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Keeper of the foul air

By: VM
22 November 2024 at 05:56

This city is essentially uninhabitable from November to January inclusive and barely liveable the rest of the year. Should it even remain the nation’s capital?

I realise Shashi Tharoor is frustrated here — revealing the increasingly evident gap between what the Delhi and the Indian governments can do about air pollution and the scale of improvements on the ground — but Delhi should certainly remain the national capital. Changing this designation because the existing one has become nearly uninhabitable for four months out of 12 is to say the capitalhood of the city is the problem, not the pollution itself. Low hanging fruit but still.

The country’s mainstream press has also been cynical enough to remember there’s an air pollution crisis only when Delhi’s air becomes patently foul, not the air in any other city. Ambient pollution in places like Guwahati and Katihar is also not concentrated in the winter months, although this isn’t to say Delhi’s air is better during the summer. If the national capital moves away from Delhi, the press spotlight will move with it, and rather than deal with Delhi’s pollution now, we’ll all deal with the new capital’s pollution a few years later.

Then again Prime Minister Narendra Modi isn’t bound to go anywhere considering he just had a fancy new parliament built for himself.

Tamil Nadu’s lukewarm heatwave policy

By: VM
21 November 2024 at 05:56

From ‘Tamil Nadu heatwave policy is only a start’, The Hindu, November 21, 2024:

Estimates of a heatwave’s deadliness are typically based on the extent to which the ambient temperature deviates from the historical average at a specific location and the number of lives lost during and because of the heatwave. This is a tricky, even devious, combination as illustrated by the accompanying rider: “to the reasonable exclusion of other causes of hyperthermia”.

A heatwave injures and/or kills by first pushing more vulnerable people over the edge; the less vulnerable are further down the line. The new policy is presumably designed to help the State catch those whose risk exposure the State has not been able to mitigate in time. However, the goal should be to altogether reduce the number of people requiring such catching. The policy lacks the instruments to guide the State toward this outcome.

On the Nature feature about the Sarafs, a rare disease, and time

By: VM
13 June 2024 at 05:56

Heidi Ledford had a tragic and powerful story published yesterday in Nature, about a team of scientists at the CSIR-Institute of Genomics and Integrative Biology racing to develop a CRISPR treatment for Uditi Saraf, a young girl whose brain was losing neurons due to a very rare, very aggressive genetic condition called FENIB. The story’s power comes from what it reveals about several facets of developing new treatments, looking for a cure for a rare disease, the importance of state support as well as control, the fact of the existence of neglected diseases, the demands made of clinical researchers, self-sufficiency in laboratory research infrastructure, and of course the cost of treatment. But most of all, it is a critical study of time. Uditi passed away four months after one of the researchers working on a CRISPR-based treatment for her told her parents they’d be ready with a solution in six. But even before her passing, there was time, there was no time, there was hurry, and there were risks.

Uditi’s disease was caused by a mutation that converts a single DNA base from a ‘G’ to an ‘A’. A variation on CRISPR genome editing, called base editing, could theoretically correct exactly this kind of mutation (see ‘Precision gene repair’). … But Rajeev and Sonam saw an opportunity for hope: perhaps such a therapy could slow down the progression of Uditi’s disease, buying time for scientists to develop another treatment that could repair the damage that had been done. The Sarafs were on board.

There were a lot of unknowns in the base-editing project. And in addition to the work on stem cells in the lab, the team would need to do further experiments to determine which base-editing systems would work best, where and how to deliver its components into the body, and whether the process generated any unwanted changes to the DNA sequence. They would need to do experiments in mice to test the safety and efficacy of the treatment. They also needed to get Ghosh’s facility approved by India’s regulators for producing the base-editing components.

Then there was the pandemic:

In December 2019, the Sarafs moved back to India. … Then the COVID-19 pandemic struck, and in January 2021, Uditi was hospitalized with severe COVID-19. She spent 20 days in the hospital and her health was never the same, says Sonam. Communication became increasingly difficult for Uditi and she began to pace the house incessantly, rarely even going to sleep. The Sarafs decided to speed up the base-editing project by funding a second team in India.

Developing treatments takes time. Uditi’s story was a one-off, a singular disease that few researchers on the planet were working on, so developing an experimental alternative based on cutting-edge medical technology was a reasonable option. And yet:

Meanwhile, Devinsky had petitioned a US foundation to devise a different experimental treatment called antisense therapy for Uditi. … The treatments didn’t work. And the experience taught Rajeev and Sonam how long it could take to get approval to try an experimental therapy in the United States. They decided Uditi’s base-editing therapy should also be manufactured and administered in India.

Uditi didn’t live long enough to receive treatment that could have slowed FENIB’s progression — hopefully long enough for researchers to come up with a better and more long-lasting solution. Now, after her death, the thinking and effort that motivated the quest to find her a cure has shifted to the future tense.

It will take years to establish the techniques needed to create rapid, on-demand, bespoke CRISPR therapies. Most people with these conditions don’t have that kind of time. … Rajeev has urged Chakraborty to finish the team’s studies in mice, so that the next person with FENIB will not have to wait as long for a potential treatment. … “We are not really trying as aggressively as we did earlier,” he says.

When the health of a loved one is rapidly deteriorating, the clock of life resets — from the familiar 24-hour rhythms of daily life to days that start and end to the beats of more morbid milestones: a doctor’s visit, a diagnostic test result, the effects of a drug kicking in, the chance discovery of a new symptom, an unexpected moment of joy, the unbearable agony of helplessness. The passage of time becomes distorted, sometimes slow, sometimes too fast. People do what they can when they can. They will take all their chances. Which means the chances they encounter on their way matters. Technological literacy and personal wealth expand the menu of options. The Sarafs knew about CRISPR, had a vague idea of how it worked, and could afford it, so they pursued it. They came really close, too; their efforts may even prove decisive in pushing a cure for FENIB past the finish line. For those who don’t know about CRISPR-based therapies and/or don’t have the means to pay for it, the gap between hope and cure is likely to be more vast, and more dispiriting. And one chapter of the Sarafs’ journey briefly threatened to pull them to this path — just as it relentlessly threatens to waylay many families’ laborious pursuits to save the lives of their loved ones:

The Sarafs studied what they could find online and tried the interventions available to them: Indian ayurvedic treatments, a ketogenic diet, special schools, seeing a slew of physicians and trying out various medicines.

Ledford’s narrative doesn’t get into who these physicians were, but let’s set them and the special schools aside. Just this morning, I read a report by Rema Nagarajan in The Times of India that a company called Natelco in Bengaluru has been selling human milk even though its license was cancelled two years ago. Specifically, the FSSAI cancelled Natelco’s license in 2021; a few months later, Natelco obtained a license from the Ministry of AYUSH claiming it was selling “Aryuevdic proprietary medicine”. When the Breastfeeding Promotion Network of India complained to the ministry, the ministry cancelled its license in August 2022. Then, a month later, the Karnataka high court granted an interim stay on this cancellation but said the respondents — AYUSH representatives in Karnataka, in the Karnataka licensing authority or from the ministry — could have it vacated. They didn’t bother. In June 2023, the ministry filed objections but nothing more. It finally moved to vacate the stay only in March this year.

Natelco’s case is just one example. There are hundreds of companies whose charade the Ministry of AYUSH facilitates by allowing specious claims ranging from “Ayurvedic toothpaste” to calling human breast milk “Ayurvedic medicine”. This is not Ayurveda: very few of us know what Ayurveda is or looks like; even Ayurveda itself doesn’t belong in modern medicine. But together with the FSSAI, the food regulation body notorious for dragging its feet when the time comes to punish errant manufacturers, and a toothless advertisement monitoring regime, the Indian food and beverages market has provided a hospitable work environment for quacks and their businesses. And inevitably, their quackery spills over into the path of an unsuspecting yet desperate father or mother looking for something, anything, that will help their child. When faced with trenchant criticism, many of these business adopt the line that their products are not unsafe. But they are terribly unsafe: they steal time to do nothing with it, taking it away from a therapy or a drug that could have done a lot. Such cynical alternatives shouldn’t be present anywhere on any family’s path, yet the national government itself gives them a license to be.

Featured image credit: Sangharsh Lohakare/Unsplash

The cost of forgetting Ballia

By: VM
1 June 2024 at 17:37

In the day or so before June 1, 14 people died in Bihar of heat stroke. Ten of these people were election personnel deployed to oversee voting and associated activities in Bihar and Uttar Pradesh, and of them, five died in Bhojpur alone. On Friday, at least 17 people in Uttar Pradesh, 14 in Bihar, and four in Jharkhand had died of heat-related morbidity. And of the 17 in Uttar Pradesh, 13 deaths were reported from Mirzapur alone. This is a toll rendered all the more terrible by two other issues.

First, after the first phase of the polls, the Election Commission of India (ECI) recorded lower voter turnout than expected (from previous Lok Sabha polls) and blamed the heat. Srinivasan Ramani, my colleague at The Hindu, subsequently found “little correlation” between the maximum temperature recorded and turnouts in various constituencies, and in fact an anti-correlation in some places. By this time the ECI had said it would institute a raft of measures to incentivise voters to turn up. These were certainly welcome irrespective of there being a relationship between turnout and heat. However, did it put in place similar ‘special’ measures for electoral officials?

On March 16, the ECI forwarded an advisory that included guidelines by the National Disaster Management Authority to manage heat to the chief electoral officers of all states and Union territories. These guidelines had the following recommendations, among others: “avoid going out in the sun, especially between 12.00 noon and 3.00 pm”; “wear lightweight, light-coloured, loose, and porous cotton clothes. Use protective goggles, umbrella/hat, shoes or chappals while going out in sun”; and “avoid strenuous activities when Balliathe outside temperature is high”.

A question automatically arises: if poll officers are expected to avoid such activities, the polling process should have been set up such that those incidents requiring such activities wouldn’t arise in the first place. So were they? Because it’s just poka-yoke: if the process itself didn’t change, expecting poll officers to “avoid going out in the sun … between 12 pm and 3 pm” would have been almost laughable.

The second issue is worse. Heat wave deaths in India are often the product of little to no advance planning, even if the India Meteorological Department (IMD) has forecast excessive heat on certain dates. But to make matters worse, there was a deadly heat wave last year in the same region where many of these deaths have been reported now.

Recall that in the first half of June 2023, more than 30 people died of heat-related illnesses in Ballia village in Uttar Pradesh. After the chief medical superintendent of the local district hospital told mediapersons the people had indeed died of excessive heat, the state health department — led by deputy chief minister Brajesh Pathak — transferred him away, and his successors later denied heat had had anything to do with the deaths.

So even if the IMD hadn’t predicted a heat wave in this region for around May 30-31, the local and national governments and the ECI should have made preparations for heat exposure leading at least to morbidity. Did they? To the extent that people wouldn’t have had to be hospitalised or have died if they’d made effective preparations, they didn’t. Actively papering over the effects of extreme weather (and of adverse exposure) has to be the most self-destructive thing we’re capable of in the climate change era.

Featured image: Representative image of a tree whose leaves appear to have wilted in the heat. Credit: Zoltan Tasi/Unsplash.

The BHU Covaxin study and ICMR bait

By: VM
28 May 2024 at 04:51

Earlier this month, a study by a team at Banaras Hindu University (BHU) in Varanasi concluded that fully 1% of Covaxin recipients may suffer severe adverse events. One percent is a large number because the multiplier (x in 1/100 * x) is very large — several million people. The study first hit the headlines for claiming it had the support of the Indian Council of Medical Research (ICMR) and reporting that both Bharat Biotech and the ICMR are yet to publish long-term safety data for Covaxin. The latter is probably moot now, with the COVID-19 pandemic well behind us, but it’s the principle that matters. Let it go this time and who knows what else we’ll be prepared to let go.

But more importantly, as The Hindu reported on May 25, the BHU study is too flawed to claim Covaxin is harmful, or claim anything for that matter. Here’s why (excerpt):

Though the researchers acknowledge all the limitations of the study, which is published in the journal Drug Safety, many of the limitations are so critical that they defeat the very purpose of the study. “Ideally, this paper should have been rejected at the peer-review stage. Simply mentioning the limitations, some of them critical to arrive at any useful conclusion, defeats the whole purpose of undertaking the study,” Dr. Vipin M. Vashishtha, director and pediatrician, Mangla Hospital and Research Center, Bijnor, says in an email to The Hindu. Dr. Gautam Menon, Dean (Research) & Professor, Departments of Physics and Biology, Ashoka University shares the same view. Given the limitations of the study one can “certainly say that the study can’t be used to draw the conclusions it does,” Dr. Menon says in an email.

Just because you’ve admitted your study has limitations doesn’t absolve you of the responsibility to interpret your research data with integrity. In fact, the journal needs to speak up here: why did Drug Safety publish the study manuscript? Too often when news of a controversial or bad study is published, the journal that published it stays out of the limelight. While the proximal cause is likely that journalists don’t think to ask journal editors and/or publishers tough questions about their publishing process, there is also a cultural problem here: when shit hits the fan, only the study’s authors are pulled up, but when things are rosy, the journals are out to take credit for the quality of the papers they publish. In either case, we must ask what they actually bring to the table other than capitalising on other scientists’ tendency to judge papers based on the journals they’re published in instead of their contents.

Of course, it’s also possible to argue that unlike, say, journalistic material, research papers aren’t required to be in the public interest at the time of publication. Yet the BHU paper threatens to undermine public confidence in observational studies, and that can’t be in anyone’s interest. Even at the outset, experts and many health journalists knew observational studies don’t carry the same weight as randomised controlled trials as well as that such studies still serve a legitimate purpose, just not the one to which its conclusions were pressed in the BHU study.

After the paper’s contents hit the headlines, the ICMR shot off a latter to the BHU research team saying it hasn’t “provided any financial or technical support” to the study and that the study is “poorly designed”. Curiously, the BHU team’s repartee to the ICMR’s makes repeated reference to Vivek Agnihotri’s film The Vaccine War. In the same point in which two of these references appear (no. 2), the team writes: “While a study with a control group would certainly be of higher quality, this immediately points to the fact that it is researchers from ICMR who have access to the data with the control group, i.e. the original phase-3 trials of Covaxin – as well publicized in ‘The Vaccine War’ movie. ICMR thus owes it to the people of India, that it publishes the long-term follow-up of phase-3 trials.”

I’m not clear why the team saw fit to appeal to statements made in this of all films. As I’ve written earlier, The Vaccine War — which I haven’t watched but which directly references journalistic work by The Wire during and of the pandemic — is most likely a mix of truths and fictionalisation (and not in the clever, good-faith ways in which screenwriters adopt textual biographies for the big screen), with the fiction designed to serve the BJP’s nationalist political narratives. So when the letter says in its point no. 5 that the ICMR should apologise to a female member of the BHU team for allegedly “spreading a falsehood” about her and offers The Vaccine War as a counterexample (“While ‘The Vaccine War’ movie is celebrating women scientists…”), I can’t but retch.

Together with another odd line in the latter — that the “ICMR owes it to the people of India” — the appeals read less like a debate between scientists on the merits and the demerits of the study and more like they’re trying to bait the ICMR into doing better. I’m not denying the ICMR started it, as a child might say, but saying that this shouldn’t have prevented the BHU team from keeping it dignified. For example, the BHU letter reads: “It is to be noted that interim results of the phase-3 trial, also cited by Dr. Priya Abraham in ‘The Vaccine War’ movie, had a mere 56 days of safety follow-up, much shorter than the one-year follow-up in the IMS-BHU study.” Surely the 56-day period finds mention in a more respectable and reliable medium than a film that confuses you about what’s real and what’s not?

In all, the BHU study seems to have been designed to draw attention to gaps in the safety data for Covaxin — but by adopting such a provocative route, all that took centerstage was its spat with the ICMR plus its own flaws.

India can do it!

By: VM
23 May 2024 at 11:39
Against the background of the H5N1 pandemic in birds and an epidemic among cattle in the US, the Government of Victoria, in Australia, published a statement on May 21 that the province had recorded the country’s first human H5N1 case. This doesn’t seem to be much cause (but also not negligible cause) for concern because, according to the statement as well as other experts, this strain of avian influenza hasn’t evolved to spread easily between people. The individual in question who had the infection — “a child”, according to Victoria’s statement — had a severe form of it but has since recovered fully as well.

But this story isn’t testament to Australia’s pathogen surveillance, at least not primarily; it’s testament to India’s ability to do it. In Vivek Agnihotri’s film The Vaccine War — purportedly about the efforts of Bharat Biotech, the ICMR, and the NIV to develop Covaxin during the COVID-19 pandemic — Raima Sen, who plays the science editor of a fictitious publication called The Daily Wire, says about developing the vaccine in a moment of amusing cringe on a TV news show that “India can’t do it”. Agnihotri didn’t make it difficult to see myself in Sen’s character: I was science editor of the very real publication The Wire when Covaxin was being developed. And I’m here to tell you that India, in point of fact, can: according to Victoria’s statement, the child became infected by a strain of the H5N1 virus in India and fell ill in March 2024.

And what is it that India can do? According to Victoria’s statement, spotting the infection required “Victoria’s enhanced surveillance system”. Further, “most strains don’t infect humans”; India was able to serve the child with one of the rare strains that could. “Transmission to humans” is also “very rare”, happening largely among people who “have contact with infected birds or animals, or their secretions, while in affected areas of the world”. Specifically: “Avian influenza is spread by close contact with an infected bird (dead or alive), e.g. handling infected birds, touching droppings or bedding, or killing/preparing infected poultry for cooking. You can’t catch avian influenza through eating fully cooked poultry or eggs, even in areas with an outbreak of avian influenza.”

So let’s learn our lesson: If we give India’s widespread dysregulation of poultry and cattle health, underinvestment in pathogen surveillance, and its national government’s unique blend of optimism and wilful ignorance a chance, the country will give someone somewhere a rare strain of an avian influenza virus that can infect humans. Repeat after me: India can do it!

The cost of forgetting Ballia

By: V.M.
1 June 2024 at 16:37

In the day or so before June 1, 14 people died in Bihar of heat stroke. Ten of these people were election personnel deployed to oversee voting and associated activities in Bihar and Uttar Pradesh, and of them, five died in Bhojpur alone. On Friday, at least 17 people in Uttar Pradesh, 14 in Bihar, and four in Jharkhand had died of heat-related morbidity. And of the 17 in Uttar Pradesh, 13 deaths were reported from Mirzapur alone. This is a toll rendered all the more terrible by two other issues.

First, after the first phase of the polls, the Election Commission of India (ECI) recorded lower voter turnout than expected (from previous Lok Sabha polls) and blamed the heat. Srinivasan Ramani, my colleague at The Hindu, subsequently found “little correlation” between the maximum temperature recorded and turnouts in various constituencies, and in fact an anti-correlation in some places. By this time the ECI had said it would institute a raft of measures to incentivise voters to turn up. These were certainly welcome irrespective of there being a relationship between turnout and heat. However, did it put in place similar ‘special’ measures for electoral officials?

On March 16, the ECI forwarded an advisory that included guidelines by the National Disaster Management Authority to manage heat to the chief electoral officers of all states and Union territories. These guidelines had the following recommendations, among others: “avoid going out in the sun, especially between 12.00 noon and 3.00 pm”; “wear lightweight, light-coloured, loose, and porous cotton clothes. Use protective goggles, umbrella/hat, shoes or chappals while going out in sun”; and “avoid strenuous activities when Balliathe outside temperature is high”.

A question automatically arises: if poll officers are expected to avoid such activities, the polling process should have been set up such that those incidents requiring such activities wouldn’t arise in the first place. So were they? Because it’s just poka-yoke: if the process itself didn’t change, expecting poll officers to “avoid going out in the sun … between 12 pm and 3 pm” would have been almost laughable.

The second issue is worse. Heat wave deaths in India are often the product of little to no advance planning, even if the India Meteorological Department (IMD) has forecast excessive heat on certain dates. But to make matters worse, there was a deadly heat wave last year in the same region where many of these deaths have been reported now.

Recall that in the first half of June 2023, more than 30 people died of heat-related illnesses in Ballia village in Uttar Pradesh. After the chief medical superintendent of the local district hospital told mediapersons the people had indeed died of excessive heat, the state health department — led by deputy chief minister Brajesh Pathak — transferred him away, and his successors later denied heat had had anything to do with the deaths.

So even if the IMD hadn’t predicted a heat wave in this region for around May 30-31, the local and national governments and the ECI should have made preparations for heat exposure leading at least to morbidity. Did they? To the extent that people wouldn’t have had to be hospitalised or have died if they’d made effective preparations, they didn’t. Actively papering over the effects of extreme weather (and of adverse exposure) has to be the most self-destructive thing we’re capable of in the climate change era.

Featured image: Representative image of a tree whose leaves appear to have wilted in the heat. Credit: Zoltan Tasi/Unsplash.

The BHU Covaxin study and ICMR bait

By: V.M.
28 May 2024 at 03:51

Earlier this month, a study by a team at Banaras Hindu University (BHU) in Varanasi concluded that fully 1% of Covaxin recipients may suffer severe adverse events. One percent is a large number because the multiplier (x in 1/100 * x) is very large — several million people. The study first hit the headlines for claiming it had the support of the Indian Council of Medical Research (ICMR) and reporting that both Bharat Biotech and the ICMR are yet to publish long-term safety data for Covaxin. The latter is probably moot now, with the COVID-19 pandemic well behind us, but it’s the principle that matters. Let it go this time and who knows what else we’ll be prepared to let go.

But more importantly, as The Hindu reported on May 25, the BHU study is too flawed to claim Covaxin is harmful, or claim anything for that matter. Here’s why (excerpt):

Though the researchers acknowledge all the limitations of the study, which is published in the journal Drug Safety, many of the limitations are so critical that they defeat the very purpose of the study. “Ideally, this paper should have been rejected at the peer-review stage. Simply mentioning the limitations, some of them critical to arrive at any useful conclusion, defeats the whole purpose of undertaking the study,” Dr. Vipin M. Vashishtha, director and pediatrician, Mangla Hospital and Research Center, Bijnor, says in an email to The Hindu. Dr. Gautam Menon, Dean (Research) & Professor, Departments of Physics and Biology, Ashoka University shares the same view. Given the limitations of the study one can “certainly say that the study can’t be used to draw the conclusions it does,” Dr. Menon says in an email.

Just because you’ve admitted your study has limitations doesn’t absolve you of the responsibility to interpret your research data with integrity. In fact, the journal needs to speak up here: why did Drug Safety publish the study manuscript? Too often when news of a controversial or bad study is published, the journal that published it stays out of the limelight. While the proximal cause is likely that journalists don’t think to ask journal editors and/or publishers tough questions about their publishing process, there is also a cultural problem here: when shit hits the fan, only the study’s authors are pulled up, but when things are rosy, the journals are out to take credit for the quality of the papers they publish. In either case, we must ask what they actually bring to the table other than capitalising on other scientists’ tendency to judge papers based on the journals they’re published in instead of their contents.

Of course, it’s also possible to argue that unlike, say, journalistic material, research papers aren’t required to be in the public interest at the time of publication. Yet the BHU paper threatens to undermine public confidence in observational studies, and that can’t be in anyone’s interest. Even at the outset, experts and many health journalists knew observational studies don’t carry the same weight as randomised controlled trials as well as that such studies still serve a legitimate purpose, just not the one to which its conclusions were pressed in the BHU study.

After the paper’s contents hit the headlines, the ICMR shot off a latter to the BHU research team saying it hasn’t “provided any financial or technical support” to the study and that the study is “poorly designed”. Curiously, the BHU team’s repartee to the ICMR’s makes repeated reference to Vivek Agnihotri’s film The Vaccine War. In the same point in which two of these references appear (no. 2), the team writes: “While a study with a control group would certainly be of higher quality, this immediately points to the fact that it is researchers from ICMR who have access to the data with the control group, i.e. the original phase-3 trials of Covaxin – as well publicized in ‘The Vaccine War’ movie. ICMR thus owes it to the people of India, that it publishes the long-term follow-up of phase-3 trials.”

I’m not clear why the team saw fit to appeal to statements made in this of all films. As I’ve written earlier, The Vaccine War — which I haven’t watched but which directly references journalistic work by The Wire during and of the pandemic — is most likely a mix of truths and fictionalisation (and not in the clever, good-faith ways in which screenwriters adopt textual biographies for the big screen), with the fiction designed to serve the BJP’s nationalist political narratives. So when the letter says in its point no. 5 that the ICMR should apologise to a female member of the BHU team for allegedly “spreading a falsehood” about her and offers The Vaccine War as a counterexample (“While ‘The Vaccine War’ movie is celebrating women scientists…”), I can’t but retch.

Together with another odd line in the latter — that the “ICMR owes it to the people of India” — the appeals read less like a debate between scientists on the merits and the demerits of the study and more like they’re trying to bait the ICMR into doing better. I’m not denying the ICMR started it, as a child might say, but saying that this shouldn’t have prevented the BHU team from keeping it dignified. For example, the BHU letter reads: “It is to be noted that interim results of the phase-3 trial, also cited by Dr. Priya Abraham in ‘The Vaccine War’ movie, had a mere 56 days of safety follow-up, much shorter than the one-year follow-up in the IMS-BHU study.” Surely the 56-day period finds mention in a more respectable and reliable medium than a film that confuses you about what’s real and what’s not?

In all, the BHU study seems to have been designed to draw attention to gaps in the safety data for Covaxin — but by adopting such a provocative route, all that took centerstage was its spat with the ICMR plus its own flaws.

India can do it!

By: V.M.
23 May 2024 at 06:09
Against the background of the H5N1 pandemic in birds and an epidemic among cattle in the US, the Government of Victoria, in Australia, published a statement on May 21 that the province had recorded the country’s first human H5N1 case. This doesn’t seem to be much cause (but also not negligible cause) for concern because, according to the statement as well as other experts, this strain of avian influenza hasn’t evolved to spread easily between people. The individual in question who had the infection — “a child”, according to Victoria’s statement — had a severe form of it but has since recovered fully as well.

But this story isn’t testament to Australia’s pathogen surveillance, at least not primarily; it’s testament to India’s ability to do it. In Vivek Agnihotri’s film The Vaccine War — purportedly about the efforts of Bharat Biotech, the ICMR, and the NIV to develop Covaxin during the COVID-19 pandemic — Raima Sen, who plays the science editor of a fictitious publication called The Daily Wire, says about developing the vaccine in a moment of amusing cringe on a TV news show that “India can’t do it”. Agnihotri didn’t make it difficult to see myself in Sen’s character: I was science editor of the very real publication The Wire when Covaxin was being developed. And I’m here to tell you that India, in point of fact, can: according to Victoria’s statement, the child became infected by a strain of the H5N1 virus in India and fell ill in March 2024.

And what is it that India can do? According to Victoria’s statement, spotting the infection required “Victoria’s enhanced surveillance system”. Further, “most strains don’t infect humans”; India was able to serve the child with one of the rare strains that could. “Transmission to humans” is also “very rare”, happening largely among people who “have contact with infected birds or animals, or their secretions, while in affected areas of the world”. Specifically: “Avian influenza is spread by close contact with an infected bird (dead or alive), e.g. handling infected birds, touching droppings or bedding, or killing/preparing infected poultry for cooking. You can’t catch avian influenza through eating fully cooked poultry or eggs, even in areas with an outbreak of avian influenza.”

So let’s learn our lesson: If we give India’s widespread dysregulation of poultry and cattle health, underinvestment in pathogen surveillance, and its national government’s unique blend of optimism and wilful ignorance a chance, the country will give someone somewhere a rare strain of an avian influenza virus that can infect humans. Repeat after me: India can do it!

Justice delayed but a ton of bricks await

By: V.M.
11 April 2024 at 11:46

From ‘SC declines Ramdev, Patanjali apology; expresses concern over FMCGs taking gullible consumers ‘up and down the garden path’’, The Hindu, April 10, 2024:

The Supreme Court has refused to accept the unconditional apology from Patanjali co-founder Baba Ramdev and managing director Acharya Balkrishna for advertising medical products in violation of giving an undertaking in the apex court in November 2023 prohibiting the self-styled yoga guru. … Justices Hima Kohli and Ahsanuddin Amanullah told senior advocate Mukul Rohatgi that Mr. Ramdev has apologised only after being caught on the back foot. His violations of the undertaking to the court was deliberate and willful, they said. The SC recorded its dissatisfaction with the apology tendered by proposed contemnors Patanjali, Mr. Balkrishna and Mr. Ramdev, and posted the contempt of court case on April 16.

… The Bench also turned its ire on the Uttarakhand State Licensing Authority for “twiddling their thumbs” and doing nothing to prevent the publications and advertisements. “Why should we not come down like a ton of bricks on your officers? They have been fillibustering,” Justice Kohli said. The court said the assurances of the State Licensing Authority and the apology of the proposed contemnors are not worth the paper they are written on.

A very emotionally gratifying turn of events, but perhaps not as gratifying as they might have been had they transpired at the government’s hands when Patanjali was issuing its advertisements of pseudoscience-backed COVID-19 cures during the pandemic. Or if the Supreme Court had proceeded to actually hold the men in contempt instead of making a slew of observations and setting a date for another hearing. Still, something to cheer for and occasion to reserve some hope for the April 16 session.

But in matters involving Ramdev and Patanjali Ayurved, many ministers of the current government ought to be pulled up as well, including former Union health minister Harsh Vardhan, Union micro, small, and medium enterprises minister Nitin Gadkari, and Prime Minister Narendra Modi. Modi’s governance and policies both written and unwritten enabled Patanjali’s charlatanry while messrs Vardhan and Gadkari were present at an event in February 2021 when Patanjali launched a product it claimed could cure COVID-19, with Vardhan – who was health minister then – speaking in favour of people buying and using the unproven thing.

I think the Supreme Court’s inclination to hold Ramdev et al. in contempt should extend to Vardhan as well because his presence at the event conferred a sheen of legitimacy on the product but also because of a specific bit of theatrics he pulled in May the same year involving Ramdev and former Prime Minister Manmohan Singh. Ramdev apologising because that’s more politically convenient rather than because he thinks he screwed up isn’t new. In that May, he’d called evidence-based medicine “stupid” and alleged such medicine had killed more people than the virus itself. After some virulent public backlash, Vardhan wrote a really polite letter to Ramdev asking him to apologise, and Ramdev obliged.

But just the previous month, in April 2021, Manmohan Singh had written a letter to Modi suggesting a few courses of action to improve India’s response to the virus’s spread. Its contents were perfectly reasonable, yet Vardhan responded to it accusing Singh of spreading “vaccine hesitancy” and alleging Congress-ruled states were responsible for fanning India’s deadly second wave of COVID-19 infections (in 2021). These were all ridiculous assertions. But equally importantly, his lashing out stood in stark contrast to his letter to Ramdev: respect for the self-styled godman and businessman whose company was attempting to corner the market for COVID-19 cures with untested, pseudo-Ayurvedic froth versus unhinged rhetoric for a well-regarded economist and statesman.

For this alone, Vardhan deserves the “ton of bricks” the Supreme Court is waiting with.

Cheers for everyone but the bustard

By: V.M.
8 April 2024 at 11:41

Behold, the legerdemain of spinning bad news into good:

Setting aside the meaningless headline, we have a lede (and the rest of the article, for that matter) that claims the Supreme Court of India “struck” a fine balancing act between the transition to renewable energy and protecting the great Indian bustard by rolling back a complete ban on overhead cables in the birds’ habitat.

Accepting sustained arguments from attorney general R Venkataramani, solicitor general Tushar Mehta and additional SG Aishwarya Bhati, the bench said, “India’s commitment to promoting renewable energy sources, particularly in regions like Gujarat and Rajasthan, aligns with its broader sustainable development objectives.”

Pats on the back for everyone.

Except while the Supreme Court is switching between imposing and revoking a ban on overhead cables and the newspaper declaring this a pro-climate triumph, there is no indication in the report that the petition before the Supreme Court is to move the power cables underground, protecting both the endangered bustards and the region’s power-generation potential.

The apex court has now asked an expert committee to examine the feasibility of underground cables and their costs, which the promoters of solar- and wind-power projects in the region have contended are too high. As such, the court’s order has created a false balance between the birds and the profit margins of these promoters, as if to say they’re equally legitimate and equally valuable.

Such are the perils of government by Supreme Court.

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