 Hello and welcome to NewsClick's special science show. In this episode, we are going to talk about the COVID-19 pandemic and some of the aspects related to its global dimensions. For instance, what has been the response to the international community? What is the kind of politics that is happening between various countries around COVID-19? To talk more about this, we have with us Prabhupur Kaisa. Prabhupur, thank you so much for joining us. So what we see is that there is definitely a clear divide in terms of responses to COVID-19 between the developed countries and the developing countries, the global north and the global south, so to speak. But one of the key interesting aspects is that in the global north, the idea of how to respond to a pandemic itself, there's been a lot of confusion. It's like in some senses, it is public health in that sense, it's kind of disappeared from a lot of the perspectives of these countries. So could we start a bit by talking a bit about this? Yeah, you see, if we look at the issue of what I call the problem of infectious diseases in the West, it's really that it disappeared from public view, as you said. And what took over is infectious diseases are really the problems of the poor, the people who have not developed countries, dirty, et cetera, et cetera, et cetera. It was essentially a colonial view of the world that infectious diseases are no longer the problem of the West or that and the colonial countries. But it is something which only bothers those who are colonized, the poor countries and who live in all kinds of filth. Now, if I take the racist part of it out, which of course it was, the underlying issue is that in advanced countries, they had actually been able to control infectious diseases, even before we have the quote-unquote rival of the modern medicines in the shape of antibiotics, the sulfur drugs and all of that, which really did, of course, have a huge effect on the infectious diseases. Before that itself, if you see the plague, for instance, which as you know, probably killed about 20 to 30% population in Europe, those infections were a real cause for concern. And you have this plague picture, which was basically of London and how it really decimated the people over there. Now, I'm not going to talk about how much it affected different sections of the people because we have now figures of different kinds to show it, of course, affected as it is doing now. Also the poor much more than it did the well-off, but it also did affect the rich then too as it is affecting now, even if it is less than what's affecting the poor. So this really spread over Eurasia. This is what's known as the second plague where the first one happened in 600 odd AD, what's called the Justinian plague. But if we leave that out, there is also a third plague which people seem to have forgotten. And that also took place in Eurasia. If you see, it really took place in countries like India, in countries like Southeast Asia, and of course China. And the total was something like 10, about 12 to 15 million people, 10 million died in India alone. Our memories are quite live to this picture of the plague. And when we had the Surat plague, if you remember, in India, there was an instant and immediate reaction. That is a part of our historical memory. But this did not happen in Europe. In fact, Europe saw only about 1,700 plague deaths in the third plague. So therefore they thought that this is not their problem. And of course, we are not going to talk about the impact of all of this in terms of inequality. It's also interesting, once you have the plagues in Europe, in fact, you had a labor shortage economy and the distribution of wealth actually improved. But because of the plague, but because of the consequence of the plague, it showed much less population. Now, people have tried to bring it about the influence epidemic also, the loss of the wealthy losing part of their wealth, being a less divided, less unequal society. But I think they forget it was really the socialist revolution of 1918, 1917, which coincided with the influence epidemic. So you see continuous reference to influence the epidemic being the last known epidemic. And what happens is we have a whole set of diseases, which you get forgot. As I said here, the third plague was not considered a major one by the West. They considered it that the last pandemic, therefore not the third plague, which continue up to about 1950, that they consider it only the last pandemic only being the Spanish flu, which of course, as we know now did not come from Spain, but came from Kansas, probably. But if you look at this, what happens is a whole bunch of infectious diseases become what's called forgotten diseases. Peter Hotez has written a book on this, Forgotten People, Forgotten Diseases, and the question is if you take the population today, about 65% of the global population, if you also include in this Forgotten Diseases, TB, malaria, and dengue, if we include that 65% of the global population really suffers from the so-called forgotten diseases or what I would call as the diseases which are forgotten by the pharma companies and the advanced countries, the quote unquote advanced countries of the West. So here is the issue. These are forgotten diseases, but not by the people who are suffering from that. But really by those who do not see the effects of it on them. And that's where we come to the chart that I quite often show, that here you have what the Forbes magazine, Forbes publication quotes as the best prepared countries. Of course, it's not their preparation. It's really a global health security index prepared by John Hopkins and Johns Hopkins and I think some nuclear body which looks at all of these kinds of issues, nuclear threat index, I think that's what came from. And now they can also join with John Hopkins for a global health security index. Then you will see these figures are a couple of days old. You will see that those countries which are supposed to be the ones which are best prepared have fallen really victim to COVID-19 in a big way. I'm not going to make this a theoretical point that that is why because they did not look at infectious diseases, therefore they have suffered the most. The reality is, of course, they're also the most well-connected countries. And therefore it's not surprising that it has spread to them so fast. The real issue is that how unprepared they have been for the re-emergence of an infectious disease and the fact that people in the United States, for instance, the first thing they did when the lockdown was imminent was stock up on guns and ammunition. So that is their collective memory that they don't remember the infectious diseases and they don't know as a society how to respond to it. And of course the fact that CDC has been gutted under Trump, the fact that we have a person heading CDC who essentially represents the American right, all of that meant that CDC, which probably has a much bigger budget than the WHO, was completely unprepared for the epidemic could not even prepare a test kit, which a number of countries did even after the month after they had put out the kit and it had failed, they still could not develop from producer kit which was working. So from the time they launched the kit, which was somewhere in February, they took one more month because the testing could start in the United States. And as you know now, that one month is what made all the difference. So I think this is the first issue that we really need to look at, that essentially what we have is the fact that there is no collective memory. The public health system have been gutted in the West. They have been handed over to private capital. There is what is called just in time manufacturing principles applied to the health system by which you don't keep the beds empty. You plan for the influenza peak that comes in the flu seasons. And once that peak is met during the peak, you should just be cut to cut. That means you should really not have any surplus capacity. Then of course the fact that private health care has taken over in a big way. So what they're discovering is private health care as well as the pharma companies basically want ill health because that's what gives the money. Public health is completely opposite to that and that's something that seems to have forgotten. So and now we've reached a situation where say Trump is threatening India over hydroxychloroquine. There is a lot of tension between the U.S. and China. So let's start with the aspect of the medicines per se. So how is big corporate, the role of the big corporates actually working in terms of the medicines that are likely to be candidates to treat COVID-19 patients? Well, you know what seems to have happened is that Trump having fallen flat on his face after talking about being a small flu, it will go away. Miraculously, it will disappear. All of that means that he now leaves in Alibi why his administration performs so pathetically and why it is still raging in different states in the United States. Still numbers are not only far higher than China but even now there are various states which are threatening to take off. So it's not a comfortable situation there at all. So Trump is trying to turn the whole argument about his failure into saying that China did not tell us and it is all China's fault. So essentially scapegoating China. And this is a part of his larger issue really of uncoupling the U.S. economy from that of China. Today, if you see the way these two economies work, China produces a huge range of goods. United States owns a lot of intellectual property and also buys a lot of these goods and the trade as you know between the two are not balanced. But since United States has enormous ability to print dollars, the global currency, therefore it can sustain a deficit which is much higher than most other countries can without their currency collapsing. So at the moment, U.S. is trying to uncouple the two economies which means that the supply chains will then have to change from being China-centric to other countries coming into play because I don't think the U.S. has the ability today to emerge as a major producer of goods. So given that they will still focus on intellectual property but try and segue this whole uncoupling story to European Union and other countries which are under their influence and India they're hoping will be one of them, that these they would link to them and not to China. So essentially what is called the Belt Road Initiative of China then to really create an Eurasian wide network and market then would hopefully according to the United States fracture and they would get a part of it particularly the European Union being a part of their hegemony. So I think this is where the whole thing is going and that brings us to the next question. What happens in this particular case because the battle is going to be fought not only on Huawei as we know is already happening, also the China's response probably which will come in terms of Boeing and other companies with their likely to sanction but the whole battle right now is going to be fought over who has the medicine and who has the vaccine because this is going to be a part of who is able to influence the globe, who is able to influence other people by having the ability to give medicine. Now here is the issue that big pharma has essentially looked only at profits and they have not developed infectious disease drugs for the last 50 odd years. You can see the malaria drugs are almost 40 years old and they came during Vietnam war, TV drugs are very old as well and only some new drugs are now emerging but again big pharma is not very interested because they're interested in medicines which you have to take for life. That means that they get a constant profit, constant market so that's what they're interested in and even though the research is really done by government institutions, the government also gives them a monopoly and that's why the picture that I have over here that some people would call big pharma as big pharma. Now coming to this issue what happens to now the new drugs which might emerge and obviously the new drugs we only have talked about earlier Remdesivir being one of them and also the retrovirals which are essentially biologics and then we have the vaccines. Now we have seen earlier that when you talk about big pharma pricing we had a case, this is an Indian case where Nexavar which is a biologic medicine was selling for the cancer medicine kidney cancer essentially was selling for $65,000 as an annual cost and this obviously something nobody in the third world can play forget third world even poor people in the United States cannot pay this it has to come out of the insurance or out of essentially the government system, Medicaid, Medicare and all of that so this is the crucial issue that what you do with such medicine. In India's case, Natco got a compulsory license issued after which all compulsory licenses have been stopped under the US threat and we have the famous statement of Bayer CEO, Deckers who said this is theft. We did not develop this medicine for Indians, we developed it for Western patients who can afford it of course, we forget that $65,000 is not an affordable cost but it's very much the same issue that happened with the AIDS drug sales also remember it was 10 to $15,000 till India, SIPLA came in with $350 per year cost of again a drug cocktail and that actually brought down the drug cost to such an extent that Asia Africa could then use these drugs for its treatment so is this issue going to be repeated again is the key question now if you take the essential issues that are there we have to as we have discussed earlier also we can't find new drugs suddenly so we have to see what are the repurposed drugs hydrochlorocoxychloroquine and quite a bit of controversy it has serious side effects so it doesn't seem to be doing well the small molecule which is also remdesivir hydrochloroquine hydroxychloroquine and remdesivir are basically small molecules meaning that it's relatively easy to create copies of remdesivir or hydroxychloroquine interestingly there is a black market of the earlier version of the medicine which was tweaked a little to make it remdesivir which is also patented and it's used under the table as against a particular kind of coronavirus which affects cats so it's very easy it appears once you know the patent which is of course in public domain to make a copy of this earlier drug so I presume it's also easy to make a copy of remdesivir so the question is if it is going to be useful then will Gilead give it at low cost will the patent be broken by countries will India issue a compulsory license as it did for next hour to natco these are questions which we have to take up and these are questions particularly since the US trade representative USTR under 301 has threatened India just I think about 20 days or one month back so this is very much on the cards antiretrovirals all the ones which are being tried at the moment which is Caleta variations and some other antiretrovirals I think they fall most of them fall before India's patent act was passed we can certainly manufacture those runs with the too much trouble and given the current scenario of a pandemic WTO trips agreement also allows for their export to other countries who need it so this is not likely to be a problem but remdesivir certainly is going to be a problem so if we come to basically vaccines are what are also called monoclonal antibodies these are two areas currently again a part of the competition and of course the United States has backed heavily its own internal production of vaccines providing unlimited budget so we are seeing this spillover also to vaccine and what could be in the future medicines which are monoclonal monoclonal antibodies that you copy the body antibodies in your body in some way and use it against the disease itself against the virus so all of these are going to also come under patent protection as well as then the issue of compulsory licensing and what is going to happen in the global level will these be allowed as Costa Rica has argued they should be allowed freely to be used by people or will it remain as a part of the protected intellectual property which will be given at concessional rates but concessional rates also being far higher than what the global at least the poorer countries can afford so I think that's the battle that's going to come up in the future is being discussed in the world health assembly so we'll have to see what comes out of that and what have one of the countries going to do countries like India which have the capability to do with compulsory licensing produce these drugs and vaccines and whether we move in that direction or we'll also fall prey to trumps this engagement with China this entangling the two economies uncoupling the economies and then we coupling ourselves to United States therefore in foregoing the use of compulsory licensing thank you so much for being for talking to us in the coming days we'll be tracking both the developments around the world health assembly as well as trumps infamous warp speed operation which in which he promises a new vaccine so keep watching newslet