 Hello and welcome to NewsClick. Today we have with us our usual discussion with Professor Satyajit Thiraj. 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 national 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 to be 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 the 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 Mohin Salim writing letters in the Lancet, New England Journal of Medicine, somewhere. So here is what herd immunity means. We have an epidemic, disease is 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 is no longer coming up as a disease, that must be because everybody is already exposed to an immune. So you test and you discover that everybody is not immune, that some 60% or 70% or 80% people are immune. But there's a good 30% odd, for example, that'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% 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%, 70%, 25% plus 50% of indeterminate immunity, which is Mohin Salim'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% 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% 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 do you say? 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, 1st 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, 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 in atrociousness. Exactly similarly, as you point out, the US FDA is issuing emergency use authorizations left, right and center, like they're the presidential favorites, polomates. 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, one of those trials is obviously being gamed a little bit within 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. And 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 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 forget 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 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 degrees 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 the 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, an EDI member 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 the issue of- Sorry, 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've 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. Well, 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 let me offer 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 8 crore people, individuals approximately I think. To go from 8 crore to 80 crore which is what this 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're talking about not just a twofold increase in the logistical strain, we're talking about a 20-fold increase in logistical strain. Why are we not hearing any planning whatsoever? That's an interesting issue because we are only hearing about past victories by Boston group or something having done some models and you and I have been talking about models and statistics and well you know if you say that so much has been avoided you can claim any number that you want except of course we are not really avoiding infections and deaths or disease we're just postponing it but leaving that aside the interesting other issue is regarding ICMR. Dr. Balram Bhargav is the head of ICMR. It seems that they have issued instructions and they've got the journal paper which is now been published. This has been reported by Telegraph and seems to have been also confirmed by what people have told them some of them willing to be named that for the most numbers of cases which had come up in certain hotspots Delhi, Mumbai of course being the two but also other hotspots the data of these hotspots have been actually asked to be taken out and only low prevalence areas data has been given for seroprevalence survey. So what does seroprevalence prevalence survey mean and apparently areas which are 30% 40% even 50% seroprevalence areas apparently they've all been taken off so does it indicate that you want to airbrush data is that the purpose of this exercise and should a scientific organization ICMR is not the director general of health services in India so they're supposed to be an independent body supposed to be looking after medical research how do you justify medical research body giving such instructions? So there's a lot to unpackage there in the first place as you point out who speaks authoritatively on behalf of government but with data evidence information and dispassionate discussion of options has always been entirely unclear. We've had the joint secretary in the Ministry of Health and Family Welfare serve as the spokesman for weeks and months simply because that desk is administratively responsible I use quotation marks advisedly for the director general of health services and particularly the one institution of the director general of health services which is relevant the National Institute of Communicable Diseases. You've not even in the last six months I suspect heard that a National Institute of Communicable Diseases exists. That's correct. In Delhi on Chandralman when they are tasked with infectious disease surveillance and related activities instead we've had administrators serving as spokespeople we've had the Indian Council of Medical Research which is a biomedical research and funding body additionally asked as is the case in very unbuilding fashion with many other government agencies with regulatory functions. The director general of the Indian Council of Medical Research is also a secretary of the Union Government of the Department of Health Research. So these multiply conflicting hacks being worn by the same person is a recipe for confusion and catastrophe in a variety of ways and that's partly what we are seeing so to be so that's the broader picture to be specific about your question here's the issue they've done sample surveys in districts they said they will do in their original plan they said they will do this many districts sample this many people they then modified it and then they remodified it while presenting the data by cherry picking so the first question is on what basis did they cherry pick we don't know clearly they cherry picked because the media reports actually quote Dr. Samiran Panna as saying yes we cherry picked those that were high because they had already been confirmed by other reports to be high this I find incomprehensible as an answer but let us do him the courtesy of saying that he may have been misquoted or and or misunderstood whichever way we don't know why cherry picking was done so the straightforward response to that is if you have cherry picked then your sample is no longer representative of the nation and if your sample is no longer representative of the nation then any interpretations based on this sampling that you're reporting from which you say something about the state of the nation is in fact but it brings up a point that you and I have been discussing repeatedly which is that because the pandemic is emerging as outbreaks in different socio geographical areas at neighborhoods really localities at different times no sample survey is going to be able to give us nationwide reliable estimates that make any sense whatsoever so zero surveys are meaningful for the locality in which they were done they're deeply meaningful but they're meaningful in the locality is it where they were done they are not to be over interpreted in any case so we would have argued that regardless of whether ICMR had goofed or not but the fact that ICMR is goofed is even more reason for us to say please don't offer us nationwide interpretations based on samples of this kind and particularly the cherry picked samples so we have two problems one is based on samples to talk about the pandemic itself is a problem but to talk about it based on cherry picked samples is like Boston Globes Boston Consulting's models you can make it say anything you want by just picking the correct quote unquote correct samples you can pick what I want only those infected high seroprevalence areas to say it's very bad and you can go to the opposite and say hey it's very good because only this is the result so in effect you have lost also the possibility having them the surveys letting others also look at the data because we don't otherwise get access to the data and we have only got access to data in some sense out of the reports that came out from the press when the seroprevalence surveys were done particularly I remember about Delhi as well as about Mumbai there were reports but we don't really have any authoritative reports on that which this kind this paper which apparently was supposed to put all of this in public domain was supposed to do and only after instructions this data set was taken so this is a gross misuse of science whatever may be the interpretation we have after the results are published we never cherry pick as you say research results for whatever to be the reason absolutely and all of this sorry episode is of a piece if you remember two months ago the same director general of the Indian council of medical research wrote a letter to hospitals asking them to speed up to facilitate approval processes so that an indigenously made vaccine in which the first research report has come out in which he is the senior corresponding author himself personally and he is demanding that they accelerate the process of clinical trial related approvals all of this completely vitiates the transparency and the trustworthiness of the investigative enterprise on which a rational response to the pandemic rests crucially and yet what we have seen which is where I began our conversation today is governments and people in authority far more worried about their own image building exercises as positive spin doctrine using cherry picked information rather than providing the people transparently and reliably with information and options you know this is the fundamental difference between a mindset a mindset which wants to take people along wants to share information believes that the people by and large have knowledge and willingness to accept scientific results and the other hand taking the people the general population as fools who can be led any way we want and basically keeping them under blinkers so this is the two mindsets we are seeing and after trumps woodward book rather and trump and what he used to say it's very clear this is the mindset of a ruler set of rulers who believe that as long they can spin what is happening their political future is assured and therefore spin is far the more important than facts and cherry picking is a part of the spin that is being imparted to data or scientific data absolutely and and and that's what's so depressing about this that instead of a a an open inclusive rational and responsive global community social solidarity to the pandemic what we are seeing is these kinds of regressive xenophobic fearful fence building perspectives the on top of that being used as petty image building opportunities by leaderships of at at all levels and of all kinds thank you satees for being with us going through rather complex issues at in complex times we'll continue to discuss go with 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 for this week today do keep watching our shows our videos and do visit our website