This article was published in “US National Library of Medicine
National Institutes of Health” in Jan 2021
The Covid-19 pandemic that descended upon us suddenly, rapidly spreading across the whole world, has been wreaking havoc on our lives and established habits. It is challenging us to interrogate and rethink many taken-for-granted ideas about our lives and institutions- the relationship between the individual and society, the meaning and value of sociality and communitas, of the common good, and perhaps above all the institutions that serve, govern and constrain us. Our focus here is on the institution of the state, the critical actor in dealing with this pandemic. An important fact that has emerged in the wake of this global outbreak is that different states and political regimes behind them responded to the pandemic in very different ways with clearly different outcomes. A seemingly counter-intuitive fact that has become clear is that some rich and powerful states (the US and the UK) have emerged as poor performers in effectively responding to the pandemic-in containing the infection by such timely measures as testing and isolating the infected, and in reducing fatalities by providing adequate health care in well-equipped medical centers. On the other hand, there are some relatively poor, so-called under-developed countries and regions, such as Vietnam (The Economist, 2020), Cambodia and the small state of Kerala in India (a state within a state) which have emerged as success stories with a record of early and effective interventions, of controlling the spread of the virus, healing the infected and reducing the death rate. This is a notable and significant fact despite later reversals and second and third wave of Covid 19 infections in some of these cases, including that of Kerala.
This article focuses on the “Kerala model” of managing the pandemic. This small state in the south-west coast of India has been well known for nearly half a century for its “model” or pattern of development that achieved high levels of social and human development and rapid reduction in chronic poverty and endemic deprivations despite low economic growth and income (CDS, 1975)2 . The “Kerala model”3 that has been studied by researchers since the mid-1970s, is once again in the news across the world as a relative success story in containing the pandemic despite economic constraints and other vulnerabilities such as its dense population4 and constant exposure to foreign contacts5 . Indeed, some of these observers see Kerala’s pandemic management as a decisive test of the Kerala model. However, this turned out to be a premature celebration6 . Even the Kerala government and the vibrant media in the state played a pivotal role in the branding of Kerala model of Covid 19 management and containment as a “successful model” too early. While everybody expected a third wave of Covid 19 infections7 following the return of Non-Resident Keralites (NRKs)8 from various parts of the globe, no one foresaw the danger of community transmission and the unprecedented spike in Covid 19 case load in Kerala. This worrying trend has raised concerns regarding the effectiveness of the Kerala model of pandemic containment and management.
The objective of this paper is twofold: to highlight the ways in which Kerala handled the pandemic and to analyze the structural and systemic factors behind the state’s success. We will especially focus on the state and Kerala’s model of an effective and vibrant democracy and “public action” in the words of Dreze and Sen. We argue that while Kerala was blessed with good and efficient leaders during this crisis, the more important factors behind Kerala’s success have been robust institutions of state and governance built over many years with the capacity to take timely and effective measures in handling the crisis. We further examine the unexpected reversal and the rise of third wave of Covid 19 infections in an attempt to identify what, if any, mistakes may have been made by Kerala and if so if these were due to any deficits inherent in the Kerala model. We argue Kerala may have made a mistake in relaxing—even abandoning—the rules for the entry of a large wave of NRKs returning to the state, and for isolating, testing and tracing these returnees, as Kerala had successfully done earlier. While recognizing the unknown and unpredictable nature of this new virus (still being studied by experts) we also identify what may be some deficits in the model such as its tradition of public action that includes adversarial politics having a disruptive tenor about it, especially at a time of impending and contentious election.
We argue further that states like Kerala which have handled the crisis well have generally been relatively effective models of social democracies in which the state and its institutions work in relative synergy with society and representative social institutions. The paper is organized in four parts. This introductory Part is followed by Part II which describes the trajectory of the pandemic crisis, timely and effective steps Kerala took in managing the pandemic, and then failed to anticipate and prevent a third wave. It also examines deficits in the model that may have been behind the state’s failure to prevent a third wave. Kerala’s adversarial and competitive politics gave birth to public action which in turn laid the foundation for Kerala model of development. However, competitive and adversarial politics may have its limitations especially when it comes to managing pandemics like the present one. Kerala should have adopted a healthy combination of competitive and adversarial politics and a consensus based democratic approach to tackle the pandemic.
Part III analyses the structural and systemic factors behind Kerala’s relative success, focusing especially on the capacity of the state and its institutions acting in synergy with society. Part IV concludes the paper by reflecting upon the Kerala experience and attempting to draw some generalizations about the capacity of “effective democracies” such as Kerala to eliminate endemic poverty and chronic hunger in contrast to India’s abysmal failure in making any serious dent into its record in these as it continues to be home to the single largest pool of chronically poor and hungry people in the world. We suggest that the roots of these lie in a major democratic deficit in the Indian system– failed or weak public action, including rational-legal social movements and popular organizations, the space for these increasingly filled by communal, caste and nativist movements (Tharamangalam, 2016). It also discusses about the dominance of adversarial and competitive politics as the reason of Kerala’s failure to contain the Covid 19 pandemic in its third wave.Go to:
2. What did Kerala do with Covid 19?
How did Kerala combat this virus better than India and many other countries? Through what means? Much of the answer to this question is public knowledge by now; for example, Italy and the UK were battered by Covid 19 in the earlier phase of the pandemic outbreak since they did too little and were too late to take measures to contain the virus by testing, isolating and treating those infected and it resulted in devastating consequences. Today, Italy, UK, Spain or much part of the Europe are slowly recovering from the onslaught of the pandemic. The US, the world’s richest and most powerful nation, was also confronting this crisis with early denials followed by confusing pronouncements and frequently changing policy initiatives by its authoritarian president even as the virus has spread rapidly turning cities like New York into epicenters of the pandemic. Brazil’s response to Covid 19 has also been a terrible one. India took some bold steps to contain the deadly pandemic by enforcing a stringent nationwide lockdown, but with little consultation, planning or provisioning in place to address the consequences of such a lockdown in a country with high levels of poverty, hunger, homelessness, weak health infrastructure and migrant laborers concentrated in its many urban centers. Despite three successive lockdowns, India failed to control the spiraling surge in new Covid 19 infections9 . India which is slowly emerging from the lockdown in a phase to phase manner has overtaken Brazil and USA and has become the global epicenter of Covid 19 pandemic.
To see how and why Kerala has been effective, we describe a few of the steps it has taken in a short time, then examine the policy priorities and values as well as the institutional structures that enabled Kerala to act quickly to battle the pandemic—all of these the legacy of the “Kerala model” over a period of time. Although, Kerala flattened the infection curve during the first two phases of Covid 1910 , it failed to contain the surge in infections in the third phase. Kerala’s strategies in containing the pandemic in the first and second wave of infections gave way to premature celebrations and it instilled a sense of false safety in the minds of people. The fear factor went completely missing and with the easing of the lockdown people paid little attention to observe physical distancing, hand washing and even wearing masks.
The Kerala model of containing the Covid 19 pandemic was a topic of discussion across the globe for a few months. National and international media11 , healthcare experts, policymakers and intellectuals were showering praises on Kerala for its effective management of the deadly virus. On May 4, the Kerala Chief Minister (CM) Pinarayi Vijayan said that the state has flattened the Covid 19 infection curve. At that time Kerala had only 34 active Covid 19 cases. But soon praises were replaced with criticism as the state saw an increasing surge in the number of Covid 19. The political scandals and the arrival of NRKs changed the whole scenario. Kerala is a politically vibrant state. Politics in Kerala is dominated by two political fronts: The United Democratic Front (UDF) led by the Indian National Congress (INC) and the Left Democratic Front (LDF) led by Communist Party of India (Marxist). At present, the LDF government is in power and UDF serves as the opposition. The adversarial and competitive politics having a disruptive tenor forms the backbone of Kerala politics. However, in the wake of Covid 19, the political bickering took a backseat. The consensus put out by the ruling and opposition party leaders were evident in the first phase of Covid 19 infections in the state. However, that was too short lived, as a controversy erupted over the dubious deal by the ruling LDF government with a US based tech firm called Sprinklr. The Kerala government was embroiled in the controversy over allegedly breaching the privacy of 1.75 lakh people under quarantine in the state by striking a deal to collate and handle the health data of those quarantined12 . The major allegation was that the data was collected without the informed consent of the people and the deal lacked strong data protection clauses13 . The government version was that such an exercise was carried out to help medical officials and doctors to make a well-informed choice about possible hospitalization in the case of those quarantined. Since the confidential data was collected under the deal made with the US company, questions were raised as to why the government did not disclose any details in the public domain regarding the deal. Opposition parties14 also questioned the rationale behind single handedly appointing the US based Sprinklr company that too without putting a global tender for the same. Since the CM also manages multiple portfolios including the department of information technology, the controversial deal was enough to rake up a political storm that too in the midst of the pandemic.
The logic behind approaching a foreign company when Kerala has institutions like Centre for Development of Imaging Technology (C-DIT)15 and Kerala State IT Mission16 which are capable of handling big data analytics also raised doubts regarding governments decision. Even the government at the Centre led by Bharatiya Janata Party (BJP) came down heavily on the state government for inking such a pact with a big data analytics company like Sprinklr, when the country has central agencies like National Informatics Centre (NIC)17 which could easily handle the task assigned to the Sprinklr. Meanwhile, the Kerala government defended its position citing that it took the decision to effectively analyze the Covid 19 data quickly. The government version was that it resorted to such a deal as it feared Kerala might see an unprecedented jump in Covid 19 infection, following the easing of lockdown. It also stated that the ownership of the data lies with the Kerala government and not with the Sprinklr, which temporarily hosted the data in its server. The state government also said that strong data protection clauses were added to ensure the data privacy. However, the opposition parties weren’t satisfied with these explanations and the reluctance of the CM to address the controversy openly added more fuel to the fire18 . Meanwhile, the government constituted a two-member committee to look into the matter. On April 22, opposition parties and privacy right activists19 approached Kerala High Court to stay and cancel the controversial deal. The Court directed the state government to anonymize the data of the people placed under quarantine for Covid 19 in Kerala20 . The Sprinklr controversy was a political setback for the government in the state and it also led to the erosion of consensus based democratic approach that was highly required to mitigate the pandemic. With the local government elections around the corner and assembly elections scheduled to take place on May 2021, the management of Covid 19 pandemic is a litmus test for the ruling party and the opposition.
Meanwhile, the Covid 19 infections continued to surge with the arrival of NRKs and people stranded in various parts of the India. Starting from May 7, under Vande Bharat21 and Samudra Setu Missions22 , nearly 5619 persons from Gulf and Maldives returned to Kerala. Nearly 59,945 Keralites staying in various parts of the country also returned to Kerala till May 21, 2020. At that time, one in every hundred NRKs were testing positive for Covid 19. Then by June 17, a total of 84,195 NRKs and 1,79,059 Keralites living in various parts of the country returned to Kerala. As per the latest figures released by the Ministry of External Affairs (MoEA), a total of 94,085 NRKs have returned to Kerala. (till July 3, 2020). Majority of Kerala’s Covid 19 positive cases were from the returnees to the state from abroad and other states within India. Total Covid 19 cases in Kerala jumped nearly nine times from 499 on May 4 to 4465 on July 4. However, the spike in Covid 19 infections after the arrival of expatriates was something that the government expected. Kerala has a large population of expatriates and the government wanted those who wish to return to their home state to conduct Covid 19 tests before boarding the plane. It was aimed at segregating the infected and non – infected people. But it did not happen due to various reasons. Then came the controversy surrounding the mandatory Covid 19 negative certificates for the expatriates who wish to return to India. The first directive came from the Central government, two weeks before nationwide lockdown was imposed in the country. It was on March 5, India issued a travel advisory that insisted on Covid 19 negative certification for evacuation of citizens stranded in countries like China, Italy and South Korea23 . Later Ministry for Civil Aviation on March 14 issued a circular directing the same. At that time, the Kerala government passed a resolution in the Kerala Assembly which termed the directive demanding mandatory Covid 19 negative certificate for expatriates as “fundamentally inhuman decision”24 . The MoEA at that time said that the norm was put in place as a safety measure to prevent Covid 19 infected people passing on the virus to others on the flight. In the wake of Covid 19 pandemic, NRKs25 , settled in various parts of the world, expressed their wish to return to their home state26 . Above all Kerala government was ready to welcome expatriates without the requirement of a Covid 19 negative certificate. But Kerala government which went on to pass a resolution against the “mandatory Covid 19 negative certificate” order of the Central government in March, suddenly changed its official stand 27 on April 22. The Central government which was demanding mandatory Covid 19 negative certificate also changed its official stand and came up with the explanation that testing all those coming back to India and Kerala on repatriation flights was impossible.
The Kerala government said that it came up with the new directive to avoid fresh overseas cases after successfully containing Covid 19 in the state. However, the new directive from the part of the state government irked the NRKs and the opposition parties alike. The unhealthy face of the adversarial and competitive politics having a disruptive tenor came out in the open following the state government’s decision to adhere to mandatory Covid 19 negative certificates for expatriates.
There was an outpouring of resentment over Kerala government’s stand. This unexpected move was dubbed as reluctance to accept more people coming by repatriation flights since the government feared that it will lose control over the fight against the pandemic. The opposition parties including Congress, Indian Union Muslim League (IUML) and BJP capitalized the public resentment against the stand of the governments. The opposition parties knew anything involving NRKs would be a highly sensitive issue in the state since it has been surviving with the support of the remittances28 by overseas workers. It gave the opposition parties an opportunity to exploit the public anger and position themselves as true advocates of NRKs. Kerala will go to assembly elections next year and keeping it in mind, the ruling LDF, has been trying its best to turn the health crisis into an incredible opportunity to revive its political fortunes. The UDF have dubbed the Covid 19 management as a mere public relations stunt with an eye on the forthcoming assembly elections. The opposition parties including BJP have accused the LDF for the spike in the infections as the government was too busy with marketing its Covid 19 story to international media and conducting debate series called Kerala Dialogue. The opposition parties in the state have always been skeptical about the Kerala model of handling Covid 19 pandemic.
The criticism by the opposition parties even had misogynistic undertones29 . The opposition accused that the health minister was not interested in saving lives and mocked her with misogynistic epithet.30
However, the segregation of the infected and non – infected returnees from abroad did not happen due to technical difficulties and reluctance of the Central government to conduct testing on expatriates boarding aircrafts from overseas. So, state government had no other go but to come up with an alternative strategy, where multi-layer screening facility was set up in airports for returnees31 . Again, on June 11, the CM wrote to the Prime Minister to seek the help from the Central government to provide facilities for conducting Covid 19 test for expatriates returning to Kerala via chartered flights. But this move was also met with stiff opposition and criticism from opposition parties and NRKs32 .
In July, a new trend emerged where Covid 19 infections through “contact” and local transmission33 started to surge in the state with more cases of community spread than imported cases. On July 9, Kerala confirmed its first “Covid 19 super spreader”34 incident in the coastal village of Poonthura and Pulluvila in Thiruvanthapuram, the capital of Kerala35 . In Poonthura and Pulluvila, people blocked vehicles of police and attacked health workers. The residents in Poonthura and Pulluvila alleged that due to stringent lockdown measures they were not even allowed to venture out of their house to buy essential items from shops nearby. The residents complained that no shops in their vicinity were allowed to open and the men in uniform allegedly went around threatening and using bad words against the fishermen coming out of their homes. In addition to that a team of 25 commandoes were deployed in Poonthura coastal village as the Covid 19 infections continued to surge. Such stringent measure didn’t go down well with the coastal villagers. The presence of commandoes in uniform provoked the resistance among fisher folk. The law enforcement agencies’ failure to understand the ecology of politics36 (Kurien, 1994, Kurien, 2001) in coastal areas of Kerala including Poonthura also led to the fall out between the authorities and the residents of coastal villages.
Government implemented stringent lockdown in these coastal hamlets since nearly 81 per cent of the Covid 19 cases reported during this time period through local transmission occurred in these coastal areas. On July 17, the Kerala government admitted that community transmission of Covid 19 had occurred in the coastal hamlets of Poonthura and Pulluvila in Thiruvanthapuram. It was the first time a state government in India officially admitted that community transmission of Covid19 has taken place. The total number of Covid 19 cases surged from 6166 on July 8, 2020 to 16,995 on July 24, 2020.
But first, a brief overview of Kerala and its specific characteristics will be helpful in providing a better context for this discussion. Kerala is one of 28 states in India, one of the smallest, but the most densely populated with 35 million people nestled between the Arabian sea and the hill ranges of the western ghats37 . Kerala is the only state in India without the nucleated village system characteristic of India; its villages are revenue divisions, sometimes called dispersed villages because of the pattern of dispersed houses and settlements. Its relatively small cities and towns interspersed across the state create a rural–urban continuum ensuring very little rural–urban differences as regards such features as literacy, readership of books and magazines, and social and political consciousness. Having achieved the demographic transition by the 1990s, it now has a high proportion of aging population which currently stands nearly 16 per cent38 (Rajan & Mishra, 2020, Kerala Economic Review, 2019), on par with many developed countries. Another notable feature of Kerala is the legacy of a matrilineal system that was prevalent among a few castes, especially the dominant caste of Nairs (Jeffrey, 2004).
Historically, Kerala has had close trade and cultural links with the outside world across the Arabian Sea; Christianity and Islam made their substantial presence here in the very early centuries of the founding of these religions making the state one of the most multi-religious and multi-cultural. The past few decades saw a mass exodus of Kerala’s young people seeking employment outside the state, especially in the Arabian Gulf, but also in Europe and North America. The remittances sent by these workers amount to about one third of Kerala’s state domestic product39 (Krishnan, 1994). Note also that there is a substantial number of migrant workers from other Indian states (called “guest workers” by the Kerala government) who fill local vacancies at the lower levels of the labor market, attracted by the higher wages and better social security in Kerala. In addition to all this, unprecedented income growth and easily available bank loans in recent years have also spurred an exodus of Kerala students seeking technical and higher education abroad, not only in the west but even in some remote parts of China and Central Asia, new destinations for those seeking medical and other degrees at relatively low cost. It is noteworthy that this small state now has four international airports facilitating the high volume of international travel. It is not surprising, then, that Kerala was the first state to experience the Covid-19 infection. Indeed, the virus was initially brought by Keralites returning from Wuhan and Italy40 .
How, then, did Kerala react to the sudden crisis? The first point to be highlighted here is that Kerala may have been among the best prepared states/regions in the world to face this crisis. One reason for this is that it had the experience of successfully handling three crises in the past two years, a very serious Nipah epidemic in 2018 and two outbreaks of unprecedented floods, the first in 2018, the second in 201941 . The experience of effectively harnessing and coordinating a variety of social players42 in all the three crises, and the accumulated social capital and networks became useful again. Even more important in this regard is the capacity of the state in terms of infrastructure facilities for public provisioning of essential services and basic security including its robust health care system, universally accessible and free for all. However, the spike in infections has exerted pressure on the healthcare system in the state. Till August 31, 2020 Kerala had a total of 71, 071Covid 19 cases, 48,079 recoveries and 280 deaths43 . The surge in infections is also taking a toll on the state’s health workers. Health workers at all levels are experiencing fatigue44 . One of the major reasons for this is the situation in which health workers are contracting the virus while treating Covid 19 patients. More than 500 health workers including 98 doctors and 148 staff nurses have been infected with Covid 19 till August 1, 202045 .
Following community transmission, government opened First Line Covid Treatment Centers (FLCTs)46 at the Panchayat level. The opening of FLCTs added more workload on the existing healthcare system. As of July 20, nearly 10,000 doctors are entrusted with the duty to treat Covid 19 patients. Though Kerala has one of the best doctor-patient ratios in the country, that is one doctor for 400 people, but for dealing with a pandemic like Covid 19 that is not at all proving to be sufficient. Occasional ostracization and attack on healthcare workers have affected their morale. For instance, in the coastal village of Poonthura in Thiruvanthapuram where community transmission was first confirmed, a medical team that went to the coastal area for Covid-19 swab collection was surrounded by angry mobs, who threatened them with abusive words and even coughed at their faces.47
Then, keeping the private hospitals away was yet another strategic error. Nearly 65–70 per cent of the population in Kerala depends on private hospitals. Sensing the gravity of the situation, in June the government asked the private hospitals to keep aside at least 20 beds per hospital for Covid 19 patients by July first week. Finally, on August 7, 2020, Covid 19 treatment in private hospitals started. In Kerala, treatment for Covid-19 is provided completely free of cost in government hospitals. Covid hospitals and FLCTs for also provide meals at free of cost to the patients. The government fixed the tariff for Covid 19 treatment at private hospitals to prevent opportunistic exploitation of patients.
Kerala also failed to make use of the vast potential of alternative medical streams like ayurveda and homeopathy in treating Covid 19. Meanwhile, as the Covid 19 infections have alarmingly increased, the government has started promoting ayurveda as a way of boosting the immunity of the population48 . However, government has made it clear that diagnosis, medication and treatment of Covid 19 will only be done through scientifically-backed modern medicine. Another criticism against Kerala was that it was not testing enough. Critics point out that Kerala was testing less and thus it had relatively few cases earlier. In fact, whether Kerala was testing enough was a cause of concern. However, in the beginning Kerala, in March, the state was testing the most, followed by Maharashtra. Kerala with a population of 35 million people conducted 137 tests per million and Maharashtra at that time conducted 27 samples per million people. But in mid – April, when Covid 19 infections were slowing down in Kerala, the aggressive testing strategy was relaxed. There had been allegation that Kerala started testing asymptomatic and people with mild symptoms at a later stage. But as on September 3, 2020, Kerala has ramped up its testing from 20,000 to 30,000 tests per day. Critics also argues that Kerala invested its energy more in contact tracing than in testing which led to the drastic situation the state is facing now.
Second, Kerala took early steps in monitoring and enforcing the rules of isolation. It has also harnessed and deployed modern technology such as surveillance by drones identifying locations of social gatherings, use of “geofencing”49 to enforce quarantine, and location tracking devices to create spatiotemporal maps for re-tracking movements of those infected. Government resorted to surveillance technology to track the spread of the Covid 19 and to monitor people placed under quarantine. Government was forced to resort to technology-based monitoring as the number of lockdown violators and those evading quarantine were increasing in the state. Geofencing technology was one among them. Cyberdome50 , developed a software based on geofencing technology to track the movement of people in quarantine.
On March 17, in Kottayam, a district in central Kerala, police first made use of the geofencing technology software. It had helped the police official to catch a total of 13 people who stepped out of their houses during their quarantine period in the district51 . Geofencing based monitoring was implemented in Kasargod and Wayanad districts where 50 per cent of quarantine violators were caught red – handed. To make sure people were observing physical distancing during the lockdown period and to aid police in effectively implementing the lockdown, Kerala police launched Project Eagle Eye, under which drones were used to catch those violating quarantine and lockdown. Police used 350 drones to track those violating the lockdown rules and physical distancing norms52 . However, the technological surveillance didn’t deter people from violating the lockdown and quarantine rules. In addition to that, the technical glitches and the laidback attitude from the part of law enforcement agencies weakened surveillance-based monitoring of those suspected to have contracted the novel coronavirus in the state. There have also been instances where police personnel got infected with Covid 19 while performing their duties53 . As per the government records, nearly 20,000 cops are directly involved with Covid 19 related works, that is almost one third of their workforce. With more and more police personnel getting infected has led to shortage of adequate police force and increased their workload. On August 4, Kerala government decided to give the police a large role in contact tracing, in ensuring greater compliance of quarantine and physical distancing at public places, functions and total control over containment zones and clusters. In the first two phases of Covid 19, these tasks were entrusted with local governments, health inspectors and accredited social health activists (ASHA). So, it is clear from these that government has distanced itself from the earlier participatory mode of governance to contain the spread of the pandemic and resorted to converting Kerala into a surveillance state54 in the midst of the pandemic. The medical fraternity was also upset with government’s decision to give more powers to police in the management of Covid 19 pandemic.
The Kerala government also made a controversial decision to collect call details of Covid 19 patients. It has been criticized as an infringement on the privacy of the people and a brazen move to convert Kerala into a police state. Meanwhile, the Kerala government on August 19 submitted55 before the Kerala High Court that the police required the mobile tower details in order to find out only the location of the Covid-19 patients and the calls they make or receive. The government informed the Court that the police are collecting the tower location details only to identify the location and stated that it is not collecting call detail records (CDR).
Third, the government during the second wave of Covid 19 infections made use of effective communication system that included daily evening press briefings by a team led by the CM. These widely attended briefings share with the people the latest facts, figures, plans, concerns, challenges, and cautions.
However, the row over the controversial deal with Sprinklr, the political blame game over the mandatory Covid 19 negative certificate for NRKs, gold smuggling scam56 and the alleged links of the smuggling suspects to Chief Minister’s Office (CMO) and corruption allegation against government’s flagship housing scheme – Livelihood, Inclusion and Financial Empowerment (LIFE Mission)57 have diverted the attention from the Covid 19 pandemic in Kerala. The administrators and politicians have forgotten that in a pandemic situation, a consensus based democratic approach is required to get things under control. The competitive and adversarial politics having a disruptive tenor about it have gained upper hand over the fight against Covid 19. The highly popular press conferences of the CM have turned into a war of words between the government, opposition parties and media. This has caused a dent in the popularity of CM’s press briefing58 .
The vibrant media in the state is now less bothered about the Covid 19 and is busy hosting prime – time TV news debates in Kerala on gold smuggling and the involvement of the CMO. In short, the over dominance of adversarial and competitive politics has shifted the focus of public attention from Covid 19. Following the controversial gold smuggling scam, the opposition parties were carrying out protests across the state by disregarding rules relating to physical distancing. The protests saw participation of a massive gathering of party workers violating physical distancing and wearing of masks. The Kerala High Court on July 15 said that all parties and associations must strictly abide by the Covid 19 guidelines59 . The reckless behaviour of the people also contributed to spike in infections. Following the easing of lockdown towards the end of May, people started stepping out of their homes feeling reassured by Kerala’s handling of pandemic, the effectiveness of public health system and the low mortality rate at that time. A section of people thinks that this overconfidence that the public authorities displayed created a false sense of safety among people leading to their irresponsible behaviour from the part of people, where physical distancing norms and wearing of masks60 were flouted. Misleading information and advertisements in the name of Covid 19 pandemic was also reported in Kerala.61 The CM on August 4 said that “laxity and complacency” were the reasons for the surge of Covid 19 infections in the state. The government said that people were complacent in taking precautionary measures against the Covid 19 and it has resulted in the spike in infections. Then law enforcement agencies and local authorities did not pay much attention to unregistered entry of people from neighbouring states through hidden forest roads and porous borders of Idukki, Wayanad, Kannur, Kollam and Thiruvanthapuram districts.62
Fourth, the government lost no time in making adequate provisions for the vulnerable groups adversely affected by the lockdown63 –causal laborers, guest workers, the very poor and the homeless– efficient and well-organized provision of food and shelter for all those in need. In sharp contrast to the heart-rending scenes of migrant workers in Delhi walking to far away homes with their babies and meagre possessions on their back, being beaten up by the police on the way, some even dying on the road, the scenes in Kerala were of free shelters, community kitchens and volunteers delivering food to the needy64 . On March 26, the government of Kerala launched the community kitchen initiative to stave off hunger and to ensure no one goes hungry in the wake of pandemic and lockdown. The government entrusted the responsibility of managing the community kitchens to the local self-governments and to Kudumbashree 65 (Mukherjee-Reed, 2015). On April 1, 2020 there were 1316 community kitchens and on May 22, the number came down to 1097. Through these community kitchens, 2.50 lakh to 2.80 lakh food packets were distributed on a daily basis. Food was provided at free of cost to the needy, migrant workers, and those under home quarantine. Due to the easing of lockdown, those stranded including guest labourers started going back to their homes and as a result the demand for food came down and this in turn has reduced the number of community kitchens operating in the state. However, with the surge in Covid 19 infections, the demand for community kitchens has increased. As per the latest figures provided by the Kudumbashree, there are 1145 community kitchens functioning in the state as on August 1, 2020.66
It also observed strict protocols avoiding assembling of people and delivering food packages to those in need at their shelters. A “hub and spoke model” of food distribution has been developed for sourcing food from existing networks such as the canteens run by Kudumbashree, and sending these out as parcels to multiple destinations.67 It is noteworthy that these services are available to all the needy completely free of cost. Apart from community kitchen, Kudumbashree also ran Janakeeya hotels68 to serve budget meals for Rs. 20 (US $ 0.27).
Fifth, a theme to be discussed further below, is the capacity of the state to harness and coordinate the high levels of social capital in the state including governmental and non-governmental organizations and associations69 . Then, transparency has been a key feature of Kerala model of handling the Covid 19 pandemic. But with the surge in Covid 19 cases and deaths have allegedly led to fudging of Covid 19 data, especially when it comes to the death toll due to pandemic. One of the major allegations is that the government has left out many legitimately probable Covid 19 deaths out of its official Covid 19 death list. It began on July 20, when the state decided not to include the death of Covid 19 patients with comorbidities in its official death tally.70 The state government denied allegations of data manipulation and insist they are following the guidelines prescribed by WHO and ICMR. The Covid 19 expert committee formed by the Kerala government has asked the government to follow the WHO or ICMR guidelines in counting the death71 . Government version is that Kerala has one of the lowest fatality rates in the country with 8 deaths per 10 lakh population. Overall, 68.85 per cent of patients who died of Covid 19 were aged 60 years and above72 . The risk of death from Covid 19 is also higher in people with comorbidities73 and in the case of Kerala it stands true. For instance, till July 27, state had a total of 61 Covid 19 deaths and out of it 47 of them had comorbidities74 .Go to:
3. Behind the success: The legacy of the Kerala model
What is behind Kerala’s success, some unique factors specific to Kerala, a Kerala exceptionalism? This is a complex question, and it is possible to highlight some unique historical and social factors, mentioned above. But our focus here is on institutional and cultural factors that are comparable and amenable to empirical investigation. From this perspective we will highlight the legacy of the “Kerala model of development” that has created what some political scientists have called an effective or vibrant democracy (Heller, 1996, Heller, 1999, Heller, 2000), itself the legacy of “public action”, as explained by Dreze and Sen75 . This latter concept includes a proactive and interventionist state that responds to popular demands for basic social security, and a mobilized and politically conscious society that puts pressure on the state and holds it to account.
3.1. A proactive and interventionist state
How Kerala evolved into such a state, at least close to this ideal, has a relatively long history. When Kerala was born as a new state in India in 1957 by combining the two princely states of Travancore and Cochin and the British ruled region of Malabar, all the three regions, especially the first two, had a half century old history of anti-caste and social reform movements followed by trade union and socialist movements, these resulting in a mobilized, and a socially and politically conscious population. The new state’s first democratically elected government was formed by the Communist Party of India (CPI), the first time a communist party came to power in a free and multi-party election anywhere in the world76 (Desai, 2006). This government did not last long in a highly contentious political environment and with an unsympathetic, if not hostile, central government in Delhi which dismissed it in response to a “liberation struggle” unleashed by landed interests and dominant religious and caste groups77 . However, within a very short time Kerala settled into a vibrant, if still contentious, democratic system governed alternatively in every five years by two coalitions: LDF and UDF. Strong popular demand led to the enactment and implementation of various welfare measures, especially under the LDF governments, and these have come to stay, with occasional modifications by a succeeding government. Especially noteworthy here is a free and robust health care system with a special focus on primary healthcare. As happened everywhere else in and outside India, both the education and health care systems came under threat from a process of mindless privatization unleashed by the neoliberal reforms of the past three decades. Nevertheless, these have survived, and the latter in particular seems to have become more efficient and accessible to people as a result of the policies of decentralization implemented since the mid 1990s. While this was an all-India initiative launched by the Central government, Kerala seems to have taken this more seriously, launching its own campaign for “people’s planning” and implementing what seems to be the most extensive and efficient decentralization program anywhere in India (Chathukulam and John, 2002, Moolakkattu and Chathukulam, 2007, Oommen, 2007). Kerala’s progress in achieving social well-being by all measures, ranging from the Human Development Index (HDI) to the Multi-Dimensional Poverty Index (MPI) and the Global Hunger Index (GHI) are not only decades ahead of India, but on par with the middle level developed countries.
3.2. Social mobilization and public participation
If the state is such a critical institution in the provision of such public goods, it still needs to be explained how and under what conditions the underprivileged classes in a society, including vast numbers of the rural poor, are able to influence state policy and make it respond to their needs. High HDI indicators, which are statistical averages, underscore the fact that development here has been more inclusive with a wider spread than elsewhere in India. This raises the critical political question of how these classes become mobilized, incorporated into relatively stable organizations with universalistic ideologies and programs, and integrated into the political process. Kerala throws considerable light on this question and shows how and why the mobilizations of these classes—the nature of their organizations and the mode of integration — are critical for the provision of such public goods and services.
Policy experts and development economists are also of the opinion that an orchestrated decentralized response system comprising the state government, local government, Kudumbashree, public health system and people demonstrated solidarity and social capital at its best helped a great deal in controlling the pandemic in the first two waves of Covid 19 infections in the state.78
Kerala has a long history of social mobilization and struggle. The trajectory began in the southern part of Kerala, the princely state of Travancore and later that of Kochi (formerly Cochin) with the well-known anti-caste and social reform movements in the latter part of the nineteenth century—combining a unique Kerala model of renaissance, enlightenment, and reformation, all in one. In British Malabar, where rack-renting and predatory landlordism were more prominent, nineteenth and early twentieth century social movements focused more on agrarian issues(Herring, 1983, 2003, Radhadrishnan, 1989 and Panikkar, 1989) One of the fascinating facets of this history in Travancore is that even the Maharajah, the kingdom’s Hindu ruler, was himself transformed from protector of Varnashrama Dharma, the caste-based social and moral order (regarded as the most oppressive in India at the time) to supporter of lower-caste struggles and changer of caste oppression (Devika, 2010, Woodstock, 1967). Eventually the Maharajah threw open to all castes’ educational institutions and Hindu temples, formerly the exclusive preserves of the higher castes. Some of these movements were later joined by, and even absorbed into, trade union and political movements that led to the establishment of strong political parties. Especially noteworthy here is a well-organized Communist Party with a universalistic and class ideology that remained purposive and programmatic and retained its mass base across caste and religion over a period of time in one of the most pluralist societies in the world. The Communist Party’s decision to function within a multi-party democratic system involved not only abandoning its orthodox doctrine of armed revolution, but compromising class struggle in favor of class accommodation, in effect transforming it into a well-organized social democratic party of the European vintage79 . It can be argued that such a class compromise may have been facilitated by the upper caste/class origins of the top leadership of the left parties. On the positive side, this strategy succeeded in influencing the right-of-center parties and traditional conservative forces to accept some basic social programs of the left parties. On the negative side, it is important to note two points here. First, the left parties abandoned such critical radical programs as land redistribution. They did enact and implement tenancy reforms that successfully abolished predatory landlordism. The traditional landless classes, of whom the vast majority were (still are) the Dalits, received only their house sites or Kudikidappu land leaving them where they had been for centuries, landless laborers, now turned into modern types of casual wage laborers80 (Tharamangalam, 1981).
Second, even the limited distribution of house sites, the most radical among Indian states, required organized struggles and intense participation of mass organizations, especially of landless workers. The newly gained home ownership, however limited, did succeed in bestowing a certain sense of dignity to the former hutment dwellers who could no longer be evicted from their houses at the whims of the landlords.
3.3. State–society synergy
We have argued above that the two key elements in the Kerala model are (1) an interventionist state committed to pro-poor policies, and (2) a mobilized society that engages the state through well-organized mass organizations and parties. In this section we discuss the way in which these two elements have interacted to create and maintain a certain synergy, a “virtuous” relationship. We suggest that this may be critical in understanding why Kerala has succeeded where many others such as Guatemala, Nicaragua, and Sri Lanka have not been so successful.
In examining state–society relations, scholars use different analytical lenses such as “equilibrium,” “balance,” “synergy,” and “state-in-society.” We find Joel Migdal’s concept of state-in-society is particularly useful for it shows the state as embedded in society and constructed by social forces, on the one hand, yet enjoying relative autonomy and the capacity to mold and even manipulate social forces and social groups, on the other (Migdal et al., 1994, Migdal, 2001, Houtzager and Moore, 2003, Evans, 1995, Evans, 1997, Evans et al., 1985). While the state can enjoy relative stability over a period of time, being a system of institutionalized practices, beliefs, and rules, every state is ultimately precarious and vulnerable as an arena in which contesting and changing social forces are continuously at play. We argue that Kerala has been successful in maintaining a balance between state and society and among a variety of social groups and organizations. By this we do not mean an equilibrium imposed by some invisible hand, but a synergy created and maintained by institutionalized mechanisms capable of accommodating differences and resolving conflicts. As noted above, in Kerala the process involved accommodation and compromise among various interest groups, mediated by rational-legal, modern institutions of the state as well as political parties and other organizations. This is not to suggest that this “virtuous” relationship has been unproblematic, or without dilemmas, strains, or contradictions or that it will be sustained indefinitely and can now be taken for granted. In fact, such a relationship is always precarious and a delicately negotiated one since democratic participation involves and requires critics of a given regime and even political opposition, and states and societies must negotiate inevitable conflicts of interests among social classes and groups.
Our argument has only been that Kerala has not only been successful in maintaining a healthy balance but has, in fact, enhanced the “virtual relationship” between state and society in the context of confronting the four successive crises of floods and epidemics, and that the state’s response to the latest and more ferocious Covid 19 pandemic, may have been a final test of the “Kerala model”. Unlike the earlier crises, which were of short duration, the Covid 19 pandemic is likely to take longer time to resolve. It is therefore a crucial test of resilience of the Kerala model.
3.4. A ‘Navodhanam”: Kerala’s own century old renaissance
“Sapere Aude” (dare to know or be wise) is a famous phrase used by Emmanuel Kant in defining the motto behind the European enlightenment (Kant, 1784). A daring critique of hegemonic ideologies and beliefs that imprison our minds is a prerequisite for liberating our minds from their hold and for imagining an alternative world of freedom. As mentioned earlier, Kerala had its own model of renaissance, a navodhanam that began in the late 19thcentury. This “awakening” and the critical thinking spawned by it played a major role in the making of the Kerala model. It brought about a transformation in beliefs, values, ideals and norms, in people’s conception of and commitment to social and distributive justice and human rights, and in people’s aspirations for themselves and their children. To be sure, prominently figured in this revolution were such radical philosophers and cultural leaders such as Sri Narayana Guru, Ayyankali, and EMS Namboodiripad, and there were “battles of ideas” and “revolutions in ideas”. What is more important in the transformation of Kerala society, however, is the process by which such ideas became part of the popular cultural movements and were internalized in the collective consciousness of the people. This process was also facilitated by a spurt of growth in popular literature and drama starting in early 20th century,81 joined also by popular cinema by the 1940s– all of these with critical social themes. Libraries and reading rooms spread all over the state in tandem with rapidly increasing literacy. In 1989–90, Kerala launched a campaign for 100 per cent literacy; by the 1990s the state had achieved 100 percent literacy (GOI, 2008).
Kerala’s navodhanam was, indeed a revolution in hope —giving new hope to people who formerly lived without hope, accepting their fate as inevitable and/or unchangeable. Kerala historian Robin Jeffrey (Jeffrey, 1992) has noted, for instance, that by the 1930s large numbers of people in Kerala had enthusiastically embraced the belief that they had “entitlements”, a concept that figures prominently in the writings of Amartya Sen. The social reform movements campaigned vigorously for the rights of the lower castes to education. An early associate of Sree Narayana Guru, Padmanabhan Palpu82 said on the subject: “We are the largest Hindu community in Kerala. Without education no community has attained permanent civilized prosperity. In our community there must be no man or woman without primary education”83 (Ramachandran, 1998). It is not accidental that universal access to education (first primary and then secondary and even post-secondary) became an issue of high priority in Kerala both in terms of public demand and public policy. A notable aspect of mass participation, especially important in health care, has been the pivotal role of “women’s agency” (women’s empowerment in terms of literacy, education and health, promoting general achievements in human development indicators such as IMR, child nutrition and health), as explained by Amartya Sen (Sen, 1999, Sen, 2006) and (Dreze and Sen, 1998, Dreze and Sen, 2002, Dreze and Sen, 2013).Go to:
4. Concluding remarks
The unprecedented Covid19 pandemic has shaken our taken-for granted “common sense” in many respects. Kerala which successfully contained the Covid 19 in the first two waves of infections is now struggling to contain the pandemic in its third wave. The Kerala model of managing and containing Covid 19, which was lauded once across the globe is now looked upon with skepticism. It is also a cautionary tale for the government, media and public at large against celebrating Covid 19 success models. Kerala’s biggest advantage was its robust healthcare system and participatory mode of governance or social democracy when it came to handling the pandemic. However, the pandemic has showed that even a participatory social democratic state face challenges in managing crises and ensuring basic security to all. Kerala is a politically vibrant state. The competitive and adversarial politics forms the very basis of the political landscape in the state. At the time of a deadly pandemic a consensus based democratic approach was highly required or at least a balanced proportion of competitive and adversarial politics and a consensus based democratic approach was required. But the state failed to do so. In Kerala, the unhealthy face of adversarial and competitive politics took the front seat while mitigating the spread of Covid 19 pandemic took the back seat. This led to the current surge in Covid 19 infections in the state. In Kerala, the pandemic has got a political hue. The handling of Covid 19 pandemic is now used as a tool to gain political mileage and dividends. Meanwhile, despite all the political turmoil and controversies, Kerala has managed to control the pandemic from going out of control when compared with other states in India.
Life after Covid may not be the same again, as the media and the chattering classes are reminding us daily. The project of neoliberal globalization and the accompanying New World Order may be nearing its end, even liberal capitalism may not be the same again. As the US, the world’s greatest power and the self-appointed leader of the this World Order, proved to be among the worst performers in managing this crisis, scapegoating other countries and even global institutions such as the WHO, whatever trust there may have been in the US-led world order seems to have eroded quickly. In this global context, and drawing especially on the example of the small state of Kerala we now return to our main question in this article: what is the role of the state in dealing with crises such as the present one, and in protecting its citizens and their well-being and providing them security—and ideally also in cooperating with other courtiers and global institutions?
We will conclude with a brief reflection on the concept of entitlement, made famous by Nobel Laureate Amartya Sen in many of his writings but especially in his classic study of famines (Sen, 1983). His now famous, but somewhat unexpected conclusion was that famines in the modern world are not caused by shortage of food, but by “entitlement failure”84 . As a corollary to this he also argued that self-governing democracies in the modern world have no famines for the obvious reason that such a government, responding to the needs of the people who elected them, and working in synergy with its citizens and civil society organizations has the knowledge, capacity and the will to take timely and effective steps to obtain and move food to the needy.
One of the notable successes of India’s sovereign democracy has been the elimination of the periodic famines that had been a recurring feature of colonial India. The country has been free of famines since the 1960s; for the past few decades India has been not just self-sufficient in food supply, but has a substantial surplus, some of it often rotting or eaten by rats in ill-equipped public storages. But here comes India’s famous paradox of “hunger amidst plenty” in contrast to Kerala, a food deficit state which has eliminated such hunger. The facts about India’s endemic and chronic hunger to which over 250 million people are victims are documented in several national and international reports, the most notable of which is the latest GHI (2019)85 presents a devastating picture of India, now ranked 102 among 117 countries (von Grebmer et al., 2019). According to the report India is suffering from “a serious hunger problem’’. Yet another point to be highlighted about India’s paradox is that such endemic deprivations such as hunger and poverty are disproportionately concentrated in India’s peculiar underclass, those at the bottom of the caste system, especially the Scheduled Castes or Scheduled Tribes86 . India’s historically excluded classes who make up about 1/3rd of the country’s population. Following Sen’s logic, it is clear that 70 years after independence these groups are excluded from entitlements to adequate food and nutrition.
As cogently argued by Patrick Heller, effective democracies put re-distributive pressure on the state. If so, it should be obvious that India fails this test; India is just not an effective democracy –in sharp contrast to Kerala which is. Atul Kohli, who has extensively studied these issues in India supports this conclusion (Kohli, 2004, Kohli, 2009, Kohli, 2010, Kohli, 2012). He addresses the class basis of the Indian state even better. According to him the redistributive capacity of the Indian state, always low, declined even further during the post-reform period. This latter period, he says, has been marked by a shift in the character of the Indian state from “a reluctant pro-capitalist state with a socialist ideology to an enthusiastic pro-capitalist state with some commitment to inclusive growth” (Kohli, 2009). He asks if and how democratic politics can counter class power and if “…democracy and activism of the poor (can) modify this dominant pattern of development “(Kohli, 2009). He sounded an optimistic note as he was writing at a time when popular demands had led to such beneficial legislative measures such as the MGNREGS87 and the National Food Security Act88 which were beginning to show some success. But the Indian state has shifted once again under the BJP which combines even more right-wing economic policies with the ideology and project of Hindutva, a militant form of majoritarian Hindu nationalism that moved from the fringes of Indian society and politics to its mainstream in a short period of time (Tharamangalam, 2006a, Tharamangalam, 2006b). No wonder the figures for poverty and hunger are showing no decline as has happened in other southern countries, especially India’s own poorer neighbors such as Nepal and Bangladesh.89 Meanwhile, it is indeed encouraging to see that a few states such as Kerala, Goa and the so called tribal states mentioned above have continued to follow more promising paths with easily visible outcomes in terms of their social development. We can only hope that the lessons learned from Kerala and other states and countries for their best practices during the Covid 19 pandemic will continue to resonate with the people of India and the world as they may be re-thinking and re-imagining a better world for the post-Covid era.
Keywords:Human Development, Participatory Democracy, State, Health Care, Covid 19, Kerala Model of Development