Vaccines for votes

A week or so ago, the Bharatiya Janata Party in Bihar released its poll manifesto, the first point on which was that should the party win, it would make a COVID-19 vaccine cleared by the ICMR available for free to every resident of the state. It was an unethical move, and Siddharth Varadarajan and I explained why.

Soon after, trolls on Twitter pointed out that Joe Biden had made the same promise ahead of the US presidential elections. And this morning, Indian Express quoted the Election Commission saying the BJP’s promise didn’t violate the poll code; the report also included a curious paragraph: that “the EC had taken the same stand on a complaint received during the Lok Sabha elections last year against the Congress’s NYAY scheme that guaranteed a minimum income of Rs 6,000 per month, or Rs 72,000 a year, for 25 crore people.”

The BJP’s promise still feels unethical to me. This isn’t for reasons that have anything to do with the poll code if only because the poll code’s scope doesn’t extend beyond the election itself, to the bigger picture.

At the outset, I don’t think vaccines should feature at all in election rhetoric (even if this may be wishful thinking with a majoritarian-populist government). But here we are.

The BJP is in power at the Centre – it runs the national government – and is hoping to come to power in the state. It isn’t necessarily including Nitish Kumar, the state’s incumbent chief minister and whose party the BJP is allied with, because the vaccine promise appeared only in the BJP’s manifesto, not in the alliance’s, and was announced with much fanfare by the Union finance minister. So Kumar was nowhere in the picture but the Centre was. This is a slight but significant difference vis-à-vis Biden’s promise.

State is a health subject in India but a COVID-19 vaccine, should one become available, will have significant participation by the Centre, from purchasing to distribution. Note that India’s states didn’t fight polio – they simply couldn’t. The country has a whole did and today COVID-19 presents an even bigger challenge.

A new study, echoing some older ones, has found that antibodies to COVID-19 fade over a few months. Assuming for a moment that vaccine-induced antibodies work like natural antibodies, and setting aside the fact that the question of antibody persistence is yet to be settled, access to vaccines (including the question of affordability) matters as much as its uniformity. That is, the level of access should be uniform across the epidemic’s ‘jurisdiction’.

For example, if a state with poor pubic health care and infrastructure to begin with is forced to administer the vaccine by itself, failures on its part could allow the virus to become endemic to that region, and allow it spread once again through the rest of the population once their antibody responses have weakened. So an additional pitfall here is if the BJP fragments the responsibility of distributing and administering a COVID-19 vaccine to the states, in an effort to legitimise piecemeal agreements based on political expediency, the vaccination drive will fail, especially in states like Bihar.

So while state governments will be able to decide whether to sell the vaccines for free, the decision depends considerably on the Centre’s cooperation. In effect, the BJP at the Centre abdicates the option to ensure everyone gets the vaccine at no cost when it offers to do so only in a specific area, and in exchange for votes.

Biden is not entirely in the clear either: ‘vaccines for votes’ is a prompt for voters to think of their choice of president as a question of life or death, which is nothing but a dire threat. But neither his case nor that of the Congress’s NYAY scheme are ones of abdicated responsibilities. Neither is yet in power in their respective countries, so neither is pulling back on their existing responsibilities, making their exercise contingent on electoral outcomes or vouchsafing the rewards to – from the epidemic’s PoV – an arbitrary section of the population.

Pandemic: A world-building exercise

First, there was light news of a vaccine against COVID-19 nearing the end of its phase 3 clinical trials with very promising results, accompanied with breezy speculations (often tied to the stock prices of a certain drug-maker) about how it’s going to end the pandemic in six months.

An Indian disease-transmission modeller – of the sort who often purport to be value-free ‘quants’ interested in solving mathematical puzzles that don’t impinge on the real world – reads about the vaccine and begins to tweak his models accordingly. Soon, he has a projection that shines bright in the dense gloom of bad news.

One day, as the world is surely hurtling towards a functional vaccine, it becomes known that some of the world’s richest countries – representing an eighth of the planet’s human population – have secreted more than half of the world’s supply of the vaccine.

Then, a poll finds that over half of all Americans wouldn’t trust a COVID-19 vaccine when it becomes available. The poll hasn’t been conducted in other countries.

A glut of companies around the world have invested heavily in various COVID-19 vaccine candidates, even as the latter are yet to complete phase 3 clinical trials. Should a candidate not clear its trial, a corresponding company could lose its investment without insurance or some form of underwriting by the corresponding government.

Taken together, these scenarios portend a significant delay between a vaccine successfully completing its clinical trials and becoming available to the population, and another delay between general availability and adoption.

The press glosses over these offsets, developing among its readers a distorted impression of the pandemic’s progression – an awkward blend of two images, really: one in which the richer countries are rapidly approaching herd immunity while, in the other, there is a shortage of vaccines.

Sooner or later, a right-wing commentator notices there is a commensurately increasing risk of these poorer countries ‘re-exporting’ the virus around the world. Politicians hear him and further stigmatise these countries, and build support for xenophobic and/or supremacist policies.

Meanwhile, the modeller notices the delays as well. When he revises his model, he finds that as governments relax lockdowns and reopen airports for international travel, differences in screening procedures in different countries could allow the case load to rise and fall around the world in waves – in effect ensuring the pandemic will take longer to end.

His new paper isn’t taken very seriously. It’s near the end of the pandemic, everyone has been told, and he’s being a buzzkill. (It’s also a preprint, and that, a senior scientist in government nearing his retirement remarks, “is all you need to know”.) Distrust of his results morphs slowly into a distrust towards scientists’ predictions, and becomes ground to dismiss most discomfiting findings.

The vaccine is finally available in middle- and low-income countries. But in India, this bigger picture plays out at smaller scales, like a fractal. Neither the modeller nor the head of state included the social realities of Indian society in their plans – but no one noticed because both had conducted science by press release.

As they scratch their heads, they also swat away at people at the outer limits of the country’s caste and class groups clutching at them in desperation. A migrant worker walks past unnoticed. One of them wonders if he needs to privatise healthcare more. The other is examining his paper for arithmetic mistakes.