The Invisible Pandemic

 AIR POLLUTION ISN’T just India’s most pervasive environmental toxin, it’s the country’s deadliest con­tinuing pandemic. Last month’s State of Global Air 2025 report estimated that it kills roughly two mil­lion Indians annually, more than Covid-19 has since its very first victim five years ago and inflicts chronic illness and disability on millions more. Yet, it is treated as casually as a seasonal cold, with Indians shrugging it off like seasonal smog. Even among the educated and aware, few truly grasp the scale of the crisis or the full burden of non-communicable diseases this nearly invisible killer triggers—heart disease, stroke, cancer, diabetes, and more. As Dr Maria Neira of the World Health Organization (WHO) points out, there are over 72,000 scientific studies linking air pollution to human health harm. Despite this body of knowledge, India still hasn’t declared it a public health emergency.

Nearly 99 per cent of India breathes air that has particulate mat­ter higher than the World Health Organization’s annual average recommended limits of PM2.5 of five micrograms per cubic metre. Much of the health harm is irreversible. Despite levels that breach WHO limits all year round, pollution and its attendant health harm receive maximum attention in hazardous winter months only— and even in those months, it has never been declared a national health emergency.

One of the critical pivots we need to make in our approach to solving this problem is to look at air pollution through the lens of health and not just treat it as an environmental issue. The problem lies in its origins. India’s Air (Prevention and Control of Pollution) Act, 1981 (APCP Act) is inherently flawed in that it does not include explicit or direct references to any “health” outcomes (illness, dis­ease burden, or life-expectancy reduction) as primary objectives. Instead, its wording focuses on air quality and pollution control generally. For instance, it defines an “air pollutant” as any substance in the atmosphere in such concentration as may be “injurious to human beings or other living creatures or plants or property or environment”.

In all these years, there has been just one credible government document generated by the Union Ministry of Health and Family Welfare through a steering committee that has given human health the place it deserves in tackling air pollution. The “Report of the Steering Committee on Air Pollution and Health Related Issues”, co-chaired by distinguished scientists of the Public Health Foundation of India and the Indian Institute of Technology, which put health in front and centre of air pollution, was instead quietly buried, leaving the work of an array of brilliant scientists laid to waste.

In order to sidestep the whataboutery that emerges the instant one talks about source apportionment, different lobbies always find the ‘other’ to blame when it comes to enforcing emissions control. What is needed is an even-handed position on every single contributor to air pollution—from the low-hanging, only-for-enter­tainment firecracker smoke to the political tinderbox of farm fires or the more justifiable biomass burning by the poor for cooking and heating or vehicular emissions from transport. Every single source needs emission controls at the source. At best, one could calibrate the controls based on how essential the end-uses those emissions served were. China, the most recent country to sharply reduce its pollution footprint, didn’t even spare coal emissions in its colder regions, which were keeping its citizens from the bitter cold.

The only effective way to reduce air pollution is to cut emissions at source. Smog towers, smog guns sprinkling already scarce water, and cloud seeding by adding chemicals to precipitate rain—these are all optics and no government should be wasting public money on them. However, before refocusing on reframing the problem and restating solutions (which, at one level, are as straightforward as strictly and even-handedly enforcing emission controls across all three sectors of the economy—agriculture, industry, and services), let’s first analyse the true human cost of air pollution.

For that, first, we need to get a few things straight. There are no safe levels of air pollution. Experts speak in one voice when they say this, whether it is the World Health Organization, the National Institutes of Health, the American Journal of Respiratory and Critical Care Medicine, or others. Current episodic hazardous pol­lution levels caused by ‘green-washed’ Deepavali firecrackers and downwind smoke from crop stubble burning dramati­cally increased visits to hospital emergency rooms, but even relatively lower pollution levels activate disease, disability and death.

Second, and equally important: air pollu­tion is not a seasonal problem. It is an invis­ible, year-round problem across India that becomes only more visible in the winter. The country’s pollution load is usually 10 times higher on average than the WHO guidelines all year through. It is just insanely almost 50 times higher in the winter months in North India, attracting international headlines and increased media attention. However, that doesn’t alter the fact that year-round pol­lution levels are also high. Unfortunately, these levels have been normalised by over a billion people torn between helplessness, resignation and apathy.

Third, almost all of India breathes polluted air, not just northern India or Delhi, though these regions remain the most severely af­fected. The Indo-Gangetic Plain alone is home to about 40 per cent of the country’s population, meaning over 500 million people are exposed to dangerously polluted air and are falling ill simply by breathing. Yet, Mumbai has demonstrated for three consecutive years that it can surpass Delhi’s AQI levels, as it did even a month before Deepavali in 2023.

As for southern India, its geography (higher altitude) and weath­er patterns (frequent rain and wind) usually help disperse or wash away particulate matter. However, in September 2023, Bengaluru had the dubious distinction of topping the State of Global Air list of cities with the highest nitrogen oxide (NOx) pollution, followed by its neighbour, Hyderabad. NOx exacerbates respiratory diseases, and a recent AIIMS study found it can lead to an increase in the number of emergency room visits by 53 per cent.

Another coastal city, Chennai, in the south has had its moments, with its AQI crossing Delhi levels too. It’s not just cities that are chok­ing: research reveals that pollution is rising even faster in southern and eastern India, and in rural areas, where smoke from burning biomass for cooking and heating already contributes almost 30 per cent of outdoor air pollution.

Now that we’ve established that most of India—not just Delhi or the north—breathes toxic air year-round, and that this silent killer claims more lives each year than Covid ever did, let’s examine why public messaging has failed to warn people, especially when the government definitively proved during the pandemic that it could communicate effectively.

Air pollution doesn’t just harm the human respiratory system, it damages every organ in the human body, especially the heart. Peer-reviewed journal Neurology’s September issue published re­search that showed a strong and significant correlation between air pollutants and death from strokes. In fact, Bengaluru has the youngest population of heart patients. The city’s Jayadeva Institute of Cardiovascular Sciences and Research treated 2,200 heart attacks of patients under 40 in two years, the youngest being 16 years old. These were mostly software professionals and auto/cab drivers who spent longer than an hour in traffic. But is 16 any age to have a heart attack triggered by just the involun­tary act of breathing?

None of this harm is short term— breathing dirty air causes long-term, irre­versible damage. You can stop the damage from getting worse once you begin breath­ing clean air—just as quitting smoking prevents further harm— but you can’t undo what’s already been done. Those microscopic PM2.5 particles that you’re inhaling right now will remain in your body until you die. The University of Chicago’s Air Quality of Life In­dex tool calculates just how deadly pollution is: if Delhi met WHO air quality limits, its residents would live 8.2 years longer. For the average Indian life expectancy, that would mean 3.5 more years.

During the pandemic, there was hardly anyone left in the coun­try who didn’t know about Covid-19 and how quickly it can kill. But ask the average Indian today about the irreversible health harm breathing dirty air catalyses, and you’ll likely be met with an indif­ferent shrug unless it is the North Indian winter when PM2.5 makes itself visible like a grey shroud of death.

And let me not even get started about how air pollution is a so­cial inequity, not an elitist conspiracy meant to distract from “real” problems. It is the most real, most critical of all issues, the biggest social injustice of our time and the most urgent crisis we face.

So the next time you’re sitting at home with your air purifier humming, think of the waste picker or daily-wage construction worker who can’t afford to skip a day’s work on a smog-filled morning. Think of the traffic cop breathing exhaust for hours, or the autorickshaw driver forced to choose between his lungs and his livelihood. These are the people with the least protection, the least healthcare, and often, the least food on their plates, so already malnourished and more prone to illness. Clean air shouldn’t be a privilege. It should be a right.

And yet, we continue to treat it like a luxury, something to worry about only when the AQI turns “severe” or when Delhi makes head­lines. The truth is the crisis is everywhere, every day, and the cost of our indifference is being paid by those with the fewest choices.

This should convince those who put up the bogey of elitism to divide a nation along air pollution lines—another piece of messag­ing that needs calling out—and make the underprivileged aware enough to ask for their fundamental right to clean air for better health. Hiding the problem behind complex or incomplete data (or no data)—weak messaging is bad enough—but hiding it from the less-educated, less privileged, and more affected is unforgivable.

What is even worse is encouraging exposure to this toxin, which both corporates and governments are doing by allowing and often sponsoring outdoor events. Whether it is marathons, cricket matches or even concerts that are held in hazardous win­ter months, permissions for all these should be linked to the levels of AQI. Even the Supreme Court unwisely allowed the bursting of green(washed) crackers during a time when the Graded Re­sponse Action Plan (GRAP) restrictions were in place. Today, due to a lack of credible data, the Commission for Air Quality Manage­ment (CAQM) doesn’t even know when to impose stricter GRAP restrictions.

The Supreme Court on Monday, November 3, pulled up authori­ties over Delhi’s worsening air quality, directing CAQM to submit a status report. A Bench of Chief Justice BR Gavai and Justice K Vinod Chandran issued the order after learning that most of the city’s air quality monitoring stations were shut during Deepavali, precisely when pollution levels peak. Amicus curiae Aparajita Singh urged the court to seek answers from CAQM, noting that “out of 37 moni­toring systems in Delhi, only nine were functioning during Diwali”.

THERE IS A difference between reducing emissions and reducing exposure to emissions. Reducing emissions is the only way to reduce pollution. But while governments work towards reducing pollution, it is their critical responsibil­ity to reduce exposure to dirty air and protect their citizens. At the current high levels of pollution, we should be in lockdown mode—the very least being that schools should have gone online (even though that too only helps higher-income families whose children have access to cleaner-air homes and the technology needed to go online), yet our CAQM doesn’t know when to im­pose stricter GRAP restrictions.

Real emission reduction has quietly taken a back seat. The government’s July dilution of sulphur dioxide norms (SO2) for coal-fired thermal power plants—conveniently timed for a “clean” month when the skies were almost blue—has sparked deep concern about the future of India’s clean air regulation and environmental credibility.

When first introduced in 2015, India’s SO2 emission standards were among the toughest in the developing world. They required all coal-fired power plants to install flue gas desulphurisation (FGD) systems—equipment that captures sulphur emissions at their source, preventing acid rain and reducing particulate pollution. It was one of the few measures that directly attacked the problem rather than just treating its symptoms.

But after nearly a decade of extensions, missed deadlines, and industry pushback, the Ministry of Environment, Forest and Cli­mate Change (MoEFCC) finally caved. The July 2025 amendment effectively exempts most of India’s thermal power capacity from FGD compliance, replacing a universal mandate with a watered-down, category-based system.

The rollback also lays bare an ongoing turf war within the gov­ernment itself: the environment ministry, tasked with the “preven­tion and control of pollution”, versus the power ministry, eager to protect profits and avoid the costs of installing FGDs. It’s a battle where short-term economics trumps long-term public health—a familiar story in India’s environmental governance. Once again, private profit wins while public health loses. One arm of govern­ment encourages higher emissions; another tries, in vain, to clean up the mess.

India’s air crisis cannot be solved through ad-hoc orders or re­active fire-fighting. What the country needs is sustained political will, transparent monitoring, and an unequivocal public-health approach that treats clean air as a fundamental right, not a season­al inconvenience. Until accountability moves from courtrooms to policy rooms, India’s citizens will keep gasping, literally, for governance.

In 2019, this writer and her non-profit had asked for a “Clean Air Boss” to solve this national health crisis, a demand supported by several other clean air advocates on television and social media. Six years later, this has been echoed by the WHO Chief Scientist Dr Soumya Swaminathan who, in an interview with the same non-profit’s governing board member, has said that India needs a strong, independent regulatory body, like the Reserve Bank of India or the Food Safety and Standards Authority of India.

Even as I write this, protest is brewing, and when the next dip in temperatures and wind speed worsens North India’s pollution further, we are going to see activists, clean air advocates and the aam aadmi and bharatiya janata out on the streets. Past protests were more an expression of anger and helpless rage and didn’t get the kind of traction needed to drive change for several reasons, including the absence of a clear demand. But the time isn’t far when the public will be able to better articulate their demands and pressure the political class and bureaucracy to solve this problem. Whether the government has the wisdom to take this seriously or not remains to be seen.