Broken clocks during the pandemic

Proponents of conspiracy theories during the pandemic, at least in India, appear to be like broken clocks: they are right by coincidence, without the right body of evidence to back their claims. Two of the most read articles published by The Wire Science in the last 15 months have been the fact-checks of Luc Montagnier’s comments on the two occasions he spoke up in the French press. On the first, he said the novel coronavirus couldn’t have evolved naturally; the second, he insisted mass vaccination was a big mistake. The context in which Montagnier published his remarks evolved considerably between the two events, and it tells an important story.

When Montagnier said in April 2020 that the virus was lab-made, the virus’s spread was just beginning to accelerate in India, Europe and the US, and the proponents of the lab-leak hypothesis to explain the virus’s origins had few listeners and were consigned firmly to the margins of popular discourse on the subject. In this environment, Montagnier’s comments stuck out like a sore thumb, and were easily dismissed.

But when Montagnier said in May 2021 that mass vaccination is a mistake, the context was quite different: in the intervening period, Nicholas Wade had published his article on why we couldn’t dismiss the lab-leak hypothesis so quickly; the WHO’s missteps were more widely known; China’s COVID-19 outbreak had come completely under control (actually or for all appearances); many vaccine-manufacturers’ immoral and/or unethical business practices had come to light; more people were familiar with the concept and properties of viral strains; the WHO had filed its controversial report on the possible circumstances of the virus’s origins in China; etc. As a result, speaking now, Montagnier wasn’t so quickly dismissed. Instead, he was, to many observers, the man who had got it right the first time, was brave enough to stick his neck out in support of an unpopular idea, and was speaking up yet again.

The problem here is that Luc Montagnier is a broken clock – in the way even broken clocks are right twice a day: not because they actually tell the time but because the time is coincidentally what the clock face is stuck at. On both occasions, the conclusions of Montagnier’s comments coincided with what conspiracists have been going on about since the pandemic’s start, but on both occasions, his reasoning was wrong. The same has been true of many other claims made during the pandemic. People have said things that have turned out to be true but they themselves have always been wrong, whenever they have been wrong, because their particular reasons for something to be true were wrong.

That is, unless you can say why you’re right, you’re not right. Unless you can explain why the time is what it is, you’re not a clock!

Montagnier’s case also illuminates a problem with soothsaying: if you wish to be a prophet, it is in your best interests to make as many predictions as possible – to increase the odds of reality coinciding with at least one prediction in time. And when such a coincidence does happen, it doesn’t mean the prophet was right; it means they weren’t wrong. There is a big difference between these positions, and which becomes pronounced when the conspiratorially-minded start incorporating every article published anywhere, from The Wire Science to The Daily Guardian, into their narratives of choice.

As the lab-leak hypothesis moved from the fringes of society to the centre and came mistakenly to conflate possibility with likelihood (i.e. zoonotic spillover and lab-leak are two valid hypotheses for the virus’s origins but they aren’t equally likely to be true), the conspiratorial proponents of the lab-leak hypotheses (the ones given to claiming Chinese scientists engineered the pathogen as a weapon, etc.) have steadily woven imaginary threads between the hypothesis and Indian scientists who opposed Covaxin’s approval, the Congress leaders who “mooted” vaccine hesitancy in their constituencies, scientists who made predictions that came to be wrong, even vaccines that were later found to have rare side-effects restricted to certain demographic groups.

The passage of time is notable here. I think adherents of lab-leak conspiracies are motivated by an overarching theory born entirely of speculation, not evidence, and who then pick and choose from events to build the case that the theory is true. I say ‘overarching’ because, to the adherents, the theory is already fully formed and true, and that pieces of it become visible to observers as and when the corresponding events play out. This could explain why time is immaterial to them. You and I know that Shahid Jameel and Gagandeep Kang cast doubt on Covaxin’s approval (and not Covaxin itself) after the time we were aware that Covaxin’s phase 3 clinical trials were only just getting started in December, and before Covishield’s side-effects in Europe and the US came to light (with the attendant misreporting). We know that at the time Luc Montagnier said the novel coronavirus was made in a lab, last year, we didn’t know nearly enough about the structural biology underlying the virus’s behaviour; we do now.

The order of events matters: we went from ignorance to knowledge, from knowing to knowing more, from thinking one thing to – in the face of new information – thinking another. But the conspiracy-theorists and their ideas lie outside of time: the order of events doesn’t matter; instead, to these people, 2021, 2022, 2023, etc. are preordained. They seem to be simply waiting for the coincidences to roll around.

An awareness of the time dimension (so to speak), or more accurately of the arrow of time, leads straightforwardly to the proper practice of science in our day-to-day affairs as well. As I said, unless you can say why you’re right, you’re not right. This is why effects lie in the future of causes, and why theories lie in the causal future of evidence. What we can say to be true at this moment depends entirely on what we know at this moment. If we presume what we can say at this moment to be true will always be true, we become guilty of dragging our theory into the causal history of the evidence – simply because we are saying that the theory will come true given enough time in which evidence can accrue.

This protocol (of sorts) to verify the truth of claims isn’t restricted to the philosophy of science, even if it finds powerful articulation there: a scientific theory isn’t true if it isn’t falsifiable outside its domain of application. It is equally legitimate and necessary in the daily practice of science and its methods, on Twitter and Facebook, in WhatsApp groups, every time your father, your cousin or your grand-uncle begins a question with “If the lab-leak hypothesis isn’t true…”.

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.

On The Lancet editorial

On May 8, The Lancet published an editorial criticising the Narendra Modi government’s response to India’s second COVID-19 outbreak, which has been redefining the meaning of ‘snafu’. All hell broke loose. Of course, hell has been breaking loose for quite some time in India now, but the latest episode was in one specific sense also gratifying to behold.

There were the usual rumbles in the week following the editorial’s appearance, until on May 17 India’s health minister Dr Harsh Vardhan shared a blog post penned by a Pankaj Chaturvedi deriding The Lancet‘s choice of arguments. (I’m fond of emboldening the honorific: it shows doctors can be stupid, too.) The post is mostly whataboutery studded with a few gems about how people who liked the editorial aren’t pissed enough that favipiravir and hydroxychloroquine were approved for use – as Dr Vardhan’s ministry did. More importantly, it seems Dr Vardhan, and his colleagues in fact, threw themselves into the barrel looking for anything with fully formed sentences that said The Lancet was wrong – a sign that their government still gives a damn about what foreign journals, and perhaps magazines and newspapers too, say about it.

We need to use this to the fullest extent, and I daresay that it’s the sort of resource the government is going to find difficult to duplicate as well. There was recently an article about Modi doing a great job during India’s second wave, published in an outlet called The Daily Guardian. There was enough confusion to draw the UK’s The Guardian forward and clarify that it was an unaffiliated entity – but no amount of confusion can supplant an institution, no matter how illiberal. Aakar Patel wrote in 2018: “The fact is that intelligent and intellectual bigotry is very difficult. There are very few people who can pull that off and that is why we can count the major ones on our fingers.” This is also why the government has twitched every time the New York Times, the Washington Post, BBC, The Lancet, Science and The BMJ have published articles critical of India, even if this isn’t the full picture.

It’s doubly interesting that the sophistry of the rejoinders aside, Dr Vardhan, his colleagues in government and his party’s supporters have all been antagonised by what they perceive to be a political act by a medical journal. This is an untenable distinction, of course – one that fantasises about a clear divide between the Watchers, who look out, and the Watched, who dare not know what the Watchers see. More pertinently, it’s a reflection of what they desperately expect from their own compatriots: to ignore how bad political leadership could help a virus ravage hundreds of thousands of families.

Featured image credit: Kunj Parekh/Unsplash.

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.

The Government Project

Considering how much the Government of India has missed anticipating – the rise of a second wave of COVID-19 infections, the crippling medical oxygen shortage, the circulation of new variants of concern – I have been wondering about why we assemble giant institutions like governments: among other things, they are to weather uncertainty as best as our resources and constitutional moralities will allow. Does this mean bigger the institution, the farther into the future it will be able to see? (I’m assuming here a heuristic that we normally are able to see, say, a day into the future with 51% uncertainty – slightly better than chance – for each event in this period.)

Imagine behemoth structures like the revamped Central Vista in New Delhi and other stonier buildings in other cities and towns, the tentacles of state control dictating terms in every conceivable niche of daily life, and a prodigious bureaucracy manifested as tens of thousands of civil servants most of whom do nothing more than play musical chairs with The Paperwork.

Can such a super-institution see farther into the future? It should be able to, I’d expect, considering the future – in one telling – is mostly history filtered through our knowledge, imagination, priorities and memories in the present. A larger government should be able to achieve this feat by amassing the talents of more people in its employ, labouring in more and more fields of study and experiment, effectively shining millions of tiny torchlights into the great dark of what’s to come.

Imagine one day that the Super Government’s structures grow so big, so vast that all the ministers determine to float it off into space, to give it as much room as it needs to expand, so that it may perform its mysterious duties better – something like the City of a Thousand Planets.

The people of Earth watch as the extraterrestrial body grows bigger and bigger, heavier and heavier. It attracts the attention of aliens, who are bemused and write in their notebooks: “One could, in principle, imagine ‘creatures’ that are far larger. If we draw on Landauer’s principle describing the minimum energy for computation, and if we assume that the energy resources of an ultra-massive, ultra-slothful, multi-cellular organism are devoted only to slowly reproducing its cells, we find that problems of mechanical support outstrip heat transport as the ultimate limiting factor to growth. At these scales, though, it becomes unclear what such a creature would do, or how it might have evolved.”

One day, after many years of attaching thousands of additional rooms, corridors, cabinets and canteens to its corse, the government emits a gigantic creaking sound, and collapses into a black hole. On the outside, black holes are dull: they just pull things towards them. That the pulled things undergo mind-boggling distortions and eventual disintegration is a triviality. The fun part is what happens on the inside – where spacetime, instead of being an infinite fabric, is curved in on itself. Here, time moves sideways, perpendicular to the direction in which it flows on the outside, in a state of “perpetual freefall”. The torch-wielding scientists, managers, IAS officers, teachers, thinkers are all trapped on the inner surface of a relentless sphere, running round and round, shining their lights to look not into the actual future but to find their way within the government itself.

None of them can turn around to see who it is that’s chasing them, or whom they’re chasing. The future is lost to them. Their knowledge of history is only marginally better: they have books to tell them what happened, according to a few historians at one point of time; they can’t know what the future can teach us about history. And what they already know they constantly mix and remix until, someday, like the progeny of generations of incest, what emerges is a disgusting object of fascination.

The government project is complete: it is so big that it can no longer see past itself.

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?

COVID-19, due process and an SNR problem

At a press conference streamed live on March 18, the head of the European Medicines Agency (EMA) announced that the body – which serves as the European Union’s drug and vaccine regulator – had concluded that the AstraZeneca COVID-19 vaccine was not associated with unusual blood clots that some vaccine recipients had reported in multiple countries. The pronouncement marked yet another twist in the roller-coaster ride the embattled shot has experienced over the past few months. But it has also left bioethicists debating how it is that governments should respond to a perceived crisis over vaccines during a pandemic.

Over the last two weeks or so, a fierce debate raged after a relatively small subset of people who had received doses complained of developing blood clots related to potentially life-threatening conditions. AstraZeneca, a British-Swedish company, didn’t respond to the concerns at first even though the EMA and the WHO continued to hold their ground: that the vaccine’s benefits outweighed its risks, so people should continue to take it. However, a string of national governments, including those of Germany, France and Spain, responded by pausing its rollout while scientists assessed the risks of receiving the vaccine.

Aside from allegations that AstraZeneca tried to dress up a significant mistake during its clinical trials of the vaccine as a ‘discovery’ and cherry-picked data from the trials to have the shot approved in different countries, the company has also been grappling with the fact that the shot was less efficacious than is ideal against infections by new, more contagious variants of the novel coronavirus.

But at the same time, the AstraZeneca vaccine is also one of the more affordable ones that scientists around the world have developed to quell the COVID-19 pandemic – more so than the Pfizer and Moderna mRNA vaccines. AstraZeneca’s candidate is also easier to store and transport, and is therefore in high demand in developing and under-developed nations around the world. Its doses are being manufactured by two companies, in India and South Korea, although geographically asymmetric demand has forced an accelerating vaccination drive in one country to come at the cost of deceleration in another.

Shot in the arm

Now that the EMA has reached its verdict, most of the 20 countries who had hit the pause button have announced that they will resume use of the vaccine. However, the incident has spotlighted a not-unlikely problem with the global vaccination campaign, and which could recur if scientists, ethicists, medical workers and government officials don’t get together to decide where they can draw the line between abundant precaution and harm.

In fact, there are two versions of this problem: one in countries that have a functional surveillance system that responds to adverse events following immunisation (AEFIs) and one in countries that don’t. An example of the former is Germany, which, according to the New York Times, decided to pause the rollout based on seven reports of rare blood clots from a pool of 1.6 million recipients – a naïve incidence rate of 0.0004375%. But as rare disorders go, this isn’t a negligible figure.

One component of the post-AEFI response protocol is causality assessment, and one part of this is for experts to check if certain purported side-effects are clustered in time and then to compare those to the illness’s time distribution for a long time before the pandemic. It’s possible that such clustering could have prompted health officials in Germany and other countries to suspend the rollout.

The Times quoted a German health ministry statement saying, “The state provides the vaccine and therefore has special duties of care”. These care considerations include what the ministry understands to be the purpose of the rollout (to reduce deaths? To keep as many people healthy as possible?) read together with the fact that vaccines are like drugs except in one important way: they’re given to healthy – and not to sick – people. To quote Stephan Lewandowsky, an expert of risk communication at the University of Bristol, from Science:

“You’ve got to keep the public on board. And if the public is risk-averse, as it is in Europe … it may have been the right decision to stop, examine this carefully and then say, ‘The evidence, when considered transnationally, clearly indicates it is safe to go forward.’”

On the other hand is the simpler and opposing calculus of how many people didn’t develop blood clots after taking the vaccine, how many more people the virus is likely to have infected in the time the state withheld the vaccine, how many of them were at greater risk of developing complications due to COVID-19 – topped off by the fact of the vaccines being voluntary. On this side of the argument, the state’s carefulness is smothering, considering it’s using a top-down policy without accounting for local realities or the state’s citizens’ freedom to access or refuse the vaccine during a pandemic.

Ultimately there appears to be no one right answer, at least in a country where there’s a baseline level of trust that the decision-making process included a post-vaccination surveillance system that’s doing its job. Experts have also said governments should consider ‘mixed responses’ – like continuing rollouts while also continuing to examine the vaccines, given the possibility that a short-term review may have missed something a longer term exercise could find. One group of exerts in India has even offered a potential explanation.

The background rate

In countries where such a system doesn’t exist, or does but is broken, like India, there is actually one clear answer: to be transparent and accountable instead of opaque and intractable. For example, N.K. Arora, a member of India’s National COVID-19 Task Force, told The Hindu recently that while the body would consider post-vaccination data of AstraZeneca’s vaccine, it also believed the fraction of worrying cases to be “very, very low”. Herein lies the rub: how does it know?

As of early March, according to Arora, the Union health ministry had recorded “50-60” cases of AEFIs that may or may not be related to receiving either of the two vaccines in India’s drive, Covaxin and Covishield. (The latter is the name of AstraZeneca’s shot in India.) Reading this with Arora’s statements and some other facts of the case, four issues become pertinent.

First is the deceptively simple problem of the background rate. Journalist Priyanka Pulla’s tweets prompt multiple immediate concerns on this front. If India had reported 10 cases of disease X in 20 years, but 10 more cases show up within two weeks after receiving one dose of a vaccine, should we assume the vaccine caused them? No – but it’s a signal that we should check for the existence of a causal link.

Experts will need to answer a variety of questions here: How many people have disease X in India? How many people of a certain age-group and gender have disease X? How many people of different religious and/or ethnic groups have disease X? How many cases of disease X are we likely to have missed (considering disease-underreporting is a hallmark of Indian healthcare)? How many cases of disease X should we expect to find in the population being vaccinated in the absence of a vaccine? Do the 10 new cases, or any subset of them, have a common but invisible cause unrelated to the vaccine? Do we have the data for all these considerations?

Cornelia Betsch, a psychologist at the University of Erfurt, told Science that “most of the cases of rare blood disorders were among young women, the group where vaccine hesitancy already runs highest”. Can India confirm or deny that this trend is reflected in its domestic data as well? This seems doubtful. Sarah Iqbal reported for The Wire Science in September 2020 that “unequal access to health”, unequal exposure to potentially disease-causing situations, unequal representation in healthcare data and unequal understanding of diseases in non-cis-male bodies together already render statements like ‘women have better resistance to COVID-19’ ignorant at best. Being able to reliably determine and tackle sex-wise vaccine hesitancy seems like a tall order.

The second issue is easy to capture in one question, which also makes it harder to ignore: why hasn’t the government released reports or data about AEFIs in India’s COVID-19 vaccination drive after February 26, 2021?

On March 16, a group of 29 experts from around the country – including virologist T. Jacob John, who has worked with the Indian Council of Medical Research on seroprevalence surveys and has said skeptics of the Indian drug regulator’s Covaxin approval were “prejudiced against Indian science/product” – wrote to government officials asking for AEFI data. They said in their letter:

We note with concern that critical updates to the fact sheets recommended by the CDSCO’s Subject Expert Committee have not been issued, even though they are meant to provide additional guidance and clarify use of the vaccines in persons such as those with allergies, who are immunocompromised or using immunosuppressants, or using blood thinners/anticoagulants. There are gaps in AEFI investigations at the local level, affecting the quality of evidence submitted to State and National AEFI Committees who depend on these findings for making causality assessments. The National AEFI Committee also has a critical role in assessing cases that present as a cluster and to explore potential common pathways. In our letter dated January 31, 2021, we asked for details of all investigations into deaths and other serious AEFIs, as well as the minutes of AEFI monitoring committees, and details of all AEFI committee members and other experts overseeing the vaccine rollout. We have not received any response.

City of Omelas

The third issue is India’s compliance with AEFI protocols – which, when read together with Pulla’s investigation of Bharat Biotech’s response to a severe adverse event in its phase 3 trials for Covaxin, doesn’t inspire much confidence. For example, media reports suggest that medical workers around the country aren’t treating all post-vaccination complaints of ill-health, but especially deaths, on equal footing. “Currently, we are observing gaps in how serious adverse events are being investigated at the district level,” New Delhi-based health activist Malini Aisola told IndiaSpend on March 9. “In many instances local authorities have been quick to make public statements that there is no link to the vaccine, even before investigations and post mortem have taken place. In some cases there is a post mortem, in some cases there isn’t.”

Some news reports of people having died of heart-related issues at a point of time after taking Covishield also include quotes from doctors saying the victims were known to have heart ailments – as if to say their deaths were not related to the vaccine.

But in the early days of India’s COVID-19 epidemic, experts told The Wire that even when people with comorbidities, like impaired kidney function, died due to renal failure and tested positive for COVID-19 at the time of death, their passing could be excluded from the official deaths tally only if experts had made sure the two conditions were unrelated – and this is difficult. Having a life-threatening illness doesn’t automatically make it the cause of death, especially since COVID-19 is also known to affect or exacerbate some existing ailments, and vice versa.

Similarly, today, is the National AEFI Committee for the COVID-19 vaccination drive writing off deaths as being unrelated to the vaccine or are they being considered to be potential AEFIs? And is the committee deliberating on these possibilities before making a decision? The body needs to be transparent on this front a.s.a.p. – especially since the government has been gifting AstraZeneca’s shots to other countries and there’s a real possibility of it suppressing information about potential problems with the vaccine to secure its “can do no wrong” position.

Finally, there’s the ‘trolley problem’, as the Times also reported – an ethical dilemma that applies in India as well as other countries: if you do nothing, three people will get hit by a train and die; if you pull a lever, the train will switch tracks and kill one person. What do you do?

But in India specifically, this dilemma is modified by the fact that due process is missing; this changes the problem to one that finds better, more evocative expression in Ursula K. Le Guin’s short story The Ones Who Walk Away from Omelas (1973). Omelas is a fictitious place, like paradise on Earth, where everyone is happy and content. But by some magic, this is only possible if the city can keep a child absolutely miserable, wretched, with no hope of a better life whatsoever. The story ends by contemplating the fate of those who discover the city’s gory secret and decide to leave.

The child in distress is someone – even just one person – who has reported an AEFI that could be related to the vaccine they took. When due process plays truant, when a twisted magic that promises bliss in return for ignorance takes shape, would you walk away from Omelas? And can you freely blame those who hesitate about staying back? Because this is how vaccine hesitancy takes root.

The Wire
March 20, 2021

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.