Estimating vulnerability to COVID-19 in India
Authors: Rockli Kim, S V Subramanian
Journal: The Lancet Global Health (2020)

In the ongoing COVID-19 pandemic, timely and best available data surveillance is crucial to guide policy decisions. Rajib Acharya and Akash Porwal (September, 2020)1Acharya R Porwal A A vulnerability index for the management of and response to the COVID-19 epidemic in India: an ecological study.Lancet Glob Health. 2020; 8: e1142-e1151Summary Full Text Full Text PDF PubMed Scopus (122) Google Scholar exemplify this by developing a vulnerability index based on socioeconomic, demographic, housing and hygiene, epidemiological, and health system characteristics across states and districts in India. Such exercises can help decision makers identify priority areas for the purpose of resource allocation and designing containment and mitigation strategies. With this motivation, we compliment the recently published district vulnerability index by extending to 543 parliamentary constituencies in India. These constituencies are political units represented by members of parliament (MPs) who are directly elected by people and are responsible for implementing their constituents' vision through legislation. Despite their salience and influence, low political engagement or will is an oft-repeated explanation for absence of progress on diverse issues. Among other reasons, low political engagement might stem from the scarcity of readily available data on population health and development at the unit of parliamentary constituency.2Kim R Swaminathan A Kumar R et al.Estimating the burden of child malnutrition across parliamentary constituencies in India: a methodological comparison.SSM Popul Health. 2019; 7100375Crossref PubMed Scopus (10) Google Scholar Consider Madhya Pradesh—the state with the highest overall vulnerability score1Acharya R Porwal A A vulnerability index for the management of and response to the COVID-19 epidemic in India: an ecological study.Lancet Glob Health. 2020; 8: e1142-e1151Summary Full Text Full Text PDF PubMed Scopus (122) Google Scholar—which is composed of 29 constituencies and 50 districts. With the exception of four constituencies, the remaining ones are all made up of segments from multiple districts (appendix p 2). Across all the 543 parliamentary constituencies and 640 districts in India, only 28 share identical geographic boundaries (appendix p 3). Such misalignments between administrative and local political or electoral boundaries are also present in other countries, including the USA.3Rolheiser LA Cordes J Subramanian SV Opioid prescribing rates by congressional districts, United States, 2016.Am J Public Health. 2018; 108: 1214-1219Crossref PubMed Scopus (19) Google Scholar Consequently, district-level data alone do not accurately reflect the status of a parliamentary constituency and are insufficient to engage both the constituents as well as their elected representatives in an informed manner. Using a published data science solution based on geographical information systems,4Swaminathan A Kim R Xu Y et al.Burden of child malnutrition in India: a view from parliamentary constituencies. Economic & Political Weekly, MumbaiJan 12, 2019https://www.epw.in/journal/2019/2/special-articles/burden-child-malnutrition-india.htmlDate accessed: October 5, 2020Google Scholar, 5Blossom JC Swaminathan A Joe W Kim R Subramanian SV Robust parliamentary constituency estimates. Economic & Political Weekly, MumbaiMay 11, 2019https://www.epw.in/journal/2019/19/discussion/robust-parliamentary-constituency-estimates.htmlDate accessed: October 5, 2020Google Scholar we present a domain-specific and overall vulnerability index1Acharya R Porwal A A vulnerability index for the management of and response to the COVID-19 epidemic in India: an ecological study.Lancet Glob Health. 2020; 8: e1142-e1151Summary Full Text Full Text PDF PubMed Scopus (122) Google Scholar for the 543 parliamentary constituencies as a data resource for MPs and their constituents (appendix p 4). The parliamentary constituencies of Darbhanga, Samastipur, Ujiapur, Saran, Hajipur, and Khagaria (from Bihar) and Sitapur, Barabanki, and Hardoi (from Uttar Pradesh) had some of the highest overall vulnerability scores (>0·980). Worldwide, the COVID-19 pandemic has starkly exemplified the adverse and costly consequences of divergence between administrative and political stakeholders. Data and evidence can play a crucial role in forging better links in a meaningful and accountable manner. It will be a missed opportunity to not think more broadly of mechanisms to bring political engagement, commitment, and accountability into public policy deliberations for all policies that affect the health and wellbeing of populations. We declare no competing interests. This research was funded by Bill & Melinda Gates Foundation (INV-002992). Download .pdf (.93 MB) Help with pdf files Supplementary appendix Estimating vulnerability to COVID-19 in IndiaRajib Acharya and Akash Porwal1 calculate a composite COVID-19 community vulnerability index at the state and district level in India. The index is based on a set of 15 indicators across five domains that contribute to vulnerability or the consequences of COVID-19 disease in the population. Full-Text PDF Open AccessEstimating vulnerability to COVID-19 in IndiaIn their ecological study, Rajib Acharya and Akash Porwal1 measure the vulnerability of India to COVID-19 in five main areas: socioeconomic, demographic, housing and hygiene, availability of health care, and epidemiological conditions. The authors examined the five dimensions and 15 indicators of vulnerability for all the districts and states of India separately, which can contribute to mitigating the ongoing pandemic. However, the study has some shortcomings. Full-Text PDF Open AccessEstimating vulnerability to COVID-19 in India – Authors' replyWe express our sincere thanks to several colleagues who took interest in our Article on a vulnerability index for management of COVID-19 in India1 and provided valuable feedback. We will address the comments in a collective way, not individually. Full-Text PDF Open AccessA vulnerability index for the management of and response to the COVID-19 epidemic in India: an ecological studyThe vulnerability index presented in this paper identified a number of vulnerable districts in India, which currently do not have large numbers of COVID-19 cases but could be strongly impacted by the epidemic. Our index aims to help planners and policy makers effectively prioritise regions for resource allocation and adopt risk mitigation strategies for better preparedness and responses to the COVID-19 epidemic. Full-Text PDF Open Access