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The second wave questions that need urgent answers

Is the government postponing the use of the Rs 35,000-crore allocated for vaccine development in the current Budget? Has it been shy in using its good offices with the US to intercede on behalf of the country’s vaccine manufacturing companies?

Written by Kaushik Das Gupta |
Updated: April 19, 2021 9:02:21 am
Health worker in PPE suit treating Covid-19 patients at an Isolation center in New Delhi on Saturday. Express Photo by Praveen Khanna)

This time, last year, India was under a lockdown announced by Prime Minister Narendra Modi in a televised address during which he issued several messages of caution. He talked about the need for extreme vigilance and underlined the salience of physical distancing and use of masks — points he would reiterate several times later in the year. A less remembered part of the PM’s speech was a note of comparison with countries more prosperous and resourceful than India. Even these countries are struggling to control the novel coronavirus, he said.

The country pushed back the virus through a combination of measures that restricted people’s movement — their socially and economically crippling effects are now well-documented — the skill of its medical professionals who took on the virus under conditions that demanded unprecedented mental and physical resolve, and a panoply of arrangements to augment the health infrastructure. Medical protocols evolved and policymakers made innovative interventions at times — the Delhi government’s home-care initiative for less serious patients that took the burden away from hospitals and quarantine facilities was one such initiative. A notable feature of the fight was also the use of makeshift facilities — stadiums, hotels, banquet halls were turned into COVID-care centres.

Healthcare facilities are strained again, a year later, with the virus striking back with a vengeance. Several state governments, including those in Maharashtra and Delhi, are back to mobilising “temporary” reinforcements.

The panic that has set in the past few weeks occasions a recall of the well-known criticisms and warnings – admissions too — about India’s health infrastructure deficit. There is little doubt that the crown-shaped virus has become multiple times more infectious compared to last year. But scientists had always cautioned about the microbe’s arbitrary ways. With governments scrambling for medical facilities, oxygen cylinders, ventilators and critical drugs such as Remdesivir, the question that must be asked is: Was the unpredictability factor sufficiently appreciated, when we decided — rightly so — to live with an adversary that is known to make its way insidiously, with most hosts not even showing symptoms?

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A virus hijacks its receptor’s cells to make copies of itself. But reproductions are not always perfect. Many of these mutations have little effect on the tiny entity’s capacity to infect humans. Some of these errors even make the virus more benign. But some changes make it more adept at jumping from one host to the other. In September last year, as India’s first wave was peaking, scientists in the UK warned of a mutant 50 times more transmissible — implying that the microbe could cause many more deaths if left uncontrolled. By the end of the year, more than 4,000 people in different parts of Europe had been infected by this mutant.

Early this year, evidence began to surface of the more prolific versions of the virus sneaking into India. In January, double mutants, now known as B.1.617, were found in samples collected in Maharashtra, a few weeks before India’s worst-affected state began to report reversals of the gains made last year. But there was no conclusive evidence that these specimens were typical of the recent surge in the state. And the jury is still out, about three months later, even as the Pune-based National Institute of Virology has found B.1.617 in 60 per cent of the specimens collected from Maharashtra. The specimen size is too small to show that B.1.617 is now the predominant coloniser. Meanwhile, there is evidence of this fast-spreading mutant in samples from Delhi, Punjab and Madhya Pradesh as well.

Scientists say that constant analysis of the virus’s genetic information, combined with epidemiological data, is crucial to providing real-time knowledge about the pathogen’s vagaries. Interestingly, both the UK and India were alert to this imperative in the early days of the pandemic. India’s enthusiasm, however, seems to have flagged — less than 1 per cent of COVID-positive specimens are subjected to genomic sequencing — while the UK was able to use this tracking method to alert the world about the changes in the virus’s biology. Globally, though, the deployment of this technology has been patchy. But as a Lancet editorial in February pointed out, “the fact that Gambia, Equatorial Guinea, and Sierra Leone have a higher rate of genome sequencing than France, Italy, or the USA, suggests that wealth is not the only determinant of capacity”. India, too, it seems, has not made optimum use of its facilities. The Delhi-based Institute of Genomics and Integrative Biology is reportedly analysing less than 30 per cent of the samples it is equipped to study.

Last week, Home Minister Amit Shah belatedly admitted the possible role of mutants in the surge. “Scientists are studying it,” he said. The health ministry, however, remains obstinate about the country’s inoculation strategy, framed when the pandemic was receding. That time it had rightly talked of prioritising frontline workers, senior citizens and those with comorbidities. With the virus taking on menacing proportions, the government tweaked the priority criteria to include all people above the age of 45. It has also granted emergency use approval to vaccines that have received the nod of the US, UK, Japan and the WHO. But the primary challenge of India’s inoculation project was always going to be the pace at which it shields a substantial section of its population to reduce the severity of COVID — this challenge has intensified with the second wave.

Last month, US President Joe Biden pledged to amass enough vaccine stocks to inoculate every American by the end of May. In India, in contrast, states have begun to complain of vaccine shortage. Though the Centre vehemently denies such claims, the CEO of the country’s leading vaccine manufacturing company first asking for Rs 3,000-crore to ramp up production capacity and then pleading with Biden to end the embargo on raw materials needed to produce the shot aggravates the miasma, and invites questions: Is the government postponing the use of the Rs 35,000-crore allocated for vaccine development in the current Budget? Has it been shy in using its good offices with the US to intercede on behalf of the country’s vaccine manufacturing companies?

India’s scientific expertise and its vaccination manufacturing capacity were, rightfully, touted as its best bet in the battle against the virus. Have we used these capacities to the optimum, given institutions enough support? Did we learn the right lessons last year? Answers to these questions hold the key to lifting the gloom that has overtaken the country.

This column first appeared in the print edition on April 19, 2021 under the title ‘Questions in a surge’.

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First published on: 19-04-2021 at 04:20:36 am
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