 Hello and welcome to NewsClick. Today, we have with us our usual discussion with Professor Satyajit Rath. Satyajit, lots of issues on the COVID-19 front and of course, we can only pick one or two of them. The first one is, let us talk about somebody has written a paper in which it has been claimed that with 20 to 25 percent infections, which should have provided direct immunity because of the COVID-19 infection itself. We already have a natural coronavirus immunity of 50, 45, 50 percent. So, we are close to reaching not the herd mentality of Donald Trump, but the herd immunity point. How correct is that? How seriously are these two figures to be taken? About particularly 45, 50 percent figure that we have a national immunity, so to say, against COVID-19. There is a saying in Marathi, which translated says. In other words, you can imagine all sorts of explanatory scenarios, all of which makes some level of plausible sense, whether any of them actually apply or not is a whole different problem altogether. But a fundamental issue in all of this is, I think, something that we have referred to in other earlier conversations as well and that is a basic misunderstanding of what the notion of herd immunity is. So, let us recapitulate what herd immunity means before we come to the argument that you are referring to, which I think comes from Muin Selim writing letters in the Lancet, New England Journal of Medicine somewhere. That's right. So, here's what herd immunity means. We have an epidemic, diseases spread, there are lots of ill people, large numbers in short time and then these numbers begin to go down in large communities. At that point, when the numbers have gone down to the point of, oh, there are practically no, practically no new cases or there are only a few cases these days, every day. At that point, you turn around and ask, well, because the disease was here, the infectious disease was here and it's no longer coming up as a disease, that must be because everybody's already exposed an immune. So, you test and you discover that everybody is not immune, that some 60 percent or 70 percent or 80 percent people are immune. But there's a good 30 percent or, for example, there's not immune and yet the disease is not spreading amongst them either at that time. That's the point at which you make an exposed fact to explanatory idea called herd immunity, where you say that this is happening, this must be happening because there is herd immunity, which for this particular infectious agent in this particular community, at this particular time is providing a break in transmission with only 60 to 70 percent people immune and that's how it's protecting the others. This is an exposed fact to an explanatory. Converting this into the opposite argument that here is a new infectious disease and my argument is, oh, if we have 60 percent, 70 percent, 25 plus 50 percent of indeterminate immunity, which is Mohin Saleem's argument, some X percentage of prior exposure in the community is going to mean a break in transmission chain is inverting the argument that we began with. The only situation in which the phrase herd immunity, I'm struggling not to follow the leader of the free world and refer to it as herd mentality, but this is not easy because he is the leader. But the fact that in one particular infectious disease where this has happened to you, natural infection has led to a lot of disease outbreak and then subsidence and you've tested repeatedly that about 70 percent of people are immune and the disease does not transmit. At that point you say now here is a prediction, if we have a vaccine that works well, then a 70 percent coverage with the vaccine will achieve the same herd immunity and will provide community protection. This is a far more complex, nuanced and limited idea of herd immunity. The way everybody is throwing around the phrase herd immunity, it may just as well be herd mentality. So Trump is not completely out on that one, what you say? Well, keep in mind that he expects herd mentality to cure his xenophobic virus. Xenophobic virus and also make him win the elections for which unfortunately the vaccine scenario that he had created that permission to be given for emergency use by end of October, first November, delivery across the United States and hopefully then influencing the November election. That seems to be at the moment not really working out. Well, you know, I mean for me the connection between what I'm complaining about frankly, loudly, which is what I'm calling a misunderstanding of the idea of herd immunity connects to the broader fact that governments across the world and the US and India being very prominent examples, both being very prominent examples are fundamentally focused on a certain kind of hype unanchored by reality about the pandemic. And as a result, all sorts of strange outcomes are turning up. So as you point out, the Centers for Disease Control, the CDC in the United States and the Federal Drug Authority, the US FDA are both being pressured to do all sorts of things. So the CDC is issuing advisories, withdrawing them, reissuing them in modified fashion. The whole thing is an atrociousness. Exactly similarly, as you point out, the US FDA is issuing emergency use authorizations left, right and center, like their presidential favorites, polo mates, they are apparently presidential favorites. And so we had a completely evidence-free authorization for hydroxychloroquine. We had a completely evidence-free emergency use authorization for convalescent plasma therapy. We now have CDC and the FDA together thinking that they will say that they will authorize an emergency use authorization for vaccine candidates based on, as we said earlier, bare bones efficacy data. And from that point of view, it's very interesting that both Moderna and Pfizer have released much more detail about their clinical trials than private pharmaceutical companies ordinarily do. This is from the point of view of public health activists. This is a very good thing, regardless of why they are doing it and they are doing it for their own public relations purposes. But nonetheless, it's a good thing. But here's the interesting thing that begins to emerge. And that is, are we looking for protection against infection? Meaning simply, is the virus growing in my throat? Or are we looking for protection against actual disease? Meaning, is the vaccine protecting me from being sick? These two are not necessarily exactly the same thing. And the way that the details of the trials are being released, the trials, one of those trials is obviously being gamed a little bit with an acceptable limits. But nonetheless, it's being gamed a little bit to provide the lowest bar possible to cross of 50% protective efficacy so that licensing can be done. Eric Pappall, for example, has pointed this out in some detail. So this is one way of governments doing favorable publicity spinning at the cost of both transparent information and trust and reliability. On the other hand, we have the government of India. Yeah, we'll come to the government a bit just a little later just to take you on the issue of the modern and Pfizer. Interestingly, modern and Pfizer also require refrigeration freezing essentially, freezers for the vaccine cold chain, much more than the existing vaccines do accept one or two also require freezers. I think the MMR vaccine has some such requirement. But that itself would be not an easy task for the United States, even the United States forgets India to put together in such a hurry. So let us simply underline the sheer difficulty. The United States government has instructed state governments. Remember, this is a federal system, so states are much more empowered unlike clearly in India. And the federal government in the US has instructed state governments to come up with plans for vaccine storage, vaccine distribution, and vaccine immunization based implementation. So there are two problems with this particular vaccine in the purely logistical issues of implementation. One, as you point out, is that some of them, in fact, don't just require a refrigerator. In fact, none of them can do with just a refrigerator. They at least require a minus 20 degree Celsius freezer. Some of them require a minus 70 or a minus 80 degrees temperature freezer storage. States in the US have been saying anxiously, we don't have this kind of storage capacity at scale in decentralized enough fashion to serve a vaccination campaign, a mass vaccination campaign. If American States cannot provide this, how exactly is India going to implement this? So I ask again for the nth time in our conversations, we have a vaccine implementation strategy group that the government of India has constituted under a, I think a needy eye member as chair. Why do we keep hearing complete silence from that group about what are the plans? We have a one or two line blanket statements. We are planned. That's all we need to hear. That brings me down since you've already raised Praveen, the second point, let's our audience forget it, is that all of these are two dose vaccines. Yes. So the logistics are immeasurably more complicated because you have to keep track of who's gotten the first and when they've gotten the first and when they should come back three or four weeks later for the second. So you have to provide the cold chain for also maintaining this for at least three months that this must be in operation in order to be able to vaccinate in the United States is a significant part of the population. Absolutely. Coming back to the Indian issue that you already touched upon that we don't hear anything about how we are going to solve the logistical problem which is difficult enough for the United States. Hopefully we are planning on the Oxford vaccine which has less rigorous cold chain requirement. It is a two to eight degree centigrade vaccine, am I right? Storage wise. That itself is going to be a massive problem in India at scale. For 1.3 billion people it is a huge problem because polio you have to do it for a much smaller number and even that we had a lot of problems with the cold chain as you are aware of. So coming off of the actual numbers in comparison in the childhood immunization program that we have in the country where public health matter children are immunized by a certain schedule with a certain bunch of half a dozen plus vaccines. We are immunizing about eight crore people individuals approximately I think. To go from eight crore to eighty crore which is what this know herd mentality is going to demand at the very least is a tenfold expansion of capacity and we are hoping for far less than one year. Three months, six months, eight months. So we are talking about not just a twofold increase in the logistical strain. We are talking about a 20 fold increase in logistical strain. Why are we not hearing any planning whatsoever? Thank you Satish for being with us going through rather complex issues at in complex times. We'll continue to discuss COVID-19 with you. It seems for at least next three to six months if we are lucky longer if we are not. This is all the time we have produced today. Do keep watching our shows, our videos and do visit our website.