International Political Will

Everyday in Mumbai, 10 people are killed on the local trains.

But no one is demanding seat belts or railroad crossing guards.

In India, diarrhea and water-born illness accounts for 20% of all child deaths under the age of 5 (double the rate in Zimbabwe), and only 50% of urban areas have proper sanitation.

Yet no businesses and schools are shutting down until clean water and toilets are installed.

Across the subcontinent, pneumonia accounts for more than 18% of deaths for children under 5 – putting India (the world’s largest democracy) in the same league as Myanmar and Pakistan.

However, children have not been lining up at clinics to be tested or treated for pneumonia when they cough or sneeze a few times.

India spends about 5% of its GDP on health care (less than Afghanistan, Cambodia, and Zimbabwe).

But so far, India’s solution to curbing the recent spread of swine flu hasn’t been to focus on improved health, but instead to sow panic among the population and close every school in the city. In a country with a literacy rate of 61%, lagging behind Zimbabwe (89%), Myanmar (89%), and even Cambodia (73%), halting any education that is happening doesn’t really seem like the best alternative.

So far, a total of 17 people in India have died (all within the last week or so) from swine flu, causing overreactions and panic. Most had secondary health conditions that complicated the H1N1 virus.  Six of those deaths occurred in Mumbai. A legitimate concern – yes – but where is the sanity and perspective?

In response, an entire city is shutting down. If you thought last spring’s media blitz and public panic in the U.S. was bad – you ain’t seen nothin’.  This is the epitome of misinformed chaos.

Even though most of the “surgical” masks being sold don’t protect the wearer from being exposed to the H1N1 virus, stores have jacked up the price by 300% and Mumbaikars with enough money are scrambling to hoard their own supply.

Those that can’t afford the masks are wearing handkerchiefs, like a bandit ready to stick-up a bank. (Because thin cotton is so effective at preventing the spread of viruses - especially when you are cramming 550 sweaty commuters into a train car meant for only 190.)

There are also those that just hold a handkerchief up to their nose and mouth, removing it to talk on the phone, to wipe their brow, to blow their nose, to set it down on the seat…and then put it right back up to their nose.  Good idea.

And those that simply put their bare hand up to their nose and mouth, then remove it to grab the handles in the train, then back up to their nose. What a great idea – make sure to grab that handle that 10,000 people have already touched today, and then put that same hand back against the face so any germs are easily passed.

I’ve watched upper-caste women who, as they walk down the street, decide to suddenly put their dupatta up to cover their nose and mouth when they pass a lower-caste person on the sidewalk – but not when standing in a high-class clothing shop talking to a clerk face-to-face.  Conveniently, the idea of catching the flu fits nicely into India’s tradition of caste pollution.

Or the rickshaw-drivers, who are exposed to some of the world’s worst pollution everyday on the streets of Mumbai, wearing a handkerchief over their face because they’re afraid of the flu (lung cancer from the carcinogens from years spent in traffic surely isn’t a concern).

And there was the confidence-building text message to the city’s cell phones from the head of the Bombay schools – asking people to text their preference as to whether or not he should shut down the schools.

Because who better to make a health and education decision during a possible pandemic than cell phone users? Especially after they have watched 24-hours of hyped coverage by the news networks.  It’s like democracy gone haywire.

The city seems to be waiting for a vaccine – waiting to reopen schools (that have not had any reported illnesses, but were shut down anyway), waiting to reopen theaters, waiting to stop wearing handkerchiefs like Butch Cassidy and the Sundance Kid. But the earliest the Indian government realistically expects their own vaccine to be available to the public is next July – and it will cost between 80-150 rupees per shot (which means half of Mumbai will not be able to afford it).

India says it will import the vaccine from the West (which could be September or October). Sorry, India – but you must have realized by now that life-saving medicines developed in the West don’t exactly get shipped on the first FedEx plane to the developing world. Those batches of vaccines are going to be hoarded until every citizen of the U.S., Canada, Australia, and Europe (and perhaps Japan) has been vaccinated. Then they’ll send the expired batches over at a “reduced” price.

India needs to realize they are in this for the long haul. There are no quick fixes – closing schools, wearing handkerchiefs – none of this will magically make the flu go away. India needs a protracted effort to improve overall health - period. They need to provide the public with the infrastructure to treat and prevent more than just the flu. They can’t afford to sacrifice education and development in the interim. They need to act, not react.

Because nothing is quite as deadly as the flu in India.

Except malaria, diarrhea from water-borne illnesses, pneumonia, heart disease, malnourishment, hunger, and – at this point – even the Mumbai trains.

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