India's Wait for the COVID-19 Vaccine and Economic Concerns Post-Lockdown
An interview with Analyst & Writer Shefali Saldanha on the COVID-19 vaccine research, logistical challenges for India, promoting hand-washing, fighting disinformation, and much more.
Editor’s Note: This article is an edited transcript of the August 19, 2020 edition of Chakkar Circle, held LIVE on our Instagram page @TheChakkar. The Chakkar’s editor/co-founder Karan Madhok interviewed investment analyst and writer Shefali Saldanha about her recent article regarding India’s wait for the COVID-19 vaccine and economic challenges that lie ahead for the country after the pandemic.
Q. Shefali, I understand that the initial idea for your article was more about the logistical challenges of this hypothetical COVID-19 vaccine, but in your research, you stumbled upon the dangers of pinning all our hopes on the vaccine itself, instead of taking measures to control the spread of the virus. Can you tell us more?
Saldanha: Thanks, Karan and good to be on the show! I've been hearing a lot about the virus and the vaccine and when it's coming out. I live in Singapore, and the government has said that Phase 3 of coming out of the lockdown, which is when all pandemic-restrictions will be lifted, will only be when the vaccine comes out.
So, I looked into the feasibility of this vaccine and it felt like there were too many unanswered questions. There didn't seem to be any consensus in the medical community about the timeline for a vaccine or its effectiveness. Some are saying it will come out next month, some are saying tomorrow, and some are even saying something like two or three years from now.
If miraculously this vaccine comes out tomorrow, we're still two years away from herd immunity. How can we wait around and do nothing for those two years and say this vaccine is coming, and pretend that it is our only solution, when there are other things that we could be doing that can slow the spread?
In terms of the effectiveness: some are saying “look it's not possible at all”. Some are saying it will decrease the severity but not eliminate whether you can get the virus or not. There are just too many unknowns around the vaccine itself. How can we pin our hopes on this? Why are our politicians super confident that they see the vaccine coming out?
More than that, I looked into what would happen if this vaccine were to come out. I looked at India’s historical track record for vaccination, and it's been quite poor. If you look at what they consider someone to be vaccinated—is that all kids are given these twelve essential vaccines when they're infants—and the vaccination rate in India was 44 per cent in 2005-6. Since then, it's gone up to 62 per cent in 2015-16. They've made progress, and this current government is focused on vaccinations, but we’re still nowhere where it should be. I think the main reasons are the logistical challenges of reaching the remote villages, and having medical professionals to get to those remote villages. Addressing these challenges requires not just a lot of people but also a lot of capital and a lot of investment, neither of which we've done enough of. And I felt if historically this is what we're going on, then the COVID-19 vaccine would have even greater logistical challenges.
There many Indian pharmaceuticals that are rearing to produce hundreds of millions per day. But how realistic is that, truly? How quickly can they make enough vaccines? And once they're made, how do we distribute it? I’ve reviewed a lot of articles from medical experts, and they are saying that it would take minimum two years to get to 60 per cent of the population being vaccinated, which is what we need for herd immunity. That means that if miraculously this vaccine comes out tomorrow, we're still two years away from herd immunity. How can we wait around and do nothing for those two years and say this vaccine is coming, and pretend that it is our only solution, when there are other things that we could be doing that can slow the spread?
Q. In the essay you wrote for us, you suggested that one of the solutions was that, instead of waiting for the vaccine, we need to take pre-emptive actions and slow the spread of the virus. Actions as simple as access to clean water. It sounds simple and rudimentary, but in India, something like access to clean water for the majority population is such a challenge. Can you elaborate a little bit more on the solution that our government should be focused on while we wait?
Saldanha: There is a consensus among the medical community, on the evidence that if you wash your hands regularly, your chances of getting the virus reduces. That's an easy way to protect yourself. But for most Indians who don't have piped water coming into their homes, that's not a possibility. And if you don’t have water, you can't be washing your hands the number of times that you should be. And if you have to line up to go to the bathroom to use a community toilet, you're not safe-distancing at all. Providing these basic services are easy fixes that can prevent the spread of the virus. These are evidence-based solutions that we can start now instead of waiting around for this vaccine. There are lots of things that we can do immediately that would help out.
Q. You mentioned our past vaccination drives and one of the examples that you mention is the poliovirus. Polio was eradicated during our lifetime. It was only eradicated in India five or six years ago. What did you learn from the polio vaccine drive, and how will the logistical challenges be different for the potential COVID-19 vaccine?
Saldanha: There were a few reasons why the polio vaccine drive was so successful. One of the main reasons is that they developed an oral vaccine. Apparently, it's not as effective as the injected vaccine, but it's effective enough. And having an oral vaccine addressed the huge logistical problem of needing medical professionals to administer it, because it allowed anybody to administer the vaccine. The entire village has to be administered the vaccine at the same time, which is why we have a few days every year when there are these vaccination drives.
The second reason it was successful is because they had an army of volunteers doing a lot of trust-building within the community. This was important because certain communities really believed that this vaccine causes infertility, and it's the government targeting minorities, and there was lots of disinformation around.
The third is because it's an ongoing effort, and to this day, they still have vaccination drives; they are still testing sewage samples to detect poliovirus in the water. It's an ongoing effort with a lot of people working on it, and that's why polio has been able to be under control. If we think about the COVID-19 vaccine, we don't have the luxury of time that we had with polio.
There's not going to be an oral COVID-19 vaccine, and what we're going to get is something to be injected. It might have temperature requirements and requirements for how it needs to be stored. There are all these other kinds of logistical challenges that we were not going to be sure about until it comes out.
Q. Also, we don't know if similar to the polio vaccine; the COVID vaccine would have to be given to the whole village together. COVID is a lot more contagious. There's even the issue of lining up to get a vaccine. It can be dangerous if it's not handled responsibly. What have you discovered about this potential vaccine? I know there are a few that have been cleared by international medical organisations for testing. But as you mentioned, politicians around the world are making these bombast promises. Putin has already announced a vaccine. ICMR in India said that we would have the vaccine by Independence Day. That didn't happen. How close are India and the rest of the world to seeing this vaccine?
Saldanha: With all my research, the only thing that I can say is: I don’t know who can answer that question with confidence! It doesn't seem like India, or the rest of the world is close to getting an effective vaccine, despite the media being filled with talk about a vaccine. I know there are four institutions in India working on it, with one that is in phase three, but it's all quite confusing, and there are a lot of unknowns. But I know that since I wrote the article, India has formed a task force for the logistics. On the flip side, we've had millions of medical workers go on strike because they are not paid well enough, and they don't have enough safety equipment. There's a lot of unknowns. I feel like we need to focus on what we know works now. We need to be putting in time and resources into this vaccine, but we also need to focus on stuff that we can do today.
Q. One of the other measures that you've stressed upon is making sure that the government stops the spread of misinformation, about the vaccine, about anti-vaxxers or anti-maskers. I think you also suggested the need to limit advertising for crack-pot theories. So... are you saying that Patanjali is not going to save us?
Saldanha: Yeah, I can't say. I have no idea. Some of these might work, or they might not. But no one knows because there's no proper process for approval or anything like that. Unless there is some proper process, it shouldn't be allowed to be advertised because it's going to harm people’s faith in medicine. When the vaccine comes out, there might be even more people saying they don't want to take it. We’re lucky we don't have a big anti-vaxx movement yet like that in the US or Europe, but it's quite the same effect when politicians endorse alternative medicines.
Q. India is funny in the way that we happen to have a lot of scientific discipline and a lot of great scientists. We tend to trust doctors a lot. If a doctor says something, it's almost like the word of God. But at the same time, we are constantly looking for an alternative, constantly looking for the quick fix. What I call the snake-oil solution. It can get dangerous. It may sound harmless, just dabbling. But it can be dangerous because it can be a waste of time and hope and opportunity, and can lead to worse situations.
Saldanha: Yeah, for sure. I'm not saying whether it works or doesn’t work. I'm not qualified to say that. But if it doesn't follow the same testing procedure as a vaccine and many other medicines, unless we institute testing of these alternative medicines, it's unfair to be selling it to people.
Q. I want to shift gears a little bit to discuss one of the earlier articles you wrote for us, which was about what you called the ‘Vulnerable 50%’ of the population, whose livelihood and economic future is really going to be in danger. But you suggested that the threat of this could be an opportunity to build a fairer economic system. Can you elaborate on that? What are some solutions you mention in that piece?
The world over there’s been this trend of inequality growing, and it's not sustainable. It's not sustainable for our planet, and it's not sustainable for our people.
Saldanha: It's horrible to say ‘opportunity’ in this tragic circumstance. Still, the thing about the crisis situation is that it's an opportunity to relook and rebuild, and what I was highlighting is that in that article is that we're all proud that India has come quite a long way in these past few decades. We've had a few decades of really strong growth. We’ve seen stories of people being pulled up from extreme poverty. But the fact is that most of India is still really quite poor. If we take a more ethical poverty line which I think is like around $3.10, then 60 per cent of the population is considered poor. We need to have an economic system that allows everyone to grow, not just the rich getting richer. Maybe this is an opportunity or a time for us to relook at that.
So far what we've had is trickle-down macroeconomic policies, but the trickle-down hasn't happened. For instance, if you look at labour reform, because there's been a lot of discussion about that after the pandemic. Suppose we can ensure that all our labourers earn a decent living and can buy the products that they're making and become consumers. In that case, it can lead to longer-term growth, and more sustainable growth, if we have greater consumption. And there's not just an ethical and a moral argument for having everyone have a decent standard of living, there is also a practical case to it. If you give one dollar to a rich person versus one dollar to a lower-income or middle-income person, it's more productive with the lower-income person, and that's how we can drive long term sustainable growth.
I think the world over there’s been this trend of inequality growing, and it's not sustainable. It's not sustainable for our planet, and it's not sustainable for our people.
Q. You've already done so much research regarding COVID-19 in India, the vaccine and the economic trends that we see post lockdown. What are you looking at next?
Saldanha: When I was doing this vaccine article, I realised that it needed a sequel. When I looked at the medical and health situation in India, I realised a lot of the top ten causes of deaths, like diarrheal diseases and diabetes, are entirely preventable. And while the investment in our medical infrastructure is poor, and of course we need to increase that, maybe we can also think about what we can do to relieve pressure on the medical system by preventing people from getting sick to begin with. That's what I’ll look into next.
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Shefali Saldanha is Singapore-based working for an Impact Investing firm managing the India portfolio. Previously she worked for a social enterprise based in Mumbai. She has an MBA from Oxford, a BA from the University of Virginia and over a decade of experience working in the social sector space in India and regionally. You can find her at linkedin.com/in/shefalisaldanha.
