📰 COVID-19 and a country club India must leave
Instead, an opportunity awaits the nation to join other states that recognise the value of a just public health-care system
•As a billion Indians watch with horror as the pandemic sweeps the land, many look with envy to countries to the east of us where the virus originated, and to the west of us in Europe which were devastated just a few months ago but appear to have beaten the bug and are starting to repair their societies. We can only draw some consolation from the fact that, thankfully, we are not alone in our spectacular failure to contain the pandemic: we have Trump’s U.S. and Bolsonaro’s Brazil to give us company.
The poison of inequalities
•Others have also noticed the curious composition of this country club, perhaps the only one in the world which no one wants to be a member of, and have begun to wonder what features these three countries might have in common, apart from the fact that they are all populous, federal, diverse and democratic. No prizes for guessing which is the most common theory which crops up in the fertile imaginations of perceptive observers. But that is not the theory which I believe tells the whole story. My proposal is that what these three countries share is the toxic levels of historic inequalities which affect every structure of society including, most importantly, the health-care system.
•The value of investing in a just public health-care system has never been as starkly obvious, for never before have entire countries been brought to their knees by one disease. To be sure, there have been far deadlier epidemics which continue to kill many more people than COVID-19 but they, like HIV, diarrhoeal diseases and tuberculosis, have mostly killed the poor and the marginalised, outside the conscious radar of those in power. More to the point, no previous epidemic brought the engines of the economy to a standstill. If some poor chaps died of a horrible disease in some godforsaken slum, C-grade town or village in the back of beyond, the stock market could not care less. However, on this occasion, for the first time, the wealthy and the powerful in their urban palaces have found themselves marooned. And their high-tech doctors and “super-specialist” hospitals can do little to rescue them.
On universal coverage
•What differentiates countries which have been able to pick themselves up and start walking within a few months after their first case was detected from those, like ours, which remain mired in the muck, is the commitment by both the state and civil society to the principles of universal health coverage. To be fair, if universal health coverage was conflated with the simple existence of a publicly financed health-care system, then India, like the United States and Brazil, can already boast to have met this goal. However, this is not what universal health coverage means in spirit: only a system which all people, rich and poor, those in power and those who are powerless, can rely on to be given care with the same quality regardless of their station in society, can be truly considered “universal”.
A question of quality
•Such a universal health coverage system does not exist in India, or the U.S. or Brazil, where more than half the population, concentrated in the upper income groups, seeks health care in the fee-for-service private sector. The private sector in India provides almost 80% of outpatient and 60% of inpatient care, as a result of which falling ill is one of the most important contributors to indebtedness in the country. While the government’s much heralded insurance scheme does buffer a segment of our population, the very poor, from impoverishment due to hospital admissions, outpatient care which comprises the bulk of health-care expenditure remains untouched. Whereas universal health coverage is recognised by many countries as a strategy to empower people to lift themselves out of poverty and as a foundation of sustainable development, health care in India has become a leading cause of poverty. The fact that, despite this knowledge, the majority of our people prefer private care, is a damning testimonial to their experiences of the public health-care system.
•I have often heard the titans of corporate medicine in India justify their costs by arguing that these are much cheaper than in the U.S. or Europe; such comparisons are ridiculous as they are oblivious of the fact that India’s per capita income places us as one of the poorest countries in the world. But beyond the clearly visible ills of the wholesale commercialisation of health care, there are a host of other challenges to realising universal health coverage, from the standards of our infrastructure to the honesty and competency of health-care workers which contribute to the abysmal quality of care, in both the private and public sectors.
•The pandemic has brought the scandalous quality of our health-care system into sharper relief as our daily diet of front-page headlines alternates between the numbers of dead on the one hand with stories of pigs roaming freely and the absence of doctors in public hospitals to shameless profiteering and refusal to care by private hospitals on the other. The proclivity of doctors to irrational medical procedures and drug prescriptions, the lack of dignity with which the poor are cared for, and the legendary levels of corrupt practices across the health-care system are well documented.
•At the heart of this pathetic state of affairs is the complete lack of accountability of either the private or public sector, and the absence of the stewardship role of the state in ensuring justice and quality of health care for all its citizens. It comes as no surprise that there is a fundamental breakdown of trust between civil society and the health-care system, exemplified at its most extreme by violence against health-care providers. Fixing the rot will need structural reforms far beyond the top-down “missions” and knee-jerk punitive actions which have dominated our policy-making for over 70 years. But for this to happen, we will need a broad coalition across the political establishment and civil society, in particular the wealthy and ruling classes, to demand change.
A historic opportunity
•For the first time, I see the possibility of this happening, as economists, business leaders and politicians who were wont to view the public health-care system as a charitable cause to address disease and death of the poor, to be attended to as a footnote to the task of building our economy, can finally witness as clear as daylight how a dysfunctional, fragmented and unaccountable health-care system will ultimately destroy the economy itself. Even if the pandemic has hit the poor the hardest, it has also crippled the nation. But we need more than just new money for while health care is the wisest investment for the economy, such an investment must be accompanied by a social compact that the same system caters to all. This philosophy of universal health coverage is already practised in diverse ways, including engagement of the private sector, by scores of countries. I cannot imagine a more historic opportunity for India to join that illustrious club.
India’s passivity in influencing global tech rules must end
•On June 29, the Indian government banned 59 Chinese apps, including TikTok, ostensibly to protect security, sovereignty and privacy. There was no public review of these apps and no assessment of the implications of this ban for the right to free speech of many people, particularly in non-urban spaces.
•Like India, the U.S. is considering banning TikTok citing national security concerns. American allies and partners including India are now wondering whether they should allow Chinese companies like Huawei and ZTE to build their 5G networks. Linkages between countries, particularly in the tech sector, are being exploited and manipulated to achieve security or strategic interests. Indian decoupling with Chinese tech comes in the wake of border tensions, while the U.S. continues its trade war with China.
Long-term strategic thinking
•While banning Chinese apps could have been a strategic necessity in the short run, the hastiness of this move should propel long-term strategic thinking on how digital issues constrain India’s foreign policy. Reactive and ad hoc tech squabbles cannot be a replacement for a robust foreign policy that marries India’s constitutional ethos with the twin needs of national security and economic growth. The realisation of this vision requires India to engage more confidently in global technology governance debates and shape incumbent rules and norms.
•The problems caused by various technologies and technology firms have generated demand for international negotiations, to create viable rules and norms. For instance, social media companies are facing a backlash after years of ignoring abuse on their platforms that stoke social and ethnic tensions. Cyberattacks are rising from state and non-state actors. Conflicts over national laws concerning data use and storage are common. Issues like data, 5G, AI, social media and cybersecurity have domestic and global effects — who controls these technologies and how they are developed and used matters greatly as it defines how nations trade, behave and fight with each other.
•These interactions hinge on drafting rules and norms that provide clarity and deter subversive behaviour. For India, the costs of not actively shaping technology rules are high. India’s economic, political and security future rests on deploying technologies and having robust rules that accelerate the empowerment of its vast demographics while deterring the use of such technologies against strategic objectives.
•Global governance is imperative for restraining, if not halting, the disruptive effects of cyberspace as the number of nefarious actors online proliferate. India has been a member of five of the six Group of Governmental Experts processes set up by the UN to foster norms for responsible state behaviour in cyberspace. Yet, it has not sufficiently exercised its diplomatic clout to weigh in on critical fissures. This passivity must end.
•Apart from protecting security interests through these debates, India must function as a rule-shaper to preserve the civil, political and economic rights of its citizens. New Delhi must ensure that export control regimes like the Wassenaar Arrangement and the Missile Technology Control Regime regulate the use and impacts of dual-use surveillance technology that have been used to target Indian journalists, lawyers and activists. Officials must extend the ethos of fundamental rights guarantees to global debates on Internet shutdowns and facial recognition technology while ensuring domestic policy fulfils constitutional responsibilities.
Economic assertiveness
•India has been assertive when technology debates affect the economy. As campaigns like Make in India and Digital India get ramped up, policy enthusiasm on e-commerce and data flows has risen. Until recently, India’s cautious approach on 5G, involving Huawei in its plans, was influenced by a desire to have space to allow multiple vendors who can meet India’s telecom needs. New Delhi’s disinclination to support unfettered data flows across borders is propelled by ‘data sovereignty’. This pronounced emphasis to nationalise data, however, could pose problems for entrepreneurs and start-ups who prefer relaxed data-sharing rules to foster innovation and product development. The sheer volume of data generated by citizens at home makes India an essential destination for foreign technology firms enabling India to exercise its authority in shaping global trade rules, but this should occur balancing the interests of all Indian stakeholders in mind, not privileging the large and powerful.
•India’s distinct economic and demographic position allows it to shape, influence and constrain global technology rules that serve its strategic interests. It can and must significantly shape the making of the digital world.
📰 A quest for order amid cyber insecurity
Better arrangements and intense partnerships, but with extra safeguards, are needed in a more contested domain
•In cyberspace, it is the best of times for some and the worst of times for others. Between them, Apple, Amazon and Microsoft have added more than a trillion dollars in market value, since the start of 2020. On the other hand, cyberattacks have grown. In one week in April 2020, reportedly, there were over 18 million daily malware and phishing emails related to COVID-19 monitored by a single email provider, in addition to more than 240 million COVID-19-related daily spam messages. Twitter hackers collected $120,000 in full public gaze, while a “ransomware” target in California quietly paid 116.4 bitcoins or $1.14 million. There is also concern about the role of states. Australia mentioned of attacks by a state actor. China has been accused of hacking health-care institutions in the United States working on novel coronavirus treatment. The United Kingdom has warned of hackers backed by the Russian state targeting pharmaceutical companies conducting COVID-19 vaccine research. The ban on specified Chinese Apps, on grounds that they are “engaged in activities prejudicial to the sovereignty and integrity of India” adds another layer of complexity to the contestation in cyberspace. Cyberinsecurity of individuals, organisations and states is expanding amidst COVID-19.
•While we are embracing new ways of digital interaction and more of our critical infrastructure is going digital, the parameters of the transformation under way are not understood by most of us. Like global public health, cybersecurity is a niche area, left to experts. COVID-19 made us realise the role of the global public health infrastructure and need to abide by agreed rules. Similarly, a better understanding of the global cyberspace architecture is required.
No global commons
•Borderless cyberspace, as a part of the “global commons” does not exist. It is an illusion that connectivity across national boundaries nurtured. The Internet depends on physical infrastructure that is under national control, and hence is subject to border controls too. Each state applies its laws to national networks, consistent with its international commitments. States are responsible for cybersecurity, enforcement of laws and protection of public good. States are responsible for their actions, as well as for actions taken from within their sovereign territory. This is easier said than done. The infrastructure on which the Internet rests falls within jurisdictions of many states with differing approaches. Cyberspace has multiple stakeholders, not all of which are states. Non-state actors play key roles — some benign, some malignant. Many networks are private, with objectives differing from those of states. Finally cybertools are dual use, cheap and make attribution and verification of actions quite a task.
•Nevertheless, states alone have the rights of oversight. There is no equivalent of a World Health Organization which can monitor, assess, advise and inform about fulfilment of state commitments, in however limited or unsatisfactory a manner. In short, the search for cyber “rules of the road“ is still on. We are at an incipient stage of looking for “cyber norms” that can balance the competing demands of national sovereignty and transnational connectivity.
Gaps in current processes
•It was in 1998 that Russia inscribed the issue of information and communications technologies (ICTs) in international security on the UN agenda. Since then six Group of Governmental Experts (GGE) with two-year terms and limited membership have functioned — the most on any issue at the United Nations. In addition, an Open-Ended Working Group (OEWG) began last year with a broadly similar mandate, but open to all. More than 100 states evinced interest. However, it is meandering along, with a report likely next year. The discussions are narrowly focused in line with the mandate of the forum that set it up. Issues such as Internet governance, development, espionage, and digital privacy are kept out. While terrorism and crime are acknowledged as important, discussion on these has not been focused on, as ostensibly best done in other UN bodies.
•The net result of the UN exercise has been an acceptance that international law and the UN Charter are applicable in cyberspace; a set of voluntary norms of responsible state behaviour was agreed to in 2015. What aspects of international law and in what circumstances will be applicable remains to be addressed. UN Secretary General António Guterres’s recent report, “Roadmap for Digital Cooperation”, gently calls for action. A few confidence building measures may follow. However, short of a cataclysmic event, these processes do not hold much hope in the current geopolitical circumstances.
More engagement needed
•Generally the growth of technology is way ahead of the development of associated norms and institutions. Cyberspace is experiencing this too. It provides countries such as ours some time and space to evolve our approach, in tune with the relevance of cyberspace to India’s future economic, social and political objectives. Despite the digital divide, the next billion smart phone users will include a significant number from India. As India’s cyber footprint expands, so will space for conflicts and crimes (both of a private and inter-state nature). Shared “rules of the road” become imperative. We have a very active nodal agency for cybersecurity in the Indian Computer Emergency Response Team (CERT-In), Ministry of Electronics and Information Technology. India has had representatives on five of the six GGEs. We participate actively at the OEWG. The Shanghai Cooperation Organisation, of which we are a member, voiced support for a code of conduct. India joined the Christchurch Call which brought together countries and companies in an effort to stop the use of social media for promoting terrorism and violent extremism.
•The next phase in an increasingly contested and fragmenting domain requires better arrangements and more intense partnerships, but with more safeguards. Domestically, we need the clarity that adoption of a data protection legislation will bring. Globally, we need to partake in shaping cybernorms. Acceding to the Budapest Convention, or Convention on Cybercrime of the Council of Europe (CETS No.185), which started as a European initiative but has attracted others, is an option that we should examine. We need to encourage our private sector to get involved more in industry-focused processes such as the Microsoft-initiated Cybersecurity Tech Accord and the Siemens-led Charter of Trust. Engagement in multi-stakeholder orientations such as the Paris Call (for trust and security in cyberspace) can help. In preparation for the larger role that cyberspace will inevitably play in Indian lives, we need a deeper public understanding of its various dimensions. Cyberspace is too important to be left only to the experts.
