Anticipating the Unintended #48: “You Are Strictly Advised To Read This. Non-compliance Will Be Viewed Seriously”

This newsletter is really a weekly public policy thought-letter. While excellent newsletters on specific themes within public policy already exist, this thought-letter is about frameworks, mental models, and key ideas that will hopefully help you think about any public policy problem in imaginative ways. It seeks to answer just one question: how do I think about a particular public policy problem/solution?

PolicyWTFs: The Aatmnirbhar Way to Cure COVID-19

This section looks at egregious public policies. Policies that make you go: WTF, Did that really happen?

— Raghu Sanjaylal Jaitley

It has been a remarkable week for Indian medical science. First, Patanjali Ayurved claimed their Ayurvedic drug Coronil could cure COVID-19 based on trials on mild to moderately ill patients. Some outrage followed. Patanjali backtracked and later released a Corona kit (including Coronil), calling it a product for COVID-19 management. Well, what can’t be cured must be endured. No sooner had we stopped throwing confetti in the air in celebrations than came the letter from DG, ICMR indicating we will have a vaccine ready for public health use by, wait for it, August 15.

What a coincidence! That set me thinking. Had we won our independence in the month of July, ICMR might have got us the vaccine earlier and saved more lives. But Nehru and Mountbatten took their own time in 1947 and we are still paying for their laxity.

How Not To Follow Ayurveda

Media has covered both the stories extensively. This is last update on Coronil where Baba Ramdev of Patanjali declared there’s no difference of opinion between them and the AYUSH Ministry. The ministry must be so relieved to hear that. Anyway, we aren’t scientists or medical professionals here. So, it is difficult to have a technical opinion on these issues. But applying tools of economic reasoning, we offer three points to consider.

First, Ayurveda or any traditional healing method works based on empiricism. Over many generations, traditional healers observe certain natural products help in healing common ailments. A meticulous record of these ingredients and their healing properties is formalised. These cures are then used over the centuries to treat people. A study of these ingredients and the chemicals contained within them using modern knowledge of biochemistry often reveal these are effective cures. Two, these traditional techniques are tried over time on a population with a common ethnicity or a similar gene pool and factoring in the local climate, food and lifestyles. These healing techniques, therefore, are endogenous to a specific ecosystem. Three, if you consider the two points above, it is clear Ayurveda or any traditional healing technique follows what modern medical science refers to as ‘trials’ over generations before formalising it. Therefore, any cure for a new ailment or a new virus should follow a similar process and timeline before it can be considered a legitimate Ayurvedic formulation. Sure Ayurveda can cure coronavirus, but we are possibly 200-300 years of ‘trials’ away from it if we were to respect the science behind it.

Modern medicine and biochemistry emerged because we couldn’t wait for this long with a low probability of success at the end of it. Also, the ‘germ theory’ was a clean break from the three dosha belief of Ayurveda on why we fell ill. But the idea that ingredients within herbs, flowers or other natural substances could heal wasn’t discarded. Instead, this knowledge, along with development of disease science and synthesis of new chemicals was used to develop medicines. Patanjali isn’t just ignoring the Ayurveda code for new products but circumventing the accelerated mechanism of trials for modern medicines using tradition as a fig leaf. This is unfortunate in a country where people trust Ayurveda and traditional methods based on their empirical experience. This is opportunism or, worse, plain quackery.

How Not To Develop A Vaccine

The ICMR vaccine story is remarkable. We have written about vaccines and their timelines in a previous edition. Vaccines need extensive trials for a simple reason. They are given to healthy people who could contract the disease or have other side effects because of the vaccine. The founding principle of medical science is the Latin phrase “primum non nocere” which translates to “first, do no harm”. Vaccines take time because they have to satisfy both the conditions – prove they prevent the disease and that they do no harm. This piece in the Indian Express highlights the near incredulity in the scientific community about the August 15 claim.

AIIMS Director Randeep Guleria, the head of the clinical research group of the national task force on COVID-19 was at his diplomatic best with this quote:

“It will be a very challenging and difficult task, considering that we have to look at both efficacy and safety of any vaccine that is introduced. Also, if we get the desired results, the other challenge is the process of mass production of the vaccine,”

Update: As expected, clarification has arrived.

“ICMR clarified that the purpose of the letter was to expedite trials so that results could be available by August 15, the vaccine would need more time for public use.”

The letter from the DG, ICMR to the 12 institutes that have been chosen as clinical trial sites is a fine example of government communication. As long-time connoisseurs, we have analysed the letter to draw our inferences.

“…. (is) one of the top priority projects which is being monitored at the topmost level of the Government” (emphasis not ours)

One arm of the state suspects the other won’t cooperate unless it is made clear the topmost level of the government is reviewing it. The usual matrix of roles and responsibilities of each institution isn’t adequate to get work done. The implicit threat of the topmost level has to be spelt out.

….you are strictly advised to fast track all approvals…. no later than 7th July 2020.

The government can take a course on how to write passive-aggressive statements. Who doesn’t want to be ‘strictly advised’ in life? I could do with some of that early on in my career. Also, this suggests approvals can be fast-tracked if there’s intent. Why that speed can’t be the usual way of working is an old puzzle while dealing with the state.

Kindly note that non-compliance will be viewed very seriously

The timelines are impossible and lack scientific basis but that doesn’t mean the state won’t coerce you to meet them.

Back To the State

Both these news items are helpful to appreciate the nature of the Indian state. We never tire of highlighting them (nor will we ever):

  1. Institutional maturity: Our political, economic and administrative institutions were set up to be inclusive as Acemoglu and Robinson would define in Why Nations Fail. This meant their charter was replete with noble intentions – share power with responsibility, focus on growth, technical excellence, independence and well-being of the society. Unfortunately, in the 70 years of being a republic, we have weakened our institutions and made it subservient to the political regime. The allegiance of those at the helm in the institutions isn’t to their constitutional mandate but to those who control their destiny. In effect, the institutions have turned extractive – privileging certain sections of society, overriding rules and using their power for rent-seeking.
  2. Rule of law: The guidelines and laws can be bent to expedite the process for some or place constraints in the path of others. This arbitrary use of power is common where the state capacity is low, and the rules are complex and often contradictory. Our economic performance is hobbled by this unpredictability of our regulatory environment
  3. Accountability: There is no transparent mechanism to measure the performance of our institutions. The political parties are held accountable for their work but institutional accountability is random. Minor mistakes that hurt the image of the government is punished severely while incompetence, in the shape of ridiculous announcements followed by clarifications, is tolerated. There is no long-term view, only immediate self-interest, that guide the functioning of the institutions

The COVID-19 cases continue to rise steadily in India. Our health and medical institutions need to be at the forefront of this fight using scientific knowledge and research capabilities at their disposal. These fast-track solutions or remedies only serve to distract them.

Read the full edition here.

Disclaimer: Views expressed on Anticipating the Unintended are those of the authors’ and do not represent Takshashila Institution’s recommendations.