On December 19, 2020, India joined the United States in having more than ten million Covid 19 cases. To put things in perspective, the number of global cases crossed that number by June end. Barely 5 months later, the United States had the same number of cases as the world had in June. About 40 days later, India too crossed the grim milestone.

As nations, India and the United States are worlds apart. India is three times smaller than the US but has three times its population. Its economy in terms of (nominal) GDP is almost 10 times smaller. Its health infrastructure lags far behind that of the US. It has fewer doctors, its expenditure on health (2017) is five times less, its health system is far less robust, and its investment in health research and innovation is no match to that of the United States.

By any stretch, India should be doing worse than the US. That is not so. With only 4 percent of the global population, the US has over 25 percent of the world’s confirmed Covid-19 cases and about 20 percent of deaths. India, on the other hand, has about 11 percent of cases and 7 percent of Covid deaths. Even the number of critical patients due to Covid in India is three times less.

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How does one explain such discrepancy?

Not by inconsistencies in data alone. Some people have rightly pointed out irregularities in how India measures its numbers and what it misses while recording Covid cases and deaths. India’s death registration system is indeed not current or very reliable. It may show gaps, but it cannot miss by a mile. There are just too many eyes to catch glaring errors.

It will be good to recall the dire predictions international experts made about India. In the beginning, many mathematical forecasts estimated that millions would die because of poor health infrastructure, crowded cities, and the poor nutritional status of half its people. That was not to be.

Back then, it made sense to a lot of ordinary folks. We now know that the predictions have been way off the mark. India hasn’t done as bad as was made out and the United States is worse off. For every nine persons that have died because of Covid in the US, India has lost one (you could double that number if you contest that India’s death registration system isn’t accurate or up-to-date). India started almost lazily with the tests but soon ramped up its facilities. Even then, the total number of tests it has carried out per million population is almost six times lesser than the USA.

If economic heft and health resources do not account for any significant difference in Covid performance between the two countries then perhaps management does.

At the level of the government, both countries manage health primarily at a decentralised level. In the US, the mayors and governors enjoy considerable autonomy. This was carried to an extreme level during Covid-19 when each state placed orders on Chinese manufacturers for the supply of much-needed equipment such as ventilators. The lack of coordination mechanism between different states led to offshore manufacturers increasing prices with each subsequent order and the states needing such equipment most not getting it on time. New York governor Andrew Cuomo bemoaned such practice and asked the federal government to intervene.

The health crisis in the US predates the arrival of Covid. The election of a Republican president embroiled public health in the political mire. President Trump’s aversion to his predecessor’s Affordable Care Act (Obamacare) was only the tip of the iceberg. What he did for the vaccination program in the country came to haunt his government later. He disbanded the global health security office at the National Security Council and the National Vaccine Program Office. His ideology aimed to cut taxes and reduce the bureaucratic bloat. All this set the nation behind the eight balls as far as Coronavirus was concerned.

India, on the other hand, did not disband the colonial Epidemic Diseases Act of 1897. During the pandemic, the Act allowed the states and Union Territories to invoke its provision (section 2) that made Health Ministry advisories enforceable. Despite differences of opinion, the centre and the state worked together to tackle Covid-19.

The greatest difference between the two countries lies in the way the political leadership reacted to the pandemic. In the US, the political class and the people were deeply divided on the course the country should adopt to deal with Covid-19. President Trump disputed the science around Covid. He ran down public health experts, scientists, and physicians, refused to promote facemasks and persisted with the demand to reopen schools and the economy.

On the other hand, the Indian Prime Minister Modi was consistent in his messaging, as was his government. He not only promoted but also enacted Covid appropriate behaviours (CAB).

Not everything the US president did was faulty and not everything that the Indian prime minister did went according to plan. But the difference showed up in the 40 days that India took to catch up with the US number. It also shows in India’s declining daily case count and the US’ struggle with record highs.

Pradeep Krishnatray is former director, Research and Strategic Planning, Johns Hopkins Center for Communication Programs, New Delhi