Commentary
Find our newspaper columns, blogs, and other commentary pieces in this section. Our research focuses on Advanced Biology, High-Tech Geopolitics, Strategic Studies, Indo-Pacific Studies & Economic Policy
Why India must vaccinate 80% of population by December 2021 — no matter what the cost
Planning for a national Covid-19 vaccination programme has begun to move forward in right earnest in India. Last week Union Health Secretary Rajesh Bhushan wrote to state governments outlining the administrative structures to be put in place to oversee the implementation in their respective jurisdictions. As of now, the Narendra Modi government expects the vaccination programme to take over a year, with healthcare and essential services workers getting the shots before the rest of the population. The Modi government has done well to reject the narrative of low expectations by setting a one-year timeline. As I have argued earlier, this is both necessary and eminently doable if we do not limit ourselves to departmental thinking and processes.Read More
Centre raises hopes of free COVID-19 vaccine, but benevolence can't be at the cost of the economy
This article first appeared in the Firstpost. COVID-19 has assaulted the health of people and economies. The impact on the economy has led to further stress on people’s livelihoods. This unprecedented threat to public health has not been constrained by measures taken by national and state governments. All humankind is waiting with bated breath for a COVID-19 vaccine that can set us on a course to normalcy. The human and economic cost of COVID-19 has been immense and governments are stepping up to expedite vaccine availability.Given the vaccine’s huge impact on public health, it is reasonable to expect that the government makes it available free for all. The cost of undertaking this exercise would depend on a variety of factors – the cost of manufacturing, the cost of supply chain, and the cost of administration of the vaccine. For example, nucleic acid-based vaccines have to be stored at sub-zero temperatures and are costly to make and transport. (Read more)
Politicisation of Covid vaccine is a good thing — it means India will get it free
It is surprising that political parties were surprised that one of them — the Bharatiya Janata Party, as it happens — announced in its manifesto for the Bihar assembly election that it would provide free Covid-19 vaccines to everyone in the state if elected to power. By now they must know that the BJP under Narendra Modi and Amit Shah is an exponent of totalpolitik that stops at nothing to win the next election, big or small. Indeed, the promise of a free vaccine is perhaps among the milder instruments in its political armoury. Moreover, in a country where political parties have promised colour televisions, cable TV connections, bicycles, electric scooters, durable slippers, lunch boxes, sarees, kitchen utensils, cooking oil, rice, electricity, fertilisers, wedding cash gifts, laptops, WiFi, and smartphones with six months of free internet to voters, a free vaccine for everyone against a raging pandemic seems even reasonable.Read MoreYou can read the story in Hindi, here.
Bring back the family doctor. India has too many specialists
If you live in a medium-sized or larger town in India, chances are that you have a private medical clinic or hospital not too far from your home. Chances are that it will describe itself as a “multi-specialty clinic” and the reception area will have a long list of specialists who you could consult. Even the smallest clinics in my neighbourhood in Bengaluru have around a dozen specialists on their roster. Every conceivable specialisation — from neurosurgery to psychiatry, interventional cardiology to maxillofacial surgery — is available within a 5-kilometre radius from my home.Read More You can also read this article in Hindi
Serosurveys point to inadequacies in India’s COVID-19 testing strategy
Over the past few months, a series of serosurveys for detecting the spread of COVID-19 have been carried out in India. The surveys are meant to identify the percentage of the Indian population with antibodies against SARS-CoV-2, as an indicator of how widespread COVID-19 is in the population. The Indian Council of Medical Research led a national survey starting May 2020, the findings of which suggest that the seroprevalence in a selection of districts across India was 0.73 percent. A follow-up survey done in August showed that seroprevalence in the same districts increased to 7.1 percent. Between May and August, city/state-level surveys have shown varying seroprevalence, ranging from 0.25 to 51 percent.Read more
Breathe new life into public health. Far too many Indians rely on Baba Ramdev, Akshay Kumar
Media headlines and public discourse might not reflect it, but one of the most important policy priorities for India now and over the next decade is health. The immediate task, of course, is ensuring that we bring the pandemic under control within the next year. The longer-term challenge is to create a health care and public health system that will form the basis of our future growth and development.
Public policies designed to bring about better health outcomes are desirable in and of themselves. But in the post-pandemic world, investment in health is important for an instrumental reason as well — to revive the Indian economy in the short-term and create a new engine of growth that the country desperately needs. Despite the beating the system has received due to the Covid-19 pandemic, the Indian healthcare sector has the potential and the opportunity to become a globally competitive hub for quality, affordable healthcare. The crisis is an opportunity for a comprehensive review of how India has approached its health policy and lay the foundations for something that is a whole lot better. Over the next few weeks, this column will focus on new dimensions and angles in developing health policy for the future.
Covid hospital, not coastal road
Mumbai is the richest municipality in India with a budget whose size dwarfs many state government budgets. For instance, it is 50 per cent larger than the state budget of Goa. It can legitimately brag about many excellent hospitals, which provide highly subsidised healthcare services to the poor and vulnerable. Patients flock to Mumbai’s hospitals from across the country, and the city does not discriminate against anybody. The doctors, nurses, ward staff are all dedicated and constantly fighting uphill battles against rising caseloads, inadequate infrastructure, long working hours, and funding shortage.Wait a minute. Is Mumbai not the richest civic body in the country? And it has funds shortage? Despite sitting on real estate whose value is greater than gold? How come?Read More
India’s Covid data like counting potholes under streetlights. There are far more in the dark
There are two ways to deal with the uncertainties arising from the Covid-19 pandemic. The first is to take them as they come, and as I wrote in an earlier column, deal with the daily developments with a Stoic mind. To play the stroke according to the ball that comes your way. The second way is to try to get a sense of how things are likely to pan out, and prepare for them in advance to the extent possible. To have a game plan, but still be Stoic about it because things might not go the way you want. Most people can choose either way. But those who have to make personal, business or policy decisions that involve a longer horizon need some way to look beyond the here and the now. In other words, we need information that helps us estimate what might happen in the future. And this is where the problem lies.Read More
WHO’s COVAX Vaccine Access Initiative Won’t Succeed Without India’s Help
by Ruturaj Gowaikar and Shambhavi NaikDespite multiple lockdowns, forms of treatment and therapies, and intermittently aggressive contact-tracing, countries around the world have failed to arrest the spread of the novel coronavirus to the extent they had intended. A vaccine administered to 70-80% of the global population seems now to be the only path to normalcy.While this is an ideal figure, the whole world – much less any individual country – doesn’t have the capacity to manufacture and distribute these doses in a reasonable time frame. Further, the expertise to develop, test, manufacture and distribute the vaccine is scattered around the world. So in the face of an international pandemic, it is imperative that countries work together to share their expertise and abilities to deliver adequate quantities of a reliable and tested vaccine to everyone.
The COVID-19 Vaccine Global Access Facility (COVAX), an initiative of 172 countries is one platform to exchange expertise and enable equitable access to the vaccine. COVAX plans to pool economic resources of its member countries to achieve two objectives: enable vaccine developers to make high-risk investments for the development of vaccines, and subsidise vaccine costs for middle- and low-income countries. (Read more)
Modi govt mustn’t hesitate to make Covid vaccine free for Indians. It only costs Rs 80,000 cr
Adar Poonawalla’s recent tweet prompted some discussion on India’s vaccination strategy. The CEO of the Serum Institute of India, one of the world’s largest vaccine manufacturers, asked if “the government of India will have 80,000 crore available, over the next one year” to pay for the purchase and distribution of the Covid-19 vaccine to everyone in the country. My own colleagues estimate that it will cost between Rs 50,000-250,000 crore (depending on the vaccine) to vaccinate 80 percent of India’s population within a year.Read MoreYou can read the article in Hindi here.
COVID-19 vaccine deployment in India: Lessons we need to learn from the past
It appears that a vaccine(s) is the only way to stop COVID-19 and return the world to some semblance of normalcy. As the race inches to a close, everybody is waiting for their turn to get the vaccine and go meet their friends for a cup of coffee.However, there are several scientific hurdles that still need to be surpassed: how effective would the vaccine be across demographics? For how long will the vaccine confer immunity? Will the virus mutate, rendering the vaccine ineffective? Even if we get a combination of vaccines that answers these questions, the capacity to produce, distribute and monitor adverse events related to the vaccine are going to limit an effective vaccine rollout. Hence, it is important India identifies the vaccine demand, invests in capacity and communicates with the public to enable a smooth immunisation programme.
Lessons from COVID-19 testing
India’s response to detecting the COVID-19 outbreak was reactive, not proactive. For weeks COVID-19 testing was limited to authorised government laboratories, and available conditional on pre-determined criteria. Instead of scaling up testing capacity and aggressively test and trace, the government took a cautious approach, most likely to protect scarce testing resources. However, a strategy to ramp up both kit manufacture and early inclusion of private laboratories could have helped India’s response in containing the spread of the virus. (Read more)
Vaccinating Indians against Covid? We should be talking days, not years
As the Narendra Modi government’s National Expert Committee on Vaccine Administration deliberates on a vaccination strategy against Covid-19, the single biggest thing it should be wary of is status quo-ism packaged as pragmatism. One thing India is not short of are people who can tell you why something cannot be done. We are now being told that a fast, universal national vaccination campaign is not possible because India does not have the infrastructure, administrative capacity and funds to do so.
A couple of weeks ago, a research report by Sanford Bernstein, a financial brokerage firm estimated that it will take as long as three years to vaccinate 60 per cent of the population at a total cost of $6 billion. The government’s share of this will be $2 billion, which will cover 30 per cent of the population. The remaining 30 per cent will purchase the vaccine privately at a cost of $4 billion (because the government will procure the vaccine at $3 per dose, as opposed to $6 in the private market). The analysis might have calculated timelines based on the public health system’s rate of delivering 60-100 million vaccinations per year. I do not have access to the report, but if the media summary is correct, it would seem that the Indian government will pursue Covid-19 vaccination as if it were any other vaccination project. It takes a lot of cynicism to set such low expectations of the government. Worse, if such low expectations get anchored in public discourse, they might creep into public policy, becoming a self-fulfilling prophecy.
The mental health cost of Covid-19
The GDP numbers are out. These refer to the three months from April to June, which were mostly about a harsh lockdown. More than three-fourths of the economy was shut down at least for a month, and hence output, income, jobs were lost. The contraction in India’s GDP was the most acute among the top 20 countries of the world, i.e. the G20 group.One of the G20 members is called EU, which is actually a collection of 27 countries of Europe. During that same quarter, China’s GDP went up by 12 per cent. China’s GDP contraction happened in the previous quarter, i.e. from January to March, which also included the Chinese New Year, when almost the entire country is on holiday for two weeks. The remarkable thing is that in just one quarter the Chinese economy has bounced back and is in strongly positive territory. India’s July to September quarter numbers will not be known until after Diwali, and it is unlikely that we will see as smart a bounce back as China. We will be lucky to see mildly positive growth from October, and then sharply higher from January. Much of this will depend on fiscal stimulus 2.0, which is aimed at urban folk (unlike 1.0, which was aimed mainly at rural folk and agriculture), and also the return of consumer and business confidence. Let’s not forget that much of the revival in GDP has to be led by the private sector. The central and state governments can only play an enabling role, and the fiscal stimulus of say 5 or 6 per cent of GDP is a lever which uses the fulcrum of “feel good” factor and business optimism to pole vault the economy into higher and positive growth trajectory.Read More
Pandemic and exam stress
Sometimes it feels as if the Supreme Court is running the country. Otherwise why does everything escalate all the way? The SC’s main job is to examine constitutional issues, but it is often and increasingly embroiled in commercial disputes. For instance, an engineering company in Chennai had registered the trademark ‘Coronil’ back in 1993, as an industrial cleaning product. When Patanjali started using the same name for its Covid-19 product, the Chennai firm said you are infringing on my trademark.Patanjali subsequently toned down its claim, and said it was an immunity boosting product. But this infringement case went all the way to the Supreme Court wherein it ruled the commercial dispute in favour of Patanjali. “In these pandemic times it would be terrible if we restrict the use of the word Coronil,” said the court. Technically the apex court has asked the parties to abide by the decision of the Madras High Court, which is in favour of Patanjali. Of course, there was another issue of the misleading claim in the earlier advertisements of Coronil being a ‘cure’. That too was looked into by the apex court.Read More
When will the coronavirus pandemic come to an ‘end’? February 2021
When will the coronavirus pandemic come to an end? The question is on everyone’s mind, and while astrologers and politicians have answers, few scientists want to be drawn into hazarding a prediction.
According to Union Health Minister Harsh Vardhan’s recent remarks, the spread of coronavirus has already been contained in India because “half the total cases are from three states only and another 30 percent from seven others.” But India has crossed two million Covid-19 positive cases and the graph continues to rise.
The endings
As Gina Kolata wrote in The New York Times earlier this year, medical historians recognise two types of endings. The medical ending, when the disease stops spreading; and the social ending, when people overcome their anxieties and move on. It would be appropriate to add a third type of ending: the political, when the government decides that as far as it is concerned, the pandemic is over. Any of these three endings could occur first, as political leaders and society can decide to move on regardless of whether the cases have peaked. If we look at the world today, it would not be overly cynical to conclude that politicians would rather move on, and that societies are distracted to such dysfunctional levels by social media-driven outrage cycles that they often ignore the extant pandemic. Maybe India is already at this point.Read More
Radio, Buddies & More: Alternatives For Students Without Internet
With the COVID-19 pandemic’s requirement for social distancing, it will be difficult to physically reopen schools. When schools in Israel reopened, clusters of COVID-19 cases were reported from them and all schools had to be closed again. Thus, keeping schools closed is a wise option. The current situation has certainly increased the demand for virtual learning and in the same direction, the Government of Maharashtra has announced the beginning of the new academic year for state board schools with online classes. While that seems like a logical decision, especially in Maharashtra which accounts for 30% of COVID-19 cases in India, it does not account for the digital disparity. Not all students have access to smartphones/internet and therefore, it is imperative to find alternatives to online learning so that all students are able to access education.Read more
Capacity is not what’s hindering India’s testing rate, government price caps are
India cannot control the spread of the Covid-19 epidemic unless the governmental authorities stay in mission mode and get better at the ‘test, trace and isolate’ strategy, as I wrote in my column a couple of weeks ago. The first and most important part of the epidemic control strategy is testing, for only when you test lots of people and get the results quickly will you be able to trace their contacts and isolate them all.
Covid-19 cases across India are rising because the country is just not testing enough people, and test reports are taking too long to come out. And the main reason why India is falling far short of its capacity to test is that governments have failed to engage private laboratories and healthcare facilities in a reasonable manner. How else can you explain the fact that while there are abundant numbers of test kits available in the country, India ranks among the lowest in terms of tests per capita? Philippines, Malaysia, Rwanda and Cuba test more people per day relative to population than India does.
ICMR should fast track coronavirus vaccine, not for 15 August but for science
There is absolutely no doubt that the world needs a vaccine for the novel coronavirus or SARS-nCOV-2 fast and the country that acquires one first will not only secure health and economic benefits but gain a geopolitical window of opportunity that it can exploit. For strategic reasons, therefore, I have previously argued that “India must accelerate efforts to develop an indigenous vaccine” and that “We should be prepared to manufacture sufficient doses for our own population and export large volumes to the rest of the world.”
To the extent that the Indian Council of Medical Research’s (ICMR) controversial letter to certain hospitals to “launch a vaccine for public health use latest by 15th August 2020 after completion of all clinical trials” indicates that the Narendra Modi government is serious about running the vaccine race, it is a good sign. However, as Warren Buffett once said, “No matter how great the talent or efforts, some things just take time. You can’t produce a baby in one month by getting nine women pregnant.” In fact, ICMR’s hope, demand, or injunction — whatever it was — is logically impossible to satisfy: all clinical trials simply cannot be completed by 15 August. It seems to have acknowledged this in its subsequent clarification.
India could afford to overlook economic inequality until now. Covid has changed that
How Ramdev’s Coronil makes social media’s fight against misinformation more difficult
This article was first published in The Print.Even as scientists around the world struggle to come up with a vaccine for the coronavirus, Ramdev’s Patanjali Ayurveda announced this week that it has developed a ‘cure’ for Covid-19. According to Ramdev, ‘Coronil and Swasari’ medicine has shown promising results and ‘cured’ all coronavirus patients not on ventilator support who were part of the trial.The introduction of a ‘cure’ and the resulting reaction — the Narendra Modi government’s AYUSH Ministry has asked Patanjali to stop advertising Coronil, and the Uttarakhand Ayurveda Department has said the company did not mention ‘coronavirus’ in its application seeking licence — raises an important debate on information disorder on social media platforms. And the question of what medical misinformation constitutes during times of a pandemic and otherwise.