In times of this pandemic genuine good news are hard to come by. This is one of them. Race for a vaccine against SARS-CoV-2 is like a marathon that is being run at the pace of a 100 meter sprint. With more than 100 vaccine candidates in the pipeline, vaccine developed by the Jenner Institute of the Oxford University is the clear front runner. The institute, named after Edward Jenner, the English physician who developed the small pox vaccine & revolutionized the field preventive medicine, is currently headed by professor Adrian Hill. Prof Hill has been at the forefront of vaccine science for many years with most of his research for malaria, ebola & MERS vaccines.

Instead of the classical way of viral vaccine making where the weakened version of a virus is used to trigger an immune response, this vaccine uses different approach. First, a different virus, in this case a respiratory virus found in chimpanzees, is modified to neutralize it's effects. Later the same virus was tweaked to mimic the SARS-CoV-2. Initially it was developed to fight the MERS virus, a close relative of SARS-CoV-2. When cases began to increase in China in late January, with full viral genome sequence being released by the Chinese scientists, Jenner institute decided to alott some resources for a small vaccine project for this novel coronavirus. Little did they know that their small project, in just 2 month's time would spreadhead the search for a vaccine against the deadliest pandemic in over 100 years.

In the preclinical phase of the trial, 6 rhesus macaque monkeys vaccinated with this vaccine showed no signs of illness even after 28 days after being exposed to large quantities of SARS-CoV-2 virus. Similar exposures consistently caused infections in other monkeys. Phase I is already underway with 1100 people in randomized placebo controlled clinical trial. Aside from measurements of antibody production – i.e. body's response to the vaccine, this is the phase in which safety & tolerability between the actual vaccine & a placebo are measured in a relatively smaller group of healthy human subjects.

Multicenter combined phase II & III trials consisting of more than 5000 participants is expected to begin before the end of May, 2020 which may also include Indian collaboration. This larger scale part of the trial will see researchers continually monitor vaccine's efficacy, along with it's immunogenicity & toxicity. If all goes well, this vaccine may get it's fasttrack FDA approval by September of this year. The Jenner institute has already made clear that it will not sell it's exclusive rights/patent to any company to prevent profiteering in these distressing times. 6 asian & european firms have already signed up for the mass production of this potential vaccine, pune based Serum Institute of India being of them. Serum institute is even going to invest a substantial amount of money & resources on starting the vaccine production by May end, so that if the vaccine gets FDA approval by September, world doesn't have to wait for further 2-3 months to start deploying it.

Even if this vaccine doesn't succeed, it will teach us a great deal more about this devious virus which in turn will be helpful in all future vaccine making efforts. Humankind will win the fight against this treacherous virus & it will not be by god's grace or some miracle but by human ingenuity & perseverance. 

It was the summer of 1945. Britain & the Allied forces had just won the Second World War against the Axis powers under the leadership of Winston Churchill and the coalition government of conservative and labour parties. This coalition government was rock solid during the war time with conservation party leader Churchill as the Prime Minister and labour leader Clement Attlee as the Deputy Prime Minister. Churchill was flamboyant and exuberant whereas Attlee was restrained and uncharismatic. Churchill was aristocratic whereas Attlee was homely. Churchill had grand rhetoric and his electrifying speeches kept British morale high in dark days of the war. In contrast, Attlee despite being a man of few words was an unconventional champion of social cause. It was Churchill who ran the war but Attlee ran the country. Attlee was even in-charge for about eight months during war times when Churchill was ill. This coalition saw Britain through the war but once the war was over, old colleagues became fierce political rivals and with the coalition broken, elections were held within a month. Conservative party planned their electoral strategy based on Churchill’s personality over sound policy. Labour’s manifesto, which was akin to a blueprint for a welfare state, was the exact opposite. They believed if you can plan war, you can also plan peace. Labour party did not field a candidate at Woodford – Churchill’s constituency out of respect. Churchill, on the other hand, berated the opposition every chance he got while campaigning for the election.

In the 1945 general elections, held just three weeks after Nazi Germany surrendered, war-tired British people threw out their greatest leader of all time to make way for an even greater leader – the improbable Mr. Attlee. It was no rosy throne for Attlee. Britain faced nothing less than a financial Dunkirk. There were shortages of food, houses, jobs, schools, hospitals. Exports had shrunk to an all-time low and with the war over, the USA had also cut the aid. The once greatest empire on the earth had to borrow loan which was to be repaid with interest over the next fifty years. But neither Mr. Attlee nor his government back down from their promise or responsibility, which meant they invested in people with thorough planning – both economically & socially. Industries, education & healthcare were nationalized. It was in this situation that the NHS – National Health Service – was born, Labour’s most celebrated achievement & Britain’s pride even to this day. Under the guidance of Aneurin Bevan – the health minister, the government took control of more than 2750 private hospitals when Britain had 3000 in total to begin with. And a publicly funded NHS was born in 1948 based on the basic principles – comprehensive care, universal coverage & free at point of use. These reforms cost big money & it has faced many problems since its inception. It has changed beyond all recognition since its implementation in 1948. But with time to time improvisation with 3 core principles at the core, it has not only survived but has thrived. The British healthcare system is one of the best today in the world. Many other countries have followed suit in the coming years with governments either providing universal health care directly or by providing health insurance to almost all its citizens. In fact, with the exception of the USA – all the developed countries in the world right now provide some form of universal health care to all its citizens. Healthcare system is ‘socialized’ in almost all of these thriving ‘democracies’.

This is war time. The entire world is waging a war against an invisible enemy – the SARS-CoV2 virus, Battle-fields today are the hospitals, and the army is wearing a different uniform. Everything else is akin to war – there is a shortage of food, jobs, and hospitals. Supply chains are broken, schools & industries are closed, borders are closed, and economic collapse is impending. 

Only a handful of countries have been able to successfully contain the spread of this virus in their respective countries. South Korea, Taiwan, New Zealand are few such examples. Among Indian states, only Kerala and Ladakh have been able to do so. It was made possible by visionary leadership, early restrictive shutdown, widespread testing and contract tracing along with public awareness and support. All of these combined are required to stem the spread of this highly infectious virus. Even if any- one of these components is missing from a country’s response to this pandemic, this virus will spread through that country, sooner or later.

On the other end of the spectrum are all the other countries of the world. They haven’t been able to contain the spread. No matter how equipped a country’s healthcare system, initial failure to contain has resulted into a rampage of sort. Even the countries with robust healthcare systems are being overrun by the virus – Italy, UK, Spain, Germany are among these countries. These countries have been able to limit the mortality rate to an extent due to their advanced healthcare systems. Many developing countries aren’t so lucky. Countries like Brazil, Ecuador, Iran, and Chile are the hardest hit with hospitals overburdened, unavailability of beds & ventilators and dead bodies are piling up even before the test for Covid-19 could be carried out but their confirmed Covid-19 case numbers may not show the real picture.

India is somewhere in between those two extremes. We have been behind the curve in initiating borders security, passenger screening at airports, procurement of PPE for the healthcare workers, arrangement of essential supplies for the socio-economically weaker sections, and prevention of migrant exodus. There has been a massive surge in unemployment, multiple instances of social violence and unrest, a break in supply chain and resultant shortages, and starvation at an unprecedented level. A month ago, our country stood at around Rank 50 among the nations for confirmed Covid-19 cases, and today we are in Top 20 with an upward trend. While praising the government for the steps they have taken – a government that likes to control the narrative at all costs, even in this pandemic – we cannot be oblivious to the fact that there have been some grave misjudgments & that is has been late to respond at multiple levels. And that is the price we Indians will have to bear for having a reactive government rather than proactive.

And yet the battle is not all lost. Governments – Both Central and State – have shown good resolve. They have been working very closely together. Lockdown, which has now been extended till May 3, has bought our fragile healthcare system some valuable time by flattening the curve. But flattening the curve won’t be enough if we are to survive the battle against this virus with minimal mortality. This virus is no common flu virus, which in itself is quite deadly. This virus has a higher reproduction number, longer incubation period, prolonged disease course & a huge mortality rate. No FDA approved antiviral treatment & no vaccine availability only adds to the lethality of this virus. And those two things aren’t going to be available for next year or so. When most of the private hospitals are on a hiatus in the wake of this pandemic, the burden of this disease has fallen squarely on the government hospitals, and that includes even the non Covid-19 hospitals admissions. This means that this pandemic is not only claiming lives of its victims directly; it is also adding to the morbidity & mortality of other diseases. Merely adding a few thousand hospital/ICU beds & buying a few hundred ventilators which our governments seem content with at the moment, won’t be enough to ward off a disaster of epic proportions.

This is a highly contagious virus with a high R0 and doubling time of 7 days. Despite 22 days of lockdown at the time of this writing, only herd immunity development can stem the tide of exponential growth.  Herd immunity is an epidemiology term that pertains to the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination. With most estimates suggesting a vaccine availability for Covid-19 being 1 year, it is reasonable to predict that large numbers of population will be infected before the spread rate starts to decline. This would translate to millions being infected over the course of next few months, more rapidly once the lockdown restrictions are loosened, and mortality skyrocketing.

The illness & the resultant loss of life, the economic fallout is all very grim, but the inequity of how it is hitting & will hit us, how unevenly it will wreak its havoc among the downtrodden & less privileged is absolutely cruel. Ayushman Bharat won’t be sufficient to help those people in its current form or shape. It is flawed since its inception & has been criticized for its several drawbacks, including the eligibility criteria, package rates, number of disciplines, involvement of insurance companies, to name a few. The government claims that it will cover the poorest 50 crore population of the country but that plainly just isn’t true. Only a tiny fraction of those eligible have signed up so far and even those who have signed up won’t be able to avail its full intended benefits due to sheer lack of empanelled hospitals under the scheme.

The situation calls for a complete overhaul of the healthcare system- like the one Britain did after World War II if we are to save the system, which is already going down a spiral, from falling off a cliff. Public health has always been talked about but has never been given this kind of resolving support. Centre and states have already taken temporary steps in the direction of socialized healthcare with regards to Covid-19 – designated hospitals for all infected patients regardless of socio-economic status, turning hotels/halls/railway coaches into temporary hospital rooms, buying multiple ventilators, etc. But it needn’t stop there. Government-funded comprehensive care with universal coverage, which is free at point of use – is not only the need of the hour; it is the obligation of the ruling class. Despite a few hiccups here & there, we, the people of India, are acting as a society. We are in the middle of the largest collective intentional action that has ever been taken. In the near future, where more international cooperation will be required to mitigate some of these effects, countries will most likely become more nationalistic. If India comes out of this nightmarish pandemic with at least a few steps in the direction of universal healthcare, my faith in humanity will only increase.

Will Churchill-esque Modi, be able to channel socialist Attlee, or will a new Attlee arise from relative obscurity? If the central government fails to seize the opportunity at hand, will any of the states show us the righteous path? In the face of such adversity, will India rise & seize this ‘Attlee moment’, so that 1.3 billion Indians and their future generations can reap the benefits of collective morality?

[Delhi]

e.mail : durgeshmodi@yahoo.in