The toxic affair between Covaxin and The Lancet

That Covaxin has been leading a ceaselessly beleaguered life is no mystery – but The Lancet journal may not know that it has been pressed into the questionable service of saving the vaccine’s reputation on at least three occasions. In the latest one, for example, Bharat Biotech, some clueless media outlets and their hordes of followers, assisted ably by the aptly named bhakts of India’s ruling party, have been hollering from rooftops high and low that The Lancet ‘has said’ Covaxin is 77.8% efficacious. Background: The Lancet medical journal has published the paper describing Covaxin’s phase 3 trial results. But to Covaxin’s misfortune, these people appear to be assuming, as they have many times before, that a journal publishing a paper is by all means synonymous to the journal itself speaking for, even endorsing, the paper’s contents.

If you didn’t know better, you’d think The Lancet had pooled together all the evidence, comments and documents pertaining to Covaxin and pronounced its own verdict about the shot’s reputation. But because you know better, you know that a journal’s editors, and peer-reviewers if they were involved, only checked if the submitted paper’s data is consistent with the submitted paper’s statements and conclusions, and that it was free of research misconduct (although I’m wholly pessimistic about the latter).

The problem is that the number of people who know better appears to be vanishingly small – so small, in fact, that it didn’t strike me until earlier this year that both clinical trials and scientific publishing involve the sort of specialised education that most people, including (seemingly) all engineers and exponents of many other fields of science, peeled away from many decades ago (depending on how old they are). Even what constitutes publishing or the qualitative differences between good and great papers varies from one specialisation to the next.

As a result, when Bharat Biotech’s people cheer that The Lancet has ‘held up’ their findings, there’s both very few people to call out their bullshit – the journal published their paper, and didn’t wave a flag for them – and they’re met more often than you’d think with resistance from both Bharat Biotech’s and other scientists, typically because of vested interests. In fact, vested interest, singular: by publishing a paper in a journal, many scientists seek to partake of the journal’s prestige. Call this a nuanced take, but it has significant real-world effects, as we’re seeing with the strange but certainly myopic ways in which Bharat Biotech has sought to defend Covaxin (including, in the latest instance, by undermining the WHO’s approval for it).

Of course, The Lancet itself, together with some other journals, including the New England Journal of Medicine, the Journal of the American Medical Association and Cell, has actively cultivated this notion of ‘prestige’ to pad its pockets as well as to passively silence questions about the many problematic papers it has published. Journals engaging in such practices together with the scientists who fall for them have thus contributed in a significant way to the idea that ‘prestige journals’ are in effect ‘prestige conferrers’, so perhaps The Lancet deserves its fate. But the many less- or entirely ill-informed people out there don’t, especially when they start to believe, “The Lancet has said Covaxin is safe, so it must be safe.”

Medical journals, including The Lancet and the New England Journal of Medicine, have expressed opposition to the idea of releasing medical research papers as preprints, contending that unlike potentially incomplete papers on other topics, the ones they receive could cost lives if they’re published without independent checks first. An entirely reasonable argument. So what happens when The Lancet or the New England Journal of Medicine publish good papers about a vaccine that’s flawed in other ways, and whose authors then piggyback on the journals’ self-proclaimed superiority to toot their own horns, even as the journals all know that they’ve only checked the papers, not anything else? Apart from all the other problems with the notion of a journal’s isolated excellence, it’s ridiculous that journals accrue it the same way they’ve been accruing their profits: with no socially meaningful contribution of their own.