The writer, Morgan Stanley Investment Management’s chief global strategist, is author of ‘The Ten Rules of Successful Nations’

Over the past month, even as the pandemic raged, nearly 150m Indians voted in five state elections. The ruling Bharatiya Janata party wanted to draw out the voting in multiple phases so that prime minister Narendra Modi could appear as widely as possible. He made more than two dozen personal appearances in the key battleground of West Bengal alone.

Rarely has a party tried harder to take over a single state’s government. The BJP mobilised its vast political machine with a lavishly funded army of cadres. Yet, when the final tally was announced on Sunday, it had failed to dislodge West Bengal’s chief minister Mamata Banerjee. In the later phases of balloting, the BJP lost momentum as the virus spiralled out of control, showing Modi’s government was way behind the curve.

Over the past six weeks, India has suffered one of the biggest surges of Covid-19 any country has seen, with cases rising by around twelvefold, according to official figures. The real numbers are probably many times worse. A crisis of this magnitude would stress even the world’s best healthcare system. In India, it has exposed a pre-existing frailty — a broken state.

A few developed countries, such as France and Italy, also suffered rapid case surges during their later waves of the pandemic. Even so, they managed to lower death rates from the first wave as their health systems had readied for the shock. In India, by contrast, the second wave has brought with it scenes of devastation reminiscent of the dark ages.

When I watch video clips of overwhelmed hospitals blocking their gates and leaving desperate patients to die, I am haunted by thoughts of my grandfather. He died of a heart attack under similar circumstances, turned away from a public hospital where there was no doctor on night duty and an orderly tried but failed to install a pacemaker. But that was in 1993. India’s underlying tragedy is how little progress has been made since.

Among the world’s 25 biggest emerging markets, India ranks last for the number of hospital beds per 1,000 citizens, fifth from last for doctors, and fourth last for nurses and midwives. Even if you drop richer emerging markets and compare India to other large countries with average per capita incomes of between $1,000 and $5,000 — which includes Pakistan and Bangladesh — India still looks mediocre on these basic healthcare measures.

Government spending generally rises as a share of the economy as countries grow richer. Indeed, India spends about as much as a typical nation in its income class, about 30 per cent of gross domestic product. So the problem is not the size of India’s state, but how it spends.

When Modi came to power in 2014, he mocked the welfare populism of his predecessors. Yet within a few years he was vying with them in his promises of generous freebies, from gas to food or houses. Today, welfare spending accounts for 9 per cent of GDP — far higher than the miracle economies India would like to emulate, like South Korea and Taiwan, when they were at similar levels of development.

Modi has, meanwhile, done little to modernise India’s state, which in many ways still operates in ways that hark back to British rule. The model for many state agencies dates to the late 1800s, the healthcare system to the 1940s. In past elections, I’ve travelled thousands of miles on India’s back roads and seen too many understaffed public health clinics — operating rooms without surgeons, X-ray machines without radiologists — to be surprised they have now faltered.

Modi promised “maximum governance.” But rather than reform India’s outdated state, he has centralised power like no other leader in India’s democratic history. He set himself up as the nation’s saviour, who would solve its every problem. But even a Formula 1 driver cannot make much progress in an Ambassador, the old Indian-made jalopy. The reality is that the BJP can no longer claim to offer a superior model of governance. This shortcoming is now starting to show in the polls.

The good news is that private groups, as so often, have rushed in during this pandemic to provide what the government does not. Expats are sending money and medical resources from abroad. Residential associations provide whatever they can to ailing neighbours. So far, the Indian stock market has barely flinched over the rising death toll. This is probably due to a collective intuition that India will survive this crisis too — but that will not be thanks to its leader or the broken state.

​Letter in response to this article:​

​Private capital alone can’t mend Modi’s broken state / From Sanjay Ruparelia, Jarislowsky Democracy Chair, Ryerson University, Toronto, ON, Canada