New Delhi: Bureaucratic resistance undermined plans drawn up more than ten years ago to prepare India for large-scale biological catastrophes, senior officials involved in the process have told Network18. The plans included the community preparedness for social distancing and lockdowns, the creation of state-level stockpiles of critical medical equipment and protective clothing, and ensuring all hospitals were prepared for biological disasters that could involve sudden, mass casualties.
The plans were prepared by experts brought together by the National Disaster Response Force, led by former Director-General of the Armed Forces Medical Services Lieutenant-General JR Bhardwaj — who earned widespread praise for his handling of medical logistics issues during the 1999 Kargil war.
Prime Minister Narendra Modi’s government efforts to battle the unfolding Wuhan virus pandemic have run into multiple logistical problems action on the NDRF’s plans could have mitigated, the officials said, including chronic shortages of protective equipment for medical staff and ill-trained first-responders.
“Instead of having to improvise solutions on the fly,” an official involved in drafting the report said, “we’d have had a clear picture of what resources were available and where”. “A great deal of hardship could have been averted”.
Elements of the public version of the 2008 NDRF report, published in 2008, were turned into a classified road-map for action, and shared with Prime Minister Manmohan Singh, the officials said. Even though early progress was made in implementation, however, progress soon stalled as key ministries pushed back against ceding control of issues in their domain to the NDRF.
Former army chief General NC Vij, the vice-chair of the NDRF from 2005, told Network 18 the resistance emerged from “the feeling within the bureaucracy that India didn’t really need something like the NDRF, because the various ministries were essentially doing the same job”.
“I’m not disputing ministries are good at what they do”, he added, “but the reality is, with their work-loads and administrative focus, the ministries had little time or energy to focus on long-term capacity-building and preparedness for crisis that, by their nature, were unexpected”.
Lieutenant-General Bhardwaj’s team, set up in the shadow of the global spread of H1N1 avian influenza from 2004, sought to create a template for how authorities from the central government down to the district level would respond to a wide array of potential disasters, from the use of bioweapons by terrorists to the spread of a new virus from India’s cattle stock to the population.
The NDRF plan underlined the need to create mechanisms to implement “non-pharmaceutical interventions, like social-distancing measures and isolation and quarantine techniques”. It also called for communities to be prepared for such measures through periodic exercises.
“All the practices and training schedules will be coupled with mock exercises followed by documentation and evaluation of lessons learnt to improve the existing system,” the report states.
Every hospital, the report said, was to be made to draw up a biological disaster-management plan, and “all-hazard training programmes will be conducted for hospital administrators, specialists, medical officers, nurses and other health care workers”.
In addition, the plan called for strengthening India’s state-level stockpiles of critical equipment. “There is no stockpile of drugs, important vaccines like anthrax vaccine, PPE [personal protective equipment] or diagnostics for surge capacity,” the report states.
“In a crisis situation there is further incapacitation due to tedious procurement procedures. Inventory management/ supply chain management concepts are not followed”.
“None of the major hospitals in the government/private sector are fully equipped and geared for managing mass casualties, particularly victims of natural outbreaks, epidemics and BT [bio-terrorism activities],” the report noted.
From the outset, official sources said, the NDRF’s disaster management plans became mired in bureaucratic power struggles. “In essence, the plans meant that the ministries, as well as state governments, would have to cede some degree of control to the NDRF. There was a good deal of unhappiness around this, especially in the Ministry of Home Affairs and Ministry of Health and Family Welfare”.
The creation of the National Disaster Management Force, now rated amongst the best of its kind in the world, ran into sharp opposition from the Ministry of Home Affairs, which controlled other national police organisations.
Following Prime Minister Modi’s election, the NDRF’s bureaucratic status was downgraded, further reducing its ability to cut through bureaucracy.
The vice-chairman of the NDRF was downgraded in rank from that of a Cabinet Minister, to the equivalent of the Cabinet Secretary. The NDRF’s members, similarly, were reduced in rank from Union Ministers of State to Secretaries to the Government of India. Fewer domain experts were included in the body.
“The thinking was that, since the Prime Minister is the chair of the NDRF, it ought function like other bureaucratic instruments of the Prime Minister’s Office,” a senior official said. “The down side of that decision was that the NDRF became just one more bit of the bureaucratic maze, without the clout to push things which were off the beaten path”.
“Lots of things did get done”, General Bharadwaj recalls. “and it won’t be fair to say everyone slept on the job. But the responses were very patchy. Some state governments were more receptive than others, and some bureaucrats understood the kinds of threats we were facing better than others”.
“But in the end, yes, we just didn’t manage to get the kind of momentum behind preparedness that should have been there. We’re paying the price for that”.
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