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The US can afford to say, “Hey, we’ll shelter in place for five months. We’re going to impose these orders and the people who’ve lost their jobs — in restaurants and salons — we’re going to give you a stimulus package for small businesses”… Developing countries don’t have that option.

Shruti Rajagopalan

When COVID-19 hit the US, everyone was told that hand sanitizer needed to be saved for healthcare professionals and to just wash their hands instead. But in India, many homes lack reliable piped water, so they had to do the opposite: distribute hand sanitizer as widely as possible.

American advocates for banning single-use plastic straws might be outraged at the widespread adoption of single-use hand sanitizer sachets in India. But the US and India are very different places, and it might be the only way out when you’re facing a pandemic without running water.

According to today’s guest, Shruti Rajagopalan, Senior Research Fellow at the Mercatus Center at George Mason University, context is key to policy. Back in April this prompted Shruti to propose a suite of policy responses designed for India specifically.

Unfortunately she also thinks it’s surprisingly hard to know what one should and shouldn’t imitate from overseas.

For instance, some places in India installed shared handwashing stations in bus stops and train stations, which is something no developed country would recommend. But in India, you can’t necessarily wash your hands at home — so shared faucets might be the lesser of two evils. (Though note scientists now regard hand hygiene as less central to controlling COVID-19.)

Stay-at-home orders present a more serious example. Developing countries find themselves in a serious bind that rich countries do not.

With nearly no slack in healthcare capacity, India lacks equipment to treat even a small number of COVID-19 patients. That suggests strict controls on movement and economic activity might be necessary to control the pandemic.

But many people in India and elsewhere can’t afford to shelter in place for weeks, let alone months. And governments in poor countries may not have the resources to send everyone money for months — even where they have the infrastructure to do so fast enough.

India did ultimately impose strict lockdowns, lasting almost 70 days, but the human toll has been larger than in rich countries, with a vast number of migratory workers stranded far from home with limited if any income support.

There were no trains or buses, and the government made no provision to deal with the situation. Unable to afford rent where they were, many people had to walk hundreds of kilometers to reach home, often carrying their kids and life’s belongings.

But in other ways the context of developing countries is more promising. In the US many people melted down when asked to wear facemasks. But in South Asia, people just wore them.

Shruti isn’t sure if that’s because of existing challenges with high pollution, past experiences with pandemics, or because intergenerational living makes the wellbeing of the elderly more salient, but the end result is that masks weren’t politicised the way they were in the US.

In addition, despite the suffering caused by India’s policy response to COVID-19, public support for the measures and the government remains high — and India’s population is much younger and so less affected by the virus.

In this episode, Howie and Shruti explore the unique policy challenges facing India in its battle with COVID-19, what they’ve tried to do, and how it has performed.

They also cover:

  • What an economist can bring to the table when studying pandemics
  • The mystery of India’s surprisingly low mortality rate
  • India’s strict lockdown, and the public’s reaction
  • Policies that should be implemented today
  • What makes a good constitution
  • Emergent Ventures

Get this episode by subscribing to our podcast on the world’s most pressing problems and how to solve them: type 80,000 Hours into your podcasting app. Or read the transcript below.

Producer: Keiran Harris.
Audio mastering: Ben Cordell.
Transcriptions: Zakee Ulhaq.

Highlights

COVID fatality rates in India

It is an underestimate. Indian fatality rates, not just for COVID, but I think India has just never been good at counting deaths. Only 70% of the deaths in India are registered by the civil registering agencies. …. Cities are a little bit better at counting deaths because burial grounds, and funeral homes, and crematoriums need to get permission from the municipal government before they can do it. But in rural areas, for instance, just a lot of deaths are not officially recorded. So the way we count deaths in India is not through the registry, but very often we count it later through the census, health surveys, various kinds of health surveys, verbal autopsies, things like that. Now, of the 70% of the deaths that are recorded in India, the cause of death is not perfectly recorded in more than 80% of the cases.

Now, coming to COVID deaths, there’s a couple of issues….. when someone has been tested for COVID and they have a COVID related death, we have decent numbers for that. When someone dies of COVID, or suspected of COVID, but they weren’t tested, but all the symptoms point towards COVID … No state has systematically reported the second category, which is COVID probable or COVID suspected, right? So that’s the second part of it. Now the third part of it is, even in the first case where there are lots of comorbidities, depending on the culture of the hospital and the local context, there’s some inflation and deflation that happens, right? So some doctors are very careful.

Normally what we do in these circumstances, especially in this kind of a pandemic is, you can solve it by counting excess mortality. Now, this is the idea that we compare say April of 2020 to April of 2019. We remove all the deaths which were not healthcare related, right? So, we remove gunshot wounds and drownings and things like that. And then we just compare, did more people die in April 2020 than in April 2019 in this particular city or this particular country during the pandemic? And that gives you a sense of how many people may have died because of something to do with COVID. Now the problem is, in India, actually, mortality rates declined during the pandemic. And this is because of the lockdown.……we can solve this using the same technique as excess mortality in other countries, which is you compare only healthcare related mortality in April 2020 with April 2019. But because we don’t precisely record the cause of death, it’s very, very difficult to do that. So this goes back to my original point about we just don’t record deaths very well. So we’re not in a position to even calculate this using excess mortality.

Different attitudes to masks globally

We’ve seen in both South Asian and East Asian countries, even in India [that people are really good about wearing masks]. I live in the United States right now. We’re having a meltdown politically and in civil society over masks. And there are various reasons for it. But in India, there is no similar meltdown. People wear masks. In India, anyway, culturally the clothing has an upper-body cloth. Most people just cover their face with that and things. So people have just been good about those sorts of things.

So in a sense, when it’s hard to socially distance because you may live in a slum or you live in a crowded place, or you live with too many people in a single dwelling, maybe people compensate by other measures. Maybe they wash their hands more. Maybe they are more compliant about mask-wearing and things like that. So there is definitely something going on culturally. I’m not able to put my finger on it because even culture vastly varies between these countries and even within India. So I think I would put it down to learning by doing both in terms of governance and within the families on how they might have reacted to the past pandemic.

I do know that in Asia, especially like Beijing, Beijing’s pollution levels are legendary at this point. Same with New Delhi. I see people wearing masks in Beijing, in New Delhi, even without a pandemic. They just wear a mask. So I think the environment imposes enough stresses and maybe some of it is past pandemics and some of it is other stresses, just bad smells or bad pollution, but people don’t seem to associate masks with loss of liberty or something like what’s happening in some of the other places in the world. And in all these South Asian countries, I think it wasn’t politicized. Masks were just not politicized in a way that they were in the United States.

Constitutional Political Economy

One key message – to distinguish the choice made by individuals in ordinary politics at one level, and in constitutional politics at another level. So it’s sort of moving the application of economic principles across all levels. We are not just economic agents when we are buying apples in the marketplace, right? Now we’re also thinking about applying the same principles to how political actors act given a set of rules, which is the school of public choice. Then you move it to the next level, and say, “Oh, this is not just rational actors acting under a given set of rules. They’re also choosing the rules themselves”. So this is a very powerful way to look at the world, and to look at political economy as a whole.

Constitutional Political Economy in India

There is this huge push that we need to create special economic zones, or we need to create large manufacturing units. So there are people in India, especially a lot of people working in economic policy, who say we need to take land from all these unproductive farmers. We need to take their land, and we need to consolidate it into large land parcels, and give it to the mining company, or the pharmaceutical company, or the car manufacturing company. Now what’s ended up happening in modern day India is we are not giving them enough compensation: the poor farmers. And there seems to be something fundamentally and morally wrong about taking from poor farmers and giving it to rich capitalists. There’s that part of it, especially with the government coming in as a broker. Now you’re trying to understand how this can be done in any functional constitutional democracy. And what I find is land reforms done in 1950, and the kind of special economic zones being created today, they are mirror images of each other. Constitutionally, it’s the same story. You’re taking from Peter and giving to Paul without just compensation. You have weakened the constitutional constraints on political actors, such that they can expropriate land, and use it for a particular kind of policy. The only difference is, in 1950s, what was considered public interest was to dismantle feudalist states. And in 2020, what is considered public interest is we need to move towards large manufacturing firms. That’s the only thing that has changed. But what is similar, is that you’re able to take land or property from one group and give it to another without balancing their interests and without paying just compensation. Now at the end of the day, this is a constitutional problem. So today, there are people in India who are protesting the plight of farmers, and how the land is expropriated by the government. They are really, I mean, technically, they are protesting the local government or the local politicians. But actually, the core area of protest is a constitutional issue. Why did we not tie the hands of those who govern us better?

Emergent Ventures

The idea of Emergent Ventures was to create a philanthropic fund or a project that will support other projects that may be too weird, too out there, too risky, very hard to measure the impact, or just very high chance of failing but should they succeed, they’d be great. Most major foundations are bureaucratic. By the nature of their setup, they like to pick more tried and tested things. Typically people who are better at grant writing end up getting the grant or the money rather than the better idea. Now there are reasons why different philanthropic foundations work in the way that they do, but Emergent Ventures is an attempt to walk away from those problems.
…. set it up is minimal to zero bureaucracy. There are no layers and layers of approval. Tyler is the final approver of any Emergent Ventures application. I approve the India applications. Of course we all talk to each other. …. But the idea is a pop-up philanthropy, which quickly hands out grants to projects that are not otherwise going to be funded….. So I also like to support ventures where there might be very, very low likelihood of the idea succeeding, but it’s come out of a very interesting, smart, creative person, and empowering them through an Emergent Ventures grant is going to change the trajectory of their careers or their lives.

Articles, books, and other media discussed in the show

Shruti’s work

Personal sites

Policy Papers

Journal Articles

Book Chapters

Everything else

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About the show

The 80,000 Hours Podcast features unusually in-depth conversations about the world's most pressing problems and how you can use your career to solve them. We invite guests pursuing a wide range of career paths — from academics and activists to entrepreneurs and policymakers — to analyse the case for and against working on different issues and which approaches are best for solving them.

The 80,000 Hours Podcast is produced and edited by Keiran Harris. Get in touch with feedback or guest suggestions by emailing [email protected].

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