Tag: healthcare

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Issue 12

Armed with Phones and Spreadsheets, How These Teenagers Took on the Second Wave

It’s 5 am and the DMs in Dasnoor Anand’s inbox are overflowing — requests for ICU beds in Pune, an enquiry about Remdesivir in Mumbai, search for oxygen cylinders in Lucknow, and many more such please for help. Anand tries her best to reply to everyone. She has only three hours to sleep before it’s time to wake up for online lectures.

This is what April and May 2021 looked like for several teenagers part of student organisation ‘Silence The Violence (STV)’.

With the second wave of COVID-19 slamming into India with an unexpected ferocity, the members of STV have been saving lives while simultaneously attending lectures and preparing for exams. The group consists of girls from all over India, ranging from those in Class 11 to those in first year of university.

In their bid to help out, STV (@stvorg) amplified the availability of resources like hospital beds, ventilators, oxygen, and even tiffin services on its Instagram account. The team gathered information through Twitter handles, personal contacts and other youth organisations, and grouped resources by city or state. They called each hospital and oxygen supplier personally to verify details before posting it. On a backup account (@stvorg_backup), a colour-coded list of resources was regularly updated – green for hospital beds, grey for ambulance services, yellow for food and blue for oxygen.

The motivation behind this venture? Nandini Nimodiya, 17, a member of the Crisis Team answered, “We are all students stuck at home. Social media is the only power we have.”

The team started with two-hour shifts but had to dial it up to five-eight hours due to the number of requests. Each day, STV got approximately 100 leads for different resources from all over the country. Out of these, half got exhausted by the time they called to verify. But of the remaining 50, STV was passing on 15-20 resources to people messaging for help.

“Even if we’re able to save one life at the end of the day, it makes everything worth it,” said Anand, 19, founder of STV, adding that they managed to help roughly 15 people daily.

The group made use of the latest ‘guide’ feature on Instagram, creating city-wise guides for all essential services. A guide is a collection of posts from various accounts that have information about a particular city’s resources. Followers of STV found this specific and timely. Shreya Joshi, 22, a resident of Pune says, “I wanted to find an oxygen concentrator for my father.  All the contacts I had were busy or switched off. That’s when I found  STV’s ‘Pune Guide’ on Instagram. It directed me to verified suppliers, and I got what I needed.”

STV started making city-wise guides when they realised that residents of small towns did not know whom to contact for resources. They started with major cities like Pune and Delhi but have compiled 12-city guides so far. They have even expanded to state level guides, with over 15 state guides in place, including Chhattisgarh and Uttarakhand.

STV’s expansive list of resources has helped make it a fast-growing account on Instagram. Over the course of five days, the number of followers shot up from 1,200 to 10,000. Currently, they’re reaching 11,100 people via social media.

Since the number of SOS calls has decreased, STV is now devoting time to spreading awareness about COVID-19. This is a major part of its threefold mission statement ‘Action-Advocacy-Awareness’. The volunteers are making informative posts on topics like ‘Covid and pregnancy’ or ‘mental health in Covid’. STV held its first online mental health event ‘Horizon’, where it partnered with certified psychologists to provide three days of free counselling sessions, seminars and workshops. This was followed by an online concert where young artists came together to unwind.

The team consists of 45 members between the ages of 16 and 20. Of the 45, 20 members have been completely devoted to the Covid crisis. Fifty additional volunteers were also roped in to help. Most of the members are from Mumbai and Pune, followed by a few in Andhra Pradesh and the Northeast. Over the past few weeks, STV has also managed to recruit volunteers from Karnataka and Kerala too.

Around 85% of the team is made up of women, with an all-girls core team. A point of grievance for these young girls is that they are often misgendered by people who contact them. They are addressed as ‘sir’ or ‘bhaiyya’. “We tell them we are women led, and that they can call us ‘ma’am’ or ‘didi‘,” says Nimodiya.

Project S.A.F.E (@project_s.a.f.e) is another all-girls organisation that has been amplifying Covid resources, specifically in Pune. This team consists of five girls from the Pimpri-Chinchwad College of Engineering. The girls spent all day finding resources – except from 3 pm-5 pm, as that’s when they were writing their exams! These engineering students collaborated with their friends interning at medical colleges to provide people with accurate information about availability of beds and medicine.

With 20 requests daily, at least 15 patients were guided to the required resources. Devika Chopdar, 20, founder of Project S.A.F.E says, “I didn’t know social media could have such a huge impact. So far, my profile has only been about myself. Seeing people receive life-saving facilities through it is a new experience.”

These local Covid helpers received a request for a ventilator bed at 1 am one night. None of the hospitals were answering their phones. Project S.A.F.E then circulated the request on social media. Within the next one hour, the Pune online community procured a ventilator and passed this information on to the critical patient.

Student communities across the country stepped up to fight the second wave. Delhi University’s Miranda House created a Covid helpline to assist residents of Delhi with quick updates on resources. A group of 22 student artists and poets from all over India came together for a night of music and poetry titled, ‘In The Dark Times There Will be Singing’, and raised Rs 1,47,000. All funds were donated to communities hardest hit by the second wave of COVID-19. Generating finances, even from outside the country. US-based Princeton alumnus Shreyas Lakhtakia and Julu Beth Katticaran, offered career counselling sessions to raise money for Covid charities in India.

The Indian student community that aided the country in its hour of need is here to stay and is only growing stronger. Even the girls of STV are planning more posts, events, and community building in the months to come. All while preparing for the upcoming Class 12 board exams, of course!

Featured image credit: antiopabg/Pixabay; Editing: LiveWire

This article has been republished from LiveWire with permission of the author.

Aditi Dindorkar is a second-year student at Ashoka University. She is pursuing a major in English and Creative Writing, and a minor in Media Studies. This report is written as part of her course, Introduction to Newswriting and Reporting.

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 11

Issue XI: Editors’ Note

The past year saw COVID-19 and lockdowns as the only issues one extensively engaged with, both in their personal and professional lives. The question, “how has the pandemic been treating you?” slipped into every catch-up conversation with peers, friends, family and colleagues. With the current surge of cases in India once again, it is safe to say that even with the vaccine, the pandemic still continues to dominate a major part of our lives. We are constantly reminded of it every time we have to step outside our homes or log in to an online meeting or a Zoom birthday call. 

With this issue, we aim to provide our readers with a ‘pandemic-break’ and delve into stories that are equally important but may have been sidelined with constant COVID updates from newsrooms. 

To begin with, Madhulika Agarwal addresses an essential question revolving around what makes an event ‘newsworthy’ in the first place? And who has the authority on prioritising which news is worth the consumers’ attention? With Amazon’s Twitter antics having grabbed the attention of the media, Samyukta Prabhu and Rohan Pai use this opportunity to highlight the gig workers’ rights that have been sidelined by tech giants such as Amazon, specifically during the course of the pandemic. 

Akanksha Mishra covers the consequences of the Afghanistan peace deal on the country’s population, revealing a critical understanding of the negotiations between three stakeholders – the Taliban, the Afghan government and the United States. Speaking of the United States, Karantaj Singh analyses 100 days of Biden administration by critiquing as well as applauding his contribution towards restoring America’s identity in the global community. With New Zealand’s recently passed miscarriages bereavement leave law, Advaita Singh captures the reader’s attention by examining the relationship between workplaces, the economy and personal grief.

Closer to home, Saaransh Mishra confronts the structure of quasi-federalism in India and its exploitation by the ruling central government in implementing controversial laws such as the recent GNCTD Bill. Furthermore, Muskaan Kanodia explores the vote-bank anxieties behind the intense dedication of political parties towards temple beautification, which appears to complement the rise of religious politics in the country. Ridhima Manocha analyses the ruling government’s contradictory campaign attitudes towards CAA-NRC when contesting the current Assam Assembly elections. Meanwhile, Vaibhav Parik questions India’s Election Commission’s decision to hold the ongoing Assembly elections in multiple phases in the state of West Bengal.

Aarohi Sharma brings back the essential climate change debate and delves into why individuals continue to deny its existence and widespread impact. For our sports enthusiasts, Kavya Satish explores the possible reasons for the increasing loss of viewership and sponsorship in F1 and what it means for the future of the sport. 

To emphasise the immense strain that Coivd-19 has placed on our global healthcare systems, Saman Fatima explores how this has resulted in the marginalisation of treatments of other prevalent diseases among several populations. 

While other stories may continue to struggle to win the fight for our attention with the intensity of the pandemic, we hope our readers are able to take a step back and keep themselves updated with events beyond rising Covid-19 cases and vaccinations. 

-Ariba, Ashana Mathur, Harshita Bedi, Rujuta Singh

Picture Credits: REUTERS/Athit Perawongmetha

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Issue 11

100 Days of Biden

It has been over 100 days since President Joe Biden took charge of his administrative duties in the United States. The Biden administration has been highly optimistic by promising to meet an expansive agenda that includes controlling the coronavirus pandemic, enabling economic recovery, revising US climate policy and reviewing their health care system. Biden has also taken active steps to reverse Trump’s isolationist policies and his decisions, alongside  catalysing the process of restoring America’s place in the international community. With only 100 days of his term completed, Biden has taken some notable steps to meet his agendas. 

Within his first few days at the White House, Biden rejoined the Paris Agreement and the World Health Organisation. He rescinded Trump’s Muslim ban, which restricted immigration from a host of Muslim-majority countries. He took the liberty to address US-China relations by getting on a call with President Xi Jinping to discuss climate change, human rights violations, and trade relations. The President has made it clear to the Americans and the world that he plans on restoring America’s position in the global community and that he is determined to get rid of the isolationist policies introduced by his predecessor. 

The Biden administration fulfilled their 100-day promise of providing 100 M COVID vaccinations within its first 50 days. Biden’s timing could not have been better – as infections were peaking and America’s vaccines were coming online because of Trump’s funding of Operation Warp Speed,  Biden utilised the opportunity to play the hero without having to put in all the work. Moreover, he recently announced that all adults in the US will be eligible for the COVID vaccine by April 19th. 

Biden is firing on all cylinders to ensure that repercussions of the pandemic can be contained, singing a $1.9 trillion relief package to fight the pandemic and restore the US economy. The relief package, currently Biden’s top priority, plans to send direct payments of up to $1,400 to most Americans. The bill also includes a $300 per week unemployment insurance boost until 6th September 2021 and steps ahead to expand the child tax credit for a year. The relief plan also allocates $25 billion into rental and utility assistance, and $350 billion into state, local and tribal relief. It puts nearly $20 billion into Covid-19 vaccinations. 

Biden’s plan to reverse Trump’s tax cuts on corporations has been championed by the Left, but the effectiveness of implementing this policy needs to be carefully considered.  Biden’s tax policy wants to raise the top income tax rate to 39.6% from 37% and the top corporate income tax rate to 28% from 21%. This move will allow the government to collect a tax revenue of approximately $4 trillion by 2030. President Biden claims that his administration will ensure American companies  contribute tax dollars to help invest in the country’s roads, bridges, water pipes and other parts of his economic agenda. The plan detailed by the Treasury Department would make it harder for companies to avoid paying taxes on both U.S. income and profits stashed abroad. 

While this move sounds good on paper, its effective implementation has several obstacles. Corporates with major accounting teams and an army of lawyers have continued to find safe havens and loopholes in tax laws to legally avoid paying taxes. A tax hike of this rate also increases the probability of tax evasion and tax fraud, which will undoubtedly lead to the creation of a larger shadow economy. Additionally, in a post covid world that has witnessed large scale unemployment, increasing taxes on corporations and high bracket earners is going to  push firms to cut costs, thereby creating disincentives for hiring. The increase in taxation may also push firms to switch gears and focus more on international markets such as Hong Kong or Singapore that offer lower corporate tax rates. While progressive taxation is ideally the way to go, the Biden government must ensure that its implementation takes into account all the limitations of the current system. 

The Trump administration focused on deregulation in the manufacturing sector to ensure productivity and economic efficiency, whereas Biden  promises to focus on sustainable development. As part of his election campaign, Biden had released a 10-year, $1.3 trillion infrastructure plan. The plan aims to move the U.S. to net-zero greenhouse gas emissions. Biden’s climate change plan in total would cost the US approximately 2 trillion dollars, which he aims to fund by reversing Trump’s excess tax cuts on corporations and putting an end to subsidies for fossil fuels. While Trump focused on short-term economic efficiency, Biden’s plan is for the future. Switching to sustainable means of manufacturing is going to undoubtedly drive up costs for the American economy, but has the potential to  create middle-class jobs and ensure environmental conservation. 

Biden has had over 100 successful days since being sworn in, mainly because the bar set by his predecessor was quite low to begin with, but also because of his constructive policies. He envisions an America that will not be easy or cheap to achieve. While Biden’s plans cease to be as optimistic as “Mexico will pay for it,” they still are overreaching. The policies and infrastructural changes that Biden aims to implement would likely add to the 28 trillion dollar debt, but as long as the economy is developed in a constructive manner, there is hope for Biden’s America.

Karantaj Singh finished his undergraduate in History and International Relations. He is now pursuing a minor in Media Studies and Politics during his time at the Ashoka Scholars Program. He enjoys gaming and comics in his free time. 

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 7

The Cost of the Cure: Understanding the Implications of India’s COVID-19 Inoculation Drive

Union Minister Amit Shah’s bold call for a duel to challenge vaccine skeptics came exactly a week after the Indian government’s inoculation program against COVID-19 was launched on 16th January 2021. The ambitious plan aims to vaccinate 300 million healthcare and frontline workers in its first phase using the vaccine derived from the Oxford-AstraZeneca candidate AZD-1222, dubbed Covishield in India, and Covaxin, produced by Hyderabad-based biotechnology company, Bharat Biotech and the Indian Council of Medical Research (ICMR).

Despite initial optimism, the program has witnessed low turnout rates, due to widespread misinformation and safety concerns. The root cause of doubt about the program stems from the announcement by the Drug Controller General of India (DCGI) on 3rd January 2021, when Covaxin and Covishield were given emergency use approvals. While the approval for Covishield was unsurprising, given its established efficacy in all three phases of trials abroad, it was the seemingly hasty rollout of Covaxin that caused a stir. 

Criticism of the vaccine primarily focused on the absence of Phase 3 clinical trial data, since the trials have not yet concluded. The initial backlash against the approval of Covaxin was met with officials responsible for India’s COVID-19 response claiming that it would be used as a “back up”, in case of the need for extra doses given the emergence of the new UK strain of the virus. Moreover, it was also made clear that Covaxin would only be administered in “clinical trial mode”, where its recipients would be asked for their consent and proper monitoring for side-effects would follow. 

However, this stance towards the vaccine changed a few days later, when it was announced that both vaccine candidates will be treated at par with one another.  According to Dr Samiran Panda, a scientist at the ICMR, the circulation of the vaccine essentially implied a single-arm clinical trial, where a placebo wouldn’t be used and results wouldn’t be published under a peer-reviewed journal. Moreover, vaccine recipients would not have the option to choose between Covaxin and Covishield. It was this sudden change of positions that raised concerns. 

Consent, Choice and the State

The question about individual choice and consent is critical to the discourse around the inoculation mission. The lack of choice between vaccine candidates has affected turnout rates with only around 56% of eligible individuals getting vaccinated due to concerns among healthcare and frontline workers about the controversy surrounding its fast-paced rollout.

Ethical concerns regarding consent plague the program – should recipients, who aren’t willing participants of a research study, not be allowed to choose between two vaccines that differ in terms of proven efficacy and safety? Given the major difference between the vaccine candidates, how can consent retain its true value when it directly robs an individual of their agency to make personal medical decisions? Most crucially, should the state have the authority to directly or indirectly force the hand of citizens in making informed medical choices?

The decision of the rollout of Covaxin under current conditions seems even more dubious at a time when essential workers are invaluable and at the highest risk of contracting the virus. 

Shifting Positions and Unwelcome Surprises

The behaviour of the Indian state and its important bodies in relation to its treatment of Covaxin is also perplexing. The very approval of a vaccine that hasn’t yet completed Phase 3 clinical trials raises alarm. The third phase of trials is critical since it provides for the closest possible model of how a vaccine candidate will behave when administered to a large population.

The vaccine’s intended use has also been disputed. The DCGI had claimed that it would be administered in an open-label clinical trial to ascertain its efficacy against the UK strain of the virus. In direct contradiction, Bharat Biotech managing director Krishna Ella has stated that there was no “confirmatory data” indicating that Covaxin works against it, and has suggested that this form of vaccine circulation was sprung upon him by the government.

The sheer disconnect between the understanding of India’s major regulatory body and the vaccine manufacturer not only is a matter of concern but also sets a worrisome precedent. Moreover, the suggestion that Bharat Biotech was unaware of the government’s expectation of the vaccine’s use can also lead to long-lasting implications for public trust in regulatory bodies and affect state standards for treatment approvals in the future. 

 Vaccine Diplomacy and Anti-Nationals
The past year has been marked by governmental positions that encourage the idea of India as a major player in the global response against COVID-19. The consequence of the same is the attachment of national pride to India’s vaccine response.  Hence, in the face of concerns about the vaccine, critics of the vaccination program have been liberally deemed ‘anti-national’, an all-too-familiar narrative that conveniently sensationalizes every aspect of the matter except its core problems.
Given that Covishield is relatively cheaper than Covaxin, it is important to question the government’s decision to purchase and circulate a vaccine that is yet to produce Phase 3 trial data. Moreover, India has only exported doses of Covishield so far despite having purchased 3.85 million doses of Covaxin, which is peculiar given the government’s otherwise confident domestic narrative around the vaccine. These facts paint a murky picture – one where India seems to be balancing domestic needs and international ambitions, with the former placed in relatively more uncertain territory than the latter.It is necessary to establish that the crux of the concerns surrounding Covaxin pertains to the confusion around its intended usage, authorization prior to completing Phase 3 trials, and the issues of recipient consent and choice. A pandemic is the worst possible time to sow skepticism around medicine. At the same time however, it is important to recognize that the consequences of any missteps in approval or administration of treatments can trigger mass disillusionment from life-saving scientific treatments for years to come. Given as things stand in India, one can only wait and observe what unfolds.

Aarohi Sharma is a Psychology student at Ashoka University. Her academic interests primarily focus on the intersection of politics and psychology in society.

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 7

Road to Recovery: A Conversation on Covaxin with Prof. Gautam Menon

What exactly do clinical trials for a new vaccine involve? 

The first step after a potential vaccine is developed is to try it out on animals to check that it is not toxic and that it leads to an immune response. If this step is successful, the next stage is to move to human trials, where these preliminary trials are called phase 1 trials.

In such trials, healthy volunteers (typically 20-50 in number) are injected with one of a range of possible doses of the vaccine, to determine the optimal and safe dose, starting from very small doses. Whether the vaccine elicits an immune response is also verified. In phase 2 trials, the immune response is examined further, and questions of side effects and safety are also explored in a larger group of volunteers, typically more than 100.

Finally, phase 3 trials involve administering the vaccine to a much larger group, often tens of thousands of people, selected to be representative of the population. These trials are called “randomized control trials”. In these trials, about half the participants enrolled are given a placebo, something that is harmless to the body, while the other half is given the vaccine. No one knows, not even the doctors administering it, whether the injection contains a placebo or the real thing.

In India, emergency use authorization has been granted to two vaccines: Covishield, made by the Serum Institute of India and Covaxin, made by Bharat Biotech.

Since Covaxin didn’t complete its phase 3 trials and publish them, what can we confidently say about its efficacy? 

At the moment we can say little since there simply is no data yet. In the much smaller phase-1 and phase-2 trials, the vaccine elicited a robust immune response, making antibodies against the virus. The vaccine was also shown to be safe in appropriate doses. It is based on an inactivated whole-virus vaccine platform which is well-understood. However, it is important to understand that efficacy—whether a vaccine works well at preventing you from getting the disease under ideal conditions—is not a simple and immediate consequence of immunogenicity, the ability of a vaccine to provoke an immune response. That is why we need phase 3 trials in the first place.

Is there a broader misunderstanding of immunogenicity and efficacy? What is the difference and why is it important? 

A vaccine should certainly provoke a response from the immune system. That’s central to how vaccines function. But whether it works in preventing people from getting the disease – protective immunity – is a harder question and there are a few things that could go wrong. One extreme case is that getting vaccinated might, paradoxically, increase your chances of severe disease, through what is called ADE or antibody-dependent enhancement. Another possibility is a vaccine-associated enhanced respiratory disease, in which antibodies induced by the vaccine bind with viruses and form immune complexes that clog the lungs. These are possibilities that a phase-3 trial should rule out.

How is Covaxin going to complete phase 3 trials?

What should happen, in principle, is the following: The scientists running the trial will wait till a certain number of people, a number pre-approved in the trial protocol, within the group that received an injection, are diagnosed with COVID-19. They then go back and check whether these people belonged to the group that was administered the placebo or the actual vaccine. If there are many more cases in the placebo group than the vaccine group than can be accounted for by chance, that suggests that the vaccine works in protecting against developing the actual disease.

The problem is that it may take some time to reach this stage of having a predetermined number infected with the disease. Since most people develop no or only mild symptoms of the disease, they may not notice they have been infected.

A second problem is that phase-3 trials are being done in a background where a good number of people have already been infected in the past, so are immune to the disease for at least some time, as far as we know. These people won’t develop the disease even if they encounter an infected person.  

Finally, currently in India, all this is happening in the background of a steadily decreasing number of new cases. This makes it harder to have new infections in the trial group.

Why aren’t people given a choice on which vaccine they would prefer? 

The government, which is, after all, making these vaccines available for free at this point, may have wanted to ensure that they did not appear to be favouring one over the other when granting emergency-use approval. Perhaps there is also an element of national pride in this, in that Covaxin is a fully indigenous vaccine while Covishield is the result of a collaboration with international groups, at Oxford University and the pharmaceutical giant AstraZeneca.

What, according to you, is the biggest health concern with not having any efficacy data on Covaxin? 

Whenever one is administering a vaccine to a healthy person, one would like to know that it has been worth it. Does the vaccine, for example, provide protection against the disease to more than 50% of the population it is administered to? A phase-3 trial, precisely because it is so large and planned as a randomised control trial, is a good way to ask this question as well as to look out for possible rare but serious side-effects of being vaccinated.

Would it have been a better move to rollout Covaxin after phase 3 clinical trial data was published? Why do you think it was encouraged over other alternatives? 

It would have been better to rollout Covaxin after the efficacy data became available, in my opinion. Data demonstrating good efficacy and safety, which could have taken another month or so to obtain, would have spoken for itself.

Of course, these decisions have to be made based on available information as well as projections for what might happen in the future, such as new variants that are more transmissible. There are certainly cases where granting emergency use authorisation might have been justified. This is why scientists as well as the lay public need to understand the basis on which these decisions were made.

The committee that approved Covaxin distribution may have had data that was shown to it that suggested that it was efficacious. We don’t know because neither the names of the committee members nor the minutes of their deliberations are available to us.

Transparency should always be a central consideration in such matters, especially since you will be vaccinating people who are healthy and you don’t want to compromise on safety.

Considering how the vaccination drive is going right now, do you think vaccine hesitancy is slowly eroding and that target numbers will be met? 

Yes, the numbers of those getting vaccinated each day are steadily increasing. That is a good sign. Unlike in the USA and some other developed countries, there is no strong anti-vaccination movement in this country and people are accustomed to large-scale immunization programs, such as the pulse polio campaign.

Do you think the vaccine rollout should’ve been critiqued more or less than it was by the Indian scientific community? What could have been different?

I think the sections of the scientific community that critiqued the Covaxin rollout did the right thing. Prof. Shahid Jameel of Ashoka University and Prof. Gagandeep Kang of the CMC Vellore, in particular, were sane voices in this, pointing out gently, but firmly, the need to stick to established procedure. One has to ensure that the public does not feel that they would be guinea pigs. Several fellows of the Indian Academy of Science also signed a document expressing their concern.

I was dismayed at the counter signature campaign, supporting the Covaxin rollout, from a group of 49 medical doctors and scientists. Their arguments made little sense to me.

Can anything be said about whether the current vaccine candidates can be effectively used for the new strains of the virus?

There is some encouraging news of the effectiveness of some of the international vaccines against the new strains, although perhaps not at the same level. Bharat Biotech has claimed very recently that its Covaxin was effective against the UK variant of the virus. Our understanding is rapidly evolving.

Do you think that the overall vaccine development process has changed in the course of the global effort in formulating a COVID-19 vaccine?

Absolutely. I thought, as many others did, that a period of 18 months to two years would be the minimum time required for a vaccine to be distributed. That we managed to do this in less than a year is a remarkable achievement. Without our ever-improving knowledge of both basic and applied science, this would simply have been impossible. Indeed, it would have been impossible even a decade ago.

I am, in many ways, proud of what India has achieved. The Serum Institute of India, located in Pune, is the world’s largest vaccine manufacturer. Bharat Biotech, the manufacturers of Covaxin, has a manufacturing plant that is the largest of its kind in the Asia-Pacific region. It is a respected company which exports therapeutics and vaccines across the world. India itself produces 60% of global vaccines. The Director-General of the WHO commented recently that “…the production capacity of India is one of the best assets the world has today”.

As an Indian, this does make me very happy.

Gautam Menon is Professor of Physics and Biology at Ashoka University as well as Professor of Theoretical Physics and Computational Biology at the Institute of Mathematical Sciences in Chennai. He works in biophysics as well as in, more recently, the modelling of  infectious disease.

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 2

National Digital Health Mission & Privacy: Should we be worried?

On the 15th of August, Prime Minister Modi announced the new National Digital Health Mission and its pilot launch in six government territories. According to the policy draft, this new mission will radically change healthcare – lowering cost, increasing transparency, and bringing healthcare services even to the most remote corners of the country. However, ever since its announcement, many have been voicing privacy concerns. 

While some believe that this will be a revolutionary change to India’s Healthcare system, making all things healthcare easier than ever before, others argue that such a program is unnecessary and distracts us from real issues. According to the Indian Medical Association, such a plan may distract us from real problems such as the lack of sufficient and proper medical health structure. The association also said that strengthening public health infrastructure and addressing social determinants of health should be our priority right now, and the new plan will possibly divert funds from these issues, further jeopardizing public health care. The biggest concern, however, is confidentiality and privacy. 

Confidentiality and health privacy of patients is one of the most fundamental principles of Healthcare. This is not only to protect the patient from any kind of stigma and discrimination but also to establish trust between health facilitators and patients. Another important cause for this is the idea of self-ownership and bodily integrity; as rightful owners of our bodies, only we have the right to own our biological data and decide with whom our data is shared. The Digital health mission repeatedly emphasizes its stringent security and consent-based shared guidelines on the policy document but many still believe that the national health mission could pose a grave threat to the privacy and security of citizens. 

One reason behind this is the numerous privacy breaches of the past. With data as sensitive as this, how can we trust the government to believe the same will not happen again? The Aadhaar, for example, has been a subject of data leaks on far too many occasions, yet there is still no accountability from the government. Furthermore, if our Health IDs will be connected to our Aadhaar, the risks of our personal health data being accessed and misused by an unauthorized person or entity further increase. Similarly, with the Aarogya Setu app, there was no transparency on whether data collected was being deleted after patients recovered and how the app functions on the phone due to the code not being open source. 

Another area of concern is the possibility of our health data sold off to private companies. According to the National Health Data Management policy, anonymized, de-identified, and aggregated data may be made available to organizations (page 21). In the past year alone, there has been an explosion in the number of cases of big tech and pharma companies collecting personal health data. The NHS was found to be providing data to Amazon, Google bought the health records of 50 million Americans from insurance companies, and pharmaceutical company GlaxoSmithKline paid DNA testing company $300 million for customer data. Big companies are chasing after our data, and with the implementation of the National Digital Health Mission, India might become a new market for getting such data. 

Big tech companies like Google, Amazon, and Apple are collecting health data for the use of building their own AI Health technologies. While these AI health technologies could prove to be highly useful and beneficial in the future, there are still concerns about whether these companies are using this data ethically. For example, last year when Google bought personal data from insurance companies and medical institutions in the USA, we found that even though those records were stripped of identifying details such as name, contact information. Google combined these records with the information Google already had from the database. This included all personal information collected form smartphones that could easily establish the identity of the patient’s medical records. This is not just true for big tech companies, research has shown that even anonymous information can be easily re-identified, even if data sold is anonymized and aggregated. How do we know that big tech companies will only use this research as they claim, and not for profit? Although tech companies say this data will only be used for research, an anonymous whistleblower has claimed Google does use this data to mine patient information, run analytics and then sell this data to third parties to be able to target healthcare ads based on the patient’s medical history. 

The truth is that there is no guarantee of how this data will be used. Although personalized healthcare ads might be a relatively light issue, we cannot even comprehend how this data could be used and what harm it could cause to us in the worst-case scenarios. The Cambridge Analytica scandal is one example of how our data was used against us to sway elections. With our sensitive health data involved and big tech companies beginning to work on AI based healthcare, the implications of possible data misuse could be even graver. 

Besides big tech companies, pharmaceutical and insurance companies are chasing after our medical data. Pharmaceutical companies have also been found to use digital record-keeping systems in hospitals to gather information and use it to sell drugs. There are also some findings that insurance companies are beginning to gather data on race, marital status, how much TV you watch, and even the size clothing you wear. With our entire medical history available, insurance companies would have more power than ever before, patients could be denied health coverage or be charged higher based on their medical history or even one’s genetic data. 

While it is true that digitizing the healthcare ecosystem in India could be beneficial for streamlining healthcare, the privacy concerns are difficult to ignore. Along with bringing transparency and accessibility, it also opens new doors for data misuse and possible stigma and discrimination. Without a data protection law in place and actual technological infrastructure to protect our data, the implementation of this project is dangerous. 

Aradhya is a psychology major at Ashoka University. In her free time you’ll find her reading books, drinking chai and cycling at odd hours.

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