to assess the full impact on the informal sector. As such, the global community has watched the harrowing journey of the migrant workers walking home, hungry and dehydrated. There were many deaths amongst migrant workers en route to their villages. These are indirect deaths, and were avoidable.
Currently, many migrant workers are stranded on their way home – uncared and forgotten in their makeshift shelters with minimum or no provision of basic amenities. The Avoidable Deaths Network is in the process of documenting avoidable indirect deaths of migrant workers and other people from the impact of the national lockdown in India. These indirect deaths were and are avoidable through effective disaster governance. This is an opportunity for the central and state governments to learn and rectify their mistakes now and for future disasters.
Now moving forward, it is commendable that the national and state governments in India have made some food items available to the rural households for free through the public distribution system. Being born and brought up in a rural village of North Bengal, the well-being of rural households is always close to my heart. I would like to advise that both central and state governments conceive social protection and social safety net schemes for the rural populace as soon as possible. These schemes must continue for at least two years so that households can recover from the shock and stress of the pandemic disaster. Without recovery interventions, it will be impossible to address the Sustainable Development Goals, especially Goal 1 (no poverty), Goal 2 (zero hunger), Goal 3 (good health and well-being).
It is never too late, as the adage goes. I would recommend that the central government, in collaboration with state governments, leverages the pre-existing state, district and village level disaster management committees for the governance of COVID-19. In one of the UNDRR’s webinars on ‘Disaster Expert Shares Lessons from China on How to Contain the Spread of COVID-19’, the WHO’s representative in China, Dr. Gauden Galea recognised that the: “overall lesson[s] from the experience to date includes improving the awareness and ability of the public and communication in disaster prevention and mitigation and risk communication”. The existing disaster management committee in the Indian states can play a pivotal role in raising awareness on COVID-19, communicate public health messages in vernacular languages, and implement public health interventions to contain the virus for the ‘last mile’. According to the Global Disaster Preparedness Center, Community Early Warning Systems (CEWS) are often referred to as the “last mile” in an end-to-end early warning system (ESW). “Reaching the last mile” means reaching out to the most vulnerable to disasters so that they can protect themselves and their livelihoods, receive information, understand it and be able to act on the information. Reaching the last mile will be a cornerstone for the COVID-19 response and recovery in India. I believe that the Indian states which have robust disaster management and EWSs will be in a better position to respond to the COVID-19 pandemic. The state of Odisha is one to keep an eye on for their response and recovery implementation plans. I have been studying the disaster management practise of Odisha since 1999. The Government of Odisha has successfully reduced disaster deaths from 10,000 in 1999 to 41 in 2019. My Avoidable Deaths Network-India Hub is located in Odisha and we are closely observing the plans and interventions of the state government for reducing the number of deaths from COVID-19.
Last, but not the least, innovation is urgently wanting in order to promote physical or social distancing in high resource and space-constrained urban slums of Delhi, Mumbai and other major cities in India. Quarantine and social distancing have been found to be effective in the UK, Italy and China in containing the spread of the virus. Urgent attention is wanting on this from the central and state governments to invest in evidence-based research, public-private partnerships, and low-budget innovations that are scalable.
What do you think will be the long-term gender impact of this crisis on communities?
We have evidence from SARS, the influenza, Ebola and HIV viruses that men and women are affected differently by these viruses. According to the Novel Coronavirus Pneumonia Emergency Response Epidemiology Team in Hubei province, the fatality rate for males was 2.8% and for females it was 1.7%. 2,232 men, as of 7 April 2020, have died of COVID-19 in New York City compared to 1,309 women, according to the City’s Health Department. According to the BBC, in Italy, 72% of those who died were men. This evidence suggests that more men died (or are still dying) than women in the pandemic. This indicates that it is important that the country-level data has gender breakdowns because it can tell us who is most at risk. Gender-disaggregated data is vital for disaster risk governance because such data has implications for policy and practice. In this context, gender-disaggregated data will have implications for flu vaccinations for men and women, and likewise medical needs for men because they are most at risk for biological reasons. As such, this information needs to be communicated to the public to avoid deaths and the disease amongst the male population. Furthermore, the Ministry of Health and Family Welfare must record not only gender-disaggregated data, but also fatality data of rural and urban population and by age – currently, these variables are lacking in the COVID-19 India Death Data.