On the Indian Plague of 1994

‘I am satisfied the war is over,’ declared N.K. Sharma, the World Health Organisation representative in India. Certainly the war against the plague has disappeared from the newspapers and the airwaves. Business India, the fortnightly gospel of the country’s burgeoning corporate sector, questioned whether there had been a plague epidemic at all. Accusing India’s doctors and government officials of making a ‘presumptive diagnosis’ and its trade partners of ‘over-reacting’, an editorial complained that ‘the damage caused to the country’s image and economy is immense.’

A subtle variation on this theme could be found in the pages of the Times of India, where one commentator denounced the ‘Orientalist’ manner in which the Western media had covered the plague, linking it to the persistence of such exotic ‘medieval’ phenomena as caste, religious fanaticism and extended families. Indian protests against the foreign ‘over-reaction’ – many of which singled out the country’s Muslim neighbours for rebuke – commonly cited WHO statistics showing that since 1986 over one hundred people a year worldwide had died of plague, but until this year, none in India (although several in the United States). They contrasted the scale of the outbreak and the speed with which it was contained, at a cost of fifty lives, with the extent of the panic and the long-term threat to India’s reputation as a dynamic modern economy.

In one respect, Indian objections to the Western media’s Orientalism are justified. The Indian plague of 1994 was not so much the recrudescence of an ancient scourge as a symptom of the contradictions of the country’s manic drive towards economic liberalisation. The Orientalism of the Western press is, in fact, a mirror image of the complacency of the Indian élite. Both have a fatalistic view of the life of the country’s masses. Both assume there are intrinsic limits to the alleviation of poverty and suffering, despite the talk of India becoming a new economic powerhouse. The Indian middle classes have no one but themselves to blame for the global panic. It was their own reaction that set the trend, and their priorities that ensured the disease would become an epidemic in the first place.

Plague is endemic in rats in the wild. It becomes epidemic among humans as a result of ecological trauma: in this case, an earthquake in Latur, in the western state of Maharashtra, which forced plague-carrying rats out of their natural habitat, and a flood at Surat in neighbouring Gujerat which brought the disease to the cities. As long as Yersinia pestis, the plague bacillus, lives on in the forests, its spread among humans remains a possibility, no matter how economically advanced the society. Early detection is therefore the key. But in 1987 the Maharashtra Government overruled expert advice and closed down its plague-surveillance unit.

The central government was warned at least four times between 1989 and 1993 of the likelihood that plague would reappear. A group that met last year to co-ordinate surveillance noted that the number of infected rats was growing and recommended that the Hafkine Institute at Bombay resume the production of anti-plague vaccine which had ceased the year before. All this was ignored by a government increasingly preoccupied with wooing multi-national capital and accommodating World Bank demands for cuts in public spending.

On 5 August, large numbers of dead rats and swarms of fleas were reported in Beed, a district near Latur. By the end of the month, there were over a hundred cases of bubonic plague – transmitted by rat fleas – in the area, but the Congress-controlled state ministry, engaged as ever in factional rivalries and corruption on the grand scale, did not issue its first communiqué about the threat of plague until 5 September.

Precisely how bubonic plague in Beed became pneumonic plague – transmitted by human sputum – 500 kilometres away in Surat remains a mystery. It is possible the bacillus, in one form or another, was carried by one of the thousands of migrant labourers who pour into the busy city every day from the rural areas of Maharashtra. The Tapti River had flooded earlier in the summer, littering Surat with decaying garbage and animal carcases, which may have nurtured bacillus-carrying fleas. The local street-cleaners’ union demanded extra staff and new equipment to deal with the mess, but the municipal government refused to comply.

In mid-September, a mysterious ‘Surat fever’ started to claim lives in the city’s hospitals. Twenty citizens, all slum-dwellers, perished before the medical staff announced, on 21 September, that plague was the cause. Despite the insistence of the Gujerat Chief Minister that there was no plague in Surat, panic struck. Within three days, 400,000 people – a quarter of the city’s population – had fled, including one thousand of its four thousand doctors, the bulk of its civil servants and administrators and most of its thriving middle class. Those who were most vulnerable to the plague bacillus were left behind: migrant workers and the poor, who had no access to private cars and could not afford to pay the prices asked by profiteering travel agents for plane tickets and air-conditioned railway seats. At the bus and railway stations, the poor were ‘lathi-charged’ – assaulted with batons – by the Rapid Action Force, which the central government despatched to quarantine the city, once the élite had made a getaway. Although they were heavily armed, the Force failed to prevent the escape of more than a hundred patients from a hospital isolation ward. They have still not been traced.

It is no surprise that Surat, one of the fastest-growing cities in Asia, was the epidemic’s epicentre. During the three weeks of plague panic, the loss in industrial production – textiles, diamonds, chemicals – was said to be costing £10 million a day. The shops in Surat contain a glittering array of consumer goods, but a quarter of the city’s population lives in slums, where, on average, a hundred and fifty families share the use of a single toilet. Even before the plague, Surat was clearly a public health disaster. ‘In other cities, you have seasonal fruits,’ one Surati who had fled to Delhi told me. ‘In Surat we have seasonal epidemics. Malaria, typhoid, jaundice, gastroenteritis, conjunctivitis. Nobody seems to be too bothered.’

The city is full of private nursing homes, hospitals and clinics, whose staff were some of the first to flee when news of the plague broke. In their absence, enraged crowds burned down several of their premises. Many of those who had the money or connections to escape from Surat found a less than enthusiastic welcome elsewhere. Three Suratis were murdered in Thane by a local man convinced that they would give him the plague. Another Surati who had fled to Delhi observed bitterly: ‘They are treating us as if we came from Pakistan.’

At the height of the panic in Delhi, people wore surgical masks or covered their faces with handkerchiefs and stepped gingerly around the piles of garbage and clusters of street-dwellers. All eyes seemed to ask the same questions. Are you infected? Will you give me the plague? Like the epidemic in Athens described by Thucydides, the panic in Delhi turned neighbours into enemies and set the rich against the poor. The bacillus had diseased the entire body politic.

At every traffic junction, vendors sold masks of various types, including anti-pollution masks (useless against micro-organisms) at 30 rupees, a day’s wage for many in the capital. Hordes besieged chemists to buy capsules of tetracycline, retailing for as much as £1 a capsule, ten times the normal value, and as often as not cut with chalk, starch, turmeric or worse. The panic buying of the drug – which is a treatment for plague, not a prophylactic – was a direct result of the Government’s failure to mount any serious public information campaign until it was too late. The information given out on Doordarshan, the state television network, and in the English-language press, was of little use to most people: avoid crowds and public transport, wear a four-layer muslin mask, take vitamin C and eat chicken soup, sleep in a high bed, wear shoes and socks.

Delhi’s wealthy inhabitants have segregated themselves in leafy residential areas. They have live-in servants and high walls to keep out the riff-raff. They filter their water. Normally, they express little concern over the two thousand tons of garbage left uncollected on the city’s streets every day or the one-third of the city’s residents who enjoy no refuse disposal facilities at all. In Delhi, there are two thousand deaths a year from viral hepatitis. Cholera, malaria, TB, Aids, kala azar, dengue fever, typhoid and gastro-enteritis each claims more lives in a month in India than were lost in the course of the plague epidemic. Last year a cholera outbreak in Uttar Pradesh wiped out at least a thousand people, but received less than 1 per cent of the coverage devoted to the plague.

It is now fashionable among the middle classes to disavow concern for the poor. (The height of ambition for the young is an MBA and a job in the corporate sector, where salaries have leaped in recent years.) Yet they live in closer proximity to the poor and are more exposed to the ugliness of poverty and disease than their counterparts in the West. Their dreams of global economic success were undermined by a nagging anxiety which turned to panic when the plague struck. India Today, voice of the entrepreneurial middle classes, despaired: ‘No one wants to invest in the dark ages.’ A cartoon in another magazine showed India as one of the Asian economic tigers, wearing a surgical mask. Subodh Jain, the director of a Delhi export house, lost £200,000 in overseas orders and was shunted, in flight, between Lebanon, Dubai and Cairo, because no one would allow an Indian to land. ‘Nobody wants to do business with an unclean country,’ he wailed. ‘I’ve never been so depressed in my life.’

The Ministry of Commerce estimates that the plague will cost £280 million in lost export earnings, but this was trifling compared to the symbolic impact of a decision by Jack Welch, Chief Executive of the General Electric Corporation, to postpone a long-planned business trip. After all, US companies have invested more in India in the last two years than in all the previous forty. Addressing a meeting of financiers in London when news of the plague first emerged, the Finance Minister Manmohan Singh, architect of the New Economic Policy (India’s fast-forward version of Thatcherism) and the hero of millions of middle-class Indians, blamed the epidemic on loss-making public-sector units tying up valuable capital. Dr Lalith Nath, dean of the All-India Institute of Medical Sciences, disagreed: ‘We have systematically demolished the public health-care system.’ India now spends only 1.5 per cent of its GDP on health, compared to a 5 per cent minimum recommended by the WHO and the 13 per cent spent by Bangladesh, a much poorer country.

Manmohan Singh’s watershed budget of 1991-2, widely seen as marking India’s acceptance of the realities of the marketplace after years of planning and state control, slashed spending on health by 20 per cent, a proportionately larger cutback than was imposed on any other service. In poverty-stricken Bihar, health service directors employed by the state have not been paid any salaries for two years. Communist-run West Bengal also claims it can no longer afford to pay for primary health care, while its ‘Marxist’ Chief Minister, Jyoti Basu, jets off to America to lure investors with his anti-labour policies. Both the central government and the international agencies seem obsessed with population control, which has consumed an ever greater share of resources at the expense of basic sanitation and hygiene. The importance attached by politicians to the health of their country is clear from the fact that between 1980 and 1994 there have been 19 health ministers at national level.

Mahatma Gandhi’s definition of India’s hygiene problem – ‘we are individually clean and collectively dirty’ – has been frequently quoted in recent weeks. It is, unfortunately, irrelevant. The multiplying health and hygiene crises in Indian cities are the result of exploding population and declining public investment. And they will only be exacerbated by a regime which encourages migrant workers to congregate in the few limited zones of economic opportunity created by an intrinsically partial and uneven pattern of economic growth.

The obvious lesson of the plague epidemic – that more resources need to be devoted to public health – is precisely the one which the champions of the new economic policy refuse to draw. On the same day that the WHO issued India with its clean bill of health, Hannan Ezekiel, a former editor of the Economic Times, declared: ‘The public sector is an anomaly in the new order and must be excised from the system.’ In its post-mortem on the epidemic, India Today called for the privatisation of municipal services, a ban on rag-pickers and a crackdown on illegal colonies of migrant workers, whose uneducated, dirty ways were responsible for spreading illness. Meanwhile, in Maharashtra, the bubonic plague epidemic continues, at what the WHO describes as ‘low levels’, and in Rajasthan an outbreak of cerebral malaria has taken at least a thousand lives.