Categories
Issue 4

The COVID-19 Vaccine: Will It Flatter To Deceive?

Since the ending of 2019, the shroud of ‘SARS CoV-2’ virus has engulfed the world. The pandemic has taken a toll of more than 1.2 million lives worldwide and a renewed tsunami of a second wave of infection looms large in the horizon. Such catastrophic infection rates along with loss of human lives has also seen massive economic downturns and widespread unemployment. The Center for Monitoring Indian Economy (CMIE), has reported a 27% rise in unemployment rate and a 38% loss in market capital by the end of May and August 2020 respectively. 

Under these challenging circumstances, scientists across the globe are racing against time to design an effective anti-SARS CoV-2 silver bullet in the form of vaccines or drugs. An efficacious protective vaccine appears to be the most promising means to contain the spread of SARS CoV-2 since the virus has shown few signs of mutating from the highly contagious to a weaker avirulent form. This is in sharp contrast to what was witnessed in case of the influenza pandemic of 1917-19. It has been estimated that the availability of a vaccine will prevent the loss of nearly 375 billion US dollars per month from the global economy and also prevent the loss of millions of lives.

Scientists and biotechnologists are burning the midnight oil to put together an ideal vaccine against SARS CoV-2. But what is this ideal vaccine? It is one that is safe, devoid of side effects and at the same time induces a robust and protective immunity in the body to counter future attacks from the virus. In field trials, the average protection rate should be greater than 80%. Furthermore, the protection should be long term. It should be cheap and preferably a single-dose vaccine. Transportation of the vaccine should be easy and companies should be able to mass-produce it in a short time. Unfortunately, not all existing vaccines fulfil all of the abovementioned criteria. 

Since the first vaccine was invented by Dr Edward Jenner in 1796, the field has progressed exponentially through the incorporation of an array of methods, namely- attenuated live agent, killed virulent agent, DNA vaccines and  mRNA vaccines to name a few. In the elusive search for the SARS CoV-2 vaccine, all possible avenues are being explored. About 300 such attempts are being witnessed in different laboratories.

While there are multiple avenues being explored to combat the CoVID19 pandemic, the question looming large in all of our minds is when will the vaccine be available in the market? Obviously, the candidate vaccines undergoing phase-III trial with most promising and favorable responses, will be marketed first. Phase-III trial is a multicentric one involving a large cohort, who are to be followed for a reasonably long time to assess the protection rate and duration of protection. It needs 3-6 months for the trial in cases of coronavirus infections. Until then our wait continues. Moreover, even if a protective vaccine is available, it may take- years to produce large quantities of doses for the world population. Therefore, it will require a well-planned immunization program.

               One might ask, what will be the protection rate, how long will the protection persist and does the vaccinated population need to wear masks, maintain social distancing or carry out the required sanitation measures.

 Regarding protection, none of the existing vaccines (for CoVID or any other diseases) imparts 100% protection. If a vaccine shows effective protection in 80% of the vaccinated population, it is considered acceptable. In case of the SARS-CoV2 pandemic situation, even 30-70% (an average of 50%) protection rate by multicentric trial on cohorts, would be acceptable. This is because if 50% population is protected through vaccination and another 20-30% have already developed herd immunity, the magnitude of active cases and active spreaders will come down to controllable limits. However, one apprehension still persists, that critical changes in viral antigen due to mutation might outsmart the immunity which has already developed. This phenomenon is observed in case of Influenza virus time and again. The issue can be tackled by careful surveillance of the viral genome and constantly incorporating new vaccine candidates as and when required.   

As far as duration of protection is concerned, the time is not right for any comments. Even if a candidate vaccine produces short term immunity of 3-6 months, it is acceptable under the current scenario considering the ever-burgeoning infection rates. Even short term immunity will significantly reduce the impact of the ongoing pandemic.

Finally, we will conclude by discussing the post vaccination situation.  A variable period in the aftermath of vaccination is expected to be no better than the present situation. Partial lockdown, wearing of masks, adherence to sanitation and social distancing will be continued. This is because of the fact that the vaccine might not give 100% protection. Production of adequate doses of vaccine to cover all the population will take a long time, possibly extending into months or years. To make matters worse the virus might mutate, thwarting the mass vaccination effort.

Thus, there are many variables to conquer the raging SARS-CoV2 pandemic. Our last hope might be the mutation of the virus in such a way, that it loses its infectivity and virulence, similar to what happened in the Influenza (spanish flu) pandemic of 1917-19. Until then, let us make masks a fashion statement, observe hand sanitation and maintain social distancing.

Dr. Kasturi Pal is an Assistant Professor and DBT-Ramalingaswamy fellow in the Department of Biology at Ashoka University, where she teaches courses in Physiology, Advanced Biochemistry, Developmental Biology and Advanced Cell Biology

Some candidate vaccines appear to be promising. Following is a short list of the potential candidate vaccines:

  • Category A :
PlatformDeveloperCurrent status
1.Non-Replicating Adenovirus Expressing Truncated ‘S’protein(rADV-S)International Vaccine InstitutePre-clinical
2.Replicating recombinant measles virus spike proteinUniv’ Health Network, Canada;Center for Disease Control and PreventionPre-clinical
3.Replicating MV-SARS recombinant vaccine expressing ‘SARS-CoV’ AgInstitute Pasteur Phase-III trial
4.Subunit vaccine- using receptor binding domain (RBD) of SARS-CoV spike ‘S’ proteinBaylor College Medicine(Sabin)NY blood center(NYBC)Pre-clinical
5.Subunit Vaccine using SARS recombinant spike protein plus delta-inulin.V19Vaccine Pty Ltd, AustraliaPhase-I
6.Virus like particle expressing ‘S’ protein of SARS and influenza M1 proteinNovavaxPhase-III
7.Inactivated rSARS CoV-E virus.CNB CSIC, Univ of IowaPre-clinical
8.Covishield-Oxford (Replication deficient simian virus- S11-Ch AdOx1 nCoV 19)SanofiA Licensed Product
9.Whole Virus containing surface structural glycoprotein Ag of SARS CoV2.Oxford University/Astra ZenecaPhase-II
  • Category- B  (DNA Vaccines)
PlatformDeveloperCurrent status
1.DNA prime protein S437-459 and M1-20Institute of Immunology, Sanghai Medical College of Fudan, ChinaNo Information
2.SARS ‘s’ DNA primed and HLA-A restricted peptidesSan Yat Sen Univ’, China        -Do-
3.3a DNA Vaccine State key Laboratory of Virology, China        -Do-
4.VRC- SRS DNA 015-00VPNIAID, USAPhase-I
5.DNA ‘s’Protein + IL-2State Key Laboratory, ChinaNo Information
6.p-IRES-ISS-S1Jilin Univ’, Academy of Military Medicine          -Do-
7.M and N DNA vaccineInstitute in Japan, Taiwan and Hong KongPre-clinical
  • Category-C (mRNA based vaccine)
PlatformDeveloperCurrent status
1.Antigen protein specific mRNA encapsulated in lipid Nanoparticle(LNP) inserted into a cell, which acts as a factoryfor translation into exact 3D specific Ags of the virus, here SARS-CoV 2.Moderna TX IncPhase III

Indian Vaccines:   

PlatformDeveloperCurrent Status
1.CoVaxin (Inactivated virus)Bharat Biotech (Hyderabad)and ICMRPhase II trial
2.ZyCov-D (plasmid DNA vaccine)Zydus Cadila LtdPhase II trial
Categories
Issue 4

Psycho-Pass

Psycho Pass is an Anime show set in a futuristic dystopia, where the omnipresent surveillance “Sybil” system that monitors aptitude, psychic health and latency to commit crimes. Set against this background, a crime unit that investigates into a series of murders that set the stage for one the most compelling and complex Anime series in recent years.

The anime questions the ethics and effectiveness of looking at one through their genetic predispositions and their unconsciousness instead of their self-awareness and free will. Throughout the show we watch Akane, a new member of the police department, grapple with the moral ambiguities that come with such a system, and what cost would we have to pay for our security. With continuous references to literature and socio-political, and moral philosophy effortlessly woven into the plot, what begins as a well-executed alteration of Orwell and Philips  Dick, soon turns out to be a giant clash of philosophies.Though the show does pick up a little slowly, 

The characters are also very carefully constructed, each character almost representing a different political philosophy. What’s more interesting is to watch all of them navigate the situations they’re in but also navigate each other’s beliefs. Other than it’s plot, the show does a very good job with its graphics and its soundtrack, both doing a very good job at supporting the dark themes the show covers. 

Overall, with a thought-provoking narrative, complex characters and beautiful animation, Psycho-Pass is a thrilling anime from start to finish.

Categories
Issue 4

how i’m feeling now – Charli XCX

Written and recorded over six weeks during the COVID-19 lockdown, Charli XCX manages to capture a lot of emotions that one may have felt during this unusual year through this 11-track electro-pop album. There’s catchy club-like songs including claws and anthems that manage to transport you to a party with friends, there’s also more serious tracks like forever and 7 years which convey feelings of love and longing. For those of you who may be wary of electronic music, this album is a great introduction to a sub-genre called bubblegum bass––a futuristic take on pop music, with electronically altered vocals and digitally exaggerated background sounds. To sum it up, this album is a fun way to virtually escape your house for 37 minutes, and enter Charli’s catchy, exciting electro pop world!

Categories
Issue 4

Editor’s Note: Issue 4

Image: REUTERS/Mark Makela (All credits to the owners)

CNN’s Van Jones broke down with tears of relief on live TV, minutes after President-Elect Biden was projected as the winner of the election. The basic decency and empathy in Biden’s victory speech were jarring as it finally faced us with the vitriol that President Trump had normalised in his time in the White House. It was surreal to realise the scale of the havoc one man had wreaked on the existence of millions across his country. The comfort brought by his ousting and the reassurance of basic human rights felt like a shooting star, brightening this dark, painful year. There was much to celebrate — Harris’ historic appointment as the first Biracial, Black, South-Asian Woman in the VP’s office, safeguarding of LGBTQ+ and women’s rights, a promise to fix systemic racism and a much too late acknowledgement of COVID and science. Of course, the very next moment, we were reminded by the victors themselves of the work left to do after taking a breath to celebrate. 

Much can be written about this election, including an unfortunately located press-conference with Trump’s lawyer Rudy Guliani at a landscaping store placed between a crematorium and an adult-toy store. But in keeping with the chaos that is 2020, it wasn’t the only the major event taking place. Closer to home, the Bihar elections are projected to end with a razor-thin victory for the NDA-alliance by a mere 12-15 seats as opposed to an expected landslide. While not great for our already anxiety-ridden lives, these too-close-to-call elections spell hope for democracy and strong oppositions 

It would be impossible to write about the events of this year without mentioning COVID. It feels strange to write the words hope and COVID in the same paragraph, but that is what this month has brought us. While parts of Europe and America see 2nd and 3rd waves and new lockdowns, other parts of the world show us that irradicating the virus is possible. Australia has begun to return to normalcy, after seeing many subsequent days and weeks without new infections and deaths. And most importantly, Pfizer Inc. has just announced the most awaited scientific discovery of this decade, a possible COVID vaccine.

As I write this note, I think of everything else I should be listing here. Arnab Goswami’s arrest and the subsequent national debate, the upcoming festival season, the reopening of educational institutes in India, the yet to be examined impacts of the virus on various industries, the many, many aspects to both the aforementioned elections. This is by no means an exhaustive list. These events leave us with much to think about. What does the Biden presidency mean for us? When will we get the vaccine? Does a vaccine mean our learning to live with COVID indefinitely? Only time will give us answers. But as we had set out to do with this magazine, we bring you another issue where we have tried to analyse bits and pieces of this chaos.

Isha Deshmukh, Karantaj Singh and Shrishti Agrawal

Categories
Issue 4

The Next Stage

COVID-19, as expected, has brought a hurricane of changes in performing arts communities around the world. Like every other industry and field, performers have faced many struggles, trying to keep themselves afloat, financially and psychologically. In a world where imagining a physical performance feels like a novel challenge, at least for the next few years, the uncertainty of work and disconnect from the creation process has been disturbing for many artists. The evolving media, for viewing performances, has also made a glaring inadequacy in India apparent- the lack of adaptability of the traditional dance and art aesthetic to the online format. But artists are innovating, across the globe and, gradually, these innovations are being adopted by performers and performing communities in India as well. 

During the initial days of lockdown, in March and April, as all scheduled performances and lessons were getting cancelled, the performing arts world started adapting to the situation immediately and online performances were offered, free of cost, by several artists. This had never been done before on this scale. The performances were very well received by audiences, who were stuck at home, and helped boost morale for performers as well. But this act of compassion gave rise to a very important debate- how will performers sustain themselves, financially, when performances and lessons are available online for free? Many dance music-theatre schools, studios and companies were at risk of eviction and bankruptcy and people became increasingly aware of the urgent need to support the arts. Donation based online performances became yet another new format. Funds from donations made by the audience are used towards upkeep of the school or company and for the support of its members. Many acclaimed schools and companies around the world embraced this way of sharing their work, and as a result, some extremely coveted performances were made available to audiences on convenient platforms in the first few months of the pandemic. Dance and theatre groups from rural and semi-urban areas in India also, gradually, equipped themselves with the technology and skill required to offer such performances and it has proven to be very helpful for their sustenance. 

My personal experience, as a performer and as someone involved in organizing performances viewed by a group of people with an academic disposition, has been an ordeal of uncertainty and lack of inspiration on most days, and sudden, lung-filling flashes of exhilaration and gratitude on others. As a dancer with some hope of ‘building a career’ in dance, I am expected to stay relevant and visible on the internet, with or without the presence of paradigm shifting COVID-19. Unfortunately, this, in the year 2020, means I should be posting videos and photographs of myself on Instagram, Facebook, YouTube… Discord? Snapchat? (Can you tell that I am turning 30 soon? I had to insert my old age anxieties here. Why must I suffer alone?). Also, not once a month or once a week, I have to be posting things every day so that people don’t forget that I am a dancer. This also helps when you want to advertise the few and far between performances that you do get to be a part of. With the constantly multiplying amount of content that people are exposed to on social media and OTT platforms, it is becoming increasingly difficult for performers to move their audiences, or at the very least, make a memorable mark with their performance. I do believe that the career of a performer does not drastically change with becoming social media savvy, but it definitely satiates a deep-seated hunger to be seen, to be heard, to be given a chance to tell our stories through different creative media. The pessimist in me realizes that, in a world that is experiencing unprecedented trauma on a regular basis, a performer’s existence is reduced to a few minutes of screen-time on smartphones; thirty minutes to an hour on laptop screens if the performer (or group of performers) is privileged/lucky/well-known or all of the above. But the optimist in me finds ways to remind myself that there is a tangible reason why the concept of performance and many performing traditions have withstood the test of time- the limitless drive of performers to adapt to a constantly changing world and the sheer creativity involved in the process. 

A wide range of methods of presentation have revealed themselves in the last few months- some established performing arts companies and performance spaces in India and abroad have streamed pre-recorded videos of their acclaimed performances; solo dancers have been dancing live, on various social media platforms, to pre-recorded music in make-shift performance setups from their homes; musicians have been posting musical covers, original music work, group and pre-recorded performances; theatre companies from rural areas in India have been live streaming performances with their full cast and crew.

The amount of technical skills that all performers have had to adopt in the last few months is astounding. Digital platforms require camera work, sound and video editing, streaming expertise… It is a long list depending on the form of art to be presented. Many performers have had to learn these skills as most of us do not have big production budgets. This is also because, more often than not, performers end up bearing most expenses related to a performance as getting paid to perform is, for some reason, a privilege in these times. Many organizations and institutions feign lack of funds and get away with meagre payments and even zero payment, although why they would organize a performance when they cannot afford to pay for it is a long, harsh conversation for another time. The end result is that the average performer is forced to be self-reliant. But the silver lining is that, because of this, new avenues for innovation have opened up for performers. 

Some performers are still choosing to film their performances in the proscenium format, where the performer faces the audience and the view of the audience is two-dimensional. Obviously, this is a time tested way of presenting work on a phone/laptop screen which is also two-dimensional. But many artists have come to realize that the camera opens multiple new dimensions in capturing performances- various two-dimensional planes that can be used to enhance the narrative or visual effect. Movement does not only have to be presented from the front anymore; one can find different angles for the most impactful view. One can also choose to place the audience as close or as far away as required, making the performance as intimate and detail oriented as one wants it to be. There are still some limitations when it comes to Indian traditional performing art forms because of the very specific aesthetics associated with them. A few established performers and critics, who have taken on the meaningless task of gatekeeping, have spent most of the last seven months questioning everything that does not fit into the upper class aesthetic. Dancers have been called blasphemous for filming dance in their bedrooms and kitchens. But I digress, because no one really cares what they think. There is a massive shift in the kind of performances that are available for viewing now and performers are exploring various permutations and combinations to create exciting new work. 

As a dancer, apart from my feeble attempts at being a ‘regular social media person’, I got to perform once during these last few months. The performance involved other dancers and musicians. Our performance was supposed to be streamed live, with musicians playing in real time. We started rehearsals on Zoom and immediately faced some roadblocks- there was a considerable lag in the video and audio due to poor internet connections. How would we understand the musicality, work on coordination and synchronization of movement? Then we rehearsed with the musicians on Zoom, with the percussion playing a few seconds after the singer and off rhythm, again, because of the lag. The only reason why this performance could come together the way it did, eventually, is because the choreographer, my teacher, worked out all the music and dance details meticulously and did everything he possibly could to make each one of us understand what we needed to do. Also, realizing that live streaming such a performance could also entail unforeseeable technical snags, we decided to record the performance a couple of days before the streaming date. A unanimous decision was made that we did not want to stop in the middle. We wanted it to feel like an actual live performance, where you don’t get to rectify mistakes or cut in the middle. I guess, the ephemeral quality of performance is what makes it an exciting pursuit for many of us. So, on the day of the performance (recording), we met in person, climbed on stage, experienced many emotions, shed a few tears of gratitude, and performed while imagining the auditorium to be filled with people. It was, hands-down, the most eerie yet one of the most cherished performances so far, for me. My gratitude knew no bounds that day. We danced like there was no tomorrow. I can vouch for this because we have not set foot on a stage since then. It is sad to think that a camera cannot give us the high that a stage can. But it is also heartening to see how performers persevere and keep trying to innovate with the camera, waiting patiently (and in some cases, not so patiently) and hoping to experience that high again. 

I was very aware of this feeling, going into the organizer/facilitator mode. Curating virtual performances for young people is a demanding task. One has to find performers/performances that add value by taking us closer to our goal of sensitizing the audience to artistic works of quality. The performance has to be cerebral enough to challenge their comfortable perceptions and, at the same time, be exciting enough to make them want to watch. We were also very clear about a few things- we wanted to give the platform to a limited number of artists, artists who had important things to share, artists who were not the usual choices and artists who could benefit from getting work with fair payment. Also, as all these performances were going to be shared virtually, we could, practically, commission work by artists from different corners of India and the world! This thought was exhilarating and helped set our plans in motion. We chose some existing work to screen and commissioned some new work to be filmed and screened. We were not entirely prepared, clearly. We started by screening a beautiful documentary which was made available to view for about two hours on a Thursday evening. We also set up a discussion with one of the filmmakers afterwards. I am not exaggerating when I say that it is one of the most beautiful films on dance I have ever seen. I watched that film almost a month back and can still feel the inspiration it induced. Guess how many people watched the film. Fifteen. Guess how many people showed up to the virtual discussion. Twelve, out of which two were the organizers and one was the guest. This screening was a huge shock to us and an important lesson. It made us realize that people’s schedules are all over the place these days so we have to give them more time to view. We immediately increased viewing time for the remaining performances. We set them all up to be viewed for entire weekends. But there was another heartbreaking realization from this experience, a realization that has been lurking around for a few years but I had managed to conveniently wrap myself up in denial- the fact that more and more people are not too keen on watching performances and performance oriented things. It is quite possible that this is a direct result of the abundance of digital content available to everyone at any given time. There is no dearth of entertainment and it is clearly visible in how performances are being approached now. One only spares time to watch something presented by someone well-known. The thrill of finding new and interesting creators, innovative works and skilled performers is getting lost in the sea of digital content being generated every day. I also think that a performance requires a certain amount of commitment from the viewers. They need to commit to watch and immerse themselves in someone’s work. It requires undivided attention during and, ideally, time for retrospection after the experience. This might be a big ask, given the stress and burdens of these times. Hence, I should celebrate the small victories. Increasing the viewing time has definitely made a difference in the number of people viewing performances set up by us, which is a win. Times have been bleak. The uncertainty of opportunities to present work, to be seen, to be heard, to be able to share our stories has had a lasting impact on all our psyches. Recognizing works of performance being created by wonderful, inspiring artists and making them available for creative immersion has been an enriching experience, despite the challenges that come with it. I think of it as a way of channeling my gratitude back into the performance universe. (Yes, if you look carefully you will find many superheroes.)

Abhinaya Penneswaran is a contemporary and bharatanatyam dancer, currently working for the performing arts department at Ashoka.

We publish all articles under a Creative Commons Attribution-Noderivatives license. This means any news organisation, blog, website, newspaper or newsletter can republish our pieces for free, provided they attribute the original source (OpenAxis).

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Issue 4

Uncovering Recovery from COVID-19

India had hit the coronavirus peak in September and the total number of cases has been coming down since. Our recovery rate has been fairly good at 92%. Coping with the virus has varied widely for different people. The virus has definitely taken a toll, not just physiologically, but mentally too: the harrowing experience of hunting for a hospital bed, the several weeks-long isolation, and even losing loved ones. We see the statistics rise and fall. But behind every single statistic is a person, their loved ones and their stories. Here I have compiled four such COVID stories in an effort to highlight the personal impacts of this virus.

A Family That Gets COVID Together, Stays Together

Mahek’s grandfather has two brothers, and their three families live together in the same house. When the pandemic hit, her entire family religiously followed lockdown rules and avoided going out. They were aware of the risk of living with five older people with comorbidities. And yet, somehow, coronavirus did make its way into their family. The first one to show symptoms was Mahek’s mother, and it was scary because she had been a heart-patient, having suffered a cardiac arrest before. The doctor asked her to be hospitalised immediately. While she only had about 15-16% patches in her lungs, the idea of being alone at the hospital was stressing her out. Her diabetes shot up because of the stress, and Mahek recalls that she had never seen her mother in so much pain before.

“It felt like a movie when the ambulance came and first took my mother away, then my four of my grandparents and finally my father. Six of my family members were in the hospital. My dad was the only one who actually could be treated at home too, but he got himself admitted so that he could take care of my grandparents in the hospital.”

After everyone left, Mahek and her siblings were isolated together, away from the only three adults who did not catch the virus—one of her grandmothers, an aunt and an uncle. Being the eldest sibling, she was suddenly saddled with several responsibilities. She was sweeping, cleaning, washing clothes, utensils, taking care of everyone’s medicines and monitoring vitals, all while she had COVID herself. She worried about her family in the hospital, but couldn’t speak her mind to anyone. Her parents were already stressed and sick themselves, and her younger siblings were dependent on her.

“The worst nightmare we could imagine for our family during a pandemic happened to us. We are very grateful that everyone came back safely from the hospital. We had been so scared of COVID, perhaps due to everything we saw on the news. After having gone through it, we are less scared but equally worried. The whole family being together in the hospital and at home made recovery easy for us, I think.”

Something unnecessarily unkind that her family had to face was their neighbour’s behaviour during the hardship. “They had put up two wooden sticks outside our house and anyone passing by would literally turn away and take another route. I understand the fear but maybe that was a little harsh.”

You Win Some You Lose Some 

Archana and her husband run a marketing firm where she is the head of accounts. Their office was running on low capacity, following protocols. In August, one of her employees came down with fever and a while later, Archana also experienced similar symptoms. The employee tested positive and the team sent to test everyone in contact with the employee at the office found everyone negative, including Archana. She was relieved and continued to take regular fever medication, although nothing explained her unusual tiredness. She decided to get tested again and turned out she had about 45% patches in her lungs. Archana had to be immediately hospitalised.

She was able to get a bed the same day, owing to her family’s contacts. On her first day in the hospital, she was stressed about how long she would have to stay there, and whether she would even return home. She knew how hard it was to get Ramdesivir (the required medicine)—people were ready to pay fifteen times the price but couldn’t get it. At the hospital, she checked her bedside drawer and when she saw her medicines, six complete doses, in there, she felt reassured that she will definitely get better and go home soon. After 8 days, she was discharged. Meanwhile, her daughter had tested positive too. Thankfully, her symptoms were mild and she was home-isolated.

Once she was home, Archana recounts, “I was so glad to be isolated with my daughter. I had been worried about work at the office, but I realised that things were going on their own, without me too. I could spend time with my daughter without worrying about going to the office, managing time, answering the doorbell—I am so grateful for that time. I had been very privileged throughout, I know this is a tragic time for many, people have lost their lives, but I was still grateful to have realised the importance of time through this disease. I am always running around, taking care of things, office to home, home to office. I felt as if I was cured and brought back home safely so that I could use the rest of my time to do better deeds in life.”

She took the whole experience positively. The only bitter part was, again, their neighbours’ behaviour. Even after they were out of the isolation period, they got their house professionally sanitised, their neighbours asked their house help, the milkman, etc. to not go to their place for another month.

The Guilt of ‘If Only…’

Kuldeep has worked at a hospital’s pharmacy for fifteen years. He continued to go to his job every day throughout the pandemic. His parents, wife and son live with him, and knowing the risk involved, he made to take all the precautions. When one day he came down with a fever, he took paracetamol, felt better the next day, and didn’t think much of it. Soon, his son and wife also came down with a fever and then got better just like he did. It all appeared fine.

A few days later, Kuldeep’s mother felt pain in her kidney. The doctor diagnosed her with a minor kidney infection. But in the X-ray they took, they detected some COVID patches in her lungs and asked them to shift to a COVID ward. That’s when they found about 85% patches in her lungs. Kuldeep was very worried. He had seen several cases in the previous months and knew the odds were against his diabetic mother to recover. When his family got tested, they all turned out to be positive as well. He felt guilty — had he isolated himself immediately when he first got a fever, maybe his mother would have been okay then.

Despite his contacts as someone working at a hospital, he had a hard time finding a bed in a COVID ward in the city. Thankfully, his mother was unaware of the severity of her condition, so she escaped the added mental trouble of worrying about her health like that. She was recovering very slowly, but after 8 days, she tested negative for COVID and was moved to the green zone. Although the infection in her lungs was still at 80%, Kuldeep felt reassured—she might take longer to get better, but he had hope that she would get better.

Kuldeep was with her when she was moved out from the COVID ward to an ICU. A few hours after that, she succumbed to the infection and passed away.

The grief, the guilt, the hustle to arrange a bed in the hospital, the struggle to get a plasma donor, it was the worst time Kuldeep had ever been through, he says. He realised that despite being employed in healthcare, despite his experience serving through the pandemic, he only understood the seriousness of this disease after the tragic loss of his mother. 

Livelihood Or Life

Usha works as a domestic helper—washing utensils and clothes in households. Some day when she was out on work, washing someone’s clothes, she believes, she came in contact with coronavirus. Maybe someone delayed informing her about an infection in their family. She is not sure. When she started showing symptoms, she went to a government hospital and tested COVID positive. She knew how it was—people were dying, hospitals were full, she had grandchildren at home, and her family depended on the money she earned. She was worried but also grateful that she did not have a severe infection. She got her medicines from the government doctors and was asked to be home-isolated.

At first, she was nauseated by the idea of being alone in a room with nothing to do. She had to take it one day at a time. Her grandchildren kept asking their mother why they couldn’t play with aaji. Talking to them on the phone was nice. Her fever went down after a few days. She knew she had to stay strong throughout so that she wouldn’t need to be admitted to a hospital, and her family remained safe.

Usha is grateful that they did not have to lose much money on her sickness. While there are other earning members in her family, and they have enough to not struggle for basic everyday needs right now, Usha worries about not being able to return to work soon. Her income is essential and she cannot sit at home for too long. 

Uncertainty, fear, and stress seem to have been common for those who contracted the coronavirus. Some people are trapped away from their homes, while some have lost family members. While every experience is different, tough times are made easier to go through if one has their loved ones supporting them. In the case of a disease where recovery comes with the prerequisite of isolation, it takes a different kind of strength on part of the patient as well as their loved ones. The pandemic is still not over, but we can hope to continue caring for each other and be more empathetic towards those who have it harder than us.

Mansi is a student of philosophy and environmental studies at Ashoka University. Her other interests include performing arts, politics and octopuses.

We publish all articles under a Creative Commons Attribution-Noderivatives license. This means any news organisation, blog, website, newspaper or newsletter can republish our pieces for free, provided they attribute the original source (OpenAxis).

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Issue 4

Busting Kangana’s Myths: The Science of Mental health

In the past couple of months, actor Kangana Ranaut has posted many tweets about depression and mental disorders. While it’s important to talk about mental health, unfortunately, many of Kangana’s tweets have incorrectly represented scientific research or left out important facts.

Here is what science actually says.

  1. The use of blood tests and brains scans to diagnose mental disorders 

While it is true that psychiatrists and psychologists don’t commonly use scans for diagnosis, blood tests are actually very commonly requested. This is to check for hormonal imbalances that could be the underlying cause of depression or any other mental disorder. For example, one commonly checked hormone is thyroid level since it can have an impact on one’s mood and sleep. 

As for brain and body scans, many recent studies have found that the brains of those suffering from mental disorders are both structurally and functionally different than those who don’t. These differences can be viewed under various brain imaging techniques. Patients with depression tend to show large volume reductions in frontal regions, especially in the anterior cingulate and orbitofrontal cortex with smaller reductions in the prefrontal cortex of the brain. These areas of the brain are responsible for executive functions such as decision making, planning, and emotion regulation. The prefrontal cortex is also the part of the brain responsible for releasing neurotransmitters such as dopamine, serotonin and norepinephrine. 

Furthermore, the hippocampus, the part of the brain that controls for emotions and memory,  has been consistently found to be significantly smaller in patients that are depressed. The longer one had been depressed, the more the hippocampus shrunk in size, further limiting memory and emotion functions.  

Unfortunately, we haven’t been able to use brain scans for diagnosis yet, but research is ongoing and hopefully, we will soon be able to use them to diagnose and create specific treatment plans. 

2. The role of environmental factors on Mental Health 

It’s true that stressful life events can contribute to the development of mental disorders, however, biological or genetic factors seem to have a more significant impact. 

It’s quite well known that biological factors such as differences in neurotransmitters and hormone levels are known to contribute to mental illness. A lesser known fact about mental disorders is that their heritability is very high, in some cases much higher than physical illness. Heritability refers to the statistic that helps us understand how much of a particular characteristic or illness is usually a result of ‘nature’ in comparison to ‘nurture’ The heritability of depression is known to be about 48% – 70%. To give context to how high this is, the heritability of obesity is known to have the same range (40%-70%), blood pressure much lower (24.4% – 30.3%) and height is a little higher (89% -93%). 

This means that approximately 90% of the time, one’s height is a result of genetic factors. Environmental factors such as nutrition, and exercise can also contribute to one’s height, however, when we look at a population, about 89%-93% people are of a certain height due to genetic factors. Only about 10% of a population’s height is not determined by ‘nature’ but instead determined by ‘nurture’. Similarly, at least 48% of a population experiences depression due to genetic factors, and in different populations this number could go up to as high as 70%. 

The reason that the heritability of mental disorders function on a range is because mental disorders are a polygenic trait, meaning that not just one gene, but multiple genes determines whether one will develop a mental disorder. However, there is one gene mutation that has been found to have significant correlation with the onset of various mental disorders. The gene is called MTHFR and it seems to be involved in the production of an essential enzyme – methylenetetrahydrofolate reductase. People with this gene mutation have been found to have a much higher risk of developing mental disorders. 

Genetic predisposition and environmental factors together determine how vulnerable one is to mental disorders. To understand this interaction, let’s look at the example of Phenylketonuria (PKU). Phenylketonuria is a genetic disorder that results in a defect in the gene that helps create the enzyme needed to break down the amino acid phenylalanine. Without the enzyme necessary to process phenylalanine, a dangerous buildup often leads to intellectual disability, seizures, behavioral problems, and mental disorders. If provided with a diet that limits phenylalanine, these can be prevented. 

Similarly, in the case of depression, genetic factors can cause one to be more vulnerable and sensitive to stress the same way PKU makes one more vulnerable to phenylalanine. In the case of no genetic risk involved, one is either not susceptible to mental disorders at all or much more resilient to stressful life events in comparison to those who are genetically predisposed. Overall, how vulnerable or resilient one is in the face of stressful life events, seems to be determined by our genes. 

This is not to say that environmental factors alone cannot cause depression. However, resilience to mental health disorder does seem to be more correlated with your genes than a healthy environment, although a healthy environment can increase or lessen your resilience.

3. The Relationship between Depression and Drug Abuse 

The relationship between depression and substance abuse is bi-directional. A large number of people who suffer from depression never seek medical treatment and instead, use alcohol and drugs to self-soothe. At the same time, those who struggle with addiction are much more likely to develop depression since alcohol and drugs tend to alter brain chemicals, possibly making one more susceptible to mental disorders. With that said, a large number of times, mental health disorders usually occur before substance abuse and addiction. 

However, an interesting point to note is that addiction too, is quite heritable.  Although everyone has the potential to become an addict, some people are more vulnerable than others. Studies show that if a parent has a drug or alcohol addiction, the chances of their child developing an addiction is 8 times greater.

Adoption studies are commonly used to study whether nature or nurture is more important for the development of a particular characteristic or behaviour. Studies have found that among adopted children, those that have biological parents with a history of drug abuse, are much more likely to engage in substance abuse themselves. On the other hand, the risk of drug abuse in adopted children raised by a parent that had a history of drug abuse was not significantly increased, suggesting that genetic factors play a greater role in determining the likelihood of drug abuse and addiction. Similarly, twin studies have found that if an identical twin (shares a 100% of your DNA) has a history of addiction, you have a higher probability of developing an addiction, than if you had a fraternal twin (shares 50% of your DNA) with a history of addiction.

Therefore, although it’s true that one’s depression may be a result of substance abuse, it is unfair to villainize any of the two. Yes, our actions and environment does influence the development of both behaviours, but given that both conditions seem to be heavily dependent on genetic predispositions, it’s important that we spend more time educating ourselves and finding efficient ways to prevent addiction and mental health, instead of stigmatizing them even more. 

Aradhya is a student of Psychology, Biology and Media Studies at Ashoka University.

We publish all articles under a Creative Commons Attribution-Noderivatives license. This means any news organisation, blog, website, newspaper or newsletter can republish our pieces for free, provided they attribute the original source (OpenAxis). 

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Issue 4

TRP Or News? The Existentialist Dilemma of News Channels.

Last month, Republic TV and two other Marathi Channels were busted for manipulating TRP ratings that influence advertising revenue, sparking a conversation about the legitimacy of TRP ratings, and it’s ethics.

TRP or Television Rating points is a commonly used metric by advertisers to decide which channel to run adverts on. It shows advertisers data on the channel’s viewers and provides a more nuanced understanding of which channel is being watched by most viewers, along with some information on the viewer demographic, so that companies can effectively decide where to post their advertisements. The higher the TRP, the higher likelihood of receiving marketing investment, ultimately increasing profits.

This is not the first time that TRPs have been tampered with, as many similar cases have come to light in the recent past. Despite that, the conversation surrounding TRP and its inefficiencies have remained insufficient and are only now beginning to gain some traction. Dr. S.Y. Quraishi, the ex-Chief Election Commission and Director General of Doordarshan, has been following the issue since the early 2000s and believes that the current system is brimming with treachery. As the director-general of Doordarshan, he found that many private channels were announcing unrealistically high TRP rates, blocking investments towards Doordarshan. At the time, he found that only 2000 meters were being used to calculate TRP for the entire country. For a country of 1 billion people, that’s a sample size too small to give an accurate representation of the population, and in recent years, that number has only gone up to 40,000. A bigger issue, however, was that information on the homes that had installed the meters was easily available, allowing companies to reach out and possibly bribe them to watch their channels more. With such a small sample size, it is much easier to manipulate TRPs ratings. If just two or three households are paid to watch a certain channel 24 hours a day, the TRP ratings of that channel could drastically increase, bringing them more investment.

Even if we ignore these cases of manipulation, the use of TRP to measure the value of news has many drawbacks. With increased competition and the dependency on a system where news channels have to compete for every second of viewership, it’s difficult to continue making profits without submitting to bad journalism. Unfortunately, fake news, controversy, and sensationalism do a much better job at engaging people than true and often uncomfortable stories that good journalism brings with it, and therefore, it’s difficult for television news to remain authentic.

According to Vikram Chandra, founder of Editorji Technologies and former CEO of NDTV, this is the big existentialist dilemma that haunts news channels today: do you provide good news, lose money and possibly go bankrupt, or do you get the TRP, make money but put out bad content instead? As long as news channels are dependent on TRP, the low-quality of news will remain, which raises the question of whether we should be using a user metric to determine the value of news at all.

Journalism is often said to be a public good, the fourth pillar of a functioning democracy, because, without informed citizens, a democracy simply won’t work. Just like other public goods, journalism too, cannot be left on the free market, as we are seeing the results of a complete reliance on user demand. What would happen if other public goods, such as education, ran the same way? Schools and education curriculums designed based on what parents and children want to learn and believe are facts. In a best-case scenario, this would result in a fall in the quality of education, and in the worst-case scenario, students from different schools would learn completely different facts, have a completely different understanding of the world, and ultimately live in different realities altogether.

Many argue that the solution to this is to regulate or subsidize journalism. However, this could end up posing a threat to free speech. Therefore, the big question for us is whether we can escape the user-metric at all.

The solution to this, according to Vikram Chandra, is to balance the two. He believes it’s time to move away from television completely and shift to newer technologies that allow for the personalization of news, whilst also balancing news that one should hear. Use a user-metric and give people the stories that they are interested in, however, along with that, also give people news that they need to read regardless of their interests or political beliefs so that people don’t end up in echo chambers.

The use of AI and algorithms may be the solution to keeping audiences engaged without distributing sensationalized news or tabloid content is by personalizing news. However, it’s a solution that still lives in the future. Until then, the only solution we have is to use our power as consumers and support news channels that provide good quality news despite the challenges of the TRP system.

Aradhya is a student of Psychology, Biology and Media Studies at Ashoka University.

We publish all articles under a Creative Commons Attribution-Noderivatives license. This means any news organisation, blog, website, newspaper or newsletter can republish our pieces for free, provided they attribute the original source (OpenAxis). 

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Issue 4

China’s Vaccine Diplomacy: Strategic Ascension to Global Power?

The global health catastrophe of COVID-19 and the current unmet need for a preventive measure has accelerated the geopolitics of vaccines. Diplomacy to assure the availability, accessibility, and quality of the vaccine to manage the COVID-19 pandemic is central to any country’s success. Vaccine diplomacy is currently a crucial soft power tool China is trying to deploy.  It is rushing like a hare with all the potential risks and rewards of such a strategy; it is hoping to disrupt the historical tortoise-like pace of vaccine development and deployment.  

China is among the earliest in the development and testing of vaccines. It has four vaccines in the third phase of clinical trials and has set strategies for global supply in motion. Capitalizing on their strategic interests in their multilateral and bilateral relations, China has adopted several diplomacy channels for vaccine distribution. Drawing from our framework on science & technology diplomacy, it has deployed a mix of financial/economic support, geographical coverage, cultural outreach, information dissemination, material distribution, timing, and transportation strategies. It has varied the mix of channels based on its relationship with the partnering country. It has sought to set up an exchange, cooperate, collaborate, or make a commercial transaction. 

China timed its diplomacy to provide early vaccine access to countries of strategic interest. Philippines, Myanmar, Indonesia, Malaysia, Cambodia, Thailand, and Laos are some of the countries that could potentially have priority early access to China’s vaccine. Each of the countries has a unique relationship with China and the objective of vaccine diplomacy is distinct for each. Today many geopolitical issues have been set aside due to the impact of COVID-19, and Indonesia did just that due to the economic conditions which prompted them to accept China’s vaccine offer. The China-Myanmar economic corridor has led to an economic partnership with Myanmar under the ‘Belt and Road Initiative’ and has set the basis for strengthening their vaccine diplomacy. A successful vaccine will only strengthen the already existing relationship. 

The long-standing relationship of United Arab Emirates (UAE), Saudi Arabia, and North Africa with China has connotations of economic, material, and transportation diplomacy. Vaccine diplomacy in these countries has a greater push in terms of providing them support in everything they need for successful vaccine deployment. China’s vaccine clinical trials are underway in UAE and the country declared emergency approval within six weeks after the trials were started. On the other hand, facilities are being setup in Ethiopia to mass-produce pandemic mitigation tools which is just the start of providing more of its resources. Transportation and transfer of resources and materials is another tool that further strengthens China’s vaccine diplomacy. State-owned Chinese pharmaceutical companies are distributing  their resources to build massive distribution networks. For this purpose, new facilities are being built in Egypt and Morocco. Weak industrial setup and political power struggle of countries has given China the opportunity to spread its vaccine diplomacy to Latin America. Technology transfer by China to the underdeveloped pharmaceutical industry to secure vaccines in the region has expanded the scope of China’s vaccine market space. It has used its economic/financial diplomacy once again by pledging loans to Latin American and Caribbean nations to fund procurement. While China has deployed varied strategies, it appears to fall short on strategies such as providing advice and gifting which could play a significant role in building goodwill among nations. 

An effective and successful vaccine will be beyond measure in terms of its diplomatic value to China. But its ineffectiveness could damage China’s power and put a risk to its established relationships. In general, if a country’s vaccine’s ineffectiveness is discovered due to its low cost, low quality, and quick development, the diplomatic favors can quickly turn into backlash. One of the biggest concerns for any country will be the quality and effectiveness of the supply chain for successful administration of the vaccine. The success of the supply chain will not only depend on quality development, testing, availability, transportation, demand, and administration of it at the lowest level, but also on management and monitoring, cold chain management, and immunization safety. The management and monitoring will depend on the demand and production of the appropriate quantity and inventory. Cold chain management will be the most crucial in terms of having the right facility location, routing, and mass distribution, all of which needs a supply chain design with rigorous temperature control resources. It will require monitoring storage temperatures, other conditions appropriate to the requirements, and conducting first-level maintenance of cold chain equipment. Last, immunization safety measures and resources must be available for the frontline workers and safe waste disposable must be employed. 

In the above context, it is imperative for a country to have resources set up well in advance to support the supply chain management. Given that all countries will not have the cold chain management resources at different levels, technology transfer to support this is a huge requirement. If India or any other country is looking to secure vaccine from countries like China, United States, or Russia, diplomatic channels for securing the necessary technology will be vital. Today, the economic conditions of the countries are affected a great deal. No country can afford to incur additional costs as there are high chances of vaccine wastage if countries do not have the cold storage management capabilities to successfully deliver the vaccine. China’s unique vaccine development and diplomacy strategies have surpassed India’s whose focus in both has been narrow. China’s economic heft is probably the most influential factor in this race given its dominance around the globe. If successful in its vaccine diplomacy, China will gain the most diplomatic dividend there is and re-order the competition for global power. If it fails, it may take a while to recover the trust of other countries in the post-COVID-19 world. While China is being like a hare to develop and distribute a vaccine , India is being like a tortoise, promising to  use its manufacturing capacity to produce and deliver the vaccine to the world.

S D Sreeganga, Research Associate, Ramaiah Public Policy Center, Bengaluru, KA, India 

Arkalgud Ramaprasad, Professor Emeritus, University of Illinois at Chicago, and Director, Ramaiah Public Policy Center, Bengaluru, KA, India 

We publish all articles under a Creative Commons Attribution-Noderivatives license. This means any news organisation, blog, website, newspaper or newsletter can republish our pieces for free, provided they attribute the original source (OpenAxis). 

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Issue 4

Reforming Antitrust Law To Regulate Big Tech

On November 10, 2020, there were two landmark events in the universe of antitrust law – China drew up its first set of antitrust laws to address anti-competitive practices in tech firms, and Europe laid out its first charges against Amazon for abusing its position as an e-commerce giant. Just last month, the United States filed a case against Google, alleging that it abused and furthered its position as the dominant search engine by unlawfully impeding its competitors. Google has also faced similar charges in India over the past three years. These include abuse of dominance across the search engine market, Android smartphone market as well as the Google Flights service. 

These cases bring to the forefront a larger structural problem at the intersection of technology, economics and the law: how can traditional competition law, which was designed to ensure free markets for brick-and-mortar stores, be reformed to include firms in the digital economy? 

Firms in the digital economy here refer to tech platforms like Google, Amazon, Facebook, ride-hailing apps such as Uber and Ola, and food-delivery apps like Swiggy and Zomato. They have gained an increasingly larger market share in recent years, and have faced few to no competitors. Here’s where regulating competition among them becomes tricky: these firms rely on the principle of network externalities, where an increase in the people using the service improves its quality. One can argue then, that the firm can only succeed when the number of people using it increases. So then, is regulating competition and ensuring the reduced market share of a firm really the best move, especially when these firms have provided services to customers at low rates? A counter-argument to this can be made regarding predatory pricing, which refers to cutting prices below cost in order to increase market share. This is considered to be anti-competitive as it drives competitors out of the market since they cannot keep up with such low prices. 

Concerns such as predatory pricing are similar across firms in the digital economy as well as regular brick-and-mortar stores. However, the unique features of the digital economy, such as network externalities, consumer lock-in effects, and usage of collected consumer data for targeted marketing are new problems that haven’t impacted businesses in the past. This calls for countries to update their antitrust laws, in order to sufficiently address anticompetitive practices among firms of the digital economy.

One way to contextualise this issue is to look at the history of American antitrust law framework, as done by Lina Khan in her seminal paper Amazon’s Antitrust Paradox. She explains how the current laws focus on regulating competition through a consumer welfare perspective which primarily looks at keeping consumer prices down. She stresses the need for restoring traditional antitrust laws that looked to preventing companies with large market shares from exploiting their dominance. 

To do this she suggests two approaches: First, to reform antitrust law in a way that it preemptively prevents a firm from becoming the dominant player in the market. This means making laws against predatory pricing more robust and scrutinising mergers that allow firms to acquire valuable data and leverage it, i.e. introducing a component of data threshold to mergers, apart from existing laws on monetary thresholds. Second, is to accept that online platforms are inherently monopolistic or oligopolistic and regulate them accordingly. This reforms antitrust law such that it allows a firm to become dominant and take advantage of the economies of scale, but neuters its ability to exploit its dominance. This includes ‘public utility regulations’, which allow a firm to maintain business across multiple lines of business while ensuring that it does not unfairly advantage its own business or unfairly gain market power. Another reform is ‘common carrier duties’ which require platforms to ensure open and fair access to other businesses, similar to the argument made regarding net neutrality.

Although Khan’s paper was primarily written in the context of American antitrust law, the arguments made can be applied to Indian competition law as well. To implement such reforms in an Indian context, Shah, Parsheera and Bose look at the Competition Act 2002 and propose certain changes to make it suitable for the digital economy age. 

They propose that the CCI use a “recoupment test” to differentiate between firms that have slashed prices competitively versus those who have done so in an anti-competitive manner (such as predatory pricing). This test checks whether a firm that currently has low prices can sustain these prices in the future and still remain solvent, or whether they would need to increase prices in the future (after having gained significant market share and kicked their competitors out of the market.) This would mean an amendment to the current definition of predatory pricing from being about merely cutting prices below cost to include the recoupment test too. 

Parsheera et al. also suggest that the CCI examine the role of investors, in cases where the same Private Equity fund has invested in the leading firms in a market. Examples of this include Tiger Global investing in Flipkart and Shopclues, ShopBank in Flipkart and Snapdeal, and so on. In such situations, the common investor could determine the level of competition in the market. This could lead to harmful outcomes such as high prices for consumers, as well as reduced quality and types of products.

There have been other reforms suggested by politicians such as Elizabeth Warren, who called for “Breaking up Big Tech.” However, experts like Charlotte Slaiman, a former antitrust lawyer in the US Federal Trade Commission, says that such solutions are unfeasible as it is difficult to determine which parts of a firm belong to which broken off entity. Nevertheless, regulators can take a retrospective look at mergers that they may have given a green light to in the past. In the Indian context, the CCI can reassess previous mergers and antitrust cases with respect to current situations of the market. This can allow for an ex post facto correction of possible anti-competitive mergers.

As Big Tech becomes increasingly intertwined with our everyday lives, it’s important now more than ever, to consider the tradeoffs of its current benefits to future disbenefits. Whether it’s trading data for the ‘free’ service of social media, or getting deep discounts on your Amazon purchases, there are significant downsides. By amending our laws to consider the economics of the digital economy, we can continue to reap the benefits of technology while sheltering ourselves from its potential pitfalls.

Samyukta is a student of Economics, Finance and Media Studies at Ashoka University. In her free time, she enjoys discovering interesting long-form reads and exploring new board games.