“Ganga has revealed the truth!” exclaims Vishwambhar Nath Mishra, head priest of the Sankat Mochan temple in Varanasi. Located in the heart of the ancient city, the temple is where the faithful come to seek an end to their problems. But the region has been witness to a grisly sight over the past week. Semi-decomposed and bloated bodies have been found floating in the sacred river. Mishra, who is also a professor at the Indian Institute of Technology-BHU, says this indicates that the COVID-19 situation in rural Uttar Pradesh is far worse than it appears.
Ever since the bodies were discovered, police personnel have been patrolling the waters and ghats. They have set up pickets in at least seven districts and even offered a support sum of Rs. 5,000 to those who cannot afford wood for cremation, to dissuade them from immersing bodies in rivers.
The State police have so far admitted to having found 44 bodies floating in the rivers, mainly the Ganga, in the districts of Ballia, Chandauli, Ghazipur, Varanasi, Hamirpur and Kanpur. For residents of Ghazipur, where the bodies were first spotted in U.P., the sight was shocking. Balwant Singh Bala of Gahmar village says he has never seen anything like this before. “We are used to bodies floating in the river once in a while. But this time we knew that there was something very grave happening,” he says. A senior police officer, who led the clean-up of the ghats with lime powder, agrees.
U.P. is officially yet to acknowledge that all or some of these were COVID-19 victims. Many observers suspect that these bodies could be of COVID-19 victims who were abandoned or disposed of in the waters by families due to lack of money for cremations, the waiting lines at cremation grounds, or the social stigma attached to the disease. Speculation intensified when countless shallow graves were found on the ghats of the Ganga in some districts, including Unnao, Prayagraj, Kannauj and Rae Bareli.
At the Baksar ghat in Unnao, cleaners, priests, locals and attendants of the dead say that though bodies have been cremated and buried there according to customs, in April, when the wave was at its peak, the number of bodies arriving at the ghat for final rites reached 70-80 a day against the daily figure of 15-20. Those who could not afford to buy wood and fuel for cremation chose to bury the dead, they say. Since there is no way of knowing whether the bodies in the river are of COVID-19 victims, the question of uncounted COVID-19 deaths in the State still hangs in the air.
Battling COVID-19 in the villages
The pandemic has put tremendous strain on the fragile health infrastructure in U.P. and exposed the lack of preparedness in urban areas. Every day, there are desperate pleas for hospital beds, essential medicine and oxygen cylinders. Crematoriums and graveyards are packed. But now, the focus has shifted to the rural areas after the discovery of the bodies in the Ganga and the alarms raised in the wake of the recently conducted panchayat polls.
According to official figures, the daily number of positive cases and deaths has drastically dropped over the last three weeks. On April 30, the State had 3.1 lakh active cases. On May 21, this dropped to over a lakh. On April 24, the State had recorded 38,055 new cases out of 2.25 lakh samples tested, while on May 21, it recorded 7,735 out of the over 2.89 lakh samples tested. The recovery rate in U.P. is now 92.5%.
However, the spread of the infection in rural areas is alarming. During a testing drive in 89,512 villages, 28,742 villages (32%) reported positive cases, says Amit Mohan Prasad, Additional Chief Secretary, Health. Prasad, however, chooses to look at the bright side. “Sixty-eight percent of our villages are still safe from the infection,” he says, adding that the government’s focus is to keep testing in rural areas. Even after aggressive testing, new cases have been decreasing while recoveries are increasing, a government official says.
All these numbers offer little consolation to the bereaved. In Mau district, nursing staff Deepak Yadav’s experience encapsulates the tragedy of battling COVID-19 in the hinterland where medical infrastructure is poor. After his parents tested positive (they were tested at home with a rapid antigen test kit), Yadav desperately searched for a hospital bed in Mau and in the neighbouring districts of eastern U.P. without success. He then arranged for oxygen cylinders at home. When his mother’s health continued to deteriorate, Yadav dialled for an ambulance but the oxygen cylinder that came with it ran out in five minutes, he says. The local community health centre in Dohrighat was shut. The family then went to a private hospital across the Ghaghara river in Barhalganj in Gorakhpur but was told that it had no oxygen. In panic, Yadav tried to move his mother to his workplace in Deoria. Meanwhile, the private hospital which had rejected him earlier called him back following the intervention of a politician, he says. The entire episode lasted more than three hours, of which the family spent an hour stuck on a 3-km stretch of road in a traffic jam, which Yadav’s brother, an Army jawan, frantically tried to clear. Yadav attempted resuscitation in the ambulance meanwhile, but by the time they reached the hospital, his mother had died. His father, who was also hospitalised for a few days, is critical at home. Barring two or three members, everyone is his house has tested positive for COVID-19.
Yadav, who was busy during the panchayat polls and vaccination drive, cannot explain how his parents who live a rural life got the virus. “It means the virus has spread in the villages,” he says.
While a large part of the media’s focus was on the worst-affected urban centres of the State such as Lucknow, Varanasi city, Kanpur, Prayagraj and Meerut, the pandemic steadily crept into the semi-urban and rural areas. In several districts, the death count doubled and even tripled within a fortnight in April. Largely rural and backward districts like Chandauli, Hardoi, Shahjahanpur, Basti, Ghazipur and Sonbhadra have recorded a high number of deaths, between 230 and 320 each, indicating the devastating impact of COVID-19 in the rural areas of U.P.
Problems with testing
Bihari Lal, a journalist in a Hindi daily in Chandauli, is among the dead. His son Ashutosh Jaiswal, who serves in the Railways, says his father faced no shortage of oxygen supply, but was not treated well at the private hospital where he was admitted. The family did not take Bihari Lal to a government centre as they do not trust government hospitals and found it easier to find a bed in a private centre, Jaiswal says. Bihari Lal, who also served as an LIC agent and ran a photo editing store, had developed a cough and fever after moving about during the panchayat polls, his family says. Initially, a local doctor prescribed some antibiotics for him. Then a blood test revealed that he had typhoid. While his fever subsided, Bihari Lal’s oxygen levels continued to drop and he was admitted in hospital. A CT scan revealed that he had lung infection. Three-four days later, a rapid antigen test showed that Bihari Lal was COVID-19 positive.
Jaiswal feels that the initial delay in starting COVID-19 treatment may have cost his father precious time. According to a senior district official, this is a common concern as people rely on quacks and are slow to start precautionary treatment for COVID-19 as per the guidelines issued by the State.
For many days after his initial symptoms, Bihari Lal’s family relied on the usual care and steam treatment as they believed that he was getting better. “People are taking the fever and cough lightly and going to doctors for usual treatment. When the doctor says the patient has COVID-19, they are unable to understand what to do,” says Jaiswal.
Despite raising a flag on the district portal, Jaiswal says no sanitation work was carried out in his house in Purwa village after his father tested positive. Similar complaints were raised by people in other districts as well.
The State government says it is conducting a massive testing and door-to-door surveillance drive in 97,000 villages. This included a special drive from May 5 to 9. However, representatives of several villages have alleged that the administration has provided minimal facilities for testing. Testimonies from rural areas show that deaths and positive cases may be much higher than recorded as not all symptomatic or suspected cases are being sent for tests. This is due to infrastructural issues such as shortage of manpower and equipment, lack of accessibility and urgency, or hesitancy on behalf of the people.
In Unnao, front-line ASHA (Accredited Social Health Activist) workers, who go door to door to trace cases in villages, say they are at high risk as many of them do not have the necessary instruments to measure temperature or oxygen levels. They are not even provided sanitisers, they say. Veermati Singh, an ASHA worker, says all she was given was a medicine kit with some strips of tablets, mainly for fever; a face mask; and a pair of gloves. “People don’t take us seriously. Why would they when I cannot even record their temperature and oxygen levels,” she says.
Many who had COVID-19 symptoms and lung infection, detected through CT scans, say they did not get RT-PCR tests done. If they did have COVID-19, they would not have been officially counted in the State’s daily case count.
On May 10, Seema Jaiswal, the Pradhan of Sauram village in Ghazipur, not too far from the Ganga, wrote to the district magistrate stating that the number of people dying due to COVID-19 in her gram sabha was increasing by the day. She attached a list of 16 persons who had died. Manoj Kumar Jaiswal, her husband, says three more people have died since, including a six-month-old girl. Though he is not sure if they died of COVID-19, he says the symptoms could not have been anything else. “Bas khasi aur bukhar(Just cough and fever)! Some had it for 2-4 days and died. Others had it for barely 12-24 hours and died,” he claims. However, he is quick to add, “We can’t say that they died of COVID-19. Only after testing will we be able to say that.” Jaiswal alleges that no tests were carried out in the village till his wife wrote the letter.
The Chief Medical Officer of Ghazipur, Girish Chandra Maurya, visited the village to inspect the deaths. He says two-three people did die in the village but due to “age and natural process” or some other illness, not COVID-19.
The administration then held testing camps in two sessions. Of the 142 persons with symptoms, four were found positive through rapid antigen tests. They were put under quarantine. Medicine kits were distributed among the others. Three sacks of bleaching powder were provided to the village head for sanitisation.
Maurya admits that “more people are dying” in the rural areas in the second wave. This has scared the rural folk and has forced many to come forward to get tested, he says. “Now more people are also wearing masks. They feel they need to get tested and treated on time,” says Maurya. The district had a target of conducting 2,000 tests per day but was testing 8,000 samples, he says. He adds that teams are especially being sent to the villages for testing drives. Neighbouring Chandauli was testing only 1,500-1,700 samples, says an official.
In Baghpat’s Lumb village, the headman released on social media a list of 34-37 persons who had allegedly died of COVID-19 over the past month. After carrying out a survey, officials said the reports were false. The teams did not find any death due to COVID-19, says the Chief Medical Officer, R. K. Tandon. Officials say though fever was reported in a couple of cases, it was not correct to say that all deaths in the village were due to COVID-19. In the last two months, 20-25 persons had died, but due to other illnesses, says Tandon. He also rubbished claims that no tests were being carried out. The administration tested 362 persons through RT-PCR and 428 through rapid antigen tests and found 21 persons positive for COVID-19. All of them have recovered, he says.
The role of Panchayat polls
The spread of the pandemic in rural U.P. has coincided with the panchayat polls, which many have blamed for the spike in cases and deaths. Despite guidelines being issued, it was impractical to imagine social distancing and proper safety norms being followed in the tightly contested rural polls which had around 13 crore registered voters, over 2 lakh voting booths and 80,762 voting centres, and over 2.43 lakh officials and staff on polling duty.
While the government says that it conducted the polls on the instructions of the Allahabad High Court, it ignored several warnings, including by its own legislators, to defer the process of voting as well as counting when the second wave hit its peak. The counting could lead to a “super explosion” of COVID-19 cases in rural areas, wrote the Bharatiya Janata Party MLA from Hardoi district, Madhvendra Pratap, to Chief Minister Yogi Adityanath. Concerned about the deaths of those on polling duty, teacher unions had declared that they would boycott the counting process on May 2. However, after the Supreme Court allowed the counting process to go ahead, on assurances by the State government that proper COVID-19 safety norms would be followed, the unions called off their boycott. The counting centres across U.P. presented a worrying picture. Social distancing went for a toss. Large numbers of people, mostly men, gathered outside or lined up at the gates of the centres in close physical proximity to one another.
The U.P. Prathmik Shikshak Sangh, a union of primary teachers, alleged that 1,621 teachers and staff died of COVID-19 after being assigned duty in the panchayat polls and control rooms for the pandemic. The Allahabad High Court, which has taken note of the issue in regular hearings, reprimanded the State over the deaths and said the Rs. 30 lakh compensation offered to the kin of the dead was not enough. It suggested that the amount be increased to Rs. 1 crore. However, the government left the teacher unions fuming after it announced that it had confirmed only three deaths due to COVID-19. The kin of the deceased and the Opposition parties say this is a ploy by the government to avoid paying huge sums of compensation.
Lawyer Satyam Rai, whose father Pankaj Rai, a school principal, died on April 24 after serving in the second phase of the panchayat polls in Azamgarh, says the election could have easily been deferred given the surge in cases. Pankaj Rai, though he tested negative in a rapid antigen test, was diagnosed with “typical COVID-19” in his CT scan. He died before the RT-PCR test could be conducted and will perhaps not be counted among the 18,760 persons who have died in U.P. till May 21. “A person does not develop symptoms and die immediately. The government’s figure is pure eyewash,” says Satyam, still reeling from his loss.
He is referring to the explanation offered by the State Basic Education Department, which said that only three teachers had died on polling duty. Citing the rules of the State Election Commission, the Education Department said that an official was considered to be on election duty only from the period he or she left their residence for training, polling and counting work till they reached their residence after work.
Dinesh Chandra Sharma, president of the union, which is at the forefront of the fight for the deceased teachers, says this guideline does not make sense since people develop symptoms and die days or weeks after exposure. “This is a scam of deaths,” says Sharma, claiming that 80% of the teachers who had died had either RT-PCR or antigen test reports taken. “They have to change the rules for COVID-19. Saying that someone didn’t die on the spot... how does that make sense,” he asks. Following the furore over the issue, Adityanath instructed officials to amend the guidelines.
Learning from the urban areas
As U.P. tackles the surge in rural areas, the Allahabad High Court recently said, “So far as the medical infrastructure is concerned, in these few months we have realised that in the manner it stands today, it is very delicate, fragile and debilitated.” Adityanath, however, is confident. He said the results of “gaon-gaon, ghar-ghar(village to village, door to door)” screening and testing have shown that the rural areas are “safe to a large extent”. At the same time, he has asked officials to further improve medical facilities in rural areas.
Neeraj Mishra, president of the United Resident and Doctors Association, U.P., who is himself recovering from post-COVID-19 complications, feels that the government should have judiciously used the experience in the urban areas to prevent the spread in the villages. “The administration should have been vigilant and active. But they left people to fend for themselves. There needs to be accountability,” he says.
Meanwhile, in Ballia, Superintendent of Police Vipin Tada says no new bodies have been found floating in the Ganga after the initial phase. Nine police teams in the district are out on patrol. The final rites of the bodies found were carried out according to customs, the police say. However, five police constables in Ballia were suspended for insensitive behaviour after an unclaimed body was cremated with petrol and tyres on a ghat.
As the State takes fresh measures to arrest the growth of the virus in its villages and the debate over the bodies in the Ganga rages on, Mishra says there is no religious sanction for the disposal of bodies in the Ganga. Even thejal samadhiritual for seers is done through a specific process of encasing the body in a box with stones, he points out. Highlighting the religious significance of the river for Hindus, he says, “The Ganga is not meant for this purpose. She is the giver ofmuktiandbhukti.”
The landslide victory of the All India Trinamool Congress in the West Bengal Assembly elections and the pushback of the Bharatiya Janata Party (BJP) in West Bengal, Tamil Nadu and Kerala have given rise to a pervasive belief that right-wing politics can be defeated by regional assertions. Undoubtedly, regional and cultural assertion in these States acted as an effective bulwark against the BJP’s expansionary plans in southern and eastern India. The regional-cultural tropes deployed by Mamata Banerjee, for example, worked so well that at one point, Home Minister and BJP leader Amit Shah was even forced to clarify that if the BJP is elected, someone from Bengal would be the Chief Minister. This underlines the effectiveness of regional culture and politics in trumping communal politics. However, this claim needs to be tempered by the realism that it cannot work in the Hindi heartland, which is dominated by caste and communal politics, and has so far not seen any serious ideological and political challenge to politics based on these identities.
Encompassing nine States whose official language is Hindi, namely Bihar, Chhattisgarh, Haryana, Himachal Pradesh, Jharkhand, Madhya Pradesh, Rajasthan, Uttar Pradesh (U.P.) and Uttarakhand, this region retains a central position in the electoral strategies of the BJP and its larger political imagination. The party’s stunning show in these States propelled it to power in the 2014 and 2019 parliamentary elections. Its continued political dominance in the heartland will neutralise its losses now as well as in future in States where it has been bested by regional players. I will focus here on U.P. to illustrate the limits of the regional assertion.
Dimensions in the heartland
The Hindi heartland is clearly different. There are at least four important dimensions of this difference. First is the absence of regional identity in States such as U.P. This is evident from the debate on States reorganisation and the reorganisation of Uttar Pradesh in the 1950s. The compulsions of nation-oriented identity emerged very clearly from the discussions in the States Reorganisation Commission on suggestions for the division of U.P. for administrative convenience. U.P. leaders argued for a large and powerful State in the Gangetic valley as a guarantee of India’s unity.
In this sense, U.P. was considered the backbone of India and the centrepiece of political identity in modern India. Importantly, it was supposed to provide the chief bulwark against growing regionalisation and fragmentation elsewhere. Instilling a sense of regional pride, an essential part of Congress strategy in southern and coastal India, was not followed in U.P. U.P. was seen as the political heartland in contrast to Punjab and Bengal for instance, which were splintered and incorporated into two different nation states. As is well known, the bases of this post-colonial identity varied from its location in the freedom struggle to staking claim as the cultural homeland of Hindi and Hinduism. In both cases, it was centred in the idiom of the nation-state and strong central authority.
Second, although U.P.’s cultural homogeneity remains a matter of disagreement, the idea of the heartland had great resonance among the political elite who opposed the demand for U.P.’s reorganisation. The long-standing traditions of composite cultural identity and shared plural cultures began to yield place to a singular homogenised identity. The Hindi-Urdu divide, which mirrored the communal cleavage of U.P. society, played a crucial role in this process. Urdu was excluded as it was seen to symbolise Muslim cultural identity in independent India, while Hindi was boosted to promote the development of a Hindi-Hindu heritage for this region. The project of homogenisation of Indian/U.P. culture as Hindu culture was quickened in later decades. Even though it would be hard to assume a direct link between Hindi dominance and communal politics of subsequent decades, it is nevertheless a fact that all political parties in the State used it as an ingredient of social and cultural differentiation and a means to consolidate political dominance.
Role of communal politics
Third, it is clear that communal politics and communal movements have played a key role in U.P.’s modern history which in turn have diluted other identities.
In some respects, this process gained momentum in the wake of Partition which cast its long shadow upon political institutions and culture in U.P. and to a great extent affected the perspectives of Hindus and Muslims alike. Hindu nationalism was marginalised within the Congress party but many of its ideas were accepted in framing party policies. The State leadership was instrumental in forging a conservative consensus in the State under Chief Minister G.B. Pant who steered the affairs of the state for eight years after Independence.
The intensification of communal politics took a new turn with the mass mobilisation for the construction of a Ram temple at Ayodhya which was deftly used by the Hindu right to establish a major presence in U.P. and to facilitate the political reconstruction of U.P. through the promotion of a collective Hindu identity. The crusade for the appropriation of disputed shrines is central to the communalisation of politics and short circuiting the more complex process of political expansion for the BJP.
Importantly, this has laid the groundwork for building permanent electoral majorities through the deployment of ascriptive symbols in U.P. which, given its huge size, helps it to establish a strong base in the Hindi heartland to offset the appeal of countervailing identities elsewhere in India.
Caste politics too
Finally, caste politics which was expected to counter Hindutva expansion has failed to do so; in fact, caste politics has become a building block for the BJP’s expansion. The party has reached out to Dalits, actively mobilising them and other backward castes to assimilate them into the Hindutva meta-narrative. Instead of erasing caste from electoral politics, the BJP-Rashtriya Swayamsevak Sangh has sought to court fragments of castes as a way of undermining broad-based political movements and opposition to it. It has used the wider appeal of Hindu nationalism to co-opt backward castes and Dalits who are keen to align themselves to the larger narrative of Hindu nationalism.
A reset is needed
While regional parties will continue to be significant in various States of the Union, the principal challenge of overcoming majoritarianism lies in the Hindi heartland, especially in U.P. Oppositional electoral alliances, notably the formation of a federal front, are important strategies in this battle but it is no less important to challenge the ideological foundations of the majoritarian project through progressive and inclusive politics. This requires a reset of the basic political mindset in U.P. which can only be done by reviving the splendid heritage of the national movement in which this region played a central role and in which Gandhiji and Nehru played a heroic part. Invoking the spirit of the Bhakti movement which was the first major challenge to the religious orthodoxy of Hinduism would also help in resetting the cultural clock. This must, however, combine with much greater concern for the fundamental social and economic issues of the State, and making the struggle between communal and secular forces the central issue through public campaigns that address the problems of religious traditionalism and the cultural underpinning that this provides to the push to make India a Hindu state.
Zoya Hasan is Professor Emerita, Jawaharlal Nehru University
In order to achieve global herd immunity and prevent new strains of COVID-19 from emerging, possibly for years to come, vaccines need to be affordable and available in massive quantities throughout the globe. This can happen through patent owners voluntarily licensing their products to other companies, especially Indian producers who are experienced at mass-producing low-cost medications. This can also be done by temporarily suspending patent rights for COVID vaccines, an option that is being pursued by India and South Africa through the World Trade Organization (WTO) and one that is legal in the event of a public health emergency, according to that organisation’s own rules. One way or the other, India and the world need several Indian pharmaceutical companies, not just the Serum Institute of India, to gain the right to make these vaccines if we are going to see an end to this pandemic any time soon.
Turning point in the HIV fight
Decades of struggles over patent rights and access to medications for HIV/AIDS demonstrate that it is possible to navigate patent restrictions using something called “voluntary licenses” where a patent holder decides to license a product to other producers. The United Nations’ Medicines Patent Pool and the World Health Organization’s COVID-19 Technology Access Pool are important tools in an effort to promote voluntary licensing for COVID products that so far have been ignored by pharmaceutical producers. Sharing patent rights through voluntary licensing would need to involve India’s large pharmaceutical sector whose production capacity helped make treatments for AIDS more affordable in low-income countries and helped mitigate that pandemic.
In the 1990s, the WTO began implementing a global intellectual property regime known as the Trade Related Aspects of Intellectual Property Rights agreement, or TRIPS. While TRIPS alarmed public health experts because of its potential to raise the price of essential medicines, voluntary licensing agreements between pharmaceutical producers were able to bring down the price of AIDS medications despite the TRIPS regulations.
Responding to anti-TRIPS activism from low-income countries and realising they would not be able to profit off of low-income markets anyway, some manufacturers placed licensing agreements to produce AIDS drugs for which they owned patent rights in the UN-affiliated Medicines Patent Pool. Several India-based companies then used these voluntary licences to manufacture these drugs on a massive scale and sold them at prices they determined. In the case of Gilead, which placed more products in the Patent Pool than any other producer, their licences required the licensee to pay Gilead a royalty of 3% of the sales of the drug and limit sales to low-income countries. This effort brought down the price of key AIDS medications in these countries. Most significantly, tenofovir, a first-line treatment for HIV/AIDS, has come down in price from $200-$500 per person per year to $39 per person per year in low-income countries now that 13 India-based pharmaceutical companies are producing it.
Context of health emergency
It is also possible for governments to issue what are called “compulsory licenses” which override patent rights to allow local production or import of drugs by generic manufacturers in the event of a public health crisis. Since 2003, this right has been enshrined in the Doha Declaration addendum to the WTO’s TRIPS agreement and this is what India and South Africa are lobbying for, having recently been joined by the United States though not as of yet the European Union (EU). The Doha addendum, Section 5c, offers AIDS, malaria and tuberculosis as examples of what qualifies as a health emergency. By this standard, COVID-19 should easily qualify. In fact, not invoking Doha exemptions in this unprecedented health crisis would make this agreement meaningless. We may thus find compulsory licences being issued in several countries for vaccines and treatments for COVID-19, although manufacturers in India say they prefer to work with voluntary licences because there is more good will between companies while compulsory licences often come with a legal battle brought by the patent holder. Voluntary licences also enable production to begin more expeditiously as they usually are accompanied by “technology transfer” meaning that the patent holder reveals to the licensee how to manufacture the medication, sparing the licensee the lengthy and costly process of figuring out how to reverse engineer the product.
The COVAX option
Some favour ensuring access to COVID-19 vaccines through the COVAX programme, which was established to purchase vaccine doses and donate them to low-income countries but does not involve modifying patent rights. Similar ventures during the AIDS crisis were chronically underfunded and had only minor effects on that pandemic compared to the voluntary licensing and mass production of antiretroviral drugs from Indian producers. COVAX is also currently underfunded and the Director-General of WHO, Dr. Tedros Adhanom Ghebreyesus, warned that people in the lowest-income countries might have to wait until 2022 to get vaccinated through this programme, which may actually be optimistic since COVAX has shipped around 68 million doses so far.
Similar concerns to those presented here were raised in last year’s annual meeting of WHO which established a patent-sharing pool for COVID products, the COVID-19 Technology Access Pool. So far, no patent holders have joined this effort which is why India and South Africa called on the WTO to temporarily waive patent protections for COVID-19. Meanwhile, the UN Medicines Patent Pool stands ready to accept voluntary licences having added a placeholder for COVID-19 on the list of diseases they address. Hopefully, the EU will join the efforts by India and South Africa at the WTO, and pharmaceutical producers will realise, as some did during the AIDS pandemic, that voluntary licensing comes with better public relations and that they are not going to make money off low-income countries regardless of patent enforcement.
A key step
Furthermore, the billions of dollars in government aid given to companies to help develop COVID-19 treatments should entail an obligation to enable the mass production of affordable vaccines. After all, as legal scholars have long explained, patents are not ironclad ownership rights. They are a temporary contract that balances the public interest with the claims of the innovator. This is not just a question of social justice and ensuring life-saving therapies are available to the world’s poor. It is a necessary step to prevent deadlier, more contagious and possibly vaccine-resistant variants of COVID-19 from proliferating in an under-vaccinated world.
Murphy Halliburton, Professor of medical anthropology at Queens College and the Graduate Center, City University of New York, is the author of ‘India and the Patent Wars: Pharmaceuticals in the New Intellectual Property Regime’
Pursuing a policy of spreading the interval between two doses of vaccine, the Centre has now outlined more scenarios of second dose deferment. While lactating women are now encouraged to get vaccinated, those who have recovered from an infection ought to be getting vaccinated three months hence — the recommendation earlier was four to eight weeks. Those inoculated but who have tested positive should defer their second dose by three months after clinical recovery from COVID-19. The recommendations follow from earlier ones that advise increasing the interval from 12-16 weeks for Covishield, the more widely available vaccine. But there are two underlying principles behind these recommendations, the first being a vaccine shortage. Until early April, India had a very different scheme for its vaccination roll-out, appearing to take stock of availability as well as prioritising those at greater disease risk. It was the ferocity of the second wave that caused the government to panic and ‘free up’ vaccine supply applying a ‘to each his own’ approach. While this benefits a fraction of the privileged, it has not improved access as seen by the stagnation in daily inoculations and a fall in second dose recipient numbers.
The second principle is that the timing of the second dose for an optimal boost to the immune system is not clear. A general policy for childhood vaccines in India is a four to eight-week interval. However, clinical trials of the AstraZeneca vaccine in the U.K (18-55 years) showed that binding antibodies (the ones that actually block viruses) were nearly twice as high in those who got their shots 12 or more weeks apart than in doses had within six weeks. The vaccine also appeared to be more protective in those above 18 with a longer dose interval. While antibody levels are a key marker of protection, they are not the only ones. Cell-based immunity, whereby the immune system confers long-lived immunity, counts too. Given that SARS-CoV-2 has been around for less than 20 months, there is uncertainty about the duration of protection. There are also documented cases of breakthrough infections as well as deaths even after a second dose. Though they fall within expected statistical boundaries so far, it is only more inoculations from now that will shed greater clarity on the degree of protection. Put together, these recommendations do buy policy makers time to stagger doses until more vaccines become available from August. On the other hand, the toll from India’s second wave continues to surpass similar daily figures from the U.S. and Brazil. Given that many Indians have still not been exposed to the virus and newer threatening variants abound, there is no reason to be complacent that people will be protected from future waves. The aim of vaccines is to prevent severe disease and death and all policy recommendations must be geared towards that goal. There is no room for knee-jerk reactions that can compromise this objective.
In doing so, MeitY has made a charge that WhatsApp has discriminated against its Indian users. Its letter to WhatsApp reportedly states that given that Indians depend on it to communicate, “It is not just problematic but also irresponsible, for WhatsApp to leverage this position to impose unfair terms and conditions on Indian users, particularly those that discriminate against Indian usersvis-à-visusers in Europe.” First, it can be argued that there are enough alternatives to WhatsApp in the market. But more importantly, it has to be pointed out that Europe’s citizens are protected by strong data laws that go by the name of General Data Protection Regulation or GDPR. Where is the Indian equivalent of such laws? When will they be implemented? These are questions that the government should answer. These questions become even more pertinent because WhatsApp has reportedly said in its affidavit that it is being singled out, and that its policy is not different from those of private apps such as Google, BigBasket, Koo, as well as public apps such as Aarogya Setu, Bhim, IRCTC, and others. A fitful approach to issues concerning the user may do more harm to India’s approach to data protection and freedom than anything else.