Editorials - 03-04-2021

India’s fight against the resurgence of the coronavirus is a challenge requiring strengthened data and better science

The optimism that India might have beaten the COVID-19 pandemic has given way to pessimism from a sharp increase in new cases and deaths from the disease. Maharashtra seems to be particularly affected, but nearly all States are reporting increases. The epidemiology of COVID-19 is poorly understood, but some early understanding of the transmission of the virus can enable a more effective science-driven response.

Spread of variants

First, the surge is probably driven by variants from the original, as variants worldwide comprise much of the current wave. A resumption of global travel meant that spread of variants into India was inevitable, with the only question being when. Evolutionary theory would expect SARS-CoV-2, the virus that causes COVID-19, to mutate to become more transmissible. After all, the only task of a virus is to reproduce. However, the expected concomitant decrease in lethality has not yet been documented. Anecdotal reports that the current surge is occurring more in younger adults and accompanied by unusual symptoms also support the idea that variants are responsible. Direct evidence is needed from genetic sequencing of the virus.

Second, it was, and remains, wishful thinking that India had achieved “herd immunity”. The patterns of infection in India clearly suggest multi-generational transmission, with younger adults the engine of transmission into the elderly. Various serosurveys have consistently found that half or more of tested urban populations have antibodies to the virus. However, this high level of infection is not the same as a markedly reduced level of transmission, which is what is required for herd immunity.

Notions of herd immunity do not fully capture the fact that for largely unknown reasons, viral transmission is cyclical. Delhi had two major peaks, in 2020, of death rates and case rates, one in June and another in November, and now is entering a third major wave. Within Mumbai, the current wave appears to be affecting more affluent areas and private hospitals, in contrast to last year where the highest infection levels were in the slums and poorer areas. Our forthcoming mortality-based analyses (https://bit.ly/3sY0KYZ) suggest several sub-waves exist within major viral peaks, reflecting subtle changes in community transmission. The ebbs and flow of vaccine transmission are far more variable than we assume.

As well, much of infection in India might well be mild, with less durable immune protection than induced by vaccination. ‘Asymptomatic infection is more commonly reported in Indian serosurveys, exceeding 90% in some, in contrast to high-income countries, where about one-third of infections report as asymptomatic’. Recent findings from Wuhan, China show most seropositive infections were asymptomatic and among these, the important protective antibodies were low during follow-up periods. Milder infection might well also correlate with lower severity of clinical illness, helping to explain the Indian paradox of widespread transmission but with low mortality rates.

Data must guide decisions

India needs to increase the quantity, quality and public availability of actual data to guide decision-making. Theories or mathematical models are hugely uncertain, particularly early on in the epidemic. Better understanding of the unique patterns of Indian viral transmission has a few pillars, which can be achieved quickly. First, collection of anonymised demographic and risk details (age, sex, travel, contact with other COVID-19 patients, existing chronic conditions, current smoking) on all positive cases on a central website in each State remains a priority.

Second, greatly expanded sequencing of the viral genome is needed from many parts of India, which can be achieved by re-programming sequencing capacity in Indian academic and commercial laboratories. Third, far better reporting of COVID-19 deaths is needed. Daily or weekly reporting of the total death counts by age and sex by each municipality would help track if there is a spike in presumed COVID-19 deaths. The Registrar General of India’s verbal autopsy studies are invaluable, but must be reactivated to review deaths occurring in 2020, given that the last available results are from 2013.

Third, the Indian Council of Medical Research’s national serosurvey had design limitations such that it probably underestimated the true national prevalence. A far larger and better set of serial surveys is required. Finally, we need to understand better why some populations are not affected. For example, COVID-19 infection and death levels in Thailand and Vietnam are remarkably low, and cannot be assigned to their stronger testing and tracing programmes. Widespread existing immunity, perhaps from direct exposure to bat coronaviruses might be one explanation. Rapidly assembled comparative studies across parts of India and Asia are a priority.

Counter growing inequity

The science pillar of a response is complementary to action. The central and State governments have already pushed for a rapid expansion of COVID-19 vaccination. India can learn from Chile, which has successfully provided at least one dose to over half of its population. Affluent and connected urban elites of India are vaccinating quickly, but the poorer and less educated Indians are being left behind. Vaccination campaigns need to reach the poor adults over age 45, without having to prove anything other than approximate age. Follow-up studies among the vaccinated can establish the durability of protection, and, ideally, reduction in transmission.

Similarly, India must capture and report data on who is vaccinated, including by education or wealth levels. The poor cannot be left in the dark.

Adult vaccination plan

COVID-19 could well turn into a seasonal challenge and thus, the central government should actively consider launching a national adult vaccination programme that matches India’s commitment and success in expanding universal childhood vaccination. The Disease Control Priorities Project estimates an adult national programme would cost about Rs. 250 per Indian per year to cover routine annual flu vaccination, five-yearly pneumococcal vaccines, HPV vaccines for adolescent girls and tetanus for expectant mothers. Per year, vaccines for one billion adults might save about 200,000 lives from the targeted diseases. Annual flu vaccination reduces the risk of influenza pandemics and perhaps even COVID-19 infection. Indeed, we might already be in the era where major zoonotic diseases are not once-a-century events, but once a decade. Thus, adult and child vaccination programmes are essential to prepare for future pandemics.

More draconian steps, such as another full national lockdown should be considered carefully, as they incur a huge toll on the poor and stunt education of Indian children. It also remains unclear if the population would comply. The resurgence of COVID-19 presents a major challenge for governments, yet the best hope is to rapidly expand epidemiological evidence, share it with the public and build confidence that the vaccination programme will benefit all Indians.

Prabhat Jha is a professor of epidemiology and global health at the University of Toronto, Canada

The Human Rights Council is where Sinhala and Tamil nationalisms meet and confront each other

“Hey Geneva” laments Ajith Kumarasiri (musician, songwriter, and composer in Sri Lanka) in powerful Sinhala rhythm and blues. “We no longer kill.” “We don’t shoot anymore.” “Give us our island back.” Geneva as an idea is firmly embedded in the Sri Lankan consciousness. For many Sri Lankans, especially the Sinhalese, it is an attack on national honour, a place where their vulnerability as a small island is exploited. For many Tamils and now Muslims, it is a place of hope. For human rights activists the world over, it is their forum.

The setting

The Human Rights Council in Geneva is a place where Sinhala and Tamil nationalisms meet, confront each other and fight countless shadow battles. In some of the side events of the Council, before the novel coronavirus pandemic, people have fainted, come to fisticuffs and been removed by UN security. It is the place where both communities have large demonstrations next to the legless chair that reminds the Palais de Nations of the consequence of war. There are heated, blood-chilling speeches aimed at the supporters. For bystanders, much of this drama is quite unsettling.

The government playbook with regard to the Geneva process at the UN Human Rights Council is to present it as an enormous power play full of double standards. It is seen as western countries ganging up on Sri Lanka for its closeness to China. Imperialism and neocolonialism remain in the frame. There is no government recognition that there may be any grievance or a victim. This just compounds the insensitivity.

The government’s aim this year was to have no resolution at all, while the major Tamil groups wanted the Human Rights Council to begin a pathway to the International Criminal Court. In the end, the resolution decided to create capacity at the Office of the United Nations High Commissioner for Human Rights (OHCHR) to collect, preserve and consolidate evidence not only on war crimes but also on other gross violations of human rights and serious violations of humanitarian law. There is no date or time period.

Geopolitics ‘plus’

Though geopolitics is the framework for decision making at the Human Rights Council, the actual process is more nuanced and may be described as geopolitics “plus”. Unless one acknowledges this “plus” factor, one will never understand the actual workings of the Human Rights Council. The activism, agitation and the momentum around a resolution created by this “plus” factor spills over and creates the atmosphere in which the resolution is adopted.

The “plus” factors around the Sri Lankan resolution were easy to identify. First came the legal experts of the Office of the High Commissioner for Human Rights, as well as the Special Rapporteurs and procedures who took very strong positions. The pivotal input by the Office was the Report of the High Commissioner on “Promoting Accountability and Reconciliation in Sri Lanka”. Michelle Bachelet as a High Commissioner, a torture victim, President, and a Minister of Defence, put her full weight behind the report. More than anything else, her report and words made the resolution inevitable.

In addition to the work of OHCHR, the Tamil groups nationally and globally were extremely active. But, it was Muslim civil society and the Muslim diaspora that made the difference for this resolution. Their passion, energy and sense of injustice filled the spaces. Despite heavy lobbying from Pakistan, (the Coordinator on Human rights and humanitarian issues in the Organisation of Islamic Cooperation, at Geneva), and from Bangladesh, after Prime Minister Mahinda Rajapaksa’s visit in March, despite pressure from China and after the Rajapaksas made personal calls to OIC members, the large majority of Muslim countries still decided to abstain.

Elements to a global cause

Though the diasporas are always active, it is an international civil society made up of a whole array of disparate groups that dominate the agitational space of the Human Rights Council. These groups are often at odds with each other but act in solidarity when it comes to global causes. Sri Lanka has again become a global cause. Once you get on the agenda of international civil society, it is difficult to get off. As Christine Schöwebel-Patel, the academic in international law and political economy, has recently written, there is a kind of “branding” in a communications sense that takes place and has severe consequences for country and community.

The events unfolding in Geneva are particularly disturbing because of their shortsightedness. In 2014, Sri Lanka faced a hostile Council and was an outlier in the international system very much like today. Most people have conveniently forgotten this history. The Resolution of the Human Rights Council in 2015 (https://bit.ly/3md0P8x) that Sri Lanka cosponsored after the government changed was to pull Sri Lanka out of the rut that it had fallen into. If that resolution were not passed, Sri Lanka would have had the evidence collection and preserving mechanism in some form by 2016.

The 2015 resolution accepted international best practices, an office for missing persons, an office for reparations, a truth commission and a judicial process for those guilty of serious crimes. At that time, the focus was on the need for a system that gave confidence to the victims. Victim groups were clear that a purely domestic process had failed them before. As a result, it was agreed to have a framework with an element of foreign participation.

International, resolution 30/1 became a great success though victim groups thought it was a failure due to a lack of implementation. International hostility disappeared; Sri Lanka was dropped from international punitive agendas, became open to GSP plus (or the European Union’s Generalised Scheme of Preferences Plus) and other trade and financial benefits and was welcomed back into UN peacekeeping. Despite its international success, 30/1 was reviled nationally as a resolution that “sold out the soldiers” — blurring the lines between the few who have committed war crimes and the large majority who have not.

Fundamentally, there was also a lack of understanding of what “co-sponsorship” meant and the enlightened self-interest that it entailed. Co-sponsorship has always meant accepting international standards while keeping control of the national process — the legislation to be enacted and the personnel to be appointed. By arbitrarily withdrawing from the resolution, Sri Lanka created the space for the Human Rights Council to create a new mechanism to collect and preserve evidence. This process is now independent of the Colombo government and will eventually have a life of its own.

The two sides

With this dedicated capacity at the OHCHR, the human rights issues regarding Sri Lanka will not go away. For many Sri Lankans, especially the Sinhalese, this is an outrage of double standards. There is real fury at what they see as global inequity. For many members of the minorities, opposition leaders, journalists, lawyers, victim groups and civil society activists who claim they are being harassed, prosecuted and intimidated on a daily basis by a surveillance state, there is relief to know that someone will be watching.

Radhika Coomaraswamy is former Under Secretary General and Special Representative of the Secretary General on Children and Armed Conflict

Rajinikanth fully deserves the Phalke, butthe timing of the announcement is suspect

Rajinikanth, the reigning demigod of Tamil filmdom, richly deserves the Dadasaheb Phalke award, Indian cinema’s highest recognition, bestowed by the jury this year. The film world has few parallels to his success story. His transition from Shivaji Rao Gaekwad, a Marathi-born struggling bus conductor in Bengaluru, to a worshipped superstar in the Dravidian heartland, was made possible only by his undimmed passion and sustained hard work. From early on, he introduced novelty to his screen characters. He has kept innovating on his unique styles of tossing a cigarette or a mint, twirling his sunglasses and walking with a swagger. While style remains his hallmark, it would be an injustice to dismiss him as just a mass hero. He had excelled as an actor with sensitive portrayals in films such asMullum MalarumandAarilirindhu Arubadhu Varaibefore getting trapped in superstardom withBillaand donning larger than life roles. He is among the rare heroes who handle comedy scenes with ease, his dual roles inThillu Mullubeing an example. His charisma has attracted three generations of fans, with a following even in Japan where he is lovingly called ‘Odori Maharaja’ (The Dancing Maharaja). He is also the only Indian actor to have featured in black and white, colour, 3D and motion capture films.

But despite Rajinikanth’s demonstrable body of work, given his active inclination for a foray into “spiritual politics” until last year, inevitable questions are being raised if the award is a calculated choice to influence poll-bound Tamil Nadu. While Rajinikanth lent support during elections to the DMK-TMC (1996, 1998) and AIADMK-BJP (2004), in recent years he has made no secret of his admiration for BJP leaders. Not only did he hail Prime Minister Narendra Modi and Home Minister Amit Shah as ‘Lord Krishna and Arjuna’ — after the scrapping of special status granted to Jammu and Kashmir under Article 370 — he targeted Dravidian icon Periyar E.V. Ramasamy while recalling the alleged attacks on Hindu deities during a 1971 anti-superstition rally. He backed the Citizenship Amendment Act. To be fair, since his ‘no show’ in politics, the actor has remained politically withdrawn, though previously he indirectly targeted the DMK and the AIADMK. He has not responded to appeals from ‘neutral’ observers to lend his support for “honest, dynasty-free politics”. Whether the award’s timing would influence the voting choice of his legion of fans is difficult to say as he remains an untested electoral force. However, had the jury put off the announcement of the award by just a week till polling was over, everyone would have unconditionally welcomed the choice. The giver has done the recipient a disservice through the timing of the announcement.

That inflation is a concern for policymakersis reassuring for consumers and savers

The Finance Ministry has put to rest all speculation about the inflation targeting framework that will guide the interest rate decisions of the RBI’s Monetary Policy Committee over the five-year period starting on April 1. In a terse notification, the Department of Economic Affairs announced that the inflation target for the quinquennium ending on March 31, 2026, will be 4%, with an upper tolerance level of 6% and a lower tolerance level of 2%. Economic Affairs Secretary Tarun Bajaj said that the framework’s parameters would remain unchanged from what had prevailed in the five years that ended on March 31. The government’s announcement is a welcome step in reiterating that inflation targeting remains the centrepiece of the monetary policy framework and signals that the fiscal and monetary authorities are in lockstep in ensuring the primacy of price stability as the bedrock for all macro-economic development. This is particularly apposite at a time when inflation pressures are mounting in an economy that is still struggling to regain its footing from the devastating contraction in the just-ended fiscal year, when the COVID-19 pandemic and the drastic measures to curb its spread resulted in widespread precarity. The latest Consumer Price Index data show retail inflation accelerated by almost 100 basis points to a three-month high of 5.03% in February, with food and fuel costs continuing to remain volatile. Also, with the prices of multiple raw materials on an upward trajectory, an IHS Markit India Business Outlook survey last month showed companies were planning to raise selling prices over the coming 12 months to cope with rising costs.

The RBI’s officials have in recent months maintained an unwavering focus on emphasising the need to retain the flexible inflation targeting framework. In a December working paper titled ‘Measuring Trend Inflation in India’, the Deputy Governor overseeing monetary policy, Michael Debabrata Patra, and a colleague underscored the importance of ensuring the appropriateness of the inflation target. Observing that there had been a steady decline in trend inflation to a 4.1%-4.3% band since 2014, they said a target far lower than the trend ran the risk of imparting a ‘deflationary bias’ that would dampen economic momentum, while a goal much above the trend could engender expansionary monetary conditions that would likely lead to inflation shocks. And in February, the RBI’s researchers authoring its Report on Currency and Finance — themed ‘Reviewing the Monetary Policy Framework’ — made clear that the framework had served the economy well, attested by a decline in inflation volatility and more credible anchoring of inflation expectations. That the government’s economic officials have heeded these calls will certainly reassure investors and savers that inflation remains a central concern for all policymakers.