We were almost criminally smug. The pandemics of the previous centuries did not bother us. We had already begun to believe, like the Americans do, that a cure for all our diseases is not only probable, but certain ~ with political clout, scientific research and development funds. After all, a disease as dreadful as smallpox, has been eradicated from the world and polio from the Western Hemisphere. But the novel coronavirus has jolted us out of our complacence.
Noam Chomsky, the distinguished 91-year-old American linguist and political analyst, now in self-isolation in Arizona because of the pandemic, believes that the origin of this crisis is embedded in a colossal market failure and the neoliberal policies that intensified socioeconomic problems. “It was known for a long time, that pandemics are very likely to happen and it was very well understood, that there was likely to be a coronavirus pandemic with slight modifications of the SARS epidemic.
They could have worked on vaccines, on developing protection for potential coronavirus pandemics, and with minor modifications we could have vaccines available today.” According to him, the Big Pharma ~ the other name for the global pharmaceutical industry ~ considers the manufacture of body creams more profitable than discovering a vaccine that will protect mankind from total destruction. Recalling how the threat of polio ended with the Salk vaccine by a government institution (without any patents, and thus made available to everyone), Chomsky lamented “That could have been done this time, but the neoliberal plague has blocked that.”
Our priorities are extremely lopsided and misplaced, betraying sharp inequities. Alongside fatalism of the hapless victims, there is the freneticism of the professional experts. Alongside the dirt and primitiveness of the indigenous environment at some places, the space-age hygiene of the Western medical efforts looks like sci-fi fiction. If in doubt, one can check with the visuals of the global pandemic currently holding us to ransom.
There has been little or no coverage of the World Health Organization’s estimates that 3.2 million children die every year of diarrhoeal diseases before reaching their fifth birthday or that 2 million people die every year of tuberculosis. As the outbreak of the novel coronavirus shows, the viruses that emerge from the remote parts of the earth and affect the indigenous population only gain attention when they move out of a small area to hit larger numbers or when they kill ~ the class angle must not be missed ~ wealthy people or foreigners, especially Americans.
The starker reality is that if the “right people” are not infected or have died, outbreaks that keep happening all the time go unnoticed and unaddressed. The focus is often not trained on the bureaucratic or institutional culpability in an existing crisis and on the bureaucratic or institutional responsibility to avert a further catastrophe.
Now that the world is craving for a vaccine, wary that the 7.8 billion members of the human race remain exposed to the new virus, and thus none is immune to it, we can discern the desperate scramble among the world’s scientists to develop a wonder drug to treat the clinical illness that is referred to as COVID-19.
As large parts of the world, including India, are under a lockdown to protect people from the threat of wider community transmission, vaccination is always perceived both as a matter of individual and community protection. Even if the scientific community comes up with a vaccine, massive public health efforts are required to control infectious diseases in the most effective manner.
Mass immunization ~ the other name for millions of people accepting the introduction of micro-organisms into their bodies for preventive purposes ~ we can see that it is very effective to protect populations at a rapid pace on account of the high coverage achieved and because of the herd immunity thereby induced, if we, for a moment do not rule out the idea of the British Prime Minister, Boris Johnson, as hare-brained.
Herd immunity is defined as the proportion immune in the population and herd effect as the reduction of infection in the non-immune segment of the population on account of the high herd immunity slowing down the circulation of the virus. But the caveat is that mass immunization campaigns must be conducted thoughtfully, with diligent strategy and attention to the logistics of supply and deployment, because such campaigns are liable to go haywire if badly conducted.
It is widely acknowledged that vaccines are the most costefficient measure in medicine since the vaccine era that began with the use of vaccinia virus to immunize against smallpox in the eighteenth century. Modern vaccination strategies of the latetwentieth century based on genetic engineering and the application of molecular biology, including the development of recombinant virus vaccines, replication-defective and DNA vaccines for enhancing and directing the immune response somehow give us a sense of deceptive security.
But the efficacy of a vaccine depends upon a number of factors, that often vary with different degrees of susceptibility and from place to place with moderate or high efficacy. Variables often determine the global urgency and action. These can relate to the geographical and social incidence of the epidemic, if the epidemic is in a remote African village or in urbane London, or if the disease is endemic only among the poor or specific minority risk populations or if it threatens much larger constituencies.
Perhaps this is the reason why vaccine research has always been a combination of basic science and enlightened empiricism. Two centuries ago, cholera due to the classical biotype of V. was endemic in the Ganges Delta of West Bengal and Bangladesh and resulted in epidemics and global pandemics.
The death of thousands of British troops and millions of Indians in the first cholera pandemic 1816-26, previously confined within the Indian subcontinent, particularly in Bengal and then spread across India by 1820, prompted the British government to take drastic public health initiatives because the trigger for cholera was insanitary conditions, lack of personal, food and water hygiene.
Apart from cholera, the British took tough measures by the end of the nineteenth century to control a scourge as deadly as plague. The steps included quarantine, isolation camps, travel restrictions and the exclusion of India’s traditional medical practices. Overarching powers were vested with Special Plague Committees to impose restrictions on the populations of the coastal cities and enforced by the British military, resented by a majority of Indians who considered the measures to be “culturally intrusive and generally repressive”.
The Russian bacteriologist Waldemar Mordecai Haffkine based in India from 1893, later appointed as the Director of the Plague Laboratory (now called Haffkine Institute) in Mumbai, where he tested vaccines against cholera and the plague, was commissioned to develop a plague vaccine. He had to work with very limited resources, but on January 10, 1897 Haffkine tested it on himself, to be followed by a control test on volunteers at the Byculla jail.
By the turn of the century, the number of people inoculated in India alone reached four million. By 1898-99, government strategies of plague control changed tack in view of strong opposition to plague regulations as the affliction had spread to rural areas, posing a logistical challenge. British health officials pressed for widespread community vaccination with Haffkine’s plague vaccine.. Several vaccine institutes were established in late Victorian India, long before many European countries, to counter the plague, cholera and other diseases.
More than half a dozen Indian vaccine institutes conducted research and also produced vaccines and sera against cholera and plague, against rabies, tetanus, diphtheria, smallpox, typhoid and snakebites. Despite India’s long record of institutional research, colonial research policies before Independence failed to lay the foundation for a sustainable path for vaccine development and production. This is rather puzzling.
(To be concluded)
(The writer is a Kolkata based commentator on politics, development and cultural issues)