“War is too
important to be left to the generals”. This statement is something often talked
about and bandied about when discussion arise about international relations.
Likewise, the current situation makes it apt to add another adage ‘Pandemic is
too important to be left to the doctors”. Without doubt, doctors are the
frontline warriors in the battles against the Chinese pandemic that is raging
across the globe. It is just not the lives that it has taken that matters but
the livelihoods it has disrupted. The light at the end of the tunnel though
often comes on the horizon but remains elusive. There is no doubt, patience is
wearing thin among the population. Disruption is galore all around. The economic
growth is in the negative zone with many economies recording fall in excess of
20% and above. The world is likely to be in recession for more time. The
lockdown seems to be generating diminishing returns. It was effective when the disease
was confined to few clusters but when it has emerged in the open, the lockdown
might not yield the same results. On a positive note however, the world is
witnessing a decline in global mortality rate. In India, the case fatality
ratio (CFR) has dropped to below 1.9% and is likely to drop further. Even
assuming undercounting of deaths, the CFR will drop even further given the
possibility of undercounting of cases, something borne about the serosurveys
conducted in different places.
In the recent
past, there have been posts discussing different dimensions of the pandemic. This
post
talked about the strategizing on the antibody surveys that are being conducted
across the country. Another post
highlighted the fact that mortality is studied, yet the long term morbidity
remains unstudied and unlikely to remain so for some more time. This is because
morbidity emerges over time while mortality would be easy to measure and
happens in relatively short time. A past post
also posited the existence of impossible trinity of the pandemic. It implied, a
conservative testing policy, low positivity rate and an open economy all cannot
exist simultaneously. In the light of the same, there was an examination of the
ICMR testing strategy in this post.
There was also a discussion on the prophylaxis and its implications and need
for the data of the same in this post.
Without doubt,
the focus now must be either on the cure or on the vaccine. There has to be a
speedy end to the pandemic. At the outset of the pandemic, there was a
discussion in this post
on the innovation paradigms and how they perhaps hinder the development of cure
or vaccine for the disease originating in Wuhan. The vaccine games are
essentially an outcome of inter pharmaceutical industry rivalries. The firms
are desirous of having their vaccines accepted but would not hesitate to use
proxy forces to pull down their rivals. The vaccines are billion dollar games
and as such no firm would like to fall behind the same. Thus there seem to be a
race to produce the vaccine first. In India, the ICMR had already permitted the
launch of trials for three different vaccines. The rationale behind this
strategy was elucidated at length in this post.
Yet as discussed
before, the vaccine games are essentially a play of implied demand
uncertainties. The vaccine utility is perhaps till the pandemic exists. The moment
pandemic disappears, the need for vaccine disappears. There might be people who
might want to have a shot at frequent intervals but the number would be
relatively less. Therefore, from a profit perspective, the cycle time for
vaccines would be relatively short. In the current pandemic round, the cycle
time could even be less than one round. In other words, there might be one
round vaccine administration globally. This could take care of the short term. In
the event the pandemic doesn’t get reported in the future, the utility of this vaccine
would disappear. This is one reason, the vaccine makers are usually reluctant
to invest their resources. At the core of their strategy, would be to divert
their resources from their existing objectives to research and development of
this vaccine as they grapple with the global health crisis.
In a recent
presentation before a parliamentary panel, the ICMR and other health experts advising
the government had suggested the possibility of emergency authorization for the
vaccine. There have been meetings between the authorities, the task force and
the pharmaceutical firms engaged in vaccine production. In the Independence Day
speech, the Prime Minister highlighted the readiness of the Indian government
in administering the vaccine in the shortest possible time as it awaits a green
signal from the scientists. Similarly President Trump in the US has indicated a
possibility of emergency authorization before the November 3 Presidential
elections. Russia has already claimed the launch of the vaccine which it terms
Sputnik, a reference to the satellite that it launched, the first country on
the earth to do so. China seems to have authorized administration of vaccine to
its citizens.
Yet as the talk
over emergency authorization gains steam, dissenting voices have begun emerging
all over. There is already considerable scepticism over Russian launch of the
vaccine. Given the opacity in China, no one is sure about the status there. In the
US, the vaccine has got caught in the middle of domestic politicking as the
elections near with the population’s health being the collateral damage. In
India, already voices are circulating on how the emergency authorization could
jeopardize health. It is just a matter of time before being picked by political
leaders notably the self-styled Crown Prince of the leading opposition party. This
is where the opening statement comes into the picture. There is no doubt on the
need of the effectiveness of the vaccines. There is no doubt on the essence of
its safety and immunogenicity. These can be demonstrated in the first and
second phase of the trials. If they are confirmed safe, they can be
administered on a larger scale. On a experimental basis, HCQ was already
offered as prophylaxis for high risk groups though little peer-reviewed data
exists. This highlights the paucity of documenting research than of the
effectiveness or otherwise of the medicine. Similarly, India has allowed
experimental transfusion of plasma for long, something US officially did only a
few days back. Therefore in reference to the vaccine too, there needs to be
some hard decisions made.
If the economy
has to turn around, the social disruptions have to be minimized, the education
system has to be rebooted, and life has to return to normal at the earliest. It
therefore goes without saying the vaccine must not just be approved at the earliest
but administered at the earliest. In India, the scale of reaching 1.4 billion
population is itself mind boggling. Testing the whole population even once
leave at frequent intervals is impossible. Therefore, there exists a strong
case for emergency authorization. The phase three of the trials can be expanded
to significant scale and as the learning curve gathers steam, the reach too can
be expanded. The time to wait for perfect vaccine simply doesn’t exist.
Perfection is the enemy of the good. Therefore, the vaccines must proceed. It is
a different matter there would be some questions raised on any vaccine and
would probably happen at any point of time. In the given context, it is the
conviction of the health authorities that matter. If the health authorities are
convinced, something they showed during the HCQ issues, the vaccine might roll
out very soon. Notwithstanding the reports over the possible dangers, the
authorities if convinced on safety in the initial trials, they must be allowed
to go ahead. It is about the cost benefit analysis. If the marginal benefits
outweigh marginal costs, the vaccine must make its way at the earliest. Procedural
and bureaucratic hassles would have too big a price to be paid by the society.
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