India is in the grip of a severe second wave of the pandemic, May 2021. With the alarming rate of increase both in the daily number of new cases and daily deaths, the healthcare infrastructure is under severe pressure. There is a dearth of hospital beds and oxygen supply; cremation and burial grounds are running out of space.
Jeemol Unni, Ahmedabad University, in conversation with Chandrika Bahadur, Chair, Lancet Commission Task Force for India, discuss containment choices beyond binaries, including medical preparedness, physical distancing, accelerated vaccinations, scaled-up testing, closure of indoor spaces, contact tracing & isolation, and beyond. We will also discuss why real-time, reliable, credible data is essential for a comprehensive strategy to defeat the pandemic.
We discussed the following questions and issues:
- Our University emphasizes interdisciplinary learning and group or team work. I see that the Lancet Task Force is a classic case of interdisciplinary team work. In this connection can you tell us what disciplines were involved and who constituted this interdisciplinary team? How did you function as a team or divide up the work required?
- Continuing on the issue of teams to deal with the pandemic, an issue we are facing today is that of shortage of personnel. Doctors, nurses, hospital staff. If this had been in place, we may have managed the second wave in a very different way. What do you think went wrong and how could we have done things better?
- To come to the question that is probably on everyone’s mind, are we expecting a third wave? Or more waves? And how credible to the story that it will affect children the hardest?
- Some researchers estimate that the B.1.617 variant is as transmissible as the B.1.1.7 variant that emerged in the U.K., thought to be more transmissible than earlier versions of the virus. What will be the impact of the third-generation versions of the variant? How does genome sequencing help and what are capabilities in this area in India? This would require a mass surveillance program, to find the new variants. How can India manage this?
- It is not just about scaling production of vaccine, but also scaling up production of testing kits. With the mutating virus we would require new kinds of testing kits that can detect the virus accurately and do it fast. How well India deal with this challenge?
- The new and scary threat now is the Black Fungus? ‘Mucormycosis’ is abundant in the environment and mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. How much is this the impact of indiscriminate use of steroids? With these multiple and new challenges coming up, how will the lack of primary health care and dysfunctional PHCs and the absence of a functioning primary health care system in urban areas affect us? What can be done?
- Now to come to the governance issues: Each state has its own unique problems and culture which the state knows best. What are your views on decentralization to the local bodies, Panchayats and Urban local bodies, as was done in Kerala in fighting the pandemic? How can the corporates and NGOs help in this crisis?
- On the issue of patents for vaccines, the US has said that it will pursue ‘text based’ negotiations with the WTO on the waiver of IPR for COVID 19 vaccines. This is following a proposal by India and South Africa in the WTO in October 2020. ‘Text based’ negotiations is a very long drawn affair as all 164 WTO members must agree with the draft and anyone member can veto it. What is the latest on this? What do you think are the reasons for the Patent Holders to resist this move? How will India benefit? And what are the other options available like compulsory licensing?
- Vaccine production is a risky business. Money spent on research in developing and testing a new vaccine for a new bug may provide no returns if the epidemic does not materialize. Serum Institute and Gates Foundation put up a lot of money to increase capacity to produce Astra Zeneca’s vaccine long before it got regulatory approval. The risk is tremendous for the company. How can one spread this risk and remove this risk in case demand for the vaccine dries up? This includes issues such as pricing and government funding.
Chandrika responded to the innumerable questions from the audience with amazing clarity and patience. Listen in to the video recording. (Link provided earlier in the post.)
Thank you Chandrika for this very engaging conversation. We, our students and the audience, have gained considerably from it.