APRIL 16, 2021

By Naresh Minocha, Consulting Editor

LET Truth Prevail About Vaccines - the Deemed Drivers of Economic Revival

"We are in the end game of the Covid-19 pandemic in India, and to succeed at this stage, we need to follow 3 steps: Keep politics out of the Covid-19 vaccination drive, trust the science behind Covid-19 vaccines, and ensure our near and dear ones get vaccinated on time".

The Union health minister Harsh Vardhan stated this on 7th March 2021 while addressing an annual event of Delhi doctors.

Exactly a month later, Dr. Vardhan found himself outwitted by Covid. It mutated with gay abundance at home and abroad by availing prolonged lockdown as a public-funded hospitality.

The variants of Novel Corona Virus have successfully challenged the efficacy of the vaccines especially in India. Hundreds of doctors, nurses & support hospital staff, leave aside other vaccinated persons, are down with covid disease across the country.

Even vaccinated doctors, who religiously wore masks, found themselves infected. Some suffered serious ailments with at least one - a 62-year well-known doctor, dying even after admission to an Intensive Care Unit (ICU).

Unfortunately, news about fully vaccinated healthcare workers catching infection is being under-played by the mainstream media for obvious reasons. About 1000 healthcare workers in Lucknow tested positive for Covid over two to three weeks, causing manpower crisis in hospitals.

In a hospital at Sanchi in Madhya Pradesh, a gardener was assigned the job of taking swabs as covid had infected many employees, leading to staff shortage.

All such cases of vaccinated persons need to be probed scientifically to know what is wrong with the first-generation vaccines.

Corona Virus is, no doubt, back in the driving seat of governance on many fronts excluding elections to state assemblies and local governance bodies. Covid is having a major say in both the Government's decisions and its inactions.

Covid has thus led the Government to extend once again the Foreign Trade Policy 2015-2020 by six months to 30th September 2021. On 31st March 2020, it had extended FTP for one year by citing the pandemic.

Similarly, the two-phase census 2021, which is extremely vital for balanced and sound planning, stands deferred. The first phase envisaged house listing & housing census during April-September 2020. This was to be coupled with updating of National Population Register (NPR) under the Citizenship Act, 1955. The second phase envisaged population enumeration during 9-28th February 2021.

The Home Minister Amit Shah has cited persisting Covid pandemic as the only reason for delay in framing rules under Citizenship (Amendment) Act, 2019. The Law came into force on 10th January 2020.

Mr. Shah made this disclosure the other day in an interview with a daily. The rules should normally be framed within six months of a law coming into force. The Government has, however, been seeking periodic extensions separately from Committee on Subordinate Legislation of Lok Sabha and Rajya Sabha.

Ironically, the same, maligned Covid proved handy for the Government in justifying issuance of three farm ordinances and their subsequent transformation into hurriedly enacted three farm laws. The same virus (risk of its spread) was invoked to rain cold water and lathis on farmers who marched from Punjab and Haryana towards Delhi to protest against farm laws.

Covid, as an act of God, might be invoked by the Centre in the coming months, if the deadlier, second wave turns out to be longer the first one.

The deaf and dumb virus has also been blamed by the authorities for the delays in implementation of several projects and schemes. A case in point is massive savings in budgetary allocation for five schemes for welfare of scheduled castes and tribes in 2020-21. The Government blamed Covid for its inability to spend the allocations. Covid helped the Government contain fiscal deficit by cutting expenditure.

The pandemic also emboldened the Executive to curtail Parliament sessions with full cooperation of Presiding entities of both houses of Parliament. Even questions were discouraged in the name of Covid.

Covid has also compelled authorities across the country to keep away non-covid patients away from hospitals as they were persona non-grata. The doors of many hospitals have been either shut or partly closed for non-covid patients. A cancer patient in Maharashtra was lucky to get admission to a hospital as she had got covid infection.

The God knows how many patients, afflicted with TB, HIV and other ailments, would die as the ones co-infected with covid virus. How many non-covid patients would be sacrificed in hyped war against Covid?

The mishandling of covid crisis is re-inflicting on public the pains of the first wave in much more vicious way. This raises a question mark about our collective willingness to learn from last year, leave aside the past influenza pandemics.

The miseries, being wreaked on all non-government stakeholders, are turning out to be much more severe and uncertain than the one thrust under the first wave.

It is suicidal for any arm-chair analyst to now forecast the impact of second wave on GDP, tax and non-tax receipts, jobs and poverty. This is because the Centre has given full freedom to the States to decide on severity of the restrictions - starting from seeking mandatory covid negative certificate for travel from one district to another to sealing the inter-state borders. Night curfews of different durations are already in place. So are weekend lockdowns in many cities. Diverse restrictions on different segments of economy are being rolled out.

It is a herculean task to track and aggregate all variables into a model to assess the impact of second wave on national economy. Under the first wave, there was centralized lockdown and centralized, phased unlocking. This made it easier to forecast the impact on economy.

The CMs of certain States hum and haw daily over lockdown option. Their posturing has heightened fear among the migrant workers. They have thus made beeline to get out of the cities. Maharashtra has finally imposed 15-day lockdown without calling it so. Others might follow suit as no Government wants its image to be soiled with sight of patients suffering due to collapse of woefully inadequate health infrastructure.

Adding to the woes of daily wage-earners, small retailers and other unorganized businesses is Prime Minister Narendra Modi's silence. Unlike in the first wave, he has avoided making a passionate appeal to better-off sections of the society to be generous towards daily wage-earners.

PM had described them as "members of his family" in his address to the Nation on 14th April 2020. He has not felt the need for such emotional bonding perhaps because he is already in touch with them through mass political rallies in election-bound five States.

Mr Modi has so far avoided announcing a new Pradhan Mantri Gareeb Kalyan Yojna (PMGKY). We don't know whether model code of conduct prohibits Prime Minister of the country in easing the miseries of migrant workers who are once again rushing back to their native places in thousands.

We don't know whether cooperative federalism has led him to leave it to the States to announce disaster relief such as free ration to poor for limited period. The country does not know whether the Government has approached multilateral institutions seeking second series of covid-linked emergency loans.

Why no ruling party/Government of the day has appealed to migrants to stay put in cities with assurance to protect their minimum wages or fulfil their basic minimum needs? Does one require a doctorate in infectious diseases to realize that the migrants moving from covid-ravaged cities would spread the virus to the small towns and villages?

No wonder Prime Minister's silence due to electoral commitments has been seized by the Congress to make fresh allegations against him. The party's spokesperson has accused Mr. Modi of being "negligent, careless, cruel and callous in tackling COVID-19".

The nation is now eagerly hoping for PM's address in which he might silence and shame his critics by unveiling a mega stimulus package. It should be truly inclusive one, covering everyone from foot salesman on the street to tax-breaker seekers of the corporate world.

Everyone has noticed that that the pendulum has swung from irrational exuberance about foreseen victory over Covid to vicious attack on non-BJP State Governments for their failure to stop the second wave.

Like PM who foresaw win over Covid after 21-day lockdown, Dr Vardhan appeared over-bullish time and again. Addressing the Boston Center of Excellence for Health and Human Development on 20th November 2020, Dr. Vardhan said: "this COVID 19 will soon be a past episode of the 21st century. Our treatment protocol for COVID patients is well defined now. Fewer and fewer people infected are dying. We will have vaccines available very soon…."

The victory bugle was blown full blast with the grant of emergency use authorisation (EUA) to two covid vaccines on 3rd January 2021. The Government trashed public concern over opacity and haste in grant of EUAs as an insult to Indian scientists.

Even recent innocuous alerts by the Opposition-ruled States about vaccine shortages have attracted strong rebuke from the Union ministers.

The mood swings can be gauged well with the recall of a few quotes. The Home Minister Amit Shah, for instance, described EUAs to Serum Institute of India (SSI) and Bharat Biotech (BB) vaccines, as "game-changer" for boosting Prime Minister Narendra Modi's vision for Aatmanirbhar Bharat.

Mr Shah congratulated PM "for striving towards a COVID-free India. Visionary leadership can make a huge difference". Mr Modi himself saw EUAs as accelerating "the road to a healthier and COVID-free nation". On 7th January, he exuded: "India is ready to protect humanity with not one but two 'Made in India' coronavirus vaccines".

Consider now the pendulum's shift towards the blame game. On 7th April, Dr. Vardhan said: "many State governments have failed to take appropriate response measures and apply the lessons that the nation has learned over the past one year of handling this pandemic".

He added: "The inability of Maharashtra government to act responsibly is beyond comprehension. To spread panic among the people is to compound the folly further. Vaccine supplies are being monitored on a real-time basis, and State governments are being apprised regularly about it. Allegations of vaccine shortage are utterly baseless".

Chairing a meeting of health representatives of 11 States on 6th April 2021, Dr. Vardhan attributed the sudden increase in covid cases to grand weddings, local body elections and farmers' protest.

Insulated from politics, the scientists are developing booster doses and second-generation vaccines to deal with mutants that are proving more virulent. The raging second wave had put a big question mark over India's duopoly-driven vaccination, where citizens have no option but to get whatever injections are administered on them.

SII is under legal obligation to supply vaccines to the UK-based multinational AstraZeneca (AZ), which licensed its vaccine technology. It was developed jointly by AZ and Oxford University.

On 4th June 2020, AZ had disclosed that it had reached a licensing agreement with SII to supply one billion doses for low and middle-income countries, with a commitment to provide 400 million does before the end of 2020.

This obligation to export vaccines, coupled with the Government's vaccine diplomacy named 'Vaccine Maitri', worked well till the second wave spiralled out of control. The surging virus is now mocking at slogans such as India as ' Pharmacy Of The World ' during pandemic and ' Aatmanirbhar Bharat ' (self-reliant India).

An apt case in point is long queues of persons outside chemist shops in several cities for purchase of remdesivir (an injection given to critically ill covid patients). This, coupled with persisting reports about the drug's black-marketing, forced the Government to ban its export.

This ban and delays in vaccine shipment by SIIs led to stoppages/slowdowns in vaccination in Sri Lanka, Nepal, United Kingdom and other countries. Recent news showed that AZ had served a legal notice on SII for supply delays, a charge on which SII didn't give its version. Information about SII's stance on this issue is hard to come by in public domain.

Acute shortage of oxygen and the resulting death of dozens of Covid patients has raised big question mark about expansion of healthcare infrastructure with few billion dollars of multilateral emergency loans. Sight of unattended patients dying in the corridor of hospitals or while waiting outside is too disturbing.

Equally nerve-racking is the sight of two or three patients sharing a bed in Government hospital. The virus is benefiting from the breach/neglect of WHO guidelines on separation of covid and non-covid sections of hospitals.

With surge in criticism about the mismanagement of unfolding crisis, the Government made the first big climbdown from its Aatmanirbhar Bharat tower.

Within four days of branding Rahul Gandhi as full-time lobbyist for foreign vaccine companies, the Government announced on 13 th April its decision to allow import and formulation of all foreign vaccines that hold EUAs abroad.

Modi Government deserves appreciation for showing the courage to moderate its ego in larger interest of the Nation and the public safety.

At least five foreign vaccines already have such approvals and have been used in vaccination drives in several countries. Of these, Russia's Sputnik-V vaccine was kept waiting for months with government experts seeking more data each time the application came up for EUA consideration.

The process for grant of clearance to Russia's Sputnik vaccine finally started on 12th April 2021 with an experts' panel recommending it to the drug regulator. This follows stringent criticism over vaccine shortages and regulatory delays (or reluctance?) to clear competing and better foreign vaccines offered for local manufacture. The criticism came from diverse quarters including the Delhi High Court.

To salvage the concept of vaccine-driven economic revival, there has to be scientific and policy debate on the unfolding challenges. Does vaccination weaken the ability of immune system to generate adequate antibodies in time to ward off attack by dangerous mutants? Such questions should be viewed as scientific ones and not as the ones designed to defame the Government of the day.

The lack of transparency in clinical trials and issue of EUAs to only two vaccines had raised a lot of misgivings. The Government frequently changed its narrative on vaccines, thereby raising questions about the long-term implications of opaque governance of mass vaccination drive.

Right from the word 'go', the Government has either attacked critical questions or ducked them. On 7th January, Dr Vardhan told the State Health Ministers to be vigilant against rumours and disinformation campaigns regarding the safety and efficacy of the COVID-19 vaccine.

He rubbished the rumours being propagated on social media which are raising doubts in the mind of the public regarding the vaccine side-effects and said, "These miscreants might derail the whole exercise, set the clock back by years".

On 30th March, Dr. Vardhan changed its tune about efficacy of two vaccines. He

told reporters: "even if someone tests positive after taking vaccines, it minimises the chances of their hospitalisation or admission to the ICU (Intensive Care Unit) wards".

He added: "There should be no doubt about Covaxin and Covishield safety and immunogenicity. Both Indian vaccines are safe and effective. A lot of people still have doubts regarding vaccines. I urge them not to believe what is being circulated in 'WhatsApp university'."

Compare this with the realistic stance adopted by a top Chinese health administrator. Gao Fu, the director of the Chinese Center for Disease Control and Prevention, told a recent conference that China was considering mixing COVID-19 vaccines since currently available vaccines "don't have very high rates of protection".

It is high time the Government issues a policy statement on covid vaccines. The policy must provide for guidelines to classify and rate vaccines: 1) their capability to prevent infection 2) their capability to only prevent severity of infection in case vaccinated persons catches the virus.

The policy must provide for public disclose of errors in administration of vaccines and of adverse event following immunisation (AEFI). A recent news report claimed that 180 persons died in India after vaccination till 31 st March. The Government had shrugged off these as tragedies due to previous, underlying causes of patients.

To inspire public confidence in covid vaccination, the Government should disclose the mechanism for compensating persons affected by AEFI. It is not just good enough to stamp Mr. Modi's photograph on each certificate issued to vaccinated persons. It should carry a declaration that PM Cares Fund would compensate the AEFI victims through the direct benefit transfer (DBT) platform.

Let the Government specify compensation for different AEFI.

The public ought to be educated about limitations of vaccines whose efficacy is highly dependent on covid dynamics and duration of vaccination. Let vaccines not create a false sense of immunity from covid, thereby creating base for deadliest third wave. The public must be told the implications of taking/ or not taking the jab every year as in the case of seasonal flu.

Let the truth and eternal vigilance prevail.