 Hello and welcome to NewsClick. The recent surge in the COVID-19 cases has struck hard on India. The daily cases have doubled in a matter of 10 days and in Tamil Nadu it touched an unprecedented 7,819 cases in 24 hours as per the government report on April 14th. We have Dr. Sundaraman with us, the global coordinator of the People's Health Movement, to tell us where the state is headed in the coming days. On March 1st the daily count was 470 in the state but now we are touching anywhere around 8,000 cases a day. So in 45 days there has been a 17 times spike in cases. Why and how is the virus spreading in such a pace? So it's always a bit difficult to answer why but we do know that we are seeing a very rapid acceleration of the cases, more than three to four times the rate of acceleration that we saw in July, August. And though case fatality rate may be low in absolute number of deaths are also rising very fast. Now one of the important reasons for this is a wave is actually when you have a number of outbreaks, smaller outbreaks in a number of sites which go unnoticed and they rise a certain amount of transmission starts in place and then they snowball into a wave. So preceding wave is number of discrete outbreaks. If it is just one outbreak then it will clearly be focused in one place but we find that it is across the state and across the country. So what you can reasonably presume is that between January and March, there have been a number of outbreaks which have snowballed. Remember that there are number of countries which have either seen no second wave or seen very small well-contained second waves. New Zealand, Australia was well-contained, New Zealand had no second wave, South Korea was well-contained, Taiwan, Chinese themselves have not had a second wave. The Japanese have had discrete waves. These are outbreaks. Vietnam had a major outbreak in Danang. They went after it, controlled it and that was the end of it. But here you have had actually a number of outbreaks that have grown unnoticed and reached a certain size. So the question to ask is why did it go unnoticed? In my understanding, there are two or three reasons. One major reason is the lack of an effective contact tracing and disease surveillance system, where you pick up the case loads when they are moved. A second thing and this in Tamil Nadu, I want to emphasize is a major problem and has not been there as part of the discourse. There is a very high degree of both stigma and denial. There is a strong sense in the village when you go, there is no such thing. This is a made up story and even when there are deaths, because there is so much shame attached to confessing that one has stigma or confessing that one has had COVID-19 or confessing that the village has had COVID-19 outbreak that they would go into denial. People will say things like, oh, there is no COVID-19 in our village. These two people got knows what happened to them when they got tested and it became positive. So as if the testing made it positive. So there is a high degree of denial and that's why Tamil Nadu is even struggling to reach its vaccination targets on that. Because at some point, this denial is a big phenomenon. That means that people don't come forward and the state has created so much of a shame and guilt complex about having COVID-19 that you can't locate it until the hospital start flooding. And we are better off than Gujarat and Madhya Pradesh where the crematoriums have started flooding. And that's one reason why is because between the last wave and this wave, we have really improved our organization of hospital care in Tamil Nadu. So therefore, we are in a much better situation in terms of getting people to hospitals and treating them there. But we haven't been just as successful in preventing spread because our engagement with the community, our contact tracing, the degree of health seeking behavior changes and whether we need is very low. All of our attention has been in only towards physical distancing and masking. While that is important, there are limitations to how far you can go with that social distancing also. But what is very important is that we have never addressed the issue of stigma and denial and how much that is acting as a barrier in our content. I don't think there is a single commentary that touches it. I do think this is a major phenomenon here. And in the same time when we have elections along with this stigma and denial, I mean, we saw massive gatherings during the elections in the rallies, in the campaigns and so on. So what has been the contribution of the election period and should we have not had elections in such a pandemic in such a time? So there are two questions here. What is the impact of the elections and should we not have elections? The elections must have acted as an amplifier. It does because there are more people out there, more contacts, more likelihood of transmission. Maybe not even so much outdoor rallies, but even if the rate of transmission is low, the numbers are so huge that the transmission would have definitely happened. And we would have also so many meetings that have happened in house, people meeting with their party workers, party workers meeting, going house to house. So definitely it has acted as an amplifier. But I would hesitate to put the blame entirely on elections. And I think that, for example, there are many states which did not have elections. Shatishgarh is seeing its largest outbreak. It did not have a single major gathering at this period. It did have in the November period when the cases actually went down. And it did have in Maharashtra, for example, has not faced elections. So to put it completely on is making it too simplistic an explanation for it. But in the middle of an outbreak, certainly we could have done much better in the use of social distinctions and restrictions when we were doing much greater self-awareness and much greater monitored awareness of how basically COVID-appropriate behaviors could have been followed. We could have done better. But come to your second question. Should we not have elections? I would actually say that's a very dangerous statement to me. Anything that undermines democracy is a serious threat in the face of abandonment. So whether you may extend tomorrow the same argument to street protests, you may extend that same argument to large gatherings of any sort which are able to respond to a highly authoritarian state. And at some point you do need people's participation. So whereas it is important and I do think that in the election queues and in the booths, it was better. It could have been even better. It was reasonably well managed. But I don't think the normal work of democracy should be interfered with. Because there are greater dangers on authoritarianism than on the sort of outbreak. There is a huge way and you need people along with you. You need a legitimate government to be able to mobilize it. So no, I don't think the election should have been postponed. It could have been done with greater caution and restraint. But at some point it should not be postponed. And that I think is a point that we need to strongly make because this will be used tomorrow against all democratic mobilization. And we should I think be on record not to oppose that. That is true. So I think I'll shift the focus now. I'll ask about the vaccine. So we are already, there's been a shortage of vaccines. But at the same time, we also see there's been wastage of existing vaccines. So what do you say about that? How can, why is this happening? So in the public health field, we know this wastage has a certain root. For reasons of cost and efficiency, usually the vaccine comes in vials where 10 to 15 are packed to a dose. And once you open the vial, then you must exhaust that vial within that time. Now, when you go to centers which have low turnout and you have one or two people trickling in, when you open a vial, then some doses are used and some are left unused. And then you can't keep them even in a refrigerator. You have to throw them out. So therefore the wastage occurs because unless you have a collection of people, you can't do. But people come in all through the day and therefore it is difficult to secure that collection of people. Now, one of the major ways in which this has been solved in public health is to actually mobilize and give appointments together so that you give appointment for 100 people together and then you can be sure that at least 90 people will be there or 70 will be there and you need to open one batch of vials at a time. So this is essentially a bit of efficient logistics mobilization that needs to be coordinated. It's a delivery issue. It is not an utter issue of lack of demand. But lack of demand is also there because in the beginning, when you did not make this logistic arrangement, you had the assumption that the moment you open up for vaccination, there'll be a flood of people there. That's not happening because the really most vulnerable people have required a far greater public outreach than what has been available now. And in fact, remember what I was telling you earlier, the issue of denial, the issue of that there is a pandemic at all. People will say things like, oh, those people are paid monetary incentive, so they come and report test positive. But it's not really test positive. So in this situation that to actually build the case for the role of vaccination is a very important step that you need to do. They also have experience of many people recovering etc. So you need to actually explain this much better. So the nature of public outreach that is required, especially to vulnerable sections. I had a long discussion on a TV show with representatives of the Coimbedo Vegetable Park. They had a lot of demands relating to lockdown and prevention of restrictions and management of restrictions. They didn't raise the demand of saying that all of us must be vaccinated. Yet these are traders and vegetables who are retailers and vegetables, which each day meet over 100 people. To prevent them from being super spreaders, you need them all vaccinated. Yet this was not one of their demands and yet they had very well articulated demands. So my sense is that you have to work with workers' associations. You have to work with working people, with different sections of the community to actually sensitize them to this and that prevents wastage incidentally. But its main thing is it is able to speed up your wastage. The state is imposing a demand that everybody below 45 be vaccinated by 25th. It's a difficult demand to meet but it is meant to stimulate their public outreach in workers. But why are they facing such a situation when world over there is actually a problem of a queue? People getting their vaccination dates too long. And that again goes back to what I am saying, the phenomenon of the day. So much has been said about blaming people. People are to blame for this particular second wave. People are to blame. You did not wear a mask. You did not do this. So everybody when they get the disease are ashamed about it, ashamed even about the need for protection. We have to break and that complex builds up. So I think in achieving vaccination preventing these public awareness and sensitization, we just fine-tune to address the real problem not there. Not the general message that you are giving across the country or world. Specifically in Tamil Nadu, respond to the ways stigmatization has promoted. It started with the tabligi jamaat. But in different forms and then the way the police repress us, the way they beat up people, all of this creates an association of criminalization with infection. And therefore, good honest people deny having the infection at all. So I think that there is a much more complex issue over here. And the point about the logistic management is a small part amenable to management, especially if you are able to have a better outreach system. See, my next question is in connection to this question and what you have answered. So the Tamil Nadu Chief Minister at Apari Paranisamy, he has said that within the next two days, two days back, he said, within the next two weeks, all the government officials and government employees have to be vaccinated. There are two kinds of responses to this, that the government should not force people, should not force anybody to get vaccinated and other response being that only coerced and mandated efforts can ensure that the vaccine is controlled. So what is your take? How do we go about this? I think that this is a difficult question. I have gone on writing to say that you cannot blame a person, you cannot insist that anybody taking a ride on a bus or a train should be vaccinated. But you can insist that the bus driver and conductor should be vaccinated. The balance of risk and proportion is different. And you are on a public service, for example, we used to insist and I think it would have been put if India also did it, that people who are in hotels or managing the hospital kitchens are examined for carrier states of certain disease that can be food-borne and water-borne. This is important for us to actually say that people who are in these services will face a number of people. I still, therefore, there is a case for making certain occupations where the risk of spreading to others is much higher, much more mandatory. For example, airline pilots, a cardiac checkup is mandatory. You cannot make that mandatory for everybody. It's a balance of risk and the public good which you are facing on that. Now, I don't see the merit in every government servant being forced to do that. But to the extent that it is persuasion, it is welcome. In fact, I would have actually worried the other way around that in some sense it is denying much more people at much more risk outside the priority to get the vaccine. Whereas a person in a backroom clock within a government office will be much less susceptible and at risk for the disease and can work at home meanwhile. So I think that there is a requirement for this. Bottom line, I think they should be using persuasion as their main means. But there are certain categories of workers where we can insist that that particular task must be performed only by a person who is vaccinated. Otherwise, the danger of others getting infection from a person who can become a potentially infected person becomes too high. That part of it is there. I think we've covered a lot of things. I think we can end it here. Thanks a lot, Tappas and Ramas. Thank you.