I sense the public panic over the HMPV outbreak in China is finally dying down. I don’t know which TV news channel picked up on it first and blew it out of proportion but it created the sort of time in which basic public health literacy would have made a big difference. Clearly such literacy is still quite low in the country.
I also don’t know why it became such a panic at all. As an editorial in The Hindu noted, the outbreak was a problem only insofar as the Indian media made it out to be: it didn’t hit the headlines anywhere else (except perhaps some Sinophobic outlets in the US). It made me wonder what exactly we learnt from COVID-19: wear masks, wash hands, maintain social distancing, and consult your physician, yes, but seemingly not that the COVID-19 pandemic was troublesome because SARS-CoV-2 was a new virus. This novelty made a world of difference.
The whole thing was constantly reminiscent of a 2014 Tamil film called Vaayai Moodi Paesavum (‘Speak With Your Mouth Shut’). In the film, there’s an outbreak of a previously unknown virus and medical researchers are slowly elucidating the full range of its symptoms. But even before they’ve learnt anything about whether it’s deadly or requires drastic action to protect against, the state health minister (played by the well-cast Pandiarajan) — desperate to quell the media outcry and to pacify a worried local populace — declares the state government will manufacture masks en masse and hand them out for free. Good call, right?
The fellow’s unscrupulous: he means to have a relative receive the government contract and take a slice. But his statement feeds the real panic: while until then neither the people nor the journalists knew whether the infection was communicable, his implication that masks are necessary suggests it does, and they’re all in a tizzy.
It was the same way with covering HMPV stories as journalists: all the experts to whom journalists spoke, irrespective of their location in the public or private sectors or their ideological tendencies, said HMPV wasn’t cause for concern. At the same time, local and hyperlocal media outlets were reporting “First HMPV case reported from X city” or “X number of people dead due to HMPV”. Those publications that did have a functional science/health journalism department would’ve been caught in between: they couldn’t deny HMPV’s existence nor leave it out of the front pages, so they had to acknowledge its existence in a way that didn’t also inflate the hype balloon.
Another problem we came across showed up the piecemeal nature of India’s pathogen surveillance programme. Many headlines simply said “X agency detects Y HMPV cases”. Since HMPV has been around for a long time, and hasn’t exactly been hiding, it was a truism that if we went looking for it, we’d find it. And the ICMR did, repeatedly, but when it put out press releases to that effect together with statements asking for the people at large to not worry, just the fact that the agency had picked up on those cases further fuelled concerns.
Public outcry is a dangerous animal. It forced the government’s hand and, in a bid to be seen to be acting, the government instituted the same sort of response measures it would have if there had been an outbreak with real cause for concern. Whatever blew the HMPV outbreak out of proportion, a cascading lack of tact — if not courage — was part of it.
I sense the public panic over the HMPV outbreak in China is finally dying down. I don’t know which TV news channel picked up on it first and blew it out of proportion but it created the sort of time in which basic public health literacy would have made a big difference. Clearly such literacy is still quite low in the country.
I also don’t know why it became such a panic at all. As an editorial in The Hindu noted, the outbreak was a problem only insofar as the Indian media made it out to be: it didn’t hit the headlines anywhere else (except perhaps some Sinophobic outlets in the US). It made me wonder what exactly we learnt from COVID-19: wear masks, wash hands, maintain social distancing, and consult your physician, yes, but seemingly not that the COVID-19 pandemic was troublesome because SARS-CoV-2 was a new virus. This novelty made a world of difference.
The whole thing was constantly reminiscent of a 2014 Tamil film called Vaayai Moodi Paesavum (‘Speak With Your Mouth Shut’). In the film, there’s an outbreak of a previously unknown virus and medical researchers are slowly elucidating the full range of its symptoms. But even before they’ve learnt anything about whether it’s deadly or requires drastic action to protect against, the state health minister (played by the well-cast Pandiarajan) — desperate to quell the media outcry and to pacify a worried local populace — declares the state government will manufacture masks en masse and hand them out for free. Good call, right?
The fellow’s unscrupulous: he means to have a relative receive the government contract and take a slice. But his statement feeds the real panic: while until then neither the people nor the journalists knew whether the infection was communicable, his implication that masks are necessary suggests it does, and they’re all in a tizzy.
It was the same way with covering HMPV stories as journalists: all the experts to whom journalists spoke, irrespective of their location in the public or private sectors or their ideological tendencies, said HMPV wasn’t cause for concern. At the same time, local and hyperlocal media outlets were reporting “First HMPV case reported from X city” or “X number of people dead due to HMPV”. Those publications that did have a functional science/health journalism department would’ve been caught in between: they couldn’t deny HMPV’s existence nor leave it out of the front pages, so they had to acknowledge its existence in a way that didn’t also inflate the hype balloon.
Another problem we came across showed up the piecemeal nature of India’s pathogen surveillance programme. Many headlines simply said “X agency detects Y HMPV cases”. Since HMPV has been around for a long time, and hasn’t exactly been hiding, it was a truism that if we went looking for it, we’d find it. And the ICMR did, repeatedly, but when it put out press releases to that effect together with statements asking for the people at large to not worry, just the fact that the agency had picked up on those cases further fuelled concerns.
Public outcry is a dangerous animal. It forced the government’s hand and, in a bid to be seen to be acting, the government instituted the same sort of response measures it would have if there had been an outbreak with real cause for concern. Whatever blew the HMPV outbreak out of proportion, a cascading lack of tact — if not courage — was part of it.
Earlier this month, a study by a team at Banaras Hindu University (BHU) in Varanasi concluded that fully 1% of Covaxin recipients may suffer severe adverse events. One percent is a large number because the multiplier (x in 1/100 * x) is very large — several million people. The study first hit the headlines for claiming it had the support of the Indian Council of Medical Research (ICMR) and reporting that both Bharat Biotech and the ICMR are yet to publish long-term safety data for Covaxin. The latter is probably moot now, with the COVID-19 pandemic well behind us, but it’s the principle that matters. Let it go this time and who knows what else we’ll be prepared to let go.
But more importantly, as The Hindu reported on May 25, the BHU study is too flawed to claim Covaxin is harmful, or claim anything for that matter. Here’s why (excerpt):
Though the researchers acknowledge all the limitations of the study, which is published in the journal Drug Safety, many of the limitations are so critical that they defeat the very purpose of the study. “Ideally, this paper should have been rejected at the peer-review stage. Simply mentioning the limitations, some of them critical to arrive at any useful conclusion, defeats the whole purpose of undertaking the study,” Dr. Vipin M. Vashishtha, director and pediatrician, Mangla Hospital and Research Center, Bijnor, says in an email to The Hindu. Dr. Gautam Menon, Dean (Research) & Professor, Departments of Physics and Biology, Ashoka University shares the same view. Given the limitations of the study one can “certainly say that the study can’t be used to draw the conclusions it does,” Dr. Menon says in an email.
Just because you’ve admitted your study has limitations doesn’t absolve you of the responsibility to interpret your research data with integrity. In fact, the journal needs to speak up here: why did Drug Safety publish the study manuscript? Too often when news of a controversial or bad study is published, the journal that published it stays out of the limelight. While the proximal cause is likely that journalists don’t think to ask journal editors and/or publishers tough questions about their publishing process, there is also a cultural problem here: when shit hits the fan, only the study’s authors are pulled up, but when things are rosy, the journals are out to take credit for the quality of the papers they publish. In either case, we must ask what they actually bring to the table other than capitalising on other scientists’ tendency to judge papers based on the journals they’re published in instead of their contents.
Of course, it’s also possible to argue that unlike, say, journalistic material, research papers aren’t required to be in the public interest at the time of publication. Yet the BHU paper threatens to undermine public confidence in observational studies, and that can’t be in anyone’s interest. Even at the outset, experts and many health journalists knew observational studies don’t carry the same weight as randomised controlled trials as well as that such studies still serve a legitimate purpose, just not the one to which its conclusions were pressed in the BHU study.
After the paper’s contents hit the headlines, the ICMR shot off a latter to the BHU research team saying it hasn’t “provided any financial or technical support” to the study and that the study is “poorly designed”. Curiously, the BHU team’s repartee to the ICMR’s makes repeated reference to Vivek Agnihotri’s film The Vaccine War. In the same point in which two of these references appear (no. 2), the team writes: “While a study with a control group would certainly be of higher quality, this immediately points to the fact that it is researchers from ICMR who have access to the data with the control group, i.e. the original phase-3 trials of Covaxin – as well publicized in ‘The Vaccine War’ movie. ICMR thus owes it to the people of India, that it publishes the long-term follow-up of phase-3 trials.”
I’m not clear why the team saw fit to appeal to statements made in this of all films. As I’ve written earlier, The Vaccine War — which I haven’t watched but which directly references journalistic work by The Wire during and of the pandemic — is most likely a mix of truths and fictionalisation (and not in the clever, good-faith ways in which screenwriters adopt textual biographies for the big screen), with the fiction designed to serve the BJP’s nationalist political narratives. So when the letter says in its point no. 5 that the ICMR should apologise to a female member of the BHU team for allegedly “spreading a falsehood” about her and offers The Vaccine War as a counterexample (“While ‘The Vaccine War’ movie is celebrating women scientists…”), I can’t but retch.
Together with another odd line in the latter — that the “ICMR owes it to the people of India” — the appeals read less like a debate between scientists on the merits and the demerits of the study and more like they’re trying to bait the ICMR into doing better. I’m not denying the ICMR started it, as a child might say, but saying that this shouldn’t have prevented the BHU team from keeping it dignified. For example, the BHU letter reads: “It is to be noted that interim results of the phase-3 trial, also cited by Dr. Priya Abraham in ‘The Vaccine War’ movie, had a mere 56 days of safety follow-up, much shorter than the one-year follow-up in the IMS-BHU study.” Surely the 56-day period finds mention in a more respectable and reliable medium than a film that confuses you about what’s real and what’s not?
In all, the BHU study seems to have been designed to draw attention to gaps in the safety data for Covaxin — but by adopting such a provocative route, all that took centerstage was its spat with the ICMR plus its own flaws.
Vivek Agnihotri’s next film, The Vaccine War, is set to be released on September 28. It is purportedly about the making of Covaxin, the COVID-19 vaccine made by Bharat Biotech, and claims to be based on real events. Based on watching the film’s trailer and snippets shared on Twitter, I can confidently state that while the basis of the film’s narrative may or may not be true, the narrative itself is not. The film’s principal antagonist appears to be a character named Rohini Singh Dhulia, played by Raima Sen, who is the science editor of a news organisation called The Daily Wire. Agnihotri has said that this character is based on his ‘research’ on the journalism of The Wire during, and about, the pandemic, presumably at the time of and immediately following the DCGI’s approval for Covaxin. Agnihotri and his followers on Twitter have also gone after science journalist Priyanka Pulla, who wrote many articles in this period for The Wire. At the time, I was the science editor of The Wire. Dhulia appears to have lovely lines in the film like “India can’t do this” and “the government will fail”, the latter uttered with visible glee.
It has been terribly disappointing to see senior ICMR scientists promoting the film as well as the film (according to the trailer, at least) confidently retaining the name of Balram Bhargava for the character as well; for the uninitiated, Bhargava was the ICMR director-general during the pandemic. (One of his aides also has make-up strongly resembling Raman Gangakhedkar.) In Pulla’s words, “the political capture of this institution is complete”. The film has also been endorsed by Sudha Murthy and received a tone-deaf assessment by film critic Baradwaj Rangan, among other similar displays of support. One thing that caught my eye is that the film also retains the ICMR logo, logotype, and tagline as is (see screenshot below from the trailer).
Source: YouTube
The logo appears on the right of the screen as well as at the top-left, together with the name of NIV, the government facility that provided the viral material for and helped developed Covaxin. This is notable: AltBalaji, the producer of the TV show M.O.M. – The Women Behind Mission Mangal, was prevented from showing ISRO’s rockets as is because the show’s narrative was a fictionalised version of real events. A statement from AltBalaji to The Wire Science at the time, in 2019, when I asked why the show’s posters showed the Russian Soyuz rocket and the NASA Space Shuttle instead of the PSLV and the GSLV, said it was “legally bound not to use actual names or images of the people, objects or agencies involved”. I don’t know if the 2019 film Mission Mangal was bound by similar terms: its trailer shows a rocket very much resembling the GSLV Mk III (now called LVM-3) sporting the letters “S R O”, instead of “I S R O” ; the corresponding Hindi letters “स” and “रो”; and a different logo below the letters “G S L V” instead of the first “I” (screenshot below). GSLV is still the official designation of the launch vehicle, and a step further from what the TV show was allowed. And while the film also claims to be based on real events, its narrative is also fictionalised (read my review and fact-check).
Source: YouTube
Yet ICMR’s representation in The Vaccine War pulls no punches: its director-general at the time is represented by name and all its trademark assets are on display. It would seem the audience is to believe that they’re receiving a documentarian’s view of real events at ICMR. The film has destroyed the differences between being based on a true story and building on that to fictionalise for dramatic purposes. Perhaps more importantly: while AltBalaji was “legally bound” to not use official ISRO imagery, including those of the rockets, because it presented a fiction, The Vaccine War has been freed of the same legal obligation even though it seems to be operating on the same terms. This to me is my chief symptom of ICMR’s political capture.
Of course, that Agnihotri is making a film based on a ‘story’ that might include a matter that is sub judice is also problematic. As you may know, Bharat Biotech filed a defamation case against the Foundation for Independent Journalism in early 2022; this foundation publishes The Wire and The Wire Science. I’m a defendant in the case, as are fellow journalists and science communicators Priyanka Pulla, Neeta Sanghi, Jammi Nagaraj Rao, and Banjot Kaur, among others. But while The Wire is fighting the case, it will be hard to say before watching The Vaccine War as to whether the film actually treads on forbidden ground. I’m also not familiar with the freedoms that filmmakers do and don’t have in Indian law (and the extent to which the law maps to common sense and intuition). That said, while we’re on the topic of the film, the vaccine, defamation, and the law, I’d like to highlight something important.
In 2022, Bharat Biotech sought and received an ex parte injunction from a Telangana court against the allegedly offending articles published by The Wire and The Wire Science, and had them forcibly taken down. The court also prevented the co-defendants from publishing articles on Covaxin going forward and filed a civil defamation case, seeking Rs 100 crore in damages. As the legal proceedings got underway, I started to speak to lawyers and other journalists about implications of the orders, whether specific actions are disallowed on my part, and the way courts deal with such matters – and discovered something akin to a labyrinth that’s also a minefield. There’s a lot to learn. While the law may be clear about something, how a contention winds its way through the judicial system is both barely organised and uncodified. Rahul Gandhi’s own defamation case threw informative light on the role of judges’ discretion and the possibility of a jail term upon conviction, albeit for the criminal variety of the case.
The thing I resented the most, on the part of sympathetic lawyers, legal scholars, and journalists alike, is the view that it’s the mark of a good journalist to face down a defamation case in their career. Whatever its origins, this belief’s time is up in a period when defamation cases are being filed at the drop of a hat. It’s no longer a specific mark of good journalism. Like The Wire, I and my co-defendants stand by the articles we wrote and published, but it remains good journalism irrespective of whether it has also been accused of defamation.
Second, the process is the punishment, as the adage goes, yet by valorising the presence of a defamation case in a journalist’s record, it seeks to downplay the effects of the process itself. These effects include the inherent uncertainty; the unfamiliar procedures, documentation, and their contents and purposes; the travelling, especially to small towns, and planning ahead (taking time off work, availability of food, access to clean bathrooms, local transport, etc.); the obscure rules of conduct within courtrooms and the varying zeal with which they’re implemented; the variety and thus intractability of options for legal succour; and the stress, expenses, and the anxiety. So please, thanks for your help, but spare me the BS of how I’m officially a good journalist.
More than half of the deaths reported during the heatwave in Uttar Pradesh and Bihar this week were reported from just one district in the former, called Ballia. On (or around) June 17, the medical superintendent of the Ballia district hospital was transferred away after he attributed the deaths (until then) to the heat. He was replaced with someone else.
The state government also dispatched a team of two experts to the district to assess the local situation (as they say). One of them was director of the Uttar Pradesh health department for communicable diseases, A.K. Singh. In one of his first interactions with the press, Singh indicated that they weren’t inclined to believe the Ballia deaths were due to the heat and that the team was also considering alternative explanations, like the local water source being contaminated. I think something fishy could be going on here.
First, Hindustan Times reported Singh saying “the deaths at the hospital were primarily due to comorbidity and old age and not heatstroke”, erratic power in the area, and the time taken to reach the hospital — in effect, everything except the heat. Yet all these factors only worsen a condition; they don’t cause it. What was the condition?
Second, a reporter from The Hindu who visited Ballia learnt that it will take “more than seven days” to issue the medical certificates of the cause of death (MCCDs), so the official cause of death — i.e. what the state records the cause of each death in this period and circumstance to be — won’t be clear until then.
Aside: During the COVID-19 pandemic, the Indian Council of Medical Research issued guidelines that asked healthcare workers to not list comorbidities as the underlying cause of death for people who die with COVID-19. This didn’t stop workers from doing just this in many parts of the country. I’m not sure but I don’t think similar guidelines exist for when the underlying cause could be heat. The guidelines also specified the ICD-10 codes to be used for COVID-19; such codes already exist for heat-related deaths.
Third: Do the district authorities, and by extension the Uttar Pradesh state government, have complete knowledge of the situation in Ballia? There was the unfortunate superintendent who said there was a link between the heat and the deaths. Anonymous paramedic staff at the Ballia hospital also told The Hindu that “some of the deaths were heat-related”. Yet the new superintendent says the matter is “under investigation” even as one member of the expert team says it’s yet to find “any convincing evidence to link the deaths with heatstroke”.
I really don’t know what to make of this except that there’s a non-zero chance that a cover-up is taking shape. This is supported by the fourth issue: According to The Hindu, “the [Uttar Pradesh] State Health Department has asked the Chief Medical Officers of districts and the Chief Medical Superintendents of district hospitals to issue statements in coordination with the concerned District Magistrate only during ‘crucial situations’” — a move reminiscent of the National Disaster Management Authority’s response to the Joshimath disaster.
For now, this is as far as the facts (as I know them) will take us. I think we’ll be able to take a big stride when the hospital issues the MCCDs.
I’m starting to think that in this day and age, you will but err when you pick individuals for traditionally ‘prestigious’ awards, prizes, recognitions, etc., probably because the sort of people who can stand out by themselves have to have had the sort of clout and power that typically comes not through personal achievement as much as systemic prejudice – or they need to have screwed up on a magnitude so large that the nature of their action must overlap significantly with a combination of centralised power and lack of accountability. And on the spectrum of possibilities between these two extremes lie The Week‘s and Time‘s persons of the year 2021.
The Week has picked – wait for it – Indian Council of Medical Research (ICMR) director-general Balram Bhargava for his leadership of India’s medical response to the country’s COVID-19 crises. I doubt I’d lose my journalistic equipoise if I said he deserved to be the “clown of the year” not just because Bhargava, and ICMR with him, has made many batty claims throughout the epidemic – principally in press conferences – but also because, to echo the recent words of Barton Gellman, he has pushed an independent medical research body outside the democratic system and into the prime minister’s office.
Yet The Week‘s article justifying its choice makes no mention of these transgressions and sticks only to Bhargava making life-impacting decisions at 3 am – like tens of thousands of healthcare workers around the country, who did that and kept their collective spine – and a can-do attitude in which The Week fails to see that “getting things done” to the appreciation of your colleagues also means that unless someone takes more initiative than they’re expected to, the organisation is systematically incapable of going “over and beyond”, so to speak. One way or another, it’s not hard to conclude that Bhargava will leave ICMR worse than it was when he joined.
Time‘s person of the year 2021 is Elon Musk. Its profile reads much less like the profilee is doing the profiler a favour, but it also fails to overcome the suspicion that it expects the sheer magnitude of Musk’s ambitions for the world to absolve him of his failures – failures that appear like minor glitches in a grand, technocratic future-vision to Silicon Valley and Wall Street honchos (and their mimics worldwide) but to anyone else suggest something worse but also familiar: a plutocracy in which each billionaire is only looking out for himself, or at best his company’s interests.
Time‘s profile is essentially a paean to the extent to which Musk’s Tesla and SpaceX companies have reinvigorated their respective industries (automotives and spaceflight) through innovations in manufacturing and industrial management, but it’s often presented in a context-limited, value-neutral fashion that prompts concerns that the magazine wouldn’t have had access to Musk if it didn’t promise to write nice things about him.
For example, Time writes that “Musk’s … announcement of a $100 million climate prize rankled some environmentalists because of its inclusion of proposals for direct-air carbon capture,” and that its sole criticism is that this tech doesn’t work. But the greater issue is that focusing on carbon capture and storage technologies is a technofix that allows Tesla and other vehicle-makers to evade responsibility to reduce the demand for carbon, and that Musk’s ‘challenge’ is really a bid through philanthrocapitlism to prolong ‘business as usual’ climate scenarios. For another related example, about Tesla’s success with electric vehicles, the profile says:
That has made Musk arguably the biggest private contributor to the fight against climate change. Had the 800,000 Teslas sold in the last year been gas-powered cars, they would have emitted more than 40 million metric tons of CO₂ over their lifetimes—equivalent to the annual emissions of Finland. But EVs may ultimately be less important to the climate fight than the central innovation that made them possible: batteries. Tesla has repurposed the lightweight, energy-dense cells that power its cars for huge grid-scale batteries that provide essential backup for renewables. Demand for Tesla’s smaller home-based Powerwall, which can store electricity from rooftop solar systems, has spiked as consumers look for alternatives to the grid, driven by everything from February’s Texas power shortage to the fire risk in California that has led to power shutoffs.
Yet the profile doesn’t mention that even when electrified, more and more people owning cars only exacerbates the underlying problem – the demand for electricity, from a climate mitigation standpoint, and urban traffic and congestion – and that we need cities to shift to more affordable, usable and efficient modes of public transport. (The profile also and obviously doesn’t include Musk’s comment in 2017 that he dislikes public transport because he grossly mistrusts other people.) And if Tesla’s technologies will ultimately benefit the US’s, and the world’s, public transport systems, it’s hard to imagine the extent to which they would’ve also undermined our fight for climate and social justice by then.
Instead, this is profiteering, plain and simple, and Time‘s failure to see it as such – throughout the profile, not just in this instance, it repeatedly tries to reflect the world’s aspirations in his own – seems to me to be a symptom of a desire to coexist with Musk more than anything else. Once in a while the profile has a few paragraphs of complaints against Musk and his businesses, only for them to be followed by an excuse for his behaviour or an indication that he was sanctioned appropriately for it, and never anything that goes far enough to contemplate what Musk’s politics might be. “Something about our upbringing makes us constantly want to be on the edge,” Elon’s brother Kimbal says – in the same paragraph that makes the profile’s sole meaningful allusion to the centrality of lucrative NASA contracts to SpaceX’s success. That, to me, said enough.
I wish both The Week and Time had picked persons of the year who make the world fairer and better in spite of the people they’ve actually picked – but at the same time must conclude that perhaps this is one more tradition whose time has ended.
Featured image credits: ICMR/Facebook and Steve Jurvetson/Flickr.
I have no plans to read ICMR chief Balram Bhargava’s new book, Going Viral, about the “inside story” of Covaxin’s making, and am grateful for that reason for Dr Jammi Nagaraj Rao’s quick but seemingly thorough review in The Wire Science. My lack of interest in the book itself also means I’m going to take those bits from the book quoted in Rao’s review literally, in no need of additional context (a reasonable assumption given the rest of the review and Bhargava’s now-tattered reputation). With this preamble: reading Rao’s review brought three things to mind.
First, is the Indian clinical research establishment aware of the catch-22 inherent to defending its decisions regarding Covaxin over and over in the public domain? Of the two major COVID-19 vaccines in use in India, Covishield hasn’t prompted even a tenth of the amount of defending (say, by number of words or inches in newspaper columns) Covaxin has seemed to need to maintain its reputation – even when there were multiple news reports in February and March to suggest Covishield may be associated with most vaccine-associated severe adverse events at the time.
Then again, the establishment will say – as it has said so far – that Covaxin has required defending because you were bent on attacking it for no good reason. And with Bhargava continuing to deflect criticism in his book, this circus will only continue. However, while both us critics and the establishment can keep going, as if our energies were conserved, the catch-22 is that Covaxin’s reputation is not: the longer the circus goes on, the more it will decline.
Second, the Indian government has progressively invaded multiple public institutions and yoked their machineries to the ruling party’s electoral agenda. Perhaps the most ‘notable’ was the fall of the Election Commission, which, in a recent example, drafted the dates for West Bengal’s assembly poll phases to the BJP’s convenience. But Balram Bhargava’s new book seems to be a new frontier: Rao’s review indicates that Going Viral is one large advertisement for the Indian government, and for the BJP by extension. It’s a new frontier because it’s a book, and it’s a book by the head of a public institution that the government has already invaded. Put another way, there may be nothing Bhargava can say or do as the ICMR chief – including write a book – that we can assume will have any distance between himself and the party itself. (Once he’s done as ICMR chief, of course, the party is likely to offer him a cushy posting in some low-intensity government position.)
Now, it is tempting to consider that by guiding the composition of a whole book and stamping some pandering functionary’s name on the cover, the BJP is also attempting to invade the space of books as an expression of intellectual achievement, of the sort that the current government has liked to associate with its fiercer critics.
Third, there is a curious line in Rao’s review that may provide the fort of insight into Covaxin’s development that no government official (at least of this government) will ever admit. Rao writes that the book
… is not a detailed exposition of the science behind vaccine development in general or Covaxin’s development in particular. There is a retelling of the well-known Edward Jenner story, and some interesting details about why Bharat Biotech was uniquely placed to develop Covaxin: mainly that it operated BSL-3 facilities and had a track record of developing vaccines from scratch.
One reason the BJP, essentially Prime Minister Narendra Modi, blessed Bharat Biotech was that it could develop vaccines from ‘scratch’? Why should this matter during a pandemic with billions of people around the planet desperately looking for an affordable and good-quality vaccine – except the power that the words “homegrown” and “Made in India” carry for the party, and the government? Neither I nor others can offer dispositive proof that this is what Prime Minister Modi was thinking when he toured Bharat Biotech’s and Serum Institute’s facilities in November last year; the closest we can come is the way in which the party-government combine micromanaged every aspect of Covaxin – down to its ridiculous approval on January 3, 2021, in “clinical trial mode”.
This façade of self-sufficiency is just that, as two counter-examples can show. First, let me quote from Rao’s review:
… in his zeal to characterise Covaxin as a ‘completely indigenous vaccine, an epitome of Atmanirbhar Bharat’, Bhargava overlooks the fact that the thing that made Covaxin appropriately immunogenic was the inspired use of an adjuvant called Alhydroxyquim-II, under license from an American research company named Virovax. The licensing arrangement between Virovax, funded by the US National Institute of Health, and Bharat Biotech dates to before the pandemic, in 2019, in a collaboration set up at a meeting organised by the Indo-US Vaccine Action Program. The terms were later extended to include Covaxin.
Second, there’s a twisted irony in insisting on building a vaccine from scratch at home (because that is politically advantageous) instead of equally supporting both vaccine development and license-based vaccine-manufacturing, then dragging your feet on licensing a vaccine when you do have one to public-sector manufacturers within the country (much less anyone else), while demanding in international fora that vaccine-makers abroad and their respective governments be okay with waiving IP rights to broaden manufacturing.
I suspect after reading this PTI report that the WHO is practically helping Bharat Biotech put together a better application to have its COVID-19 vaccine, Covaxin, get the body’s approval for international use, instead of simply considering what Bharat Biotech chooses to submit. The overall tone of the report is mollificatory – as if the WHO wishes to appease both the angry and the doubtful that the many months the relevant committee is taking to decide on Covaxin’s candidature shouldn’t be taken as a comment on the Indian vaccine-manufacturing industry. The biggest supplier of vaccines to the WHO’s COVAX initiative is Serum Institute of India, in Pune, so the WHO has a conflict of interest when it says it holds the industry in good esteem. But even vis-à-vis Bharat Biotech (whose production planning and output have both been disappointing), PTI writes:
India’s Bharat Biotech has been submitting data on the EUL of Covaxin “regularly and very quickly” to a technical committee which hopes to have a final recommendation to the WHO next week, a top official of the global health agency said on Thursday, stressing that the UN body “trusts” the Indian industry that manufactures high quality vaccines.
There is something of an analogy with customer service. Say two companies both sell the same product at the same price. Company A’s customer service is excellent and its product has a quality rating of 75%. Company B’s customer service is average and its product has a quality rating of 100%. Which company will you buy from? I’d pick Company B because being spared the trouble of having to contact customer service is more valuable than having to contact customer service and then having a good experience. The same goes for Bharat Biotech’s application with the WHO for Covaxin: the company has been submitting more information “regularly and very quickly”? Great. But why does it have to do this at all instead of keeping all the data ready before any kind of approval?
This characterisation of Bharat Biotech by the “top official” also feeds into what the committee is prepared to do en route to Covaxin’s apparently impending approval. As the PTI report says later:
[Bruce Aylward, senior advisor to the WHO chief,] added that WHO’s job is to save as many lives as possible and as fast as possible. This includes ensuring no product lies unused.
Considering COVAX’s premise, to ensure everyone everywhere has access to vaccines instead of just the rich guys (and ignoring its inability to fulfill this mandate so far), what Aylward says is desirable, that all good vaccines should be used up. But this also raises a question about where the WHO draws the line between rejecting a bad application and accepting a bad application and helping to make it good.
Covaxin is clearly a bad product – its clinical trial, its emergency-use approval, its rollout and the agonising wait for access to the trial data (followed subsequently by issues of trial ethics and data quality) threw up so many questions, but none of the Drug Controller General, Bharat Bitoech or the Indian Council of Medical Research (ICMR) have deigned to answer any of them, at least not honestly. This was followed later by questions about how Bharat Biotech, and the Indian government with it, estimated that the company would be able to produce X number of doses by certain dates, only to fall strikingly short on each occasion, so much so that together with Serum Institute’s failure to project output and demand, India – the “vaccine superpower” that ICMR’s Balram Bhargava recently said it was – had a shameful vaccine shortage for the first half of 2021.
As good as the science underlying BBV152 may have been, Covaxin the product is untrustworthy. This isn’t a comment on the science so much as a reiteration of the oft-overlooked fact that science progressively gives away to social issues that emerge in non-linear fashion when science’s requirements collide with societal gradients, particularly once the giant phase 3 tests have begun.
Given all of these issues, the WHO committee repeatedly asking for more data from Bharat Biotech regarding Covaxin served to highlight – loudly and effectively – an immutable fact: that the Indian government and Bharat Biotech didn’t have this data at the time the Drug Controller General approved the vaccine for emergency use (in “clinical trial mode” to boot) in January 2021, and probably that Bharat Biotech didn’t have this data ready when it claimed, on more than one occasion, that it had submitted all the info it had on Covaxin to the WHO.
Now, with a WHO committee member seemingly suggesting that Covaxin’s approval is a question of when, not if, are we to believe that the vaccine is really good and that we’re all thinking about it wrong? This is an important question, to me at least, because one less-than-ideal alternative is to contemplate how one committee can ‘fix’ a vaccine – by legitimising it with its approval – that is so broken that even with the Indian government’s support, only some 11% of eligible Indians have taken it. Another is to confront the similarly dispiriting possibility that millions of people are so desperate for vaccines around the world that the WHO can no longer afford to stop at being a quality filter – and should step up to help insincere vaccine-makers over the fence. (Recall the ‘right to choose without choices’ from January?)
Any which way, the implied promise of approval seems to me to be too much of an easy way out for Bharat Biotech, and the intractable, unabashed Indian government behind it.
#100crore vaccination in record time. The biggest strength India has in 2020-21 is that it did not have to depend upon western countries for anything, be it drugs, vaccines, or diagnostics,” @shekhar_mande @TheStatesmanLtd https://t.co/2aD6TsSREH
Truth be told, I didn’t expect CSIR chief Shekhar Mande could be so disingenuous. “India didn’t have to depend on western countries,” he says. What is this abject refusal to thank other countries for help – and preferring instead to take their help and rewriting the past to pretend we didn’t need any?
Of all those who received at least one dose of a COVID-19 vaccine in India, 88% received Covishield, which was first conceived by scientists in the UK and licensed by a British-Swedish pharmaceutical company to an Indian manufacturer. Even Covaxin, which accounts for the remaining 12% (screw Sputnik V), draws on technologies perfected by scientists in the US, among other places, against the SARS and MERS viruses. And while India’s drug controller approved a glut of drugs to treat severe COVID-19, the rights to the most popular among them and which also demonstrated some efficacy in any well-designed trials and observational studies – remdesivir – belong to a Californian pharmaceutical company.
Some of the special containers and chemical reagents required to conduct RT-PCR tests are mostly imported. Indian industry adapted in a relatively short span of time to boost local production of masks, PPE kits and syringes, but there’s a lot that it depended on the west for and for which the west depended on India.
In The Statesman article, ICMR chief Balram Bhargava also says, “The experience of developing Covaxin has instilled self-confidence in us that India is now much more than the pharmacy of the world. It is also a vaccine superpower.” Kind sir, India is no longer the ‘pharmacy of the world’. And we’d have to be a shitty kind of “vaccine superpower”, whatever that means, to a) run low on vaccinesandsyringes and completely fail to see that coming, b) celebrate 100-crore preordained inoculations, c) go so gung-ho with COVID-19 that we fail to deliver doses of a DTP vaccine to 3 million children in a year (the world’s highest) and d) preferentially award vaccine-making contracts to private companies.
Of course, BB has been a foregone conclusion for a while. But that Mande can thump his chest like this… Are we to believe, then, that the rumours about why the Manipal Centre for Virus Research was shut, just as the pandemic was beginning, are true? That it was poised to undermine, with its foreign funds, foreign collaborations and foreign-trained scientists, the ‘Make in India’ narrative that the government as much as the government-funded scientific enterprise is wedded to.
Perhaps the most regrettable thing about Mande’s comment is that – if the head of India’s largest government-funded scientific research establishment is prepared to lie in public, and to himself, that Indian researchers, manufacturers, traders, healthcare workers and patients didn’t want for anything that wasn’t already available in the country in early 2020, he is also prepared to believe there aren’t any problems that need to be fixed or resolved today either. I sincerely hope I’m wrong, but I don’t have my hopes up. Whatever we’re atma-nirbhar with today, it isn’t spine among government scientists, it seems.
If you’re looking for a quantification (although you shouldn’t) of the extent to which science is being conducted by press releases in India at the moment, consider the following list of studies. The papers for none of them have been published – as preprints or ‘post-prints’ – even as the people behind them, including many government officials and corporate honchos, have issued press releases about the respective findings, which some sections of the media have publicised without question and which have quite likely gone on to inform government decisions about suitable control and mitigation strategies. The collective danger of this failure is only amplified by a deafening silence from many quarters, especially from the wider community of doctors and medical researchers – almost as if it’s normal to conduct studies and publish press releases in a hurry and take an inordinate amount of time upload a preprint manuscript or conduct peer review, instead of the other way around. By the way, did you know India has three science academies?
ICMR’s first seroprevalence survey (99% sure it isn’t out yet, but if I’m wrong, please let me know and link me to the paper?)
Mumbai’s TIFR-NITI seroprevalence survey (100% sure. I asked TIFR when they plan to upload the paper, they said: “We are bound by BMC rules with respect to sharing data and hence we cannot give the raw data to anyone at least [until] we publish the paper. We will upload the preprint version soon.”)
Biocon’s phase II Itolizumab trial (100% sure. More about irregularities here.)
Delhi’s first seroprevalence survey (95% sure. Vinod Paul of NITI Aayog discussed the results but no paper has pinged my radar.)
Delhi’s second seroprevalence survey (100% sure. Indian Express reported on August 8 that it has just wrapped up and the results will be available in 10 days. It didn’t mention a paper, however.)
Papers of well-designed, well-powered studies establishing that HCQ, remdesivir, favipiravir and tocilizumab are efficacious against COVID-19 🙂
Aside from this, there have been many disease-transmission models whose results have been played up without discussing the specifics as well as numerous claims about transmission dynamics that have been largely inseparable from the steady stream of pseudoscience, obfuscation and carelessness. In one particularly egregious case, the Indian Council of Medical Research announced in a press release in May that Ahmedabad-based Zydus Cadila had manufactured an ELISA test kit for COVID-19 for ICMR’s use that was 100% specific and 98% sensitive. However, the paper describing the kit’s validation, published later, said it was 97.9% specific and 92.37% sensitive. If you know what these numbers mean, you’ll also know what a big difference this is, between the press release and the paper. After an investigation by Priyanka Pulla followed by multiple questions to different government officials, ICMR admitted it had made a booboo in the press release. I think this is a fair representation of how much the methods of science – which bridge first principles with the results – matter in India during the pandemic.
