South Asia's Response to the Coronavirus

BUSSEY: Well, thank you very much. And welcome, everybody, for a discussion of COVID-19 and South Asia.

We’ve got a very good panel to speak on this topic. I will ask each of them to make a few remarks at the beginning. Then I have a few questions for them. And then we’ll turn it over to questions and answers from our audience. We’ve got about four hundred people on the line, so we’ll do our best to expeditiously get to your questions.

I’m joined today by CFR—Council on Foreign Relations Senior Fellow Alyssa Ayres; Dr. Bill Haseltine, who’s from ACCESS Health International; and Husain Haqqani from the Hudson Institute, former ambassador to the United States from Pakistan. We are very much looking forward to your comments in the Q&A session. And a reminder that this session is on the record, so your questions will be on the record as well.

I thought we would start with Dr. Haseltine to just give us kind of a five-minute overview of the status of COVID-19 in South Asia. So, Doctor, over to you.

HASELTINE: Thank you very much. I hope my voice is clear for people.

BUSSEY: Yes, it is.

HASELTINE: At this point South Asia is not experiencing a serious epidemic. There is great concern that it will. There are certainly cases of the infection in India. There are cases in Pakistan. But it is not as widespread as far as we can tell.

The information I have comes from people who work with me as part of my foundation, ACCESS Health International, in Hyderabad, in Delhi, and around other parts of India. In particular, my country director there has created a network of over twenty hospitals in six Indian states, is in real touch with what’s happening.

It isn’t that they don’t have the infection, but it’s not at all clear that it’s taken off in the same way. Most of the infections that they have have come in from travelers from abroad. There are a few who seem to be locally transmitted, but very few at this case.

The caveat with that is to say that there’s very little testing done, and there’s a very high incidence of disease in India. So it could be overlooked. And there are many people who don’t have access to a health-care system. So it’s fully possible that there is a hidden disease which has not been detected.

The other thing to say is India has been very active through its traditional bureaucracy in doing contact tracing. When there is a known case, they’ve been very diligent as far as my information goes, in identifying that person, identifying their contacts, and doing everything they can to quarantine those contacts.

We’ve seen scenes in television and elsewhere of great dislocation in India, as particularly the—we would call them unlicensed workers, but the part-time workers, the construction workers that you see all over that country, really don’t have a permanent residence and have no way of getting care, no way of supporting themselves, and there’s been a mass exodus of those people, mostly from the north of India back to the south of India. But there are also transitions from richer parts of the north to poorer parts of the north.

So at this time it’s not an out-of-control situation. It certainly could become that. But at this point it doesn’t seem that it is. That’s a very quick overview from the information I have at this time.

BUSSEY: Thanks very much.

Alyssa, can you walk us through some of the political and economic implications of this for India and Bangladesh? We may not be seeing a lot of cases yet, but that most likely is because of, as Dr. Haseltine said, undertesting and certainly underreporting. And the presumption is that this will spread. So what are the political and economic implications of this?

AYRES: Right. OK. Let me just note that in terms of numbers, as of yesterday, April 6, India has only tested around a hundred thousand people, and from today’s data from the health ministry there’s a little more than forty-three hundred active cases. So these numbers are quite small. But, again, it’s the importance of not knowing really what the true picture is.

The political and economic implications here are quite important. The economic implications are, in fact, enormous. So I’ll spend a little bit of time on that. Obviously, India has the world’s second largest population including urban areas of great density and that brings with it the potential for large-scale gatherings where you can see, you know, a lot of contact.

As Dr. Haseltine mentioned, a health profile that now also includes—I mean, I think we’re used to thinking of India and other places in South Asia as having a lot of infectious diseases. But India also now has a lot of noncommunicable diseases like asthma and hypertension, diabetes, and we’ve seen all over the world that this can actually make people more vulnerable. So that’s another element to add to this.

Economically, India is now—it hovers between the world’s sixth or seventh largest. It’s about a $2.8 trillion economy. However, it remains on a per capita basis in the bottom third globally, about a $2,000 a year per capita income, and, most importantly, India’s economy has been—its economic growth has been slowing prior to the onset of the pandemic. It was just in early January, actually, before any impact of coronavirus in India the IMF had revised downward its growth estimate for India for FY ’20 to 4.8 percent. They earlier had estimated a 6.1 percent growth rate for India.

It’s also not surprising against that context, that backdrop, that India also currently faces an unemployment situation that even prior to the countrywide lockdown and the onset of the coronavirus in India has been—the unemployment rate had been at a forty-five-year high. So that’s the kind of backdrop for everything that has transpired.

I think one thing that’s important to note about the Indian government’s response to coronavirus is that it first really tackled this as an external threat, as many other countries around the world did. In fact, you saw the foreign affairs ministry, the Ministry of External Affairs, quite actively work to get Indian citizens abroad out of harm.

So you saw the Indian government launch these evacuations of Indian citizens who were in Wuhan or in Iran or in Italy. This was happening during February. So at that time it was—you know, the threat was external and the effort was to rescue Indian citizens who were in places where the disease had already spread.

By mid-March, you saw the Indian government, again, like many other countries, decide that they needed to close their borders. So they closed all their borders and they stopped all international flights by mid-March, again, thinking of this as something only coming from the outside. You saw an emergence of some Italian tourists who were some of the initial case clusters in India. The prime minister then called for a one-day people’s curfew, kind of a practice for a national lockdown, and then a few days later he announced this twenty-one-day lockdown that’s in place now.

Obviously, locking down the entire country of 1.3 billion people is coming at a great cost. I mean, that’s a really enormous decision to have to make. This is the world’s largest COVID-19-related lockdown. The lockdown that took place in China was much more limited. The kind of economic pain we’ve seen in the United States from state or city-specific shelter-in-place guidelines we’ve had unemployment spikes. In India, the vast majority of employment is in the informal sector or what people call the unorganized sector in India. So the lockdown has had a huge impact. As Dr. Haseltine said, you’ve seen these images of migrant laborers setting off for home because interstate transport had been suspended on foot for, you know, hundreds of kilometers. Your jobs had evaporated.

There was new data that came out today from India’s Centre for Monitoring Indian Economy. This is a private organization. They provided the—an initial unemployment data point for the last week of March that would put India’s unemployment rate at almost 24 percent. That’s a real spike there. You can imagine the kind of hardship that level of unemployment entailed. A few days ago, Moody’s revised their estimate of India’s growth rate for 2020 down to 2.5 percent.

I’d also just note that the Indian government created a relief package of around $23 billion that’s specifically designed to help the poor during this unprecedented time—this lockdown—that’s both a cash transfer as well as a food staples distribution package. I think the real question is whether the relief will be enough, and of course how long this lockdown ends up lasting and how long the economic aftereffects will last. We’re in completely unchartered territory, here. Like in other countries, there’s also a debate in India about when to end the lockdown, whether to extend it or lift it early, and how to try to get the economy moving again.

John, just twenty seconds on Bangladesh. Bangladesh has very small numbers for coronavirus impact. The thing I just wanted to note here is that the most significant effects of the global pandemic so far has actually been a real disruption of Bangladesh’s world-class garment industry. As a result of the economic lockdown in Europe, in the United States, Bangladesh’s garment industry has really felt a lot of pain. It had something like more than $3 billion worth of orders canceled, and this puts at risk millions of people who are employed in the garment industry in Bangladesh—an industry that’s lifted many people out of poverty. About 2.2 million people have been laid off or sent on leave while this is happening. So that’s just another aspect to keep in mind.

I hope that the virus does not spread further in Bangladesh. It is another country that’s quite population dense, 160 million people, and land the size of Iowa, so it is quite dense. But as of right now the most important effect has actually been through their deep supply chain relationship with the United States and with Europe. And I’ll just stop there.

BUSSEY: Alyssa, thank you very much. That’s excellent.

Husain, can I ask the same of you for Pakistan, particularly the economic and political implications of the virus and its likely spread?

HAQQANI: Thanks, John.

Let me just begin by saying that Pakistan represents probably the most serious country in South Asia within the context that we’ll explain to us—or Dr. Haseltine explained to us—about South Asia not having the kind of pandemic that the rest of the world is having at the moment. Pakistan has the same number of reported cases almost as India even though its population is one-sixth the size of India.

The first patient was reported on 26th of February. The one-thousandth patient came twenty-nine days later. But since then, you know, it reached for example the four-thousandth patient came only in the last three days. So the disease is definitely spreading.

The federal government of Imran Khan was not ready for it, was not interested in the beginning. It did not evacuate Pakistani tourists from Wuhan who kept saying to please evacuate us. Flights between China and Pakistan continued long after the rest of the world had suspended those flights.

And then Iran, which had the first big obvious outbreak, people from there, and especially pilgrims, were allowed to come in without any quarantine up until the 23rd of March. Only on the 23rd of March did the government actually act seriously and announced a number of measures, quarantining more than three thousand travelers from Iran, closing borders with neighboring countries, international travel restrictions, social distancing measures, lockdown of different scales across various provinces, and inviting the military to help the government in their measures to contain the spread of the virus.

The government’s measures have met resistance from religious groups that do not want any restrictions on religious observations and gatherings. But that has already had a serious consequence. The Tablighi Jamaat, which is an Islamic fundamentalist group, they had their annual gathering, and twenty thousand of them have had to be quarantined as a result. Pakistan’s health management does not have the capacity for dealing with these kinds of situations.

So what has been the impact? Well, first of all, of course there is a health emergency. The second is that the civil-military relationship, which has been very good under Imran Khan because he’s seen by the military as their prodigy and he looks upon the military as the people who actually put him into office, for the first time there’s tension between them. The military is making decisions now for the last few days which it’s quite obvious that they have just been conveyed to the prime minister rather than having been cleared with him. So there will be some consequence there.

The economy, which was already in bad shape, is likely to worsen. The Asian Development Bank has given its estimates. They had ultimately thought that 2020 Pakistan will have 4 percent growth. They think that it will be 2.3 to 2.6 percent. Considering that Pakistan’s population grows every year at 2 percent, that’s not much. And then another important thing is that despite all of this Pakistan is prioritizing its strategic relationship with China to caring for its own people or dealing with the pandemic. And it has become a center for conspiracy theories. Former Pakistani Ambassador to the U.N. Hussein Haroon, who many of you might know, has put out a video explaining how this virus was created by the British and the Americans and unleashed on the world. There are other conspiracy theorists who are active.

So once this pandemic goes away, all of that propaganda will still linger, and we will have a sort of very close to China but a very anti-Western Pakistani public. Lastly, there has been an increase in the unrest in Baluchistan because of the pandemic. Baluchistan has always felt that it was the most neglected Pakistani province. In this case Baluch doctors have protested that they haven’t been given any protective gear and have ended up in prison, some of them. And at the same time, the fact that many of the coronavirus carriers who are coming from Iran to Baluchistan, there has been a reaction in Baluchistan to that. Lastly, in terms of the—in terms of the performance of provincial governments, the government of Sindh, which is run by the opposition PPP, and the government of the Khyber Pakhtunkhwa province, which is run by the ruling PTI, have performed much better than the government of Punjab, which is the country’s largest province. And that is partly because of attitudes—the attitude of God will take care of us versus we have to do something about this pandemic.

BUSSEY: Fascinating. Thank you very much.

I’m going to spend a few minutes with a few questions of my own, and the audience should be formulating their own. I’ll be coming to you in about seven or eight, nine minutes. And we’ll instruct you on how to ask questions through the recording system. Dr. Haseltine, maybe I’ll start with you. In the United States, in Europe, in China, lockdowns have been the best prescription for reducing infection—really, the only prescription. Not much else you can do at this stage. In India—a pretty robust lockdown was announced in Pakistan. Imran Khan has said very tough to do here. Hard to imagine that the lockdown will be as effective in India as it has been in authoritarian China, or even in the United States. If the lockdowns aren’t working and people can’t socially distance, what are the alternatives for these two countries in dealing with COVID-19?

HASELTINE: Let me say, first of all, it’s a false dichotomy between democracy, dictatorship, and the effectiveness of lockdowns. New Zealand, Taiwan, and many other countries have very effective lockdowns, and they are functioning democracies. India is, of course, a special case. But it’s a special case in many ways that people wouldn’t imagine. For example, the Aadhaar system, the cashless electronic system. They have ways of contacting and paying their people which we don’t. They can reach each and every person’s bank account if they want to put money into it, which we have, and as you’re about to see, have great difficulties doing, even with our Social Security system.

The second thing I should say is India’s industry is fully activated. First of all, we’re familiar with this pharmaceutical industry and the power it has. But you may not be as familiar with the diagnostic industry. There’s over a hundred different companies currently in India making serology tests, which are scarce as hen’s teeth in the United States. So that there are things that they’re doing. Also, their bureaucracy, as cumbersome as it may seem, has swung into action in ways ours hasn’t even begun to do in terms of contract tracing. So there are benefits to having the kind of society that India is. It’s not entirely hopeless. Contact tracing is much more effective than lockdown if done properly. That’s how South Korea has controlled its epidemic. That’s how Taiwan has controlled its epidemic. It’s a very, very effective tool.

So it isn’t completely hopeless and lockdown is not the only tool. The best tool is contact tracing and forced quarantine for anybody who has been exposed; not tested—exposed.

BUSSEY: Alyssa, would you agree with that? Is that pretty much the way you see things?

AYRES: I mean, it’s almost an impossible policy choice, right, not knowing to what extent the threat of transmission really could exist. How fast could it move throughout a population?

I think a lot of the criticism you see happening now in India about the lockdown, it’s really focused on the economic duress and the hardship. And that is an inevitable outcome of a policy move like this.

My best understanding is that this is the decision the government took rather to act quickly and swiftly to prevent a far worse problem down the line.

There’s a quite well-known case on contact tracing in the state of Kerala. In fact, at a friend’s suggestion just a few days ago, I watched a film that’s been made about it called Virus, actually. And it takes a look at the way the state bureaucracy really swung into gear two years ago on the Nipah virus. And so they’ve got really strong systems in place for how to identify, create a grid structure, fan out, find everybody who has been part of the exposure of an individual, and really put people under surveillance and supervision to make sure that something doesn’t spread.

Of course, this is the federal. State—there’s different states across all of India, not all of which have these same systems in place to the same degree. So I think we will probably also start to see much more of a state variation. We already have, to some extent.

As numbers grow in India—which I hope they don’t grow, but it may happen—I think we’ll probably also see the strength of different state-level bureaucracies and their ability to carry out this kind of really detailed public-health work.

BUSSEY: Husain, there’s a—there are pieces of the Pakistani economy that relies upon remittances from migrant diasporas. How is that being affected by this? Is there a large loss of revenue?

HAQQANI: This is expected to be, for the simple reason that sort of people who work on daily wages in the Gulf, for example, will not get paid. And when they will not get paid, they will not be able to remit much money.

The professionals in the United States and in Europe will probably still continue to send some money. But that fear has been expressed, that there will be a turndown in remittances. And we can see that. We can see the fact that the Pakistani rupee has fallen significantly against the United States dollar in the last few weeks. Pakistan’s foreign-exchange reserves have dipped. Pakistan is already in negotiation with the IMF for another relief package.

But basically, Pakistan’s economy was not in a very good shape before the coronavirus hit us. And I think that it is going to be adversely impacted. The government has announced that Pakistan rupees 1,200 billion relief package, about 5 ½ billion dollars, for cash transfers to low-income families for procurement of meat, for health and food supplies, even for electricity payment relief. But the fact remains that none of that is going to help the underlying weakness of the economy, including the potential for diminished remittances.

BUSSEY: Alyssa, I want to make this my last question before we go to the audience questions. Alyssa, Husain mentioned the IMF. What sort of economic response from international aid organizations or international financial organizations like the IMF, like the World Bank, do you think that India is going to need to get its way through this? And is that already under discussion? Does India have an idea of the economic dislocation it’s going to seek to help fill by approaching the IMF and the World Bank?

AYRES: I would be surprised to see India approach the IMF. The Indian economy is quite large. They’ve been doing very well for a while. And I think my best understanding is that they’ll probably try to manage this using their own tools. To the extent that there are assistance packages that, for example USAID has recently offered I think 2.9 million. These are extremely small compared to the overall size of the economy, so they’re essentially, you know, catalytic efforts to try to help. They’re not systemic. I would frankly expect that India would look to manage this within their own economic system. I wouldn’t expect them to go to the IMF.

BUSSEY: OK.

Let’s go to questions. Brandon (sp), do you want to explain how to do that for the audience?

OPERATOR: Yes, sir. At this time we will open the floor for questions.

(Gives queuing instructions.)

The first question will come from the Council on Foreign Relations. Please go ahead with your question.

Q: This is—hello? This is Suhil Mitelhear (ph). May I ask a question?

OPERATOR: Go ahead, sir.

BUSSEY: Yes, please go ahead.

Q: Yeah, my question is to Dr. Haseltine. I come from India and, you know, the number there this evening was 5,100 with about 150 deaths. But as explained by Dr. Haseltine just now, the economic consequences, and therefore arising out of that the social consequences, could be extremely bad for our country if you want to keep the lockdown beyond the 14th of April. What would be the risk factor for India if they were to allow the young and able to take their chances and come back into work?

HASELTINE: The risk would be very high. The reason for that is the young and able could get infected and infect everybody else.

And the idea that the young and able are resistant to this infection turns out to be untrue. The majority of people, actually because of numbers, that are ill in most countries are under sixty. So I don’t know what you mean by young. The only class of human being that seems to be highly resistant to this are very young children, and even some children have died.

But a very large number of people between the ages of thirty and sixty-five have become very seriously ill, and many have died. Just look at our local paper today, the New York Post. I was looking at the ages of the people who have died, and there were many people between the ages of thirty and fifty. And so those people can serve as a nidus of infection and spread the infection enormously widely.

The first thing to do in the period that you have of seven days and possibly longer that you have in India is to get as many tests done as possible so you have a true idea of the magnitude and see whether or not it’s feasible to control it by what other countries have done, which is very rigorous contact tracing and absolute isolation—usually unique and solo isolation—for all those who have been exposed. And let me just say exposed, not tested positive, because the tests aren’t perfect. I hope that addresses your question.

OPERATOR: Thank you. The next question will come from Center for Arms Control and Non-Proliferation. Please go ahead with your question.

Q: This is Peter Galbraith.

I wanted to ask Ambassador Haqqani about sort of the political fallout in Pakistan. I was hearing from a friend in Karachi who is saying, well, the crackdown or the lockdown by the Sindh government isn’t really very operational there. Is that perhaps because Karachi is essentially ungovernable, and it would be more effective in the rest of Sindh Province?

And is this having any impact—of course elections are far away—but any impact on the relative standing of the political parties?

And if I may very quickly to Dr. Haseltine, is the BCG vaccine a reason that, as some people have suggested, that the effect of the virus might be less severe in South Asia—not the contagion, but how people endure it?

HAQQANI: Yeah, if I may go first, we really do not know the political impact fully. We’ll find that out a little later. Judging by sort of comments on social media and in the mainstream media, it seems that nobody’s satisfied with the performance of the prime minister and the federal government. It’s said the lockdown has been effective in most of the province. Karachi is definitely a problem city because it has very ethnic neighborhoods, areas controlled by various political groups, and ethnic groups, and militias.

So there has been a problem in some parts of Karachi, but by and large the lockdown has definitely helped manage the curve in Sindh. And everybody acknowledges that considering that the way that the contagion came, it was pilgrims from Iran, through Baluchistan, and into Sindh. And the government of Sindh acted first and started quarantining. And that’s how the first Pakistani case of coronavirus was actually discovered. So I think that the lockdown has been effective in part. However, Pakistan’s economy—in Pakistan’s economy, Karachi is very important. And so locking down Karachi has significant economic ramifications. It’s the biggest port, the biggest industrial city, and the main financial center. And so the lockdown has also had a paralyzing economic effect.

HASELTINE: Let me—let me respond to the question about BCG. In my opinion, that was one of the worst papers that I have had the pleasure to read. It was extremely poorly done. It was highly selective.

BUSSEY: Can I just—can I just jump in, just to remind—for viewers who don’t know what this is. If I’m not mistaken, this is a vaccine for—this is a treatment for tuberculosis, is that right?

HAQQANI: It’s a very ancient vaccine treatment that is not particularly effective to tuberculosis either. The method is for that. I mean, the claim was that populations that have been infected—have been vaccinated for BCG are more resistant to the coronavirus than those populations that haven’t been. I was saying, it’s a very, very poor paper. The methods were sloppy. They did not get down to any individual level whatsoever. It was selective in the way populations were picked and was by no means representative of the world population. And there is no theoretical basis whatsoever to imagine that it might work. I’m certain that if—you’re never certain in science—but reasonably sure that should that work be done properly you would find no effect. It is not something that any population should count upon. And it doesn’t take into account also the very different means of assessing the impact of the virus on the population. Some countries do it well and other countries do it poorly. And many of the countries that do it poorly are those in which the vaccine was widely distributed. And I could go on, but I won’t.

BUSSEY: Let’s go to our next question.

OPERATOR: Thank you. The next question will come from Muslim Marine (sp). Please go ahead with your question.

Q: Hello? Yes, just to switch gears a little bit, the Indian government claims that 30 percent of these coronavirus cases are linked to the Tablighi Jamaat. Is it fair or accurate to link the uptick in coronavirus cases to a Muslim organization? And will such statements by the government cultivate a further Islamophobic environment in India? Thank you.

BUSSEY: Alyssa.

AYRES: Is that for me? Yeah. Hi, glad you could join the call.

It seems clear, actually, that the Tablighi Jamaat gatherings, not just India but actually in Pakistan outside Lahore and an earlier one in Malaysia, have been occasions where, you know, large numbers of people, in the thousands, have come together, and they have created transmission. So that seems indisputable. What I do think this pandemic is surfacing is a lot of the kinds of discrimination that already exist find another vector, another way to express it.

So people who have been infected with the coronavirus as a result of being at the Tablighi Jamaat gathering, well, they’ve been tested. I mean, there’s just—since most of India has not been tested, there is no real accuracy of the denominator. We don’t really know exactly how many people have this, really. So it’s really a problem of statistical accuracy. And the whole universe just simply isn’t known. But it is the case that that gathering took place in Delhi, was a point of further transmission, and people who were part of that, this is now part of the contact tracing operation that many different state governments are trying to follow through.

But it is a concern. I mean, there’s now a quite robust conversation in India about what this means, and the ongoing discrimination against India’s Muslim minority, and the way that people are in—

BUSSEY: Did we lose Alyssa?

OPERATOR: I’m not sure what happened. Her line is—shows her connected, but I don’t hear a voice.

BUSSEY: OK. Alyssa, we seem to have lost you, so maybe would be good to dial back in. And why don’t we just go to the next question?

So I want to ask Ambassador Haqqani, that same question. How concerned are you that in the region—is that Alyssa back?

AYRES: Can you hear me?

BUSSEY: Yeah. Now we can hear you. Go ahead, sorry. We lost you for a minute.

AYRES: It was so strange. I was happily talking, and then all of a sudden you couldn’t hear me. What was the last thing that was audible?

BUSSEY: You were talking about the communal tensions that this was inflaming.

AYRES: Yeah. I just think that it’s really quite unfortunate that we are now seeing a scapegoating of a religion, in some cases—you know, you see the social media forwards—and it’s quite clear that this isn’t a problem of a religion. There are challenges of large gatherings happening around the world. So I don’t see why somebody would make that leap. But it is happening. And that’s something that I think we should all be concerned about.

BUSSEY: Good. Let’s take the next question.

OPERATOR: Thank you. The next question will come from the United States Marine Corps. If you would please go ahead with your question.

Q: Good afternoon. This is Bryceson Tenold.

And I was just wondering, once these states bring the transmission under control and begin lifting some of the broader mitigation measures, we do have a sense of how they’re going to proceed with reopening the economy and society while continuing to protect against COVID?

HASELTINE: I can take a crack at that. The answer to that, again, is testing, contact tracing, and quarantine. And China’s right now in the early stages of that. I just read an article just now, talked to friends in Wuhan. Wuhan’s—the quarantine has been lifted, and it’s now people are beginning to get out and about. However, the restrictions, and the testing, and the following of the people—are you, or are you a risk—has not been lifted. So you still must show your QR code. It has to be green if you’re going to travel. They are following very strict procedures. People who come in from outside the country are still quarantined for fourteen days. If you travel within the country there have been and there still may be quarantine restrictions.

So it’s a very slow process, but there are whole things that need to be done. Before you can begin to lift these, there has to be a period of at least fourteen, probably twenty-eight days of virtually no infection. You have to put in place really effective testing, contact tracing, and quarantine. Once you have those in place, you can begin to have people resuming normal life. But for some time, it’s going to be necessary to restrict large gatherings—theaters, sports events, et cetera. Those aren’t going to be in the cards for some time to come. I hope that helps.

BUSSEY: Dr. Haseltine, are you confident that the data that you’re getting out of China is accurate and that perhaps the authorities have just—you know, are doing their best on contact tracing but also have just accepted that a low level of infection and continued hospitalization and deaths from the disease is unavoidable if they wish to start up the economy?

HASELTINE: You know, I don’t think we have any reason to doubt the death statistics—the actual deaths from—that are known from this or the numbers of infections that you see out of China, which are now quite low.

There are reports, which are probably accurate, that there are far more deaths that have occurred that have actually been reported and those deaths are correlated with the COVID infection but not necessarily a consequence. Diabetics who can’t get insulin, people who have a coronary infarc who can’t get to the hospital or other reasons, and that’s happening in—it’s happening in Italy, it’s happening in Spain, and, in fact, the non-CO excess deaths—that are non-COVID-related—as a consequence of the COVID epidemic may be equal to the number that actually die of the infection.

And so there is doubt over the total number of dead. But I’m not—I do not personally doubt the ability to control the infection. It is going to linger. It will be there for some time. But the way to control that and keep it low is through what they are doing, is very serious monitoring of the disease and rapid action.

I mean, I have many personal—(inaudible)—we all do—who have friends in China of exactly how they do it, or Taiwan, or Singapore, or any other countries. We have very good details, really lots of details, of how they control the infection and it is truly impressive, and it’s not going to let up.

BUSSEY: I think there’s some debate over whether or not those are—infection rates and deaths have been significantly underreported. Let’s go to another question, though.

OPERATOR: Thank you. The next question will come from the Center for Strategic and International Studies in Washington, D.C. Please go ahead with your question.

Q: This is Ambassador Siddiqui. Good afternoon. It is very useful to have this information this afternoon.

So my question is to Dr. Haseltine. With the reports of low numbers both in India and (Pakistan ?), is it quite possible that these are underreported because they had pretty much the same start of the cycle when these travelers from Wuhan and other countries came into India and Pakistan?

HASELTINE: Of course it’s possible they’re underreported. It’s even likely. The question is by how much, and we don’t know. Is it a huge underreporting or is it somewhat underreported? I would sort of tend to think that it’s not a huge underreporting yet or you’d be seeing a lot of dead people in the streets, which so far don’t appear to—it doesn’t appear that it happened.

BUSSEY: OK. The next question.

OPERATOR: The next question will come from the University of Kansas Law School. Please go ahead with your question.

Q: Thank you. This is Raj Bahla from KU in Denton.

My question is about the Congress Party in India and what its reaction has been to the measures that Prime Minister Modi has taken to fight the virus. Have they said much? Have they been in opposition to his measures? Have they joined in a national crusade against the virus? What sort of—can we say about the Congress Party and its leadership amidst this crisis?

BUSSEY: Alyssa?

AYRES: Hi, Raj. Thank you. Yes. Actually, Sonia Gandhi wrote a letter to the prime minister today that had a number of points that she requested him to consider in the way that the Indian government is managing both the lockdown as well as the relief package. One of the points the congress and others in India have called for is the suspension of a new plan to redo India’s central government district. It’s a quite expensive idea to kind of consolidate all of the government buildings inside New Delhi under the rubric of a Central Vista. That’s what it’s being called. So she proposed suspending that for the time being. She’s not the only person who suggested this, but I thought that was interesting.

She also has proposed that the—this is getting quite weedy—that the new coronavirus relief fund that the prime minister set up, money that’s in that fund should be transferred to the regular PM’s national relief fund. I’d be happy to follow up separately with you and send a link to this letter if you’re interested in reading it.

It's interesting that we don’t see a lot of noise from the Congress Party on this, but I think there is a sense that this is a real time of crisis for India and that broadly people have to do something to prevent this from getting worse. And so many of the recommendations you see in this particular letter are really along the lines of here are the ways the Congress Party would recommend implementing in a different way.

BUSSEY: Go to our next question.

OPERATOR: Thank you. The next question will come from Cora Management. Please go ahead.

Q: Hi, Alyssa. You mentioned in India that there’s been a hundred thousand people tested so far. My question is, what is the policy on testing in India? And do you think it’s energetic, or do you sense that Delhi and the state governments might not want to know the true answer? Thank you.

AYRES: I don’t have any way to read the minds of state governments and the central government on the issue of testing. I think they just simply didn’t have enough tests earlier on, in the same way that we’ve had problems with testing in the United States. They have pretty rapidly looked to scale up the testing, and it went from, I guess in the course of a couple of weeks, from quite a low number of tests to now I think they’re doing ten thousand a day. And the last I read was that they were aiming to be doing on the order of twenty thousand tests a day and then continuing to ramp up.

They have enabled private labs to be able to conduct these tests themselves as well, so extending the reach of the public-health infrastructure beyond government and into the private sector. India has a quite good private-sector health-care system. So that’s another element of it.

But it does seem that they just didn’t have all the pieces in place much earlier on. These pieces weren’t in place in January. They’ve begun to focus on this kind of mid-February forward; part of what, as I said earlier, did seem to be a shift in thinking about this from a problem that was only external and coming from the outside and could be managed through kind of border surveillance to something that really was on the inside and would require a much deeper level of domestic engagement to tackle.

OPERATOR: Thank you. The next question—

BUSSEY: And our next question?

OPERATOR: —will come from the New York Times. Please go ahead with your question.

Q: Hi. This is Maria Abi-Habib from the New York Times. Thank you so much for having this conversation, because it’s really weird to be disconnected from our beats as journalists. We’re used to being able to meet people on the street all the time and, you know, yap it up with all of you in your offices, usually.

So, anyway, I wanted to ask a little bit about just South Asia, especially India and Bangladesh, and their wars, for lack of a better word, against extreme poverty, especially Bangladesh and to, you know, a lesser extent, India has really made, like, quite amazing inroads to—you know, to fight against extreme poverty and bring their masses kind of to—you know, to a little bit more prosperity; obviously not what we’re seeing in the West, but still.

How will this lockdown really impact the way that—the way that these governments have been able to—you know, their fight against extreme poverty? That’s what I’m curious to hear, and also just the prospect for social unrest, particularly in India.

AYRES: Is that for me? John, do you want me to try it or—

BUSSEY: It is indeed, yeah.

AYRES: Hi, Maria. I will give that a shot.

I mean, I think these are kind of the big unknown questions, right. I mean, this kind of an economic lockdown having such an impact on people whose livelihoods are entirely in the unorganized sector, it’s having quite a severe effect. So if you—if the survey data from CMIE is to be believed, unemployment has just shot up to almost 24 percent the last week of March. What we saw in the United States is the severe impact on the hospitality sector. And you know we’ve had these two waves of unemployment filings. The second was twice as large, if not greater than the first wave.

So it doesn’t suggest that the worst is behind us already. I mean, if I were an Indian policymaker, I would be lying awake at night. These are really difficult decisions to try to think about.

One of the ways the Indian success story on poverty came about was really through economic growth. And so not being able to maintain 8 percent or higher to be able to pull people of workforce age into jobs, provide livelihoods, I mean, if they don’t have the ability to do that, that creates other questions about social unrest, the kinds of questions that you just raised. So I think those are the kinds of things that people will be looking at not tomorrow but maybe two and three months down the line and will be cause for concern for any policymaker. That’s why I think a lot of the criticism of the lockdown, I mean, what do you choose? How do you make that choice if you’re faced with that kind of a policy question? And it’s just got to be a tremendously difficult thing to have to do. Do you try to go for the short-term economic pain thinking that this will stop, halt, transition, and save lives, even knowing that there will be economic hardship and it will impact your country’s ability to continue pulling people out of poverty? And that’s got to be just one of the kind of most difficult questions a leader would face.

On the social unrest, I simply don’t know. I mean, I think that’s something I’d have to watch pretty closely in the months ahead. And I would worry about that.

OPERATOR: Thank you. The next question will come from Voice of America. Please go ahead.

Q: Hi. This is Ancil Marapty (ph), Voice of America.

My question is—I mean, I have two questions. While talking to VOA about some of the steps that the government is taking to control the coronavirus spread, Minister for Healthcare of the Punjab Province Yasmin Rashid suggested that Pakistanis tend to have elevated immunity against the virus and they’re most exposed to, you know, diseases like flu yearlong—year-round, I mean three times a year. That’s what she said. What do you make of that suggestion, that maybe people in general in South Asia may have a better immunity against the virus?

The second question that I have is, India opened up some of its exports of hydroxychloroquine upon the demand by President Trump. Do you see India meeting its own domestic demand and while also catering to export demands, and then if that will generate some backlash within India from opposition since the extent of the virus spreading is only growing?

BUSSEY: Dr. Haseltine, maybe you can tackle that?

HASELTINE: I mean, yeah, the first question, is the population of Asia in general, Southeast Asia likely to be immune to this virus? Absolutely not. There is absolutely zero evidence. Quite the contrary. So don’t expect that anything that this population is privileged in its immunity.

Second thing, with respect to hydroxychloroquine, there is no empirical evidence that the drug has any effect whatsoever. It’s all anecdotal, and the studies that I’ve reviewed and looked at pretty carefully show that at very best it has a weak and most probably no effect whatsoever. So whether or not India keeps or exports its hydroxychloroquine will have no effect on either India nor the rest of the world.

BUSSEY: Let’s take another question.

OPERATOR: The next question will come from EconVue. Please, go ahead with your question.

Q: Hi, it’s Marsha Vande Berg in San Francisco.

Reflecting on the comment that was made earlier about the effectiveness of the use of technology by the government, I’m curious about the deployment of the private sector, the technology private sector in India, and then also if there’s been any effort to tap the considerable foreign presence in the technology sector. Could somebody please comment?

BUSSEY: Alyssa.

AYRES: On medical technology, I’m afraid I don’t know very much about that. I don’t know if Dr. Haseltine has had a little bit more interaction with the way people are deploying tech.

HASELTINE: You mean companies—

Q: Yeah. Excuse me, in the sense of medical as well as others.

HASELTINE: You know, it’s very hard to—(inaudible)—from question to give you a definitive answer or even any kind of an answer from this distance as to what the private-sector technology companies are doing. They do have enormous capabilities in communication, in creating various networks. I think you will see the private sector get involved, both the pharmaceutical sector—which is already involved—and the systems like GEO (ph) are going to get deeply involved in terms of creating apps that help. But I think that’s in the future. It isn’t present.

BUSSEY: Thanks. Our next question?

OPERATOR: The next question will come from Charney Research. Please go ahead with your question.

Q: Hello. This is Craig Charney from Charney Research.

My question is for Dr. Haseltine. You mentioned testing as the key to an opening up, but India has over a billion people. How can you test them all? If you can’t, who would you prioritize in order to get the economy going again? And how would you—how many people does this actually involve testing?

HASELTINE: Well, you know, size is a relative matter. You’ve got a lot of people who can do a lot of tests, so—and you’re got a lot of administrators and a lot of health people all over the country. So it’s—when you come to testing, it’s actually what is the effect regionally and more locally than it is across the entire country. That is the first thing to say.

The second thing is who do you prioritize to test. You test anybody with symptoms and then you do as thorough a job as you can of identifying everybody who has been exposed. You test those and you quarantine those. That’s how you control this infection. And it doesn’t matter what the size of your population is. China has done it and it’s got a size in population equal to that of India, so it can be done on very large populations.

BUSSEY: Let’s get one more question before we have to wrap up.

OPERATOR: Thank you.

(Gives queuing instructions.)

BUSSEY: Brandon (sp), are we out of questions?

OPERATOR: I’m showing there are no further questions, sir.

BUSSEY: OK, well, very good. Then I’m going to give two minutes back to our panelists and to our audience. Thank everybody for attending. Alyssa Ayres, Will Haseltine, and Hussain Haqqani, thank you so much for your comments. Thanks for the Council on Foreign Relations for putting on this program. It was fascinating. I learned a lot for sure. And thank you all who attended on the line. This concludes the conference call.

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