Pandemic response in Kerala

The Interpreter newsletter
24 May 2020
9 minute read

Per-capita gross domestic product in the United States [pop. 328m] is about 30 times bigger than in Kerala [Indian state, pop. 33m]. Even the poorest U.S. state, Mississippi [pop. 3m], still has a per-capita G.D.P. about 15 times bigger than Kerala’s. Kerala had its first confirmed case of Covid-19 on Jan. 30, just nine days after the first confirmed case in the United States. As of today, the coronavirus has killed 94,700 people in the United States. In Kerala, that number is four.

Pavithra Suryanarayan, a political scientist at Johns Hopkins University who studies state capacity in Kerala and its neighboring state of Tamil Nadu, had some insights about why Kerala has been so successful in fighting the pandemic.

Amanda Taub: I am trying to get some context for Kerala’s success against the coronavirus…. Can you help me understand how that has happened?

Pavithra Suryanarayan: We can think about three things that matter.

One is: Does the state actually have the ability to do something when something like the coronavirus happens?

But the second is: Even if the state has the ability to do something, does it actually do it when it needs to?

You have to have a political will that aligns with the capacity. You have to have some basic understanding within the system that, regardless of who the party in power is, a certain basic political will is going to be exercised, to make the state do the things it’s supposed to do when the crisis hits.

AT: I think before this pandemic, if you had asked most Americans in the abstract, “If a pandemic strikes and the United States is in danger, and we are facing the loss of hundreds of thousands of lives as well as a chunk of the economy, will the government take swift action to protect the country?” they would have said yes! But it turns out not to be that simple.

PS: Nobody would have thought the U.S. would not be able to do this!

But you really see that the key factor is whether you are going to use the state to do what it’s supposed to. And Kerala, and also the neighboring state Tamil Nadu, have both shown that they have the capacity and they have the will to act.

AT: So that’s two factors: state capacity and political will. But you said there were three.

PS: The third dimension, which gets a lot less attention, is whether you have been exposed to a crisis of this sort before.

So here, East Asian countries and those countries that do a lot of migration with Southeast Asian countries, like Australia and New Zealand, because they’re so proximate to Singapore, Malaysia and Hong Kong, they knew what to do as soon as the coronavirus alarm was blared.

They did not mess around, because they’d already experienced the previous waves of bird flu, and of SARS.

And it’s the same with Kerala. They’ve had exposures to the Nipah virus, they’ve had a crisis with dengue, for a brief moment there was even a worry that the plague would re-emerge. So then there was a protocol in place that they immediately went onto.

AT: What does that protocol involve?

PS: In this instance, a lot of the work of tracking, isolating and surveilling came down to very quick action of the local-level officers in charge of various jurisdictions.

Kerala and Tamil Nadu, I would argue, were very clever about thinking about low-resource initiatives – things you could do without relying on stockpiled resources.

So there were these low-resource interventions that they went to right off the bat. They were making sure they were taking temperatures of people entering the country, having them give detailed histories of where they had been, and whether there was any contact with someone symptomatic, putting into place isolation and surveillance.

They may not have masks or ventilators, but they have people. And so they’ve made them into health census takers. They’ve made them into track-and-trace investigators. Into people who stand in airports taking temperatures. They’ve taken the resource that they have and put it to good use.

And quickly shutting down schools, preventing mass gatherings, closing markets – those kinds of interventions also kept infections low. And they were done much before the government was doing it in any other part of the country.

AT: What made that kind of effort possible?

PS: In both Kerala and Tamil Nadu there is a long history of deeply penetrated political parties that can carry political will down to the local level. And there’s a deep understanding between the administrative arm and the political arm to work together.

That dynamic is very different in the weaker-performing states in India. There you have political parties that are largely defined by their ethnic bases of support, which are often derived from distinct caste bases of support. And they are at loggerheads with a bureaucracy that’s largely upper-caste, and doesn’t have a good listening relationship with the political arm.

AT: How does having more caste- and ethnicity-based support change politics in a crisis like this?

PS: Very early on, Kerala started to have the feeling of a class-based dynamic, in which what is to be discussed is: “How do we create a solid welfare state? How do we come to an understanding about the basics of society that everybody needs?”

Which is very different from when you think about politics as “It’s my group now in power, how can I use this time to enrich my group and help my group get ahead?”

Which also means when your group gets out of office, the other group can come in and redistribute to itself. If you think about it, that’s in a sense what has happened in the U.S.