Since the onset of the COVID-19 pandemic last year, the Narendra Modi government has fielded three scientists to brief the media and the public at large. They are principal scientific adviser K. VijayRaghavan; NITI Aayog member and chief of national expert group on vaccines V.K. Paul; and Indian Council of Medical Research director-general Balram Bhargava.
Individually and collectively, they, along with various bureaucrats and ministers who purportedly have sought to inform and guide the public, have been far less forthcoming in handling questions than their counterparts in other democracies reeling from COVID-19, especially the UK and the US.
On behalf of The Wire, I have made multiple attempts to interview each of the three official experts over the past year as part of a series of interviews I have conducted with leading Indian and global experts on the pandemic and its effects. These requests, sadly, have all been unsuccessful. Since it is clear that they will not give us an interview, I would like to put in the public domain a set of questions that are top of my mind – in the hope that someone to whom they do consent to speak can ask them.
1. No doubt no one could have predicted the suddenness and severity of the second COVID-19 surge but was it not more than likely, if not almost inevitable, that there would be one? After all, if Europe and the US experienced second and third waves, was it credible to believe the impact of the spread in India would end with only one wave?
2. Did they advise Prime Minister Narendra Modi and the government to expect a second wave?
3. Given the second wave in Europe and the US was considerably worse than the first, did they advise the prime minister and the government that that could be the case in India as well?
4. When it became clear in January that special facilities created for the first wave, such as the DRDO and Satsang centres in Delhi and the jumbo centres in Mumbai, were being dismantled, did they advise the government (either at the Centre or in the states) that this was hasty and would have leave Mumbai and Delhi unprepared in the event of a second wave, particularly if it was greater than the first?
5. The Indian Express reported that as far back as April 2020, the empowered group headed by V.K. Paul anticipated oxygen shortages and the need to enhance production. Did they monitor what was happening in this regard and did they inform the government that follow-up action was tardy or even altogether missing?
6. Did they advise the government that mass election rallies, huge gatherings at the Kumbh Mela and cricket matches with up to 60,000 spectators in stadiums was not just unwise but could easily become super-spreader events? Did they tell the government that this must stop because this was playing with fire?
7. As far back as May and June last year, when it became clear Pfizer, Moderna and AstraZeneca were developing two-dose vaccines, did they work out that to fully vaccinate 75% of the Indian people, the country would need two billion jabs? And given India’s total vaccine producing capacity is insufficient to produce so many doses in the required timeframe, did they realise it must be hugely ramped up very quickly? And if they did work this out – by the way it’s elementary mathematics, not rocket science – did they accordingly advise the government?
8. If such advice was not given to the prime minister and the government, why wasn’t it?
9. When it became clear that the UK, the US and the EU were all funding vaccine research and placing advance orders to guarantee assured supplies, did they advise the government to act similarly? If they did, what response did they get? If they did not, why not?
10. Dr Balram Bhargava said in early July 2020 that Covaxin would have to complete its phase 3 clinical trials by Independence Day that year – less than two months. As a medical researcher himself, how did he hope to have robust clinical trials completed in such a short span? Considering that his notice was accompanied by a threat to hospitals that don’t comply, did the directive arise from elsewhere in the government? (Since ICMR doesn’t have the power to sanction institutions this way.)
11. Did they advise the government that the accelerated “clinical trial mode” approval for Covaxin when its phase 3 trial efficacy results were not available was not just a breach of scientific ethics and practice but would also seriously increase vaccine hesitancy?
12. There are a few supplementary questions which are worth raising at this point to clarify the arguments made for clearing Covaxin in January. In raising these questions, now we are indicating questions that should have been answered in January:
a. Dr Bhargava told a press conference that Covaxin’s efficacy could be gleaned from animal trials and its phase 1 and phase 2 trial results. How then does he answer questions raised by Dr Gagandeep Kang, Dr Shahid Jameel and others? First, while it is true animal trials have been used in America to clear drugs, that has only happened when you can properly mimic the human disease in animals. Thus far, that isn’t the case with COVID-19. So how could animal trials have indicated efficacy in the case of Covaxin?
b. Second, phase 1 trials establish only safety – that too not long-term safety and safety from rarer side-effects – and not efficacy.
c. Third, the number of people involved in phase 1 and 2 trials was around 800. This is too small a cohort to establish a vaccine’s efficacy.
13. Have VijayRaghavan, V.K. Paul and Balram Bhargava raised the following questions about the government’s decision to open vaccination to everyone over the age of 18 from May 1?
a. Since India currently only makes under 2.5 million vaccine doses a day, how will we vaccinate the 595 million people between the ages of 18 and 44 who will become eligible on May 1?
b. Is it ethically right for vaccines to be free for people over the age of 45 but require payment from those under that age? This is not just a moral and ethical question but also a practical one. Many people under the age of 44 are poor and may not be able to easily afford a two-shot vaccine.
c. Why are state governments being asked to pay for vaccines when the people they will vaccinate are citizens of India and in no way different from the people the Central government is vaccinating for free?
d. Is it right to put state governments and the private sector in competition with each other – indeed, state governments are also competing with each other – for the 50% the Serum Institute and Bharat Biotech will set aside for sale to state governments and the private sector?
14. Given that Covaxin is an indigenously developed vaccine created with support and collaboration from the ICMR, did they advise the government to buy out Bharat Biotech’s intellectual property rights and permit the widest possible production of this vaccine within the country and in other countries as well? This would have substantially supported India’s request to the WTO to suspend IP rights of other COVID-19 vaccines as well.
15. India’s official tally of total COVID-19 deaths is just over 200,000. Practically everyone in the country believes this is a gross, if not unbelievable, underestimate. How can they convince the country the figure is right?
16. Why did the government stop releasing reports on adverse events following immunisation from February 26, 2021? A subsequent analysis from within the health ministry did not find any causative links between receiving Covishield and rare blood clots of the sort that the US and countries in the EU had reported. How reliable is this conclusion when reports in the press have said officials in many states are already engaged in a case and fatality undercounting exercise?
17. Jamie Mullick, writing in the Hindustan Times on April 27, says the rolling weekly average of deaths has been increasing by 50% each week for the last four weeks. In fact, last week it increased by 84%. Consequently, he says, India’s case fatality rate jumped from 0.7% in early February to 1.7% last week. Does this suggest we can no longer take comfort from a low case fatality rate?
18. Officially, India’s case load is increasing by nearly 400,000 cases a day. If the case fatality rate remains 1.7%, would they accept that in two weeks’ time, we could expect something like 6,800 deaths a day?
19. At this point, one could also ask a wider question: they always compare the number of cases and the number of deaths in India with the EU and the US. Why don’t they compare it with our neighbouring countries like Pakistan, Bangladesh, Sri Lanka, Nepal or, even, countries further afield like Malaysia, Thailand and Philippines? Is it because both cases and deaths per million are lower in those countries and in comparison India would look worse, whereas if you compared India to the EU and the US we would look a lot better?
20. Why don’t they honestly tell us what they believe is the undetected increase in cases each day? We know the official increase is nearly 400,000 a day. We also know that different organisations estimate the undetected increase differently. Prof. Gautam Menon says it’s 20-25-times more. The last serological survey released by the government in February suggested it’s 27.5-times more. The Seattle-based IHME said it’s 29-times more. But what is the view of our government, which these three gentlemen are in a position to tell us? Don’t they have a duty to tell us?
21. What do they think of Prof Bhramar Mujherjee’s mathematical projections of 500,000 daily reported cases by early May, climbing possibly to as much as a million by mid-to-late May, when the wave is likely to peak?
22. The Drug Controller General has approved various questionable drugs for COVID-19 patients without the requisite evidence that they work. They are tocilizumab, itolizumab, favipiravir and most recently Virafin. The health ministry has also recommended the use of hydroxychloroquine despite no evidence of its efficacy as well as its non-trivial side effects. As scientists themselves, did VijayRaghavan, Paul and Bhargava consult with the DCGI on these decisions? How do they square the wealth of robust expert skepticism in the public domain about these drugs against the government’s continued endorsement of their use?
23. Let’s come to the viral strains. Do they accept that the B.1.1.7 strain (first reported from the UK) is not just the main cause of spread in Punjab but has reached community levels of spread?
24. Why do they not share details of the B.1.617 strain (colloquially called the “double mutant”)? Is it both more easily transmissible and, perhaps, more resistant to vaccines as has been widely reported in the press? Or do they agree with top British scientists who have told Financial Times that there is “little hard evidence about the virulence and transmissibility of the variant”? In other words, why don’t they tell us what they know rather than deliberately hide things from us and leave the Indian people open to speculation, possible misreporting and consequent exaggeration, even panic?
25. Have they told Prime Minister Modi that the personal example he set by repeatedly holding political rallies across the length and breadth of the country (from Assam to Kerala and Bengal to Tamil Nadu) and then marvelling at the size of the crowd he attracted, undermined the government’s message of physical distancing, mask wearing and COVID-appropriate behaviour?
26. In fact, given the prime minister is widely acknowledged as a superb communicator, did they tell him to make a much greater personal effort – and to do so repeatedly – to tell people to wear masks and physically distance? Did they tell him to hold press conferences, on a weekly or even daily basis if need be, to ram this message home and to make videos and commercials to be run on television to remind people of this?
27. Last year, an investigation by The Wire Science found that the market was inundated with masks falsely claiming to be N95. There are still many anecdotal reports, and considerable confusion, about which masks to buy. There are regulations but these are technical, and enforcement is absent. What has the government done to ensure people only get and use the right masks?
28. What do they say to the government when ministers make foolish statements that endanger proper behaviour? For instance, when Assam health minister Himanta Biswa Sarma said there was no need to wear masks in his state or when Uttarakhand Chief Minister Tirath Singh Rawat said faith in God and the power of the Ganga river would protect people from COVID-19?
29. The Ministry of AYUSH has pushed the use of ‘alternative medicines’ to treat COVID-19. At one point, the city of Mumbai and the state of Telangana distributed homeopathic pills to its residents. Perhaps more egregiously, Baba Ramdev and his company Patanjali Ayurved first marketed ‘Coronil’ as a “cure” for COVID-19, with the health minister as the chief guest at the product launch. More recently, the same minister, Harsh Vardhan, scolded several ministries for delay in making ‘significant progress’ in ‘cow science’ before India’s 75th independence day. You are advocates of evidence-based medicine. None of these ‘solutions’ have evidence to prove they help or are safe. How have you allowed their continued use?
30. What did they say when Prime Minister Modi told the World Economic Forum in January that India had succeeded in “containing corona effectively”? Or when the BJP, in a formal resolution on February 21, said India had “defeated Covid”? Or when the Union health minister on March 7 told a gathering of doctors “we are in the end game of the Covid 19 pandemic in India”? Did they tell the government these were foolish and unjustified claims? Or were they silent because that was more expedient?
31. Have they advised the government that weddings should not be permitted because they will spread the virus? In some states, up to 50 guests are allowed. In others, up to 100.
32. Why did they not advise the government to distribute rapid, self-administered testing kits developed by scientists in India last year – instead of forcing people to crowd at testing laboratories, and those labs to have to turn people away for want of time and other resources?
33. How can they convince the country that sufficient levels of genome-sequencing are being done? India, as of April 23, designated labs had sequenced 15,133 samples, which is fewer than 1% of total samples, compared to 8% in the UK and 4% in the US.
34. How do VijayRaghavan, Paul and Bhargava respond to the view of several experts who believe India’s vaccine strategy must change? For example, Prof Bhramar Mukherjee has strongly recommended ‘ring vaccination’ and focused concentration on regions and districts where the virus is spreading furiously. Prof Giridhara Babu has recommended extensive use of ASHA workers and adoption of techniques and systems used for polio vaccination campaigns.
35. Finally, what can they tell the people of India about the possibility of a third wave and, in particular, how much the lessons learnt during the second wave will help us at that time?