‘COVID-19–A View from the Margins’

Bharat Dogra

While the pandemic has brought distress to all sections of people, the poor and vulnerable sections have suffered the most in this phase, not just from the disease directly but including the impact of policy measures like prolonged lockouts which caused huge unemployment and loss of income. The urgency of discussing this issue particularly from the perspective of weaker sections cannot be over-emphasised. Hence the various writers and editors who have contributed to bringing about an important collection of papers, articles, reports and memoirs written from this perspective deserve credit for taking up a very important task.

The reference here is to an important new book (2022) titled ‘COVID-19: A View from the Margins’, edited by Yogesh Jain and Sarah Nabia and published by Manohar. As Prof K Srinath Reddy, the president of the Public Health Foundation of India says in his foreword, this book “brings together many distinguished analysts and commentators, who provide astute insights into the fault lines of people’s health and social systems and indicate the changes that are needed to build more efficient, equitable and empathetic systems. Dr Yogesh Jain knits these contributions together into a remarkable tapestry that presents many shades of the pandemic experience, enriching it with his own experience as a healthcare provider, researcher, policy analyst and public health advocate.”

In his opening chapter Dr Yogesh Jain has done well to highlight the need for studying the pandemic and its impacts from the perspective of the poor. This is re-emphasised later in an important contribution of Dr Shah Alam Khan of the All India Institute of Medical Sciences. This need comes out effectively also in a chapter on a history of pandemics in India which brings out clearly how in various pandemics it is the poorer and weaker sections who suffered the most.

 While this book includes contributions on a wide diversity of COVID-19 related issues, what is particularly valuable are accounts of several doctors, known for their commitment to serving the poor, of how they tried to cope with the pandemic. In terms of regional studies this book is particularly rich in terms of contributions from Chattisgarh, Kerala, Telengana,Odisha and South Rajasthan. Hence areas with a significant population of tribal communities in particular are well covered, although generally these are the most neglected. In terms of the urban poor and slum areas, the chapter on Mumbai is particularly useful, in addition to being very informative about TB as well.

In fact there are several valuable essays about how the COVID-19 pandemic and its policy response have increased difficulties in the context of other serious health problems and diseases including malnutrition, TB, non-communicable diseases, mental health, maternal and child health. Several of these important issues have separate chapters.

Although this book is mainly written from a medical perspective, its value has been enhanced by the important contributions made on how the economic difficulties of the poor increased during the pandemic, written by such eminent economists like Jean Dreze and Reetika Khera who have been in the forefront of drawing attention to these issues of great importance, particularly in the context of more vulnerable sections like migrant workers.

Similarly the legal side of some of the related ongoing debates has been well-covered inthis book, as issues like privacy, digital rights and arogyasetu are discussed in a separate chapter as well as at other places.

While this book covers a vast ground, some very important aspects, such as the changes in the vaccine industry and multinational companies towards seeking incredibly high profits and control, as also some related issues to which several eminent scientists and doctors have drawn pointed attention in several countries, are not covered comprehensively here. The valuable work done by eminent doctors like Dr Jacob Puliyel and some other researchers in India also easily comes to mind in this context.

In the case of a diverse collection of many essays, it is not easy to briefly draw common conclusions, particularly in the absence of a joint statement of authors and editors which could have been included at the end of the book. However Dr Yogesh Jain has made an attempt to emphasise some points. He writes, “Decentralisation of decision-making is the way forward, rather than centralisation of power that we saw. Effective communication between the centre and the state, and the government and people and between different institutions of the state is of critical importance.”

Further, Dr Jain writes, “While so much of emphasis on data and on digital verification was on display in the state’s response, protection of people’s privacy concerns should be ensured when digital health mission is on the anvil. The consequences of underperforming health systems have shown so clearly the need to develop resilient healthsystem and to provide universal health care to all people…We need to re-capture solidarity at all levels—local, regional, national and global.”

[The reviewer is Convener, Campaign to Save Earth Now. His recent books include Man over Machine and Protecting Earth for Children.]

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Vol 54, No. 40, April 3 - 9, 2022