Epidemics, Public Health and State Responsibility: What Sastras Say

 

 

Pandemic is not a war. It’s a development challenge. Charaka Samhita, ancient Indian Ayurvedic text, names epidemic as janapadoddhvamsaroga, meaning that which destroy the social life. The term janapadoddhvamsa is a combination of two words janapada and uddhvamsa, popularly referred as nation and destruction, respectively. The word janapada is a further political concept used in sastras like Arthasastra and Dharmasastra and a combination of the two words jana and pada, each referring to people and path, respectively. Scholars like R Hari have noted the uniqueness of Indian conception of nation or janapada is that it is a community marching towards a common destination. So, the complex of two words jana and pada, should ideally give us a notion of a progressive national community. An epidemic is a disease that basically destroys this forward march of the community.

 

It results in a massive realignment of the wealth destabilising the usual redistributive actions of the Government and the market. It results in concentration of wealth at some place and draining at some other place. The progress in various walks of like, which the global humanity has been making, is not only halted, but also reversed. The partial success against the global poverty, the incremental improvements in gender justice, trends indicating greater social inclusion and the efforts of equitable distribution undertaken for decades –are all reversed. Nobody is actually in hate with anyone; people beyond class, caste and creed are helping each other; people are sympathetic towardsthe other, yet helpless to save life and wealth. This is why pandemic is not a war, but a development challenge.

 

The Charaka Samhita, which identifies rightly this concern (CS.3.3.6), discusses how can a certain disease affect the entire population even though the individuals vastly differ in their biological (bodily) composition, food habits, strength, mentality, age and fitness. The dialogue between the scholars like Atreya and Agnivesha detailed in the samhita further explains the causes, prevention and responses of such diseases.

 

Readers are then reminded of the deteriorating social values and are required to commit to qualities like honesty, empathy, unconditional sharing, co-operation and such other qualities that help rebuild the social connect. Charaka, in his crude bard voice, argues that those people who have the said qualities of honesty, empathy and sharing are the ones destined to live beyond the pandemic period (CS.3.3.15-18). It requires medical professionals to use the above differentiating features in choosing their patients and leave the others to fate.

 

 

The responsibility of the State in an epidemic period is further explained in Kautilya’s Arthasastra, Book 4, Chapter 3. Both the role of the Government (king) and the role of the people is mentioned in this chapter on responses to disasters. Kautilya categorises the ‘epidemic’ as one of eight disasters and makes it an explicit duty of the king to protect people from epidemics by the emphatic using of the Sanskrit word ‘rakshet’ – the imperative form of verb ‘to protect’.

 

He should be protecting people by giving shelter in the fort, by distributing his reserve collection of provisions or by redistributing the hoarded income of the rich among the people – says Arthasastra. According to Shamasastry, the first authority on the Arthasastra, the king is allowed to seek for help from other kings, or to adopt a policy of karsanam (the policy of thinning the rich by extracting excessive revenue), orvamanam (inducing people to bring out their accumulated wealth) during such calamities. The king must also increase investments in agriculture, animal husbandry or hunting and fishing, both in order to increase the food supplies and provide people with employment. While the king is allowed to do properly planned resettlements, both internal and external, the people are alsorequired to subject themselves to medical treatment, and associated prayers and rituals. The repeated use of precative verbs and the conjunction ‘or’ in the text indicates that the Government needs to diversify its strategies and resources allocation.

 

However, for the last several decades, neo-liberal ideas have hollowed out the State, draining out the creative talent and efficiency from governmental departments. The Governments are not anymore strong enough to demand support from large scale industry players and monopolists. It has even affected the nations like India. It must be noted that the new Liberalised Pricing and Accelerated National COVID-19 Vaccination Strategy along with the hesitation in scaling up the production by allowing multiple producers to share up the demand is not only a disregard of the above strategic advice from the Arthasastra but amounts to depriving people of their last chances of the resorting to the medicines and treatment. The impact of the strategy is already seen as there is in irregular vaccine supplies at Government centres and private sector enterprises.

 

Organisations like Jan Swasthya Abhyan and People’s Health Movement have reported before the Supreme Court how the vaccine manufacturers are giving tiring negotiations to various State Governments, sometimes by not even responding to their calls and requests. The vaccines which are available in open Indian market for Rs 600, Rs 750 and Rs 1,200 are available for Rs 160 and Rs 297 in the Europe and US, respectively. Instances of such rent-seeking are assumed to be a normal market behaviour and the present Governments are forced to negotiate with the manufacturers. Arthasastra, whereas, is hell-bent on crushing such behaviour of tradesmen and market players who intends, conspires or combines to sell at a higher price. Yajnavalkya Smriti concurs the same, according to RP Kangle, another authority of Arthasastra. According to its chapter 2 of book 4, it’s the duty of the State to fix the price after taking into consideration of investment, production of the stock, duty, interest, rent, and other prices.

 

The above ideas are not different from the India-sponsored United Nations Human Rights Council Resolution 23/14 on Access to medicines in the context of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. The Operative Paragraph (OP)3 of the resolution emphasises the responsibility of States to ensure the highest attainable level of health for all, including through access, without discrimination, to medicines, in particularessential medicines, that are affordable, safe, efficacious and of quality.

 

Further under OP.5, states are required to promote access to medicines for all, establish and strengthen national monitoring and accountability mechanisms for policies relating to access to medicines, and promote transparency and the informed participation of all relevant stakeholders, etc. The State is also required to promote universal health coverage in national systems and must also improve domestic management capacities in order to improve delivery and access to quality, safe, efficacious and affordable medicines.

 

The present India Government’s move to approach the WTO for the TRIPS wavier is also consistent with its duties under the UNGA Resolution 23/14 to apply measures relating to intellectual property rights in such a manner as to avoid creating barriers to the legitimate trade of affordable, safe, efficacious and quality medicines, and to provide for safeguards against the abuse of such measures and procedures.

 

 

While Manusmriti chapter 3 explicitly avoids a medical practitioner, who sells medicines or treatments from being invited or entertained in the ceremonies like yajnas or havans. The Rayasana Chikitsa chapter of Charaka Samhita, explains that those who makes healthcare a business gathers dust. This chapter, which focusses on immunity enhancing treatments and which are also prescribed for epidemic periods, profoundly explains the role of the healthcare in few verses (CS.6.1.55-62). Gopinath summarises them in Foundational Ideas of Ayurveda: “Not for self, not for the fulfilment of any earthly desire or gain, but solely for the good of suffering, should you treat your patients and so excel all. Those who sell the treatment of diseases as merchandise gather dust and neglect gold.”

 

Going by the normative analogy of Charaka Samhita, the individuals, persons and corporates who commercialises vaccines or treatments, commit a wrong – ‘Prajna-Aparadha’. Prajna-Aparadha loosely translated as “intellectual error” is an error which is committed by the people who defy principles of sustainable development and social harmony by following wrong pursuit. In Hitopedsa 1.28, it is said that Prabhu Ram when followed an illusory golden deer, was acting against his own intellect.

 

The philosophical underpinnings of the term are as follows and are at the root cause of disruption of social progress during an epidemic (CS.3.3.19). For Atreya, it is very clear that an intellectual error happens when leaders from different fronts of life, such as politics, trade, and academia commit errors. Owing to their intellectual falsity, the people who generally follow them repeat the error multi-fold. This multitude of errors of both the Government and the governed collectively upset the functioning of nature, violates the principles of developmental justice and causes vitiating forces in the universe to appear as if they are warranted by the nature (CS.3.3.20).

 

 

Epidemic is not a war, but what it ensues “may be a war” – says later Atreya in the Charaka Samhita. The intellectual error motivated further by greed and anger persuades people not only to disregard sustainability principles, but also to oppress the weak and ignore their needs. This again deteriorates social cohesion and may be followed with war and violence (CS.3.3.21) climaxing the retardation of the social progress.

 

 

 

There is no need for an epistemological reason or economic rationale to prescribe and practice “care” as a policy. Care, in its two variants shushrusha and shraddha, are the proto-principles of all knowledge, governance and success according to the Bharatiya Sastras 

What is needed to counteract this social disruption is a clear vision of the one who needs what, and who is to be protected and how. Going by Arthasastra, it is a vision that never opens without the practice of the care (shushrusha). The capacity and readiness to serve is the first quality that a king should possess and it is the first duty of the king as well. There is no need for an epistemological reason or economic rationale to prescribe and practice “care” as a policy. Care, in its two variants shushrusha and shraddha, are the proto-principles of all knowledge, governance and success according to the Bharatiya Sastras.

 

Therefore, it’s not a strange thing to do in this pandemic situation to appeal to innate human qualities of love, and sacrifice. It might be “normal” and people may be allowed to pursue pleasure, wealth and power even notoriously during theusual times. But during a pandemic, pursuing the same is “abnormal”, even if such pursuit the principles of free and fair market. As far as Government of Bharat is concerned, its time to withdrew its jnanendriyas (policy advisors) and karmendriyas (policy implementers) from the neo-liberal vasanas of the market, like a tortoise withdraw its limbs and head, and contemplate on the vision of the Bharatiya philosophy of the Public Health. Then the people of Bharat and rest of the world will come forward trusting the Government like the scholars from various countries approach a vishwaguru. However, a dilly-dallying stance with the pharmaceutical companies and other healthcare businesses shall be adharmic (illegitimate) as well as kunitiparam (ill-policy).

 

It is emphasised that the import of the language and grammar used in the Arthasastra require the State to plan, be organised and deterministic and not to depend on the random charities from different parts of the world or individuals. Therefore, State, which includes both the Government and the people, should develop a consistent normative outlook about the situation without being apologetic, compelling the individuals, organisations and officials dealing with the pandemic be efficient as well as accountable.