United States President-elect Joe Biden has promised to administer 100 million doses of COVID-19 vaccines in 100 days and even his advisers are sceptical that this can be done. Yet Prime Minister Narendra Modi has pledged to inoculate 300 million people in roughly the same time, and there is little doubt that he will succeed. India was also able to run an election with a nearly a billion people without the drama and turmoil of the US presidential elections.
What is the difference? It comes down to having a strong federal government — which takes responsibility for national emergencies — and facilitating democracy.
The disarray of the US SARS-CoV2 vaccine rollout and distribution will likely result in tens or even hundreds of thousands of unnecessary deaths. The vaccines are highly effective yet millions of doses remain sitting in coolers in hospitals around the country. How is this possible? Why aren’t they sticking needles into arms literally the minute the vaccine coolers roll off the trucks?
The answer is Ronald Reagan and the mistrust of Big Government. The US has long enjoyed a healthy dose of scepticism towards government solutions. Yet it owes its existence as a nation to Big Government. Prior to the formation of the Continental Army and the awarding of the US Federal Government to raise funds for the army, the early colonial soldiers were destitute, hungry and poorly equipped. The US didn’t defeat Adolf Hitler by hoping that each state could supply enough troops and that their radio systems would communicate with each other. Wars have traditionally been a job for Big Government, and rightly so.
National emergencies that require top-down decisions on key matters have almost always done better when Big Government stepped in to take charge. This extends into the public health realm. The victory over smallpox was a product of Big Government, with a centralised plan to eradicate the scourge. The US did not make progress towards clean water and clean air without Big Government intervention. Likewise, the Acid Rain crisis was addressed through market forces brought to bear by Big Government. State-by-state laws on the pollutants causing acid rain would not have worked nearly as well.
Reagan famously said, “The nine most terrifying words in the English language are, 'I'm from the government and I'm here to help.'”. This quote has animated much of conservative thinking ever since. The idea that Big Government is invariable intrusive, incompetent and unnecessary became a key attribute that nearly every conservative lawmaker had to recite and pay fealty to.
Reagan was a product of his time and place. He was reacting to a Soviet menace and the clear failure of centralised economic planning that ultimately destroyed the Eastern Bloc. Reagan was also tapping into a long history of the American frontier ethos holding that people can and almost always should do it themselves without government interference. Yet Reagan himself pushed for and oversaw a broad military expansion, a clear manifestation of Big Government. In fact, Big Government was fine if it fit the political mould of military need.
This outmoded way of thinking is now hurting the US in its greatest hour of need. The US Federal government has until recently refused to provide any guidance to states on how to distribute vaccines. States have provided light guidance to hospitals. Hospitals have frozen, like deer in the headlights, and put in place questionable policies.
The basic guidance from the Federal Government has been that the first people to receive vaccines are frontline workers and care home residents. Even within these guidelines there is much room for interpretation. Are grocery store workers frontline? Are hospital administrative staff frontline workers? Should care home residents that have had COVID-19 and recovered receive the shot? If some of my hospital frontline workers refuse the shot, how long do I need to hold their doses in case they change their minds?
This debacle has cried out for guidance and simplicity. Vaccinate all healthcare workers first. Those who refuse the vaccine can receive it in the future but their dose will be immediately released for others. Vaccinate everyone over 65. Vaccinate all frontline workers like first responders, transit workers and workers in supermarkets. Require proof of employment but don’t be precious about it. The perfect is the enemy of the good, and good enough is much better than letting vaccines go bad, as is currently happening. These are the sort of decisions that India made.
India has suffered economically more than most countries have. It has dire problems of hunger, poverty, and inequity. Yet, despite the additional setbacks caused by the pandemic, Modi showed a determination to demonstrate effective and reliable leadership in a time of crisis. He positioned himself as a modern-day CEO of the country and showed what good governance looks like.
This is why I went on Twitter and commented to NITI Aayog CEO Amitabh Kant that the irony is that it may make sense for Washington to outsource vaccine delivery and inoculation to New Delhi.
The US should also get India’s help to run its elections.
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