The HINDU Notes – 12th May 2021 - VISION

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Wednesday, May 12, 2021

The HINDU Notes – 12th May 2021


📰 Questions remain on DRDO’s COVID drug

Experts flag lack of published data on performance in human trials, history of drug’s use in cancer cure

•A drug developed by the Defence Research and Development Organisation (DRDO) and approved by the Drug Controller General of India (DCGI) for “emergency use” in those with moderate to severe COVID may soon make its way to hospitals for treating moderate and severely ill patients, but independent experts say that from the information so far available, the drug's utility in COVID care has not been established.

•The lack of published data on its performance in human trials, opaqueness on whether the phase-3 trial objectively evaluated the benefit from, or lack of it, of the drug and the drug's history — of being an unapproved anti-cancer drug and therefore potentially able to harm healthy cells — some of the concerns contributing to the uncertainty, experts told The Hindu.

•2-Deoxy-D-Glucose drug has historically been extensively tested for treating cancer but is so far an unapproved drug.

•The Institute of Nuclear Medicine and Allied Sciences (INMAS), a lab of the DRDO, in collaboration with Dr Reddy’s Laboratories (DRL), Hyderabad, too has been studying this drug, in the context of radiation therapy for cancer.

•The drug had been tested in trials and was given to Dr Reddy’s Laboratories in 2014 as part of a collaboration, according to Dr. Sudhir Chandna, Additional Director, INMAS, DRDO. The basic mechanism of the drug involves inhibiting glycolysis, or one of the ways in which cells break down glucose for energy. This approach while used to starve and kill cancer cells, could in theory work in inhibiting virus cells too, that were almost entirely dependent on glycolysis for replication.

•Tests at the Centre for Cellular and Molecular Biology, Hyderabad, last year indicated that the drug demonstrably killed virus cells after which it progressed to trials in people. Dr Reddy's Labs approached a Subject Expert Committee (SEC) of the DCGI for permission to commercially market and furnishing data from a Phase-2 trial to evaluate the optimum dosage of the drug. The SEC, however, recommended a larger Phase-3 trial “with adequate sample size” and “clearly defined” criteria to evaluate if the drug demonstrably cured COVID.

•Dr Reddy's in its application to the SEC for Phase-2 trials in June 2020, noted that while the drug was yet unapproved, it had been tried in 218 clinical trials so far as an anti-cancer drug.

•“Dr Reddy’s believes that this could potentially result in a preferential and disproportionately high accumulation of 2-DG in inflamed lung tissue of COVID-19 patients thereby leading to starvation in the lung cells, which in turn would lead to inhibition of viral replication,” their statement noted.

•Annoucing the success of the drug, a press statement from from the DRDO said: “Clinical trial results have shown that this molecule helps in faster recovery of hospitalised patients and reduces supplemental oxygen dependence. Higher proportion of patients treated with 2-DG showed RT-PCR negative conversion in COVID patients.”

•A “significantly higher proportion” of patients improved symptomatically, were free from supplemental oxygen dependence (42% vs 31% (in those who didn't get the drug) by Day-3 in comparison to SoC, indicating an early relief from oxygen therapy/dependence, the statement noted.

•“Cancer cells depend heavily on glucose for their survival and hence by tagging them with 2DG we can restrict cancer cell growth. Similarly, it can also affect high glucose utilising normal cells like brain cells (neurons) and could cause brain related side effects,” Dr. Cyriac Abby Philips, who specialised in Hepatology and Liver Transplant Medicine, at Rajagiri Hospital in Kerala said in an email.

•He perused the available literature on the drug and observed that the safety profile of the drug was “still questionable” At a dose of 63 mg/kg/day, a clinical trial had observed cardiac side-effects and cast doubt on the feasibility of this drug for further clinical use in cancer patients. The sample size of 220 as mentioned in the CTRI (an ICMR website where all human trials must be registered) was inadequate for assessing safety profile along with efficacy, he noted.

•Dr. Chandna told The Hindu that a detailed publication was due next month. The phase-3 trial having been conducted in 27 hospitals spanning several States, in the middle of a pandemic, meant that data “hadn't been uploaded” from some sites. He, however, said the necessary data had been submitted to the DCGI, based on which the emergency use authorisation had been given. He added that in the set of patients who got the drug, there was “complete recovery” and there was “statistically significant improvement” in those who got the drug.

•A properly conducted trial must be double blinded and the expected outcomes be clearly defined. This wasn't apparent in the trial details, said Dr Sahaj Rathi, Assistant Professor, Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India, in an email. “The CTRI website has very limited information. For example, the primary outcome is listed as “efficacy of 2DG as adjunctive therapy”, which is not an outcome. Outcomes are supposed to be objective, and tangible, eg- survival, duration of hospitalisation, proportion of patients requiring mechanical ventilation.”

•In the 1970's, the drug had previously been tried as an antiviral against influenza, as a stimulator for gastric acid secretion and had been experimented with as a lone therapy or an add-on to cancer chemotherapy drugs, he noted. He said that he wouldn't recommend the drug until peer-reviewed phase 2 and phase 3 data was published.

•Rathi described the claimed result, of 42% of patients on the drug improving symptomatically and being free from supplemental oxygen within three days, against 31% who didn't, as needing more substantiation

•“Was this improvement sustained? Did it actually prevent patients from going onto the ventilator? Did it prevent deaths,” were crucial questions that so far lacked answers.

📰 What is happening in Jerusalem?

Tensions have been building up since the start of Ramzan in mid-April when Israeli police set up barricades at the Damascus Gate outside the occupied Old City

•The story so far: On Monday, Israeli armed forces stormed Al-Aqsa Mosque in the Haram esh-Sharif in Jerusalem, ahead of a march by Zionist nationalists commemorating Israel’s capture of the eastern half of the city in 1967. More than 300 Palestinians were injured in the raid. In retaliation, Hamas, the Islamist militant group that runs Gaza, fired dozens of rockets. The Israelis launched an airstrike on Gaza in response, killing at least 21 Palestinians, including nine children.

What is behind the current escalation?

•Tensions have been building up since the start of Ramzan in mid-April when Israeli police set up barricades at the Damascus Gate outside the occupied Old City, preventing Palestinians from gathering there. As clashes erupted, the police removed the barricades, but tensions were already high.

•The threatened eviction of dozens of Palestinian families in the East Jerusalem neighborhood of Sheikh Jarrah escalated the crisis further in the last week of Ramzan. Clashes erupted on the night of May 7 in Jerusalem between Palestinian protesters and Israeli police in which hundreds of Palestinians and over a dozen Israeli police personnel were injured.

•The Israeli authorities had given permission to the Jerusalem Day march, traditionally taken out by far-right Zionists through the Arab Quarter of the Old City. Ahead of the march on May 10 (which was rerouted given the tensions), Israeli armed forces stormed Al-Aqsa Mosque with rubber bullets, stun grenades and tear gas to evict Palestinians, who Israel said had camped with stones and Molotov cocktails. Hamas issued an ultimatum to the Israeli troops to stand down from Al-Aqsa. By the evening, they launched rockets. Israeli strikes followed.

What is the Sheikh Jarrah dispute?

•Hundreds of thousands of Palestinians were forced out of their homes when the State of Israel was created in historical Palestine in 1948 (the Palestinians call the events ‘Nakba’, or catastrophe). Twenty-eight of those Palestinian families moved to Sheikh Jarrah in East Jerusalem to settle there.

•In 1956, when East Jerusalem was ruled by Jordan, the Jordanian Ministry of Construction and Development and the U.N. Relief and Works Agency facilitated the construction of houses for these families in Sheikh Jarrah. But Israel would capture East Jerusalem from Jordan in 1967.

•By the early 1970s, Jewish agencies started demanding the families leave the land. Jewish committees claimed that the houses sat on land they purchased in 1885 (when Jews were migrating to historic Palestine that was part of the Ottoman Empire). Earlier this year, the Central Court in East Jerusalem upheld a decision to evict four Palestinian families from their homes in Sheikh Jarrah in favor of Jewish settlers.

•The Israeli Supreme Court was scheduled to hear the case on May 10. But it was postponed on advice from the government amid the ongoing violence in Jerusalem. The issue remains unresolved and potentially inflammable.

Why Jerusalem?

•Jerusalem has been at the centre of the Israeli-Palestinian conflict. According to the original 1947 UN partition plan, Jerusalem was proposed to be an international city. But in the first Arab Israel war of 1948, the Israelis captured the western half of the city, and Jordan took the eastern part, including the Old City that houses Haram al-Sharif. Al-Aqsa Mosque, Islam’s third holiest site, and the Dome of the Rock are situated within Haram esh-Sharif (Noble Sanctury).

•One side of the compound, called Temple Mount by the Jews, is the Wailing Wall (Western Wall), which is believed to be the remains of the Second Jewish Temple, the holiest site in Judaism.

•Israel captured East Jerusalem from Jordan in the 1967 Six-Day War and annexed it later. Since its annexation, Israel has expanded settlements in East Jerusalem, which is now home for some 220,000 Jews. Jews born in East Jerusalem are Israeli citizens, while Palestinians in the city are given conditional residency permits. Palestinians in East Jerusalem, unlike other parts of the occupied West Bank, can, however, apply for Israeli citizenship.

•Very few Palestinians have done so. Israel sees the whole city as its “unified, eternal capital”, a claim endorsed by Donald Trump when he was U.S. President but not recognised by most other countries. The Palestinian leadership across the political spectrum have maintained that they would not accept any compromise formula for the future Palestinian state unless East Jerusalem is its capital.

📰 A matter of concern: On Indian coronavirus variant

New variants do not always merit changes in public health response, but keep people alert

•The Indian variant, B.1.617 and its family of related coronaviruses have been categorised as a Variant of Concern (VOC) by WHO, a classification which will now prompt greater international scrutiny of those who test positive overseas. While there are several so-called ‘variants of interest’, only three, other than the B.1.617, have been categorised as VOC — the U.K. variant (B.1.1.7), the South Africa variant (B.1.351) and the Brazilian variant (P2). Usually, in countries that detect emergent variants, it is the health authorities there who flag them as potential VOC. To qualify as one, the identified variant must be linked to increased transmission or be associated with more severe disease or found to be evading detection by diagnostic tests. Concerns that the B.1.617 may be playing a role in disease spread in India were expressed by scientists by mid-March. The INSACOG, or the Indian SARS-CoV2 Genomic Consortia, had flagged a variant with two concerning mutations, E484Q and L452R, that separately had been found in other variants elsewhere. INSACOG said they now seemed to appear together on a variant that was linked to a large fraction of cases in Maharashtra and began to be called ‘double mutant’ or even ‘triple mutant’ (as it also had another important mutation, P614R).

•In March nearly 20% of the cases out of Maharashtra, which has consistently been among the most afflicted States, were being linked to the variant. However, it was in early April that this variant became formally classified as a lineage, B.1.617. It was only after the U.K.’s labelling it as a VOC that it was called so by health authorities in India. In fact, unlike the United States’s CDC or Public Health England, India still does not have a classification criterion for labelling viruses as variants of interest, or concern. Classifying variants is not just a matter of mere academic interest. Based on the prevalence, some variants may go on to become the dominant strain in a region or multiple geographies. It then becomes the responsibility of vaccine companies to check whether their vaccines continue to be effective. Such studies have already begun in India, but while laboratory studies show that vaccines continue to be effective, some of the emerging variants do seem to be better at evading antibodies. Along with monitoring reinfections and cases of breakthrough infections (testing positive after being double inoculated), flagging variants must be seen as a crucial health response. Detecting newer variants does not always merit radical changes in public health response — such as masking up — but they go a long way in reminding people to continue being alert, viewing vaccines as an important defence but not a magic pill, and keeping health authorities on their toes.

📰 Not all crises are opportunities for reforms

The call for reforms today leaves out the stakeholders, which might undermine the very purpose of reforms

•This year marks 30 years of the landmark economic reforms that permanently altered the production and distribution structures of the Indian economy. Swayed by the success of the 1991 reforms, albeit, at the macroeconomic level, there has been a growing clamour from economic commentators for some more doses of reforms in 2021. Both 1991 and 2021 have one thing in common: an economy facing a severe growth crisis. This raises two fundamental questions. First, is crisis a prerequisite for reforms? Second, given the magnitude of economic contraction, in 2021, are reforms capable of rejuvenating the economy or will they push the economy towards growth fatigue?

Crises and reforms

•It is not very common to depart from initiating incremental policy changes to making fundamental shifts in economic policy. Big-bang policy reforms often face hurdles in terms of rules and routines. Overcoming these requires effort and conviction. Crises provide opportunities for radical changes as they break down the legitimacy of existing policy approaches. Crises thus create a space for new proposals and possibilities, which could have far-reaching consequences for the economy and society. Viewed from a sectoral perspective, during a crisis, the services delivered by some sectors do not meet societal expectations, which in turn sets the stage for institutional reforms to enhance the credibility and legitimacy of those sectors. For the policymaker, crises can generate increased demand for change and that could be the opportunity for which they would have been waiting. However, not all crises create conditions for widespread acceptance of reforms, as they could generate other by-products. Thus, to posit a linear causal relationship between crises and reforms could be erroneous.

•Crises cause the breakdown of established structures leading to instability. They create uncertainty as the prevailing behaviour and choices of actors change. This combination of uncertainty and instability sets the stage for a reorientation of policies, packaged and delivered under the banner of reforms. The argument for converting a crisis into an opportunity to reform arises due to three factors. First, during a crisis, group relations and modes of interactions change, which sets a suitable background for change. Second, at times of crises, authority replaces rules, which makes it easier to push the polices in a short time span. Third, during periods of crisis, the legitimacy of prevailing rules and routines diminish, which makes it easier for actors to depart from them.

2021 is not 1991

•The character and consequences of the crisis of 1991 and 2021 are different. In 1991, the crisis of the economy was the product of endogenous factors, that is, factors which were operating within the economic system. The crisis of 2021 is different, as it is the product of a pandemic, which is exogenous to the economic system. The cause-and-effect relations are entirely different in the latter, as the cause originates from outside the economic system and the economy is forced to adjust to this external shock. Further, in 1991, the crisis was limited to the Indian economy, while the present calamity has engulfed most global economies with varying intensities. This makes policy responses very challenging. In the former case, we could have India-specific policies, assuming that there would not be drastic changes in the rest of the world, while in the latter case, India-specific policies will have to be tempered with the dynamics of the rest of the world, as all affected economies are formulating policy responses at the same time.

•The availability of a semi-fixed template for reforms eased the matter in 1991. The template, which had some generic measures for all the economies experiencing external sector imbalances, was a tried and tested one. This gave policymakers some headroom to anticipate the likely consequences in the post-implementation phase.

Two uncertainties

•However, in 2021, the challenge is to evolve a country-specific package. Two uncertainties pose serious problems in charting such a set of measures. The first is the uncertainty with regard to the government’s own revenues which would limit the policy space for interventions. Expenditure reduction is not a viable strategy for expanding the scale and scope of policies in a situation of demand contraction due to the pandemic. The second is the unpredictability of global factors, as India’s dependence on the global economy increased manifold after the 1991 reforms. Both these have the potential to jeopardise the effective implementation of strategic changes.

•The magnitude and intensity of the crisis of 2021 is manifold compared to that of 1991. There is also a lag effect in the unravelling of the scale and extent of the crisis, which is surfacing slowly. To highlight this point, I use only one piece of empirical data. In its recent research report, Pew Research Center observes that a large section of India’s population would be pushed into poverty as a fallout of the economic crisis driven by the novel coronavirus. To quote: “…. the number of people who are poor in India (with incomes of $2 or less a day) is estimated to have increased by 75 million because of the COVID-19 recession. This, too, accounts for nearly 60% of the global increase in poverty. Perhaps not surprisingly, media reports from India point to a spike in participation in its rural employment programme – originally intended to combat poverty in agricultural areas – as the many who have lost jobs in the reeling economy seek work. The number now participating is setting record highs in the programme’s 14-year history”. The enormity of the crisis is appropriately captured in the research cited above, which throws light on the circumstances of 2021 and its non-suitability as a year for radical reforms.

•All crises do not inevitably lead to possibilities for reforms, even though some do create opportunities for fundamental changes. However, to gauge whether a crisis can be turned into an opportunity for reforms requires an in-depth understanding of the factors that led to the crisis. Further, all the three clusters of actors who are crucial agents in the policy process — political leaders, policymakers and implementers, and the relevant stakeholders — need to have a shared vision. In 2021, the call for reforms leaves out the stakeholders, which might undermine the very purpose of reforms itself.

📰 How to adopt a child legally

During a crisis, an outreach programme must warn everyone not to entertain any illegal adoption offers

•Profiteering from child trafficking rackets knows no bounds. Today, some people are offering infants for instant adoption by selling sob stories of how the children have lost their parents to the dreaded virus. These unscrupulous people target gullible persons who fall into the trap, little realising that such adoptions are illegal. The lack of inputs for proper procedures for legal adoption and hasty sentimental considerations are exploited for exorbitant sums of money. Tough times call for tough measures. This business of criminal trading of children must be checked with an iron hand.

Protection granted by the law

•According to UNICEF, India has over 30 million orphan and abandoned children. Unfortunate parental deaths added unknown numbers of orphans to the list. Many children escaped monitoring by the official machinery due to the breakdown of systems. The Juvenile Justice (Care and Protection of Children) law was enacted in 2015. The Juvenile Justice Rules of 2016 and the Adoption Regulations of 2017 followed to create the Central Adoption Resource Authority (CARA) as a statutory body for the regulation, monitoring and control of all intra-country and inter-country adoptions. Furthermore, CARA became pivotal in granting a ‘no objection’ certificate for all inter-country adoptions, pursuant to India becoming a signatory to the Hague Convention on Protection of Children and Co-operation in Respect of Intercountry Adoptions. India is also a signatory to the UN Convention on the Rights of the Child. Thus, protections afforded to children became a legal mandate of all authorities and courts. Laws were enacted. Machineries and mechanisms created were put in place.

•The Juvenile Justice Act is a secular law. All persons are free to adopt children under this law. However, persons professing the Hindu religion are free to adopt under the Hindu Adoptions and Maintenance Act of 1956. Rehabilitation of all orphaned, abandoned and surrendered children is regulated by the strict mandatory procedures of the Adoption Regulations. Children of relatives can also be adopted under the Juvenile Justice Act, if desired. Only such children declared legally free for adoption under the Juvenile Justice Act by prescribed procedures can be adopted. Any person or organisation offering or receiving such children for adoption in violation of the Juvenile Justice Act and the Adoption Regulations invites punishment up to three years and a fine of ₹1 lakh, or both.

Following procedure

•The eligibility of prospective adoptive parents living in India, duly registered on the Child Adoption Resource Information and Guidance System (CARINGS), irrespective of marital status and religion, is adjudged by specialised adoption agencies preparing home study reports. Upon approval, as per seniority in the adoption list, prospective children are offered and pre-adoption foster care follows. The specialised adoption agency then secures court orders approving the adoption. All non-resident persons approach authorised adoption agencies in their foreign country of residence for registration under CARINGS. Their eligibility is adjudged by authorised foreign adoption agencies through home study reports. As per seniority, they are offered profiles of children and child study reports are finalised. CARA then issues a pre-adoption ‘no objection’ certificate for foster care, followed by a court adoption order. A final ‘no objection’ certificate from CARA or a conformity certificate under the adoption convention is mandatory for a passport and visa to leave India.

•Not many may know this. CARA must conduct an outreach programme on social media, newspapers and TV, warning everyone not to entertain any illegal adoption offers under any circumstances whatsoever. The legal process of adoption must be adequately publicised. The National and State Commissions for Protection of Child Rights must step up their roles as vigilantes, as they are empowered by law to take effective action against those engaging in illegal activities. Social activists, NGOs and enlightened individuals must report all the incidents that come to their notice. Respective State Legal Services Authorities have the infrastructure and machinery to stamp out such unlawful practices brought to their attention. The media must publicise and shame all those involved in this disreputable occupation. Innocent children deprived of the love and care of their natural parents due to tragedies cannot fall prey to traders of human smuggling. At the same time, the police authorities need to be extra vigilant in apprehending criminals. A joint private-public venture must come into motion. Every citizen of the nation has a role to play in eradicating this unhealthy practice.

📰 Evaluate the Ladakh crisis, keep China at bay

A critical assessment of the stand-off offers New Delhi key lessons in managing the strategic competition with China

•After over a year, the stand-off between Indian and Chinese troops in eastern Ladakh shows no signs of resolution. Disengagement has stalled, China continues to reinforce its troops, and talks have been fruitless.

•More broadly, the India-China bilateral relationship has ruptured. Political relations are marked by hostility and distrust. Reversing a long-held policy, New Delhi will no longer overlook the problematic border dispute for the sake of a potentially lucrative wider relationship; now, as India’s External Affairs Minister S. Jaishankar has made clear, the relationship is conditional on quietude on the border.

•Even if — a big if — disengagement continues, the relationship will remain vulnerable to destabilising disruptions. On the Line of Actual Control (LAC) and beyond, India’s military and political leaders will need to learn the right lessons from Ladakh, to ensure they are better postured to meet the challenge of Chinese coercion.

Study and findings

•In a recent study published by the Lowy Institute — The crisis after the crisis: how Ladakh will shape India’s competition with China — this writer has argued that the Ladakh crisis offers New Delhi three key lessons in managing the intensifying strategic competition with China.

Revamping strategies

•First, military strategies based on denial are more useful than strategies based on punishment. The Indian military’s standing doctrine calls for deterring adversaries with the threat of massive punitive retaliation for any aggression, capturing enemy territory as bargaining leverage in post-war talks. But this did not deter China from launching unprecedented incursions in May 2020, and the threat lost credibility when retaliation never materialised.

•In contrast, the Indian military’s high-water mark in the crisis was an act of denial — its occupation of the heights on the Kailash Range on its side of the LAC in late August. This action served to deny that key terrain to the Chinese People’s Liberation Army (PLA), and gave the Indian Army a stronger defensive position from which it could credibly defend a larger segment of its front line.

•A doctrinal focus on denial will give the Indian military greater capacity to thwart future land grabs across the LAC. By bolstering India’s defensive position, rather than launching an escalatory response, such a strategy is also more likely than punishment to preserve crisis stability. Over time, improved denial capabilities may allow India to reduce the resource drain of the increased militarisation of the LAC.

Political costs

•The second key lesson of Ladakh is that China is more likely to be deterred or coerced with the threat of political costs, rather than material costs. Admittedly, the Chinese military’s deployment to the LAC was also large and extremely expensive. But China’s defence budget is three to four times larger than India’s, and its Western Theatre Command boasts over 200,000 soldiers. The material burden of the crisis would not disrupt its existing priorities.

•In contrast, India successfully raised the risks of the crisis for China through its threat of a political rupture, not military punishment. A permanently hostile India or an accidental escalation to conflict were risks that China, having achieved its tactical goals in the crisis, assessed were an unnecessary additional burden while it was contending with the instability of its territorial disputes and pandemic response.

•The corollary lesson is that individual powers, even large powers such as India, will probably struggle to shift Beijing’s calculus alone. To the extent that China adjusted its position in the Ladakh crisis, it did so because it was responding to the cumulative effect of multiple pressure points — most of which were out of India’s control. Against the rising behemoth, only coordinated or collective action is likely to be effective.

Indian Ocean Region is key

•The third lesson of Ladakh — and possibly the hardest to address — is that India should consider accepting more risk on the LAC in exchange for long-term leverage and influence in the Indian Ocean Region. From the perspective of long-term strategic competition, the future of the Indian Ocean Region is more consequential and more uncertain than the Himalayan frontier.

•At the land border, the difficult terrain and more even balance of military force means that each side could only eke out minor, strategically modest gains at best. In contrast, India has traditionally been the dominant power in the Indian Ocean Region and stands to cede significant political influence and security if it fails to answer the dizzyingly rapid expansion of Chinese military power.

•The Ladakh crisis, by prompting an increased militarisation of the LAC, may prompt India to defer long-overdue military modernisation and maritime expansion into the Indian Ocean. To keep its eyes on the prize, New Delhi will have to make tough-minded strategic trade-offs, deliberately prioritising military modernisation and joint force projection over the ground-centric combat arms formations required to defend territory.

•This will be a politically formidable task — blood has now been spilled on the LAC, and for domestic political reasons, India cannot be seen to be passive on the border. Rebalancing India’s strategic priorities will require the central government, through the Chief of Defence Staff, to issue firm strategic guidance to the military services. This response will be a test not only of the government’s strategic sense and far-sightedness, but also of the ability of the national security apparatus to overcome entrenched bureaucratic and organisational-cultural biases.

•As these three lessons show, the future of the strategic competition is not yet written. Thus far, India has suffered unequal strategic costs from the Ladakh crisis. Chinese troops continue to camp on previously Indian-controlled land, and worse, India may jeopardise its long-term leverage in the more consequential Indian Ocean Region. But if India’s leaders honestly and critically evaluate the crisis, it may yet help to actually brace India’s long-term position against China.

📰 COVID mishandling foretold in the Budget

That the government did not come up with a detailed ‘COVID-19 Emergency’ Budget for the year 2021-22 is telling

•“India has begun medically safeguarding not only her own citizens against COVID-19 but also those of 100 or more countries. I have provided ₹35,000 crores for Covid-19 vaccine in BE 2021-22...,” was the bombastic claim made by Finance Minister Nirmala Sitharaman in her Budget speech to the nation on February 1, 2021.

•Ms. Sitharaman assured the nation that her government at the Centre was protecting not only Indians but also people of other countries against COVID-19 and that she had provided enough money. She also boasted that the overall Budget for health had been increased substantially and pointed to details in Annexure I of the Budget speech. In Annexure I, a table under ‘Health and Wellbeing – Expenditure’ lists ₹35,000 crore for ‘Vaccination’ under ‘CoVID related Special Provisions’.

Zero amount

•Logically, when the Finance Minister says that the Budget for ‘Health and Wellbeing’ is being expanded significantly, one would expect to see these details in the Ministry of Health and Family Welfare’s Budget. Page 155 of the 350 page ‘Notes on Demands for Grants’ lists the Health Ministry’s Budget details for the year 2021-22. Item No.19 is clearly titled ‘Covid-19 Emergency Response & Health System Preparedness’, which lists an expenditure of ₹11,757 crore that was incurred in the previous year (2020-21) by the Centre in its fight against COVID-19.

•But for the current year 2021-22, the amount budgeted for ‘Covid-19 Emergency Response’ is zero. One then ponders, wondering whether for some reason, COVID-related Budget provisions have been made under another expenditure item in the Ministry’s Budget this year.

•The answer is ‘No’. It is a matter of alarm that there is no provision in the entire Ministry of Health’s 2021-22 Budget for COVID-19 vaccinations and other related expenditure. Moreover, the Health Ministry’s Budget for this year is lower than the amount spent last year when more money was needed to defeat the novel coronavirus this year. It turns out that ₹35,000 crore for COVID-19 vaccination has been allocated as “Loans/Grants to States” in the Budget of the Ministry of Finance.

•Does this mean that when Ms. Sitharaman and the government sat down to prepare the Budget earlier this year, they did not think the Centre had any role to play in vaccination? Did they think that COVID-19 would just disappear providentially and that there was no money required this year for health supplies, infrastructure, and other expenses under the Health Ministry’s ‘Covid-19 Emergency Response package’? On what basis then did the Finance Minister say that her government would not only “safeguard” Indians but also the citizens of 100 or more other countries?

•After this writer pointed this out first in a tweet, the Finance Ministry gave a long and a bureaucratic response about how even if the vaccination amount is not budgeted under the Health Ministry, the Centre could still use the money to procure vaccines and give it as an ‘in-kind’ grant to the States. This misses the point.

•This is not a squabble about the technical details of budgeting for activities under different heads. This is about the intent, thought and actions of the Narendra Modi government in the middle of a national health emergency. Either the government was callous about the nation’s continued fight against COVID-19, or wanted to abdicate responsibility to the States entirely. If not, it would have made a meticulously detailed ‘Covid-19 Emergency’ Budget for the year 2021-22.

More questions

•It is also justifiable to say that public health is a State subject, vaccination is the responsibility of the States, and hence, COVID-19 vaccination money should rightfully be given only to the States and not to the Health Ministry at the Centre. In which case, the States should also be given the full rights to decide and implement a COVID-19 health policy.

•How is it then that the Centre chose to intervene and dictate an irrational vaccination pricing policy that has a lower price for the Centre and a higher price for the States for the exact same vaccine? If at the time of the Budget, the Finance Minister thought COVID-19 vaccination money was fungible and could be used either by the Centre or the States, then how does it square with the fact that with the same money, the Narendra Modi government would buy vaccines at a lower cost to vaccinate Indians above the age of 45 while the States would buy the same vaccines at a higher price for all others?

Vaccine is public good

•It is amply evident that the Finance Minister and her government’s handling of the COVID-19 pandemic is like a deer caught in the headlights. The thought behind the Budget for COVID-19 is at odds with its health policies for COVID-19. A knee-jerk and confused vaccination policy, with varying price structures and quotas for the Centre, States and private hospitals for the same vaccine, has made a royal mess of India’s vaccination efforts. The basic economic principle that a COVID-19 vaccine is an essential public good and not a private good like flight tickets to be priced differently for everyone, seems to have been lost on the government’s policy makers. It has now put the lives of a billion Indians and India’s $3 trillion economy at risk.

•Earlier in January this year, it was crystal clear that India would need to vaccinate the vast majority of its people to put an end to the COVID-19 pandemic. It was also well-established then that there were at least two vaccines available in India and more could be imported, as the Finance Minister herself alluded to in the Budget speech. The approximate costs for these vaccines were also known. Presumably, the Finance Minister and her team also knew the size of India’s population, and that they should multiply the costs of the vaccines with the total number of people to calculate the total amount needed for vaccinations.

•Then, all that the government needed to do was to explicitly budget for the vaccination amount and other attendant costs in this final battle against the virus. The Health Ministry should have negotiated one standard price for each type of vaccine and procured them directly. After this, the vaccines should have been distributed to the States to set up vaccination camps and vaccinate people. All this was blindingly obvious even in January before the Budget was prepared. Lives and livelihoods were at stake. Instead, the Finance Minister resorted to headline and narrative management using half-truths and misleading claims.


•Is the Narendra Modi government so incompetent and reckless that even after five months, and after lakhs of lives have gone and billions of dollars lost in economic output it is still struggling to come up with a coherent vaccination policy and save Indians from this deadly pandemic? Alas, the answer is a yes. Let us not forget that it is the same Prime Minister and his government who thought that invalidating all currency overnight, in 2016, would magically eliminate black money or locking down the entire nation last year at just four hours notice would defeat the coronavirus as quickly as ‘the Pandavas won the Mahabharata war’.