The problems with one-shot Covishield

NDTV quoted unnamed sources in the Indian government saying it will be conducting a study to assess the feasibility of deploying the Covishield vaccine in a single-dose regimen instead of continuing the extant double-dose regimen.

At any other time, such a statement may have been sufficient to believe the government would organise and conduct a well-designed trial, publicise the findings and revise policy (or not) to stay in line with the findings, informed by socio-economic considerations. But the last 15 months have thrown up enough incidents of public-health malpractice on the state’s part to make such hope outright stupid. I’m fairly certain, especially if the vaccine shortage persists and the outbreaks on an upward trajectory in some parts of the country at the moment aren’t tamped down quickly, that the government is going to conduct a trial, not publish its methods and findings and push through a policy to deploy Covishield as a single-dose shot.

Of course I would be happy to be proven wrong – but in the event that I’m not, I’m already filled with a mix of sadness and fury. The government seems set on finding new ways to play with our lives.

News that the government is going to conduct a feasibility study broke to the accompaniment of a suggestion, by NDTV’s same unnamed sources, that Covishield was originally intended as a single-dose vaccine and that it was later found to be better as a two-dose vaccine. This is ridiculous to begin with, considering Covishield’s phase 3 trials around the world, conducted by AstraZeneca and the University of Oxford, tested the two-dose regimen.

But it is rendered more ridiculous because Public Health England (PHE) reported just a week ago that two doses of Covishield are necessary for a recipient to be sufficiently protected against infections by the B.1.617.2 variant. The PHE study found that one dose of Covishield had an efficacy of 33% against symptomatic COVID-19 caused by the variant, increasing to 60% after both doses. Has the Indian government forgotten that B.1.617.2 is becoming the more common variant circulating in the country? Or is laundering the national party’s image more important than the safety of hundreds of millions? (The latter is entirely plausible: in the last seven years, the country has seldom been larger than the supreme leader’s ego.)

The PHE study isn’t without its shortcomings – but I’d be more inclined to pay attention to them at this moment if:

  1. I didn’t have to contend with the non-trivial possibility that the Indian government will bury, obfuscate and/or twist the data arising from its assessment, and therefore we (the public) need to bank on whatever else is available;
  2. I didn’t have to contend with the fact that data from Covaxin’s phase 3 trial (which apparently went past its final interim-analysis endpoint in April) and Covishield’s bridging trial (which IIRC concluded on March 24) are still missing from the public domain;
  3. If we could access large-scale effectiveness data of the two vaccines (the National Institute of Epidemiology, Chennai, is set to begin collecting such data this week); and
  4. If there was any other reliable data at the moment about the two vaccines vis-à-vis the different variants circulating in India.

There is another problem. If Covishield is administered as a single-dose vaccine, its efficacy against symptomatic COVID-19 caused by B.1.617.2 viral particles is 33% – which is below the WHO’s recommended efficacy threshold of 50% for these vaccines. If the Indian government formalises the ‘Covishield will be one dose’ policy and if the B.1.617.2 variant continues its conquest, will the vaccine, as it is used in India, lose its place on the WHO’s vaccine list? And what of the consequences that will follow, including other countries becoming reluctant to admit Indians who received one dose of Covishield and one dose of the BJP’s way of doing things?

I would be wary, too. The longer the particles of the novel coronavirus are able to circulate within a population, the more opportunities they will have to mutate, and the more mutations they will accumulate. So any population that allows the virus to persist for longer automatically increases the chance of engendering potentially deadlier variants within its borders. One-dose Covishield plus B.1.617.2, and other variants, will set just such a stage – compounded by the fact that Serum Institute, which makes Covishield, has a much larger production capacity than Bharat Biotech, the maker of Covaxin.

(The PHE study also found that Covishield and the Pfizer-BioNTech vaccine had an efficacy of “around 50%” against symptomatic COVID-19 caused by an infection of the B.1.1.7 variant.)

In fact, the government could have made more sense today by saying it would prioritise the delivery of the first dose to as many people as possible before helping people get the second one. This way the policy would be in line with the most recent scientific findings, be synonymous with a single-dose campaign and keep the door open to vaccinating people with both doses in a longer span of time (instead of closing that door entirely), while admitting that the vaccine shortage is real and crippling – something most of us know anyway. But no; Vishwaguru first.

The political theatre of Vardhan v. Ramdev

Last week, Baba Ramdev made offensive remarks against allopathic medicine and against people desperately looking for oxygen for their loved ones hospitalised with COVID-19. On Sunday, Union health minister Harsh Vardhan sent a letter to Ramdev asking him to withdraw his comments. On Monday morning, news reports suggested Ramdev had done so.

However, it wasn’t clear why the Indian government – so trigger-happy against any small, even nonexistent, slights against “India’s reputation” – didn’t book Ramdev under the Epidemic Diseases Act 1897 or any other law. Or is this not the right question to ask?

Compare Vardhan’s letter on Sunday to Ramdev to his letter on April 20 to former prime minister Manmohan Singh. A day earlier, Singh had written to Modi suggesting that the Centre give the states more flexibility to locally adapt the vaccination programme and share the Centre-company vaccine orders with the people.

In response, Vardhan lashed out, accusing Singh’s Congress party of “fuelling vaccine hesitancy”, spreading fake news and the states in which it was in power of being the biggest contributors to India’s second wave. It was a madman’s diatribe with no basis in fact or sense, designed to curry favour with his own party, and his Supreme Leader, instead of taking the opportunity to respond directly to Singh’s suggestions.

In contrast, Vardhan’s letter to Ramdev – whose remarks were as destructive as Singh’s were constructive – is cajoling. Here’s a translation by NDTV (the original is in Hindi):

The people of the country are very hurt with your remark on allopathic medicines. I have already told you about this feeling over phone. Doctors and health workers are like gods for the people of the country for whom they are fighting against the coronavirus risking their lives.

You have not only insulted Corona warriors, but have hurt the feelings of the people of the country. Your clarification yesterday is not enough to make up for it… I hope you will think hard on it and withdraw your statements completely.

A former prime minister and one of India’s greatest economists is met with blockheaded whataboutery whereas an unscrupulous businessman in cahoots with the national party and with no regard for the morals of public healthcare is coaxed gently into withdrawing his remarks, as if the minister is wary of tripping the wrong wire. This is political theatre pure and simple.

In a government apparatus that has never, in the last half-decade of its rule, done anything without the express permission of its prime minister, it’s not likely that Vardhan or Ramdev have violated this rule now. The big flip side of totally centralised power is that the buck never moves past the same person.

Ramdev was set up to say something offensive and Vardhan was set up push back in a display of understated authority, but authority nonetheless – to signal to the party’s followers that the government, despite so many expressions in India, the US and Europe to the contrary, is in charge and is looking out for the interests of healthcare workers, who show up in Vardhan’s letter as “Corona warriors”. Now that the project has accomplished its goals, the Supreme Leader and his office has allowed Ramdev to withdraw without consequence into his corporate offices and for Vardhan to bask in his ‘victory’.

But numerous healthcare workers have been offended by Ramdev’s remarks, many of them on Twitter, and so has the Indian Medical Association. Is the minister really looking out for anyone here apart from the party followers? This is the right question to ask.

Featured image: Harsh Vardhan and Baba Ramdev. Credits: MST/PIB and Kumari Anu/PIB, Wikimedia Commons.

On the PSA’s new COVID-19 advisory

The Office of the Principal Scientific Adviser (PSA) to the Government of India, K. VijayRaghavan, has issued a new advisory emphasising the roles of “masks, distance, sanitation and ventilation” to end the country’s COVID-19 epidemic.

Over the last few weeks, VijayRaghavan has been sharing similar messages from his official Twitter account, most recently on May 15. The advisory reflects many of his suggestions, including following COVID-appropriate behaviour, maintaining distances and ventilating rooms.

It’s noticeable that this advisory has shown up in the middle of the country’s second wave – instead of before the first wave, which began around February 2020.

What to do but not what not

The advisory begins with a recap of how the virus is transmitted: “Even one infected person showing no symptoms can release enough droplets to create a ‘viral load’ that can infect many others,” it says. “Symptoms can take up to two weeks to appear in an infected person, during which time they may continue to transmit the virus to others. Some people may never show symptoms and still transmit the virus.”

Next, it briefly discusses the mechanics of aerosol versus droplet transmission, starting with: “Aerosols and droplets are the key transmission mode (sic) of the virus.”

Both aerosols and droplets describe fluid particles; aerosols are just smaller and lighter, thus less susceptible to being pulled down by gravity and more likely to be blown around by winds. All persons release both aerosols and droplets when they breathe, talk, cough, sneeze, etc. If a person is infected with the novel coronavirus, the aerosols and droplets will contain viral particles.

Early last year, when the pandemic was just getting underway, the WHO refused to admit that particles of the novel coronavirus could be transmitted through aerosols.

Because droplets are bigger, they typically settle down to the ground within six feet, or two metres – a point that the advisory also makes. Fluid dynamics expert Ronak Gupta wrote for The Wire Science in May 2020 that this figure is based on a study conducted with tuberculosis patients in the 1930s. This is also where the suggestion to maintain a distance of six feet from people around you comes from.

The WHO didn’t change its mind until 200 scientists expressed their concerns in an “unusually public outcry”, and forced the international body to reconsider the evidence for aerosol transmission.

The advisory also reminds readers of the reality of transmission via surfaces. “Virus-laden droplets can survive on non-porous surfaces such as glass, plastic and stainless steel for a fairly long time,” it reads, and recommends that people regularly clean surfaces they touch often, like door-knobs and light switches, with bleach or phenyl.

Note that the US Centres for Disease Control (CDC) said last month that the chance of a person getting infected after touching surfaces is “1 in 10,000”. The PSA’s advisory doesn’t mention the relative unlikelihood of this mode of transmission, suggesting that it is as equally likely as the other two (droplets and aerosols).

The advisory also doesn’t advise against unnecessarily disinfecting certain surfaces. For example, Sumi Krishna has written about civic officials in Bengaluru spraying bleach on trees, roads and vehicle tyres, echoing reports of similar activities in other parts of the country. In the face of uncertainty about what to do, people have often done whatever they can – leading to what some have called ‘hygiene theatre’.

In one infamous incident in March last year, municipal officers in Bareilly forced a group of migrant workers to squat on the road and hosed them with a sodium hypochlorite solution.

Masking strategies

Next, the advisory discusses masks and the risks of different masking strategies in different situations.

Wear a surgical mask, then wear another tight fitting cloth mask over it. If you do not have a surgical mask, wear two cotton masks together. Ideally surgical mask should be used only once, but when pairing, you can use it up to 5 times by leaving it in a dry place for 7 days after one use (ideally give it some sun exposure) and then reuse as double layer.

The next five pages are devoted to ventilation. It describes having windows and doors shut as “poor ventilation”, having doors and windows open as “good ventilation” and doors/windows open with an exhaust system as “ideal ventilation”. Second, it describes what people living in hutments can do to improve ventilation, including requesting gram panchayats to install small windows to improve air flow.

Its recommendation for work spaces is the same as in the first case, with the addition of air conditioners, thus ensuring both directed inflow and directed outflow.

Fourth, the advisory recommends “offices, auditoriums, shopping malls, etc.” install “roof ventilators and HEPA/regular filters” and that the people in charge be mindful of the filters’ service lives and replacement schedules. High-efficiency particular air (HEPA) filters are filters designed to remove at least 99.95% of particles that are 0.3 µm wide.

Finally, it makes similar recommendations for people travelling in crowded vehicles, that passengers should have as many opportunities as possible for fresh air to flow in a direction away from them.

The last part of the advisory deals with “community-level testing and isolation” in rural and semi-urban areas.

Get rapid antigen testing done for people entering the area. ASHA/anganwadi/health workers must be trained and protected for conducting the rapid antigen test. These health workers must be given a certified N95 mask even if they are vaccinated. ASHA/anganwadi/health workers to also be provided oximeters to monitor infected person (sic).

It also asks that “every person who tests positive should be given a certified N95 mask, or a surgical mask if this is not feasible, and advised isolated (sic) as per ICMR guidelines.”

Other communication events

Many behavioural economists have said that clear, simple and authoritative communication that encourages good behaviour vis-à-vis controlling the epidemic is always welcome. The Office of the PSA also released an advisory early last year stressing the importance of wearing masks, including a widely appreciated guidance (PDF) on how to stitch one’s own masks.

This said, the advisory’s timing is interesting because it coincides with some other significant pandemic-related communication events.

First, Tamil TV channels, especially those affiliated with the Dravida Munnetra Kazhagam, have been airing a two-minute long video in which Tamil Nadu’s new chief minister M.K. Stalin describes the proper way to wear a mask, to wash hands, the importance of staying indoors to the extent possible and of getting vaccinated as soon as possible.

Second, the CDC recently updated its guidelines to say people in the US who had received both doses of their vaccines needn’t have to wear masks in public. The update stoked some confusion among experts, but CDC director Rochelle Walensky said the agency’s decision was based on early reports that suggest the Pfizer-BioNTech and Moderna vaccines also significantly cut transmission. That is, people who have received both doses of either vaccine also become highly unlikely to be able to transmit the virus if they get infected.

However, any similar data for the vaccines in use in India – mostly Covishield and Covaxin – are lacking. We don’t know, provably at least, if Covishield and Covaxin cut down transmission and, if so, to what extent.

Conflicting aims

Third, as a document that sticks to the ‘physical’ characteristics of the epidemic, the advisory doesn’t address what people without the resources whose availability it presumes – like room enough to maintain a gap of six feet, exhaust fans that open to meaningful air-streams or clean running water – can do to avoid getting infected.

Even if this criticism can’t be laid at the PSA office’s doorstep alone, the issues make up a significant point of difference between the government’s poor communication thus far and the lived realities of many lakhs of Indians, especially in rural parts, where the second wave is expected to surge next.

By not discussing what the government could have done better, differently or not at all, the advisory gives the impression that the pandemic’s future is in the people’s hands. However, the Indian and many state governments are already out of step with many of the recommendations.

For example, the advisory spends five pages on ventilating rooms properly – but many vaccination centres and hospitals around the country have become potential sites of new infections themselves: the queues are long, the rooms often crowded; in some instances, overcrowding forced healthcare workers to accommodate two people on each bed, sharing oxygen supplies.

For another example, the advisory suggests that air-conditioned trains and buses install HEPA filters. This demand is a far cry from the conditions in which many of these vehicles, but especially buses, currently operate – with torn seat covers, broken handles and guardrails and grime covering most surfaces.

There is no indication that VijayRaghavan or his colleagues have spoken up against these shortcomings before. VijayRaghavan himself has been silent in the face of many questions about his role in the government’s actions. For example, as Karan Thapar asked: “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”, what did VijayRaghavan say to them?

Prem Shankar Jha has pointed out that the government has maintained “two conflicting aims”, each undermining the other, since the pandemic began: one to avert a second wave and the other to extract political mileage. The PSA is a high office in the government: articulating the bare minimum of what needs to be done is necessary to further one set of aims. But what happens when he doesn’t push back against the other?

The Wire Science
May 21, 2021

Melinda, Bill and Jeffrey (Epstein)

I’m not sure what to make of Bill Gates as he features in the New York Times‘s report on his divorce with Melinda French Gates, although it’s tempting to see hints of that attitude so often on display when the Jeffrey Epstein scandal broke in 2019: “I had to have known of the sort of man I’m doing business with but I’m going to pretend that stuff doesn’t exist – or if I can’t then I’m going to remember that it doesn’t bother me – and if someone asks I’m going to say ‘I didn’t know’, and if they don’t believe me I’m just going to offer some money.”

The Wall Street Journal‘s revelation on May 9 that Melinda had been speaking to divorce lawyers since 2019 made it hard to discount an Epstein connection, too.

Other people who came tumbling out of the closet at the time, crooning excuses of various degrees of similarity, include Joi Ito, John Brockman, Lawrence Krauss, George Church, Seth Lloyd and Jean-François Gariépy, plus MIT and Arizona State University.

Excerpts from the report:

And then there was Jeffrey Epstein, whom Mr. Gates got to know beginning in 2011, three years after Mr. Epstein, who faced accusations of sex trafficking of girls, pleaded guilty to soliciting prostitution from a minor. Ms. French Gates had expressed discomfort with her husband spending time with the sex offender, but Mr. Gates continued doing so, according to people who were at or briefed on gatherings with the two men.

So, in October 2019, when the relationship between Mr. Gates and Mr. Epstein burst into public view, Ms. French Gates was unhappy. She hired divorce lawyers, setting in motion a process that culminated this month with the announcement that their marriage was ending.

About a year after the settlement – and less than two weeks after Ms. French Gates’s column in Time – The Times published an article detailing Mr. Gates’s relationship with Mr. Epstein. The article reported that the two men had spent time together on multiple occasions, flying on Mr. Epstein’s private jet and attending a late-night gathering at his Manhattan townhouse. “His lifestyle is very different and kind of intriguing although it would not work for me,” Mr. Gates emailed colleagues in 2011, after he first met Mr. Epstein.

(Ms. Arnold, the spokeswoman for Mr. Gates, said at the time that he regretted the relationship with Mr. Epstein. She said that Mr. Gates had been unaware that the plane belonged to Mr. Epstein and that Mr. Gates had been referring to the unique décor of Mr. Epstein’s home.)

LOL!

The Times article included details about Mr. Gates’s interactions with Mr. Epstein that Ms. French Gates had not previously known, according to people familiar with the matter. Soon after its publication she began consulting with divorce lawyers and other advisers who would help the couple divide their assets, one of the people said. The Wall Street Journal previously reported the timing of her lawyers’ hiring.

The revelations in The Times were especially upsetting to Ms. French Gates because she had previously voiced her discomfort with her husband associating with Mr. Epstein, who died by suicide in federal custody in 2019, shortly after being charged with sex trafficking of girls. Ms. French Gates expressed her unease in the fall of 2013 after she and Mr. Gates had dinner with Mr. Epstein at his townhouse, according to people briefed on the dinner and its aftermath.

The Daily Beast reported on May 7:

Melinda Gates met with convicted sex offender Jeffrey Epstein alongside her husband, Bill, in New York City and soon after said she was furious at the relationship between the two men, according to people familiar with the situation. The previously unreported meeting occurred at Epstein’s Upper East Side mansion in September 2013…  The meeting would prove a turning point for Gates’ relationship with Epstein, the people familiar with the matter say, as Melinda told friends after the encounter how uncomfortable she was in the company of the wealthy sex offender and how she wanted nothing to do with him. Gates’ friendship with Epstein—who for years was accused of molesting scores of underage girls—still haunts Melinda, according to friends of the couple who spoke to The Daily Beast this week…

Again, a hint of the “the two things aren’t connected” logic.

And for his part: “A person who attended meetings at Epstein’s townhouse says Gates enjoyed holding court there. … Gates used the gatherings at Epstein’s $77 million New York townhouse as an escape from what he told Epstein was a ‘toxic’ marriage, a topic both men found humorous, a person who attended the meetings told The Daily Beast.”

Gates’s spokesperson has denied all these allegations, and others.

Back to the New York Times:

For years, Mr. Gates continued to go to dinners and meetings at Mr. Epstein’s home, where Mr. Epstein usually surrounded himself with young and attractive women, said two people who were there and two others who were told about the gatherings. Ms. Arnold said Mr. Gates never socialized or attended parties with Mr. Epstein, and she denied that young and attractive women participated at their meetings. “Bill only met with Epstein to discuss philanthropy,” Ms. Arnold said.

Read: “The other stuff didn’t bother him. Bill only met with Epstein to help launder Epstein’s reputation.”

Sometime after 2013, Mr. Epstein brought Mr. Gates to meet Leon Black, the head of Apollo Investments who had a multifaceted business and personal relationship with Mr. Epstein, according to two people familiar with the meeting. The meeting was held at Apollo’s New York offices. It is unclear whether Ms. French Gates was aware of the latest meetings with Mr. Epstein.

It seems the Bill-Jeffrey friendship wasn’t as benign as media reports have suggested, but while he was clearly bad news for the couple, Epstein was also the last straw – and not the sole cause of the break-up. As the rest of the Times article discusses, as do articles in The Daily Beast and Wall Street Journal, Melinda had been discomfited by Bill’s response to accusations of harassment against his money manager and his affair with an employee a year before he quit the Microsoft board in 2020.

Featured image: A photograph of Jeffrey Epstein in 1980. Credit: Wikimedia Commons.

Courts and COVID

India’s courts have played a prominent in helping (or not) the country manage its COVID-19 epidemic, especially during the second wave this year – from asking the government to explain which proofs of identity will be accepted at vaccination centres to recommending lockdowns. Two high courts, Madras and Allahabad, have also expressed sentiments that had until then been confined to Twitter – that the Election Commission should assume responsibility for the deaths of thousands of people and that state failures to supply oxygen amount to “genocide”. Here are some of the more notable search results from Bar & Bench, plus one from The Wire.

Death of COVID patients due to Oxygen shortage nothing less than genocide: Allahabad High Court orders inquiry

“Election Commission should be put up on murder charges:” Madras High Court on ECI’s failure to stop “abuse” of COVID norms in election rallies

Delhi High Court seeks report from Delhi Police in plea alleging hoarding of COVID-19 medicines by political leaders

Pained that orders are being completely ignored: Gujarat High Court asks why real-time updates on hospital beds are not available

Karnataka High Court suggests judicial inquiry into death of 24 patients in Chamarajanagar COVID-19 facility due to lack of oxygen

Overcrowding at COVID vaccination centres could become a “super spreader:” Kerala High Court registers suo motu case

Structured response required to give adequate relief to voiceless and the marginalised sections: Delhi High Court

News of death not negative: Delhi High Court dismisses PIL to regulate “negativity” due to reporting on COVID-19

“Current COVID vaccine policy will create disparity; Bahujans, marginalised groups may not have ability to pay:” Supreme Court

Is Aadhaar necessary for COVID-19 vaccination? Bombay High Court asks Central, Maharashtra government to clarify

“All you are showing is that things will be hunky-dory in June, did Central govt consult experts?” Madras High Court

SC Stays Delhi HC Order on Contempt Proceedings Against Centre Over Oxygen Supply

I’m not yet sure if one variety of proclamation will be more effectual than the other (social-media outrage versus outbursts from the courts) in terms of causing real change.

In addition, while the courts’ expertise is less questionable on matters related to the people’s rights and governments’ responsibilities, they do trip up when they recommend lockdowns or the supply of unproven drugs the same way the Supreme Court has tripped up asking for smog towers in Delhi. Have the courts assessed the trial data? Have they consulted doctors? If so, which ones were consulted? Do the courts also intend to ensure migrant and daily-wage workers don’t get fucked over this time?

It’s good that the judiciary is cracking the whip when almost no one else is, but knowing how the judicial system works, I’m not sure if we should rejoice already… “This is what things have come to, and the courts can help ensure the only way we go from here is up” is not a bad argument in their favour. But you may also notice a distinction between the high courts and the apex court: the latter seems reluctant to admit the idea that the government is responsible for the mess that almost everyone else (on this side of the aisle) believe it created. Is recovery sans accountability a good bargain?

Being apolitical doesn’t mean politics doesn’t exist

A few years ago, we had a writer who would constantly pitch articles to us about how the Indian government should be doing X, Y or Z in the fight against this or that disease. Their submissions grew quickly tiresome, and then wholly ridiculous when, in one article (well before the pandemic), they wrote that “the government should distribute good-quality masks for TB patients to use”. That the government should do this is a banal truism. But to make this recommendation over and over risks hiding from sight the fact that the government probably isn’t doing it not because it doesn’t know it should be done but because it has decided that what it is doing is more important, more necessary.

I find myself contending with many similar articles today. It is people’s right to express themselves, especially on counts on which the Indian government has dropped the ball via-à-vis the country’s COVID-19 epidemic. But to repeat recommendations that are often staring most of us in our faces I fear could be harmful – by only reminding us of what needs to be done but hasn’t been, over and over, is an act that deepens the elision and then the forgetting of the real reason why it hasn’t been done.

This doesn’t mean reminders are redundant; to the contrary, there is important value in repetition, so that we may not lose sight of which outcomes are ultimately desirable. But in tandem, we also need to start acknowledging what could be standing in the way and contemplating honestly whether what we’re advocating for could surmount that barrier. (This issue is also of a piece with the one about processes and outcomes – whereby some commentators stress on what the outcomes can or should be but have nothing to say about the processes that will get us there.)

For example, what happened to the rapid self-administered COVID-19 tests that many scientists in India developed last year? A reporter with an appetite for a small investigation could speak to the researchers, university administrators, the DST or the DBT as the case may be, and finally to officials in the Union health ministry, and weave together a story about where exactly in this pipeline of translation from the lab to the market the product vanished. There is value in knowing this but it is not paramount value. It is on equal footing with the view, from the perch of the political economy of public healthcare, that the Modi government is unlikely to okay the widespread use of such tests because many Indian states, especially BJP strongholds like Uttar Pradesh and Gujarat, are widely underreporting cases and deaths, and a state-managed project to suppress this data is easier to do with centralised testing facilities instead of freely distributed rapid tests whose results can also be quickly crowdsourced.

Quite a few authors of articles (many of them scientists) also like to say that we shouldn’t politicise the pandemic. They ignore, deliberately or otherwise, the fact that all pandemics are political by default. By definition, a pandemic is an epidemic of the same disease occurring in multiple geographically distinct regions at the same time. Governments have to get involved to manage them. Pandemics are not, and should never be, carte blanche for scientists to assume power, their prescriptions to assume primacy and their priorities to assume importance – by default. This can only lead to tunnel vision that is blind to problems, and in fact solutions, that arise from social and political compulsions.

Instead, it would be much more valuable if scientists, and in fact any expert in any field, could admit the politically motivated parts of a government’s response to its local epidemic instead of forcing everyone else to work around their fantasies of separation – and even better if they could join the collaborative efforts to develop solutions instead of trying to solve it like a science problem.

Anthony Fauci demonstrates this same… attitude (for lack of a better word), in an interview to Indian Express. When asked how he might respond to India’s crisis, he said:

The one thing I don’t want to do and I hope it doesn’t turn out this way, is to get involved in any sort of criticism of how India has handled the situation because then it becomes a political issue and I don’t want to do that since I’m a public health person and I’m not a political person.

It just seems to me that, right now, India is in a very difficult and desperate situation. I just got off, in preparation for this interview, I watched a clip from CNN… it seems to me it’s a desperate situation. So when you have a situation like that you’ve got to look at the absolute immediate.

I mean, first of all, I don’t know if India has put together a crisis group that would meet and start getting things organised. I heard from some of the people in the street bringing their mothers and their fathers and their sisters and their brothers searching for oxygen. They seem to think there really was not any organisation, any central organisation.

When asked about what India should do towards getting more people vaccinated:

You’ve got to get supplies. You’ve got to make contractual arrangements with the various companies that are out there in the world.

😑 And what about the fact that the US didn’t just advance-book the doses it needed but hoarded enough to vaccine its population thrice over, and blocked a petition by India and South Africa, and some other countries, to release the patents on US-made vaccines to increase global supply?

Fauci’s answers are, again, a reminder of which outcomes are or ought to be ultimately desirable – what goals we should be working towards – but simply repeating this needs to stop being a virtue. Fauci, like many others before him, doesn’t wish to consider why we’re not on the path to achieving these outcomes despite fairly common knowledge of their existence. He may not be a political person but being apolitical doesn’t mean politics isn’t involved. The bulk of India’s response to its COVID-19 epidemic has been driven by political strategy. Is the idea that even the ideal part science can play in this enterprise is decidedly finite so off-putting?

And even if there is a legitimate aspiration to expand the part science should be allowed to play in pandemic governance, scientists need to begin by convincing political institutions – and not attempt to seize power. They may be tempted to, as we all are, because our current national government seems to think accountability is blasphemy, and without being accountable it has stopped speaking for the people of the country, even those who put it in power. Nonetheless, the fruits of scientific work need to be democratic, too.

I would also contend that Fauci complicates the picture by implying that there can be a clean separation of political and scientific issues on this matter; many scientists in India and perhaps too many people in India have an elevated opinion of Fauci, to the point of considering his words to be gospel. As one friend put it recently, “Unbelievable – the idea that a single white man is the foremost disease epidemiologist in the world” (emphasis in the original). “How do people say it with a straight face?”

This post isn’t intended to disparage Fauci, even if our exalted opinion of him deserves to be taken down a few notches. Instead, I hope it highlights how Fauci nicely demonstrates a deceptively trivial prejudice against politics that, I could argue, helped land India in its latest disaster. Even when he pitches, for example, that India should lock itself down for a few weeks – instead of a few months like it did last year – he is at liberty to ignore the aftermath. We are not. Does that mean a lockdown shouldn’t come to be? No. But if he accommodated the political in his considerations, will it mean a man of his smarts will be able to meaningfully contemplate what the problem could really be? Maybe.

Featured image: Former US President Donald Trump, VP Mike Pence and NIAID director Anthony Fauci at a press briefing at the White House on April 16, 2020. Credit: Public domain.

The constructionist hypothesis and expertise during the pandemic

Now that COVID-19 cases are rising again in the country, the trash talk against journalists has been rising in tandem. The Indian government was unprepared and hapless last year, and it is this year as well, if only in different ways. In this environment, journalists have come under criticism along two equally unreasonable lines. First, many people, typically supporters of the establishment, either don’t or can’t see the difference between good journalism and contrarianism, and don’t or can’t acknowledge the need for expertise in the practise of journalism.

Second, the recognition of expertise itself has been sorely lacking across the board. Just like last year, when lots of scientists dropped what they were doing and started churning out disease transmission models each one more ridiculous than the last, this time — in response to a more complex ‘playing field’ involving new and more variants, intricate immunity-related mechanisms and labyrinthine clinical trial protocols — too many people have been shouting their mouths off, and getting most of it wrong. All of these misfires have reminded us of two things: again and again that expertise matters, and that unless you’re an expert on something, you’re unlikely to know how deep it runs. The latter isn’t trivial.

There’s what you know you don’t know, and what you don’t know you don’t know. The former is the birthplace of learning. It’s the perfect place from which to ask questions and fill gaps in your knowledge. The latter is the verge of presumptuousness — a very good place from which to make a fool of yourself. Of course, this depends on your attitude: you can always be mindful of the Great Unknown, such as it is, and keep quiet.

As these tropes have played out in the last few months, I have been reminded of an article written by the physicist Philip Warren Anderson, called ‘More is Different’, and published in 1972. His idea here is simple: that the statement “if everything obeys the same fundamental laws, then the only scientists who are studying anything really fundamental are those who are working on those laws” is false. He goes on to explain:

“The main fallacy in this kind of thinking is that the reductionist hypothesis does not by any means imply a ‘constructionist’ one: The ability to reduce everything to simple fundamental laws does not imply the ability to start from those laws and reconstruct the universe. … The constructionist hypothesis breaks down when confronted with the twin difficulties of scale and complexity. The behaviour of large and complex aggregates of elementary particles, it turns out, is not to be understood in terms of a simple extrapolation of the properties of a few particles. Instead, at each level of complexity entirely new properties appear, and the understanding of the new behaviours requires research which I think is as fundamental in its nature as any other.”

The seemingly endless intricacies that beset the interaction of a virus, a human body and a vaccine are proof enough that the “twin difficulties of scale and complexity” are present in epidemiology, immunology and biochemistry as well – and testament to the foolishness of any claims that the laws of conservation, thermodynamics or motion can help us say, for example, whether a particular variant infects people ‘better’ because it escapes the immune system better or because the immune system’s protection is fading.

But closer to my point: not even all epidemiologists, immunologists and/or biochemists can meaningfully comment on every form or type of these interactions at all times. I’m not 100% certain, but at least from what I’ve learnt reporting topics in physics (and conceding happily that covering biology seems more complex), scale and complexity work not just across but within fields as well. A cardiologist may be able to comment meaningfully on COVID-19’s effects on the heart in some patients, or a neurologist on the brain, but they may not know how the infection got there even if all these organs are part of the same body. A structural biologist may have deciphered why different mutations change the virus’s spike protein the way they do, but she can’t be expected to comment meaningfully on how epidemiological models will have to be modified for each variant.

To people who don’t know better, a doctor is a doctor and a scientist is a scientist, but as journalists plumb the deeper, more involved depths of a new yet specific disease, we bear from time to time a secret responsibility to be constructive and not reductive, and this is difficult. It becomes crucial for us to draw on the wisdom of the right experts, who wield the right expertise, so that we’re moving as much and as often as possible away from the position of what we don’t know we don’t know even as we ensure we’re not caught in the traps of what experts don’t know they don’t know. The march away from complete uncertainty and towards the names of uncertainty is precarious.

Equally importantly, at this time, to make our own jobs that much easier, or at least less acerbic, it’s important for everyone else to know this as well – that more is vastly different.

Exporting risk

I’m torn between admitting that our cynicism about scientists’ solutions for the pandemic is warranted and the palliative effects of reading this Reuters report about seemingly nothing more than the benevolence of richer nations not wasting their vaccine doses:

Apart from all the other transgressions – rather business as usual practices – that have transpired thus far, this is one more testimony to all those instances of insisting “we’re all in this together” being just platitudes uttered to move things along. And if it weren’t enough already that poorer nations must make do with the leftovers of their richer counterparts that ordered not as many doses as they needed but as many as would reassure their egos (a form of pseudoscience not new to the western world), the doses they’re going to give away have been rejected for fear of leading to rare but life-threatening blood clots. To end the pandemic, what kills you can be given away?

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Anti-softening science for the state

The group of ministers (GoM) report on “government communication” has recommended that the government promote “soft topics” in the media like “yoga” and “tigers”. We can only speculate what this means, and that shouldn’t be hard. The overall spirit of the document is insecurity and paranoia, manifested as fantasies of reining in the country’s independent media into doing the government’s bidding. The promotion of “soft” stories is in line with this aspiration – “soft” here can only mean stories that don’t criticise the government, its actions or policies, and be like ‘harmless entertainment’ for a politically inert audience. It’s also no coincidence that the two examples on offer of such stories skirt the edges of health and environmental journalism; other examples are sure to include reports of scientific discoveries.

Science is closely related to the Indian state in many ways. The current government in particular, in power since 2014, has been promoting application-oriented R&D (a bias especially visible in budgetary allocations); encouraging ill-prepared research facilities to self-finance; privileging certain private interests (esp. the Reliance and Adani groups) vis-à-vis natural resources like coal, coastal zones and spectrum allocations; pillaging India’s ecological commons for industrialisation; promoting pseudoscience (which further disempowers those closer to society’s margins); interfering at universities by appointing vice-chancellors friendly to the ruling party (and if that doesn’t work, jailing students on ridiculous charges that include dissent); curtailing academic freedom; and hounding after scientists and institutions that threaten its preferred narratives.

With this in mind, it’s important for science journalism outlets and science journalists to not become complicit – inadvertently or otherwise – in the state project to “soften” science, and start reporting, if they aren’t already, on issues with a closer eye on their repercussions on the wider society. The idea that science journalism can or should be objective the way science is is nonsensical because the idea that science is an objective enterprise is nonsensical. The scientific method is a technique to obtain information about the natural universe while steadily subtracting the influence of human biases and other limitations. However, what scientists choose to study, how they design their studies and what is ultimately construed to be knowledge are all deeply human enterprises.

On top of this, science journalism is driven by journalists’ sense of good and bad: We write favourably about the former and argue against the latter. We write about some telescope unravelling a long-standing cosmogonic problem and also publish an article calling out homeopathy’s bullshit. We write a scientific paper that uses ingenious methods to prove its point and also call out Indian academia as an unsafe space for queer-trans people.

Some have advanced a defence that simply focusing on “good science” can inculcate in the audience a sense of what is “worthy” and “desirable” while denying “bad science” the platform and publicity it seeks. This is objectionable on two counts.

First, who decides what is “worthy”? For example, some scientists, especially in the ‘senior’ cadre and the more influential and/or powerful for it, make this choice by deferring to the wisdom of scientific journals, chosen according to their impact factors, and what the journals have deemed worthy of publishing. But abiding by this heuristic only means we continue to participate in and extend the lifetime of the existing ways of knowledge production that privilege white scientists, male scientists and richer scientists – and sensational positive results on topics that the scientists staffing the journals’ editorial boards would like to focus on.

Second, being limited to goodness at a time when badness abounds is bad, at least severely tone-deaf (but I’m disinclined to be so charitable). Very broadly, that science is inherently amoral is a pithy factoid by this point. There have been far too many incidents in history for anyone to still be able to overlook, in good faith, the fact that science’s prescriptions unguided by human morals and values are quite likely to lead to humanitarian disasters. We may even be living through one such. Scientists’ rapid and successful development of new vaccines against a new pathogen was followed by a global rush to acquire enough doses. But the world’s industrial and economic powers have ensured that the strongest among them have enough to vaccine their entire populations more than once, have blocked petitions at global fora to loosen patents on these vaccines to expand manufacturing and distribution, have forced desperate countries to purchase doses at prices higher than those for developed blocs like the EU, and have allowed corporate behemoths to make monumental profits even as they force third-world nations to pledge sovereign assets to secure supplies. It’s fallacious to claim scientific labour makes the world a better place when the fruits of such labour must still be filtered, like so much else, through the capitalist sieve.

There are many questions for the science journalist to consider here: why have some communities in certain countries been affected more than others? Why is there so little data on the vaccines’ consequences for pregnant women? Do we know enough to discuss the pandemic’s effects on women? Why, at a time when so many scientists and engineers were working to design new ventilators, was there no unified standard to ensure usability? If the world has demonstrated that it’s possible to design, test, manufacture and administer vaccines against a new virus in such a short time, why have we been waiting so long for effective defences against neglected tropical diseases? How do the racial, gender and ethnic identifies of clinical trials affect trial outcomes? Is it ethical for countries that hosted vaccine clinical trials to get the first doses? Should we compulsorily prohibit patents on drugs, therapies and devices important to ending pandemics? If so, what might the consequences be for drug development? And what good is a vaccine if we can’t also ensure all the world’s 7.x billion people can be vaccinated simultaneously?

The pandemic isn’t a particularly ‘easy’ example either. For example, if the government promises to develop new supercomputers, who can use them and what problems will they be used to solve? How can we improve the quality and quantity of research conducted at institutes funded by state governments? Why do so many scientists at public universities plagiarise scientific papers? On what basis are the winners of the S.S. Bhatnagar Award chosen? Should we formally do away with subscription-funded scientific journals in favour of open-access publishing, overlay journals and post-publication peer-review? Is methane really a “clean fuel” even though its extraction and transportation will impose a considerable dirty cost? Why can’t we have more GM foods in the market even though the science is ‘good’? Is it worthwhile to invest Rs 10,000 crore in a human spaceflight programme that lacks long-term vision? And so forth.

Simply focusing on “good science” at our present time is not enough. I also reject the argument that it’s not for science journalists to protect or defend science simply because science, whatever it’s interpreted to mean, is not the preserve of scientists. As an enterprise rooted in its famous method, science is a tool of empowerment: it encourages discovery and deliberation; I’m not sure if it’s fair to say it encourages dissent as well but there is evidence that science can accommodate it without resorting to violence and subjugation.

It’s not for nothing that I’m more comfortable holding up an aspirin tablet for someone with a headache than a jar of leaves from the Patanjali Ayurved stable: being able to know how and why something works is power in the same way knowing how the pharmaceutical industry manipulates markets, how to file an RTI application, what makes an FIR valid or invalid, what the election commission’s model code of conduct stipulates or what kind of land a mall can be built on is power. All of it represents control, especially the ability to say ‘no’ and mean it.

This is ultimately what the GoM report fantasises about – and what the present government desires: the annulment of individual and institutional resistance, one subset of which is the neutralisation of science’s ability to provoke questions about atoms and black holes as much as about the circumstances in which scientists study them, about the nature, utility and purpose of knowledge, and the relationships between science, capital and the state.


Addendum

In January 2020, the Office of the Principal Scientific Adviser (PSA) to the Government of India organised a meeting with science journalists and communicators from around the country to discuss what the two parties could do for each other. Us journalists and communicators aired a lot of grievances during the meeting as well as suggestions on fixing long-standing and/or particularly thorny problems (some notes here).

In light of the government’s renewed attention on curbing press freedom and ludicrous suggestions in the report, such as one by S. Gurumurthy that the news should be a “mixture of truth and untruth”, I’m not sure where that leaves the PSA’s plans for future consultation nor – considering parts of the report seemingly manufactured consent – whether good-faith consultation will be possible going ahead. I can only hope that members of this community at least evoke and keep the faith.