 Hello and welcome to Newsclick. Today we're going to discuss the 5 million mark in terms of number of acknowledged deaths that COVID-19 has already created in the world. Of course, this is much less than the Spanish flu as it is called, though we know it did not originate from Spain, probably originate from the United States. But that had a tone which is much higher. In fact, in India alone, numbers seem to be anything between 12 to 18 million who died. So looking at these numbers, 5 billion is not that big a number. Of course, it's only about 20, 24 months that we are seeing the COVID-19 pandemic. Question, of course, is that this is a figure which is the official death toll. The actual figures are probably at least three to four times. Of course, we don't know what these figures are, but the excess death calculation seemed to show that could be anything between 10 to 20 or million. So do you think given this, this is par for the course for this kind of pandemics or have you controlled the death numbers better than earlier pandemics? So the simple and unsatisfactory answer to that question is that every infectious disease is different. So death rates are not going to be a function of pandemic. Death rates are going to be a function of the actual particulars of that infectious disease, of that virus, that bacterium and the illness that it causes. As an example, in influenza viruses, for example, which cause the disease group that we commonly refer to as influenza fever, children tend to die in large numbers, in large proportions. Clearly, we know for the past two years, for COVID-19, that children don't tend to develop severe illness at a very high frequency as compared to the elderly, as compared to what we have gotten accustomed to calling us as the comorbid people. So I'm afraid there isn't a simple comforting narrative here that we have learned from the past and that we have dealt well with the pandemic. I will, however, say one thing. We have dealt better with the pandemic this year than we did last year. By all accounts, even though the numbers are hazy and not completely accurate, even though reportings across the world are variable and not terribly robust, the general trend has been very consistent. That last year, many more people with severe COVID-19 illness died than this year. That's again two quick questions here related. One is, of course, that the health systems at least recognized how to treat COVID-19 better than last year. And therefore, the hospitals, particularly the treatment in the hospital seems to have been better as long as they were not overwhelmed. In fact, the largest number of deaths, particularly when you look at excess deaths that occur, the gap between the acknowledged deaths and the unacknowledged excess deaths seem to be much higher during the period when the hospitals are overwhelmed. And we saw that in India too. So normal times that ratio of excess deaths to actual deaths is different. But when it comes to the hospitals being overwhelmed, that number seems to shoot up. So do you think that both of these, in fact, reflect that as long as hospitals function, we can control the excess deaths relatively better or the deaths relatively better? Well, yes, to a significant extent. I'm sounding more skeptical because the sad fact across, I was going to say the global south, but unfortunately in the United States of America as well, is that the public health care system, as far as publicly accessible, freely accessible, truly accessible, decentralized hospital based specialist medical care facilities are concerned, they are simply not available in the network and the scale that communities across the world need. And therefore, we are talking about the pressures put by the COVID-19 pandemic on systems that were deficient to start with. Let us not lose sight of that core fact. It's possible to say, oh, we were doing fine, but this once in a century pandemic came along, what can we do and invoke like insurance companies force measure as an excuse. But the reality is that we have had across much of the world an extraordinarily deficient and defective system and pattern of delivery of public health care, both as far as community outreach is concerned, which is why counting COVID-19 infections has been such a problem. And as far as, as you point out, hospital based specialized medical care facilities are concerned, which is why the peculiar combination of both they are getting overwhelmed and resulting in needless deaths and they are struggling to pretend that many of these deaths are not in fact COVID-19 related. Hiding the actual numbers. Coming back to the last question, vaccines. Again, it seems to be that in Asia, Latin America, Europe and North America, the vaccines uptake has been not too bad give or take few countries, but Africa seems to be still in a very bad state. In fact, if you look at it, even the health workers in certain countries do not have vaccines or have not been vaccinated. The figures are extremely low. We have the charts to show this. It's a really striking and stark contrast. Of course, we can pick out small countries or countries in different places as well, where there is a localized reason why vaccination has not occurred. But a global trend, it seems that while we are talking of a third vaccine, booster dose, etc., we are still not willing or able, whichever the case, to provide Africa vaccines. And we have also discussed earlier in our discussions that if we don't, then of course you have run the risk of Delta equivalent variant coming up again. And therefore, you might lose all the benefits you have had or partially lose the benefits of vaccination itself. So do you think that there is really a very urgent case to now look at vaccines much more seriously, particularly for Africa? How to make it available? Not that we should make it available and just pontificate on this. So in the first place, absolutely yes. We've been dealing, we've been seeing for the past two years, all of us, the world over as countries dealing with the pandemic, with attitudes of short term crisis more responses and really, frankly, narrow nationalist perspectives. Not seeing that not only are both of those of doubtful ethicality as arguments, but also that in pragmatic terms, there are going to be failures in the long run. It's sort of reminiscent of what's going on in Glasgow at the moment with the climate change related meeting. There are uncanny parallels there to be drawn. But that said, here's my difficulty. It surprises me that the companies that are attempting to transfer COVID-19 vaccine technology to the African continent to manufacturing facilities in Africa, fill and finish facilities, actual bulk manufacturing facilities are the mRNA vaccine makers. BioNTech has now promised that it is going to ship containerized manufacturing facilities, prefabricated, pre-built to Africa for manufacture and to transfer the technology. Moderna has been talking to the BioVac Institute, I think in South Africa, for doing something similar about transferring technologies. The oddity is that these are mRNA vaccines that require ultra cold chain storage. They are, in terms of the vaccine technologies, the least suitable technologies for distribution in tropical and subtropical global South communities. And yet the adenoviral vaccines don't seem to be gearing up to be provided to the African continent with any enthusiasm. Is this simply a matter of the mRNA vaccine companies winning the publicity war and are there things happening with other companies that are not getting publicized? Or is this some other deal-making? I'm completely unable to understand. Going further on this, there are protein vaccines such as the Novavax vaccine that we've been hearing about they're coming for months and months and months and months now without any actual evidence on the ground. Those are vaccines where the technologies are even easier to transfer in some ways and we haven't seen any evidence of that. Connect that to the fact that India has licensed approved for emergency usage not two vaccines but four vaccines as far as I can count. And yet India's vaccination campaign primarily still consists of two vaccines even months after more than two have been approved. What's going on with upscaling of vaccine manufacture? And I'm beginning to wonder if vaccine manufacture upscaling is beginning to lose steam as we arrive at the dreary unpleasant and familiar reality that the only people lacking something are terribly poor marginal communities in the global south. It doesn't matter. Well, I think just to add two points to what Satyajit has said. One is who provides the funds for producing vaccines and in fact the funds then come from sources who would like to promote a certain kind of companies, BioNTech, mRNA vaccines, Moderna and so on. So it's really the funding for the recipient countries that determine what technology gets transferred. And the second that even the other old-fashioned inactivated virus vaccines are not getting transferred while actually that at least for a number of countries in the global south there is capability for that and has been so for long years. India is a special case. India should have also invested in exactly what you said that those vaccine manufacturers who came later than the co-vaccine or the Pune Sedum Institute that apart from these two other vaccine manufacturers need financial and other support at least in terms of bank loans etc. Orders on hand have they been forthcoming is a big question. That also means that their ability to get off the ground becomes much slower and lastly India is not a special case for another reason. It was the largest vaccine supplier to the world and in this particular case because of the reasons what you said look after yourself first before you look after anybody else the argument that the US gave that it is like the passengers in an aircraft first do your oxygen mask then help others kind of principle that seems to be what India is still following and therefore it has still not been able to resume supplies in the significant way to the world which it had promised with the co-vaccine platform. So that is the other big challenge that we have that should we not have invested more heavily with other vaccine manufacturers also let the existing vaccine manufacturers expand so could fulfill our commitments to our people and also to the world. Otherwise we are still starting to talk about our third shot while we have not yet fulfilled our requirements and we are still reneging the commitments we had made to the co-vaccine platform for which we had also received money. So big tasks for the world as yet no country is free from blame on this but certainly the poorest countries or the most underdeveloped countries in terms of financial and technological infrastructure receiving the short end of the stick. Saty, thanks for being with us this is all the time we have today for news click do tune in to our COVID-19 discussions which you propose to expand soon to cover other public health issues as well and also do come and visit our website.