In addition to causing a humanitarian and economic disaster, the Covid-19 pandemic has also had strategic consequences. It has demonstrated the limits of India’s ability to lead South Asia and raised China’s standing at India’s expense among some of its neighbours.
Stories of inadequate facilities for patients, even in big cities across the Indian subcontinent, has highlighted South Asia’s healthcare crisis. But an even bigger story is how India, the largest country in the region, ended up having to receive assistance from Bhutan, the smallest member of South Asian Association for Regional Cooperation (SAARC.)
South Asia is the least integrated region in the world, notwithstanding its pre-1947 status as a cohesive whole. On the one hand, since the creation of SAARC in 1985, Pakistan’s insistence on resolving its disputes with India before discussing regional integration has handicapped regional cooperation. India, on the other hand, has insisted on being recognised as the region’s natural leader.
During the Covid pandemic, both India, the claimant to regional leadership, and Pakistan, the spoiler, have fared poorly. Statistics from rural areas are often unreliable but even the urban data points to how the Covid surge overwhelmed hospital capacity in both India and Pakistan.
Covid’s impact on South Asia
More than a year after the worldwide outbreak of Covid-19, South Asia accounts for over 11 percent of global cases and 6 percent of coronavirus deaths. The region comprises 23 per cent of the world’s population. But the pandemic’s impact cannot be measured only in terms of the ratio between population size and the number of those infected.
The long-term economic consequences on families and the ability of the nation’s healthcare infrastructure to cope are both important measures for the impact of the pandemic. On both counts, all South Asian countries have fared poorly. China, with its deep pockets, has taken advantage of the situation, rushing in with vaccines and loans to assist countries it deems strategically significant.
In 2020, lockdowns across South Asia helped avert high case numbers and deaths. One year later, the region is worse off than it was in 2020. Overburdened healthcare systems and slow vaccinations reflect under-investment in human development by the three largest countries of South Asia — India, Pakistan, and Bangladesh. Now, these countries face the spectre of rise in poverty, income inequality, unemployment, and slow economic growth as a consequence.
India’s pandemic role
At the start of the Covid-19 pandemic, as the traditional ‘first responder’ in the region, India had supported its immediate South Asian neighbours through aid, training of personnel, and personal protective equipment and medications. As the pre-eminent power in South Asia, India used its position as a global manufacturer of vaccines for ‘vaccine diplomacy’ in January 2021. But that advantage dissipated amid the surge that India faced at home from March onwards.
The revelation that it had only managed to fully vaccinate 3.1 per cent of its 1.3 billion by May people was a setback for India’s stature. Although India started its vaccination programme early, it did not ramp up the scale of vaccination. At the current rate, it would take a year for the majority of India’s population to get vaccinated.
The Narendra Modi-led government had declared victory in the fight against Covid-19 prematurely. It ignored the warnings of its scientific advisors about a dangerous second wave. Large public gatherings were allowed, both for election rallies and religious events, especially the Kumbh Mela — a gathering of over ten million people — turning into a super-spreader event.
South Asia’s flailing pandemic response
Across the border in Pakistan, the government was similarly complacent. Prime Minister Imran Khan had been reluctant to impose a lockdown through most of the pandemic. Unlike other Muslim countries, Pakistan did not limit congregational prayers or gatherings during the holy month of Ramzan and left it to mosques and religious clerics to implement safety measures.
As of 19 May, 2021, Pakistan reached 886,184 confirmed cases and 19,856 Covid-19 deaths. With only 0.6 per cent of its people fully vaccinated, a high global demand, and a shortage of vaccine supply, Pakistan has ended up being dependent on its close ally, China, for help in vaccinating a majority of its 200 million-plus population. This at a time when army chief General Qamar Javed Bajwa is reported to be trying to balance Pakistan’s ties with China, with overtures to the United States.
Both the Indian and Pakistani governments chose to ignore the health of their people to curry favour with specific constituencies within the electorate. Discounting requisites of good governance in favour of electoral expediency is not unique to the subcontinent but, in this instance, its effects could be disastrously far-reaching.
The vaccination rates in other South Asian countries are also unimpressive. Bangladesh has fully vaccinated 2.5 per cent of its population, while Nepal has only been able to fully vaccinate 2.2 per cent. Sri Lanka’s vaccination rate is an abysmally low 1.6 per cent. The exceptions are tiny Bhutan, which has vaccinated 63 per cent of its people, and Maldives, which has managed to vaccinate 30 per cent of its population.
Nepal, Maldives, and Bhutan, were expected to rely on India providing enough vaccine doses for their people. But India’s resurgent Covid emergency and the need to vaccinate its own population diminished its ability to share vaccines with its neighbours. Bangladesh and Sri Lanka – like Pakistan – have purchased vaccines from China as a result. For Nepal, however, China has donated one million vaccines as a gift.
The official humanitarian toll, with 30 million confirmed cases and 400,000 deaths across South Asia, is bad enough. But the region has also suffered a significant economic setback from the pandemic. Except Bangladesh, the economies of all South Asian countries contracted in 2020 and that might continue in 2021. Bangladesh’s growth rate has also significantly declined.
China’s intervention
Amid the economic downturn, Pakistan and Sri Lanka have had to look towards China for greater economic assistance. Almost all countries of the region, except India, have had to seek International Monetary Fund (IMF) bailouts to ride through the storm. They would all have to deal with heavier debt once the pandemic is over. India will take time to get back to the high economic growth rates that made it a potentially bigger player on the international scene.
The negative impact of the pandemic on South Asia was not pre-ordained. With 1.8 billion people, South Asia is the most populated region of the world. It has the largest and one of the youngest workforce in the world of around 650 million people. The region also comprises two countries, India, and Bangladesh, that until recently were among the world’s fastest growing economies.
The shock of a pandemic that no one could predict demonstrates the failure of governments and elites in the region to invest in their people. Each South Asian country boasts world-class education and health facilities for the privileged, but has tended to not provide the same for the masses.
Strategic decision-making in India and Pakistan, for example, has almost never taken into account investment in healthcare. India wants to be a major power while spending only 3.6 per cent of its GDP on healthcare. Pakistan’s healthcare spending, at 3.2 per cent of its GDP, is even lower. That compares poorly with average global healthcare spending as a percentage of GDP of 9 per cent.
Nuclear-armed India has only 0.5 beds per thousand people, while nuclear-armed Pakistan at 0.6 per thousand has only slightly more. But the global average for hospital beds per thousand is 2.8, and even poverty-stricken and chronically ill-governed Haiti offers its people 0.7 hospital beds per thousand.
As they plan their post-Covid recovery, South Asia’s militarily powerful countries, like India and Pakistan, as well as their smaller neighbours, might want to pay greater attention to the needs of their people. Ignoring public health while pursuing power and pre-eminence results in the type of crisis that the subcontinent is currently going through. And then, during an emergency, a cash-flush malign power like China gets an opportunity to expand its influence.
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