The World

India’s States Are Leading on COVID-19

As the country starts to reopen, the outbreak looks very different depending on where you look.

Two kiosks bearing signs that say "Break the Chain." In each kiosk, a medical professional takes a swab sample from a seated person's nose.
Walk-in COVID-19 testing at Ernakulam Medical College in Kerala, India, on April 6. Arun Chandrabose/Getty Images

Despite what you may have heard, from the World Health Organization or World Economic Forum or wherever else, India has not done a good job of containing the coronavirus.

According to the country’s Ministry of Health and Welfare, India now has over 110,000 cases, having already surpassed the total of the only country with more people, China. The total death toll, as of this writing, stands at about 3,500. In a country of 1.3 billion people, these may seem like small numbers. But they do not actually give a full accounting of the virus’s toll. Testing has been far from sufficient—as of now India is reportedly conducting 100,000 tests per day, which is way more than previously but still nowhere near enough. (By early May, it hadn’t even tested 1 million total people.) And as tests actually ramp up, the situation looks more dire: Over the weekend, India reported the largest number of new COVID-19 cases in the world for two days straight, and on Friday had its biggest single-day surge, with more likely to come following the wreckage left by the disastrous Cyclone Amphan. The coronavirus crisis isn’t just far from over—it hasn’t even done its worst. Yet as of this week, India is fully pulling ahead with reopening.

If there is one place where India can be given credit, it’s in the responses of some of its states and their continued concern for the welfare of their people. Kerala, for one, has received no shortage of international praise for “flattening the curve” early on, due to aggressive—and humane—measures like instituting frequent testing and contact tracing, building shelters for displaced people, providing food to young students and those in need, and passing a generous economic stimulus package.

The success of the state on India’s southwest coast, and the long-standing factors that contributed to it, is certainly a bit of an anomaly. Kerala, where Communist governments have ruled for decades, has an acclaimed public health system, a highly centralized state government, and a lasting “Kerala model” that distributes land ownership to residents, helping ensure equity. It has the country’s highest literacy rate as well as the lowest infant and maternal mortality rates. It also has a track record of disease control success: In 2018, it managed to stop the spread of the deadly Nipah virus without any deaths.

Overall, federalism is a messy business in India. The country is divided into 28 states, eight union territories, and one National Capital Territory (Delhi). States have their own legislatures, while union territories are controlled directly by the federal government. Certain states do have certain tasks of oversight constitutionally allotted to them, such as criminal justice, health care, sectors of industry and real estate, and specific taxes. But even the states are not as autonomous as their American equivalents.

The ultimate control and funding these states get is dependent on the whims of the national Parliament, with borders and dynamics of power shifting sometimes drastically over time. India was initially established with strong central power due in part to the scars of separation from the Partition, but clashes between states and the national government have for a long time played a role in shaping the nation.

The trend in recent years has been toward more federalism and somewhat reduced central national power, albeit with caveats. State governments’ power and ability to implement their desired laws is hampered by the financial and bureaucratic control exerted by the federal government. Yet states have persisted in standing up for themselves. Multiple regions led by the opposition Congress Party stood up to the national government in protest of the discriminatory Citizenship Amendment Act, voicing the fury channeled by millions of protesters at an official level. Some of them said they would refuse to implement the law, even though doing so would possibly be unconstitutional—however, it certainly would be a blow to the government’s power if it didn’t have state-level cooperation and consent, something these savvy leaders very well understood.

This defiance, which had continued through this year, is now continuing with the response to the coronavirus. Kerala, Karnataka, Odisha, and other states instituted their own stay-at-home orders even before the national government took action, something they could do because of laws giving states leeway to deal with epidemics and manage disasters. Even after the national lockdown was finally set, some states still took their own initiative. Tamil Nadu’s government claims its state has completed more tests than any other, and West Bengal has also sharply increased its testing rate. The state of Odisha, which has been pummeled by natural disasters in the past, used its readiness infrastructure, such as cyclone shelters and equipment manufacturing facilities, to its benefit. States like Punjab have spoken out against Prime Minister Narendra Modi’s ban on alcohol sales, which deprives states of much-needed tax revenue. Uttar Pradesh provided financial aid and food rations to workers while also assigning some hospitals to specifically treat COVID-19. The district magistrate for the city of Bhilwara in Rajasthan helped enforce a model of contact tracing, door-to-door screening, and establishing isolation wards that caused the city reduce its number of positive cases from 26 to zero in just 10 days. And even as the national government preemptively started loosening certain restrictions in late April, Jharkhand, Uttar Pradesh, and other states made clear they would reopen at their own pace.

Not all state actions have been uniformly positive: Maharashtra has stamped positive patients with ink to shame them into staying inside and used drones to monitor people, while Rajasthan and other states have imposed a notorious anti–public assembly law, often used to stifle protest. Still, in at least a few significant cases, states have shown their overall responses to be much more careful, humanitarian, and effective than that of the national government. As epidemiologist Ramanan Laxminarayan explained in April, “the states that have spent time on building a health system, such as Tamil Nadu, Kerala, and to some extent Karnataka, but definitely Maharashtra and Punjab” stood to handle the pandemic better than states that haven’t—and this has shown, especially considering that the national government barely contributes 1 percent of GDP toward health care and has taken to peddling pseudoscience.

As India starts a bigger reopening this week, cases are still spiking in states that have resorted to aggressive testing measures. This is good, in that the numbers may actually be trustworthy. But the whole of India has not caught on yet, and if cases continue to ramp up, this relaxing of stay-at-home and shutdown orders will be seen as extremely premature and deadly, especially in the midst of the Cyclone Amphan disaster, which has already destroyed people, homes, streets, and farmland in West Bengal and Odisha. And for all we know, Modi may continue to use his power to override state acts and use federal money to pressure them to do his bidding.

Already, funds for states are drying up, and only the central government can provide more financing. “[Modi’s] federal government is emerging stronger than before while states seem weaker,” researcher and author Rahul Verma told Bloomberg, and in the long run that may turn out to be correct. What’s happening now in India may portend the future of its governance, as states splinter off, governmental clashes become more frequent, and the Modi administration takes advantage of the pandemic and natural disasters to further entrench its power.

But for now, it seems that some states will continue to take the opportunity to look after their people as the country “reopens.” We should be grateful for that.