Priyanka Pulla
Last week, The New Indian Express, one of India’s major English newspapers, pulled down an article that was heavily critical of the Centre’s response to the COVID-19 outbreak. The article, entitled ‘Centre’s COVID-19 Communication Plan: hold back data, gag agencies and scientists’, discussed the government’s reluctance to share outbreak-related data and attempts to muzzle scientists.
It noted how scientists from India’s apex medical research agency, the Indian Council of Medical Research (ICMR), have suddenly and inexplicably disappeared from the health ministry’s daily COVID-19 press briefings. It also claimed ICMR had disbanded an expert panel it had previously set up to study COVID-19 drugs and vaccines because the group’s members had been critical of the government’s actions.
The article was published on The New Indian Express’s website at 7:09 pm on May 8, and it disappeared from its link within a day without any explanation. The page at the same link now has a short message: “Oops! Looks like you are looking for a page that doesn’t exist or has been moved.”
In the absence of any explanation from the newspaper, there was speculation on social media about whether the New Indian Express pulled the article down on its own volition or had been asked to by someone – presumably in government – and quietly complied. An article in The Caravan on March 31 had described how Prime Minister Narendra Modi met several heads of media publications ahead of the first lockdown, and requested them to carry positive stories about the government’s COVID-19 response.
However, The Wire Science’s questions to The New Indian Express’s editor-in-chief G.S. Vasu, asking if government pressure was the reason the article was retracted, went unanswered. The author of the piece, health journalist Sumi Sukanya Dutta, also didn’t respond to questions.
In India, news reports often disappear the way The New Indian Express’s report did. On May 27, 2019, The Caravan listed 10 such articles that newspapers had retracted during Prime Minister Narendra Modi’s first term, likely because they were unfavourable to his administration. One of them was an article published by The New Indian Express; it was retracted after it raised issues with an Ahmedabad-based bank whose director was home minister Amit Shah, as The Wire reported.
Now, it seems this phenomenon has come to plague public health journalism as well, in the midst of an epidemic that has claimed at least 2,415 lives in the country thus far. The appalling irony is that the government – and probably a newspaper’s editors as well – gagged a journalist for criticising the gagging of scientists. One can’t make this stuff up.
Transparency helps fight outbreaks
Refusing to share data during an outbreak is immoral because it costs lives. This argument underlies journalistic coverage of the lack of transparency during an outbreak. It is also why The New Indian Express article was important. A copy archived by the Wayback Machine is attached below.
One issue Dutta reported was that the government was yet to release the list of hospitals dedicated to treating COVID-19 patients; a gender- and age-wise distribution of patients; and the state-wise distribution of oxygen-supported beds and ventilators. Calling out this lack of information is not an idle carp. During an outbreak, a central government can and should take stock of where resources are available if only to help decide how to improve the infrastructure in vulnerable regions.
Stakeholders outside of the government – like doctors, epidemiologists, state-level administrators and public-health researchers – should also have access to this data because it helps them scrutinise government policy, propose alternatives and prepare themselves. After all, the government is not the exclusive reservoir of public-health expertise to make decisions, and they can be wrong too. There is also nothing wrong with a reporter demanding this data: data-collection is funded by taxpayers, so this information belongs to taxpayers.
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ICMR must talk
The second issue that Dutta raised was the conspicuous absence of ICMR scientists in the health ministry’s daily press briefings. Until April 23, around the time journalists began to highlight the low accuracy of rapid diagnostic tests the ICMR had procured from China, either the agency’s chief of epidemiology Raman Gangakhedkar or the director-general Balram Bhargava were present at all briefings. But as ICMR’s role in the test-kits fiasco became more apparent, representatives from the agency stopped attending the briefings, leaving no medical expert there.
At the same time, several journalists noted that ICMR scientists had been asked not to talk to journalists. For example, on April 28, health journalist Anoo Bhuyan tweeted an ICMR official’s statement to her that the agency’s headquarters had directed them to refrain from interacting with the media. When asked if this was true, Balram Bhargava responded by WhatsApp: “No such instructions. All scientists are busy working.” He didn’t respond to a follow-up question about why ICMR representatives had suddenly stopped attending press briefings.
Again, the absence of ICMR representatives at media interactions is a crucial issue. The agency is behind most of India’s COVID-19 policies on drugs, vaccines, treatment and tests. Clearly these policies have an outsized impact, and any flaw or oversight – however slight – in their design can have a snowball effect across the country. As The Wire Science reported recently, ICMR’s failure to follow its own ethics protocols in recommending the use of hydroxychloroquine as prophylaxis and treatment for COVID-19 has encouraged thousands of people to take the drug indiscriminately.
The questions pile up
Thus, ICMR is answerable to the country, and its representation at daily press-briefings is non-negotiable. However, the agency’s disappearing trick means unanswered questions from journalists and external experts are only piling up. Here are three.
Question 1: In a press release dated May 10, ICMR said it had developed a COVID-19 antibody-testing kit that would be mass produced by the Gujarat-based company Zydus Cadila. Why was Zydus Cadila chosen for this task over other medical diagnostic firms?
Why is this question important? By now, it is amply clear that ICMR bungled the procurement of rapid antibody kits from China. It awarded orders to companies with no import licenses, sending its own procurement price through the roof. It is also strange that ICMR discovered how inaccurate these kits were only after they had been dispatched to various states, and had been used on the field.
Many countries have already stumbled with rapid antibody kits. As early as April 5, scientists in the UK had evaluated rapid kits from China, including from a company that ICMR had also purchased from, and found them unsuitable. Why didn’t this event raise ICMR’s antennae considering it received its first consignment of kits, including from that company, only after April 16?
The agency also claims to have checked the kits’ quality before okaying them for field use in the states. How did this quality control step miss major accuracy issues, all well-known since the UK had caught them over a week earlier?
This history with rapid-testing kits suggests ICMR needs to be more transparent both with its procurement and quality control, and explain how it did both. And this is why journalists and external experts demand to know further details of how the new kits were tested for quality, and why Zydus Cadila was chosen over other companies for mass production.
It isn’t unusual to share such details. When researchers from New York’s Mount Sinai Laboratory developed an antibody testing kit, they uploaded a preprint paper explaining their methods. But when a reporter asked during the press briefing on May 11 as to why Zydus Cadila was chosen as ICMR’s partner, the health ministry joint secretary Lav Agarwal said only ICMR could answer that question, before sharing some vague details about the procurement process.
Question 2: Why has ICMR made no attempt to alter its flawed March 22 advisory suggesting hydroxychloroquine as prophylaxis for COVID-19, given newer evidence has shown the drug is not efficacious?
Why is this question important? ICMR’s advisory on hydroxychloroquine violated its own ethical guidelines, as The Wire Science has reported. Now, it seems like the worst-case scenario – which the guidelines were designed to prevent – has come to pass. Even as newer evidence of the drug’s inefficacy against COVID-19 piles up, states like Maharashtra are riffing off of the ICMR guidelines to come up with their own absurd ones.
For example, the state’s Directorate of Medical Education and Research has started prescribing hydroxychloroquine to children, contrary to ICMR’s advisory, which clearly states paediatric use of the drug is not recommended.
Nonetheless, there is good reason for ICMR to have expected its advisory would trigger indiscriminate use. India has historically seen plenty of irrational off-label drug use by doctors. But if ICMR didn’t anticipate this, why isn’t it making a course-correction now, given the damage already done?
Question 3: How many cases of influenza-like illnesses (ILI) have there been in India in the last few years, and is this number rising in atypical fashion in some districts this year?
Why is this question important? India’s National Centres for Disease Control (NCDC) maintain a record of the number ILI cases each year as part of their influenza surveillance programme. This data could be an excellent indicator of how widespread COVID-19 is in India, given India’s testing strategy is not enough to determine this.
For example, if any one district is seeing a rise in ILI cases compared to the historical average during that month, it could point to the presence of COVID-19 there. So journalists have asked both ICMR and the NCDC to share ILI numbers several times, but neither agency has done so.
It’s quite odd that the two agencies aren’t mining this data, or aren’t sharing the results if they are. For one, such data could indicate how many severe acute respiratory illness (SARI) cases occur in India at any time of the year. One part of ICMR’s COVID-19 testing strategy is to look for the novel coronavirus in samples from all SARI patients in India; SARI is simply ILI severe enough to require hospitalisation. So if we could estimate the number of SARI cases from ILI data, we could get an idea of how many tests India ought to be conducting overall.
But it’s troubling that while this important data set remains unpublished, government officials have been cherry-picking unrepresentative data to claim India isn’t severely affected by COVID-19 at all. For example, NITI Aayog member Vinod K. Paul recently cited the number of SARI cases hospitalised under the Ayushman Bharat insurance scheme to claim India does not have community transmission. These daily cases had declined between February and April 2020, contrary to what one would expect during a respiratory disease epidemic.
The problem with Paul’s claim was that only a small percentage of all SARI cases in India are treated under the Ayushman Bharat scheme. It is also impossible to say if the February-April decline is unusual unless it is compared with data from previous years. And it is ultimately strange that government officials aren’t sharing the comprehensive ILI data they have access to, turning instead to limited datasets that may be painting a distorted view of reality.
Non-scientists replace scientists
Now that ICMR has disappeared from press-conferences, questions such as those above, which are intended for scientists, are being answered by government representatives with no medical training. The three representatives who appear at every press conference are Lav Agarwal, the joint secretary to the Union health ministry; Punya Salila Srivastava, the joint secretary to the Union home ministry; and an official from the Press Information Bureau.
Of these three, questions intended for scientists typically end up with Agarwal, and some of Agarwal’s statements have, worryingly, betrayed a complete ignorance of basic epidemiology. For example, on three separate occasions, journalists asked him when the Indian COVID-19 epidemic would peak.
An outbreak is said to peak when the total number of daily new cases (or deaths) reaches its highest point, and begins to decline thereafter. The director of the All India Institute of Medical Sciences in Delhi, Randeep Guleria, has said the outbreak is expected to peak in July. Researchers at ICMR also reportedly modelled the progress of COVID-19 in India to get a sense of when the peak could arrive. So the journalists’ questions were perfectly reasonable.
However, on all three occasions, Agarwal said India could avoid the peak if people diligently practiced physical distancing. It doesn’t take an epidemiologist to understand the absurdity of this statement. Never reaching a peak only means the outbreak will continue indefinitely. And the fact that he repeated this statement thrice suggests nobody bothered to correct him. Such carelessness with scientific terminology is why journalists have been asking for ICMR scientists to speak instead.
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Arbitrarily targeting scientists
Another issue Dutta raised in her now-missing article in The New Indian Express was about ICMR recently disbanding an expert panel it had appointed, to look into new COVID-19 drugs and vaccines. Her article said the trigger was criticism of the government by the panel’s members, although Dutta didn’t name any of particular members.
But the very next day, The Hindu published more details of the dissolution. The panel had been headed by microbiologist Gagandeep Kang, and its members are not sure why it was broken up. Some of them told the newspaper that the panel’s objectives hadn’t been met. The Wire Science also reached out to one of them, Debashish Mitra, the director of the Centre for DNA Fingerprinting and Diagnostics, Hyderabad, who reiterated that he didn’t know the reasons behind ICMR’s decision.
ICMR’s Bhargava did not respond to The Wire Science’s questions on the matter.
Why would a key expert committee studying the important subject of new drugs and vaccines for COVID-19 be dissolved so arbitrarily? This question is particularly significant because this isn’t the first time the health ministry and ICMR have been accused of penalising scientists for no apparent reason. For example, The Wire reported in February that the ministry had accused the Manipal Institute of Virology (previously the Manipal Centre for Virus Research) of storing samples of the Nipah virus despite not being allowed to do so. Subsequently, ICMR removed the institute from its network of Virus Research and Diagnostic Laboratories, and the home ministry revoked the institute’s Foreign Contribution Regulation Act (FCRA) license. Neither ICMR nor the health ministry shared any evidence of their accusations.
Even today, the Manipal Institute of Virology is not one of the 350+ laboratories around India that are testing for COVID-19. Instead, academic institutions with no history of medical diagnostic testing, such as the Birbal Sahni Institute of Palaeosciences, have been roped in, presumably to bridge the acute shortfall in testing capacity.
This erratic behaviour of the country’s top policymakers is disturbing. An epidemic like COVID-19 is a time for the country to bring its best scientists together instead of sidelining them sans explanation. Such capricious decisions can cost lives. The Manipal Institute of Virology is widely credited with identifying the Nipah virus early during Kerala’s 2018 outbreak, allowing the state to mount a quick and effective response. Separately, Gagandeep Kang was a key member of the team that developed India’s first indigenous rotavirus vaccine. Surely their removal from India’s flailing COVID-19 response needs more clarity. (Kang refused to comment for this story.)
The New Indian Express article appeared at this juncture, summarising the disturbing opacity in the government’s response. And the fact that a newspaper decided to retract it with no explanation is the ultimate irony. When the government is hoarding information and muzzling scientists, at least the fourth estate should speak out. But if Indian citizens can’t expect even this much from their more powerful media houses, they have more than just a pandemic to worry about.
(Priyanka Pulla is a science writer. Article courtesy: The Wire.)
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Appendix
Centre’s COVID-19 Communication Plan: Hold Back Data, Gag Agencies and Scientists
Sumi Sukanya Dutta, 8 May 2020
Amid India’s rising COVID-19 count and mounting data on its spread and patterns, the Centre has clamped down on its own top scientists and agencies and is releasing selective data that handicaps both patients and doctors.
Picture this: if you or someone in your family has COVID-19 symptoms, develops some quick complications, which is not uncommon in the disease, and needs to immediately go to a hospital–would you know which hospital you should head to?
Probably not, because the Union ministry of health and family welfare till date has not made the list of dedicated COVID-19 hospitals public even as the number of total confirmed cases stands at 56,432 and 1,886 people have succumbed to the infection.
None of the basic information such as gender and age distribution of the cases, clinical features of the patients who are in hospitals, district wise distribution of cases, state wise distribution of claimed 2 lakh oxygen supported beds, 20,000 ICUs and 20,000 ventilators are publicly available.
What the country is sporadically fed is sketchy figures instead — much of which does not make sense in the absence of denominators, say experts.
“For instance, if the government tells X number of people have tested positive for COVID-19, they should also elaborate on what were the testing protocols and what number has been found in which category — that will help us see a clearer picture related to the outbreak,” said Dr T Sundararaman, community medicine expert and former head of the National Health Systems Resource Centre under the health ministry.
“But crucial pieces of information are missing completely.”
And instead of improving, things seem to be going further on a downswing. The Indian Council of Medical Research, the nodal agency for the outbreak management, for the last 10 days has just been giving out daily updates on total tests in the country but no updates on how many people have been tested or what’s the state wise distribution of tests.
Economist and former member of the PM’s economic advisory council Shamika Ravi, whose daily info-graphics on the COVID-19 situation have emerged as a hit on Twitter and has been even cited by the government in press briefings, is now relying on information by CovidIndia.org — a private network of volunteers who have been putting together publicly available information from states.
“ICMR stopped publishing regular updates in the last week of April. So I had to move to data for states,” she tweeted on Friday responding to a query on why she had stopped posting confirmed cases per 100 tests at the national level.
And if lack of crucial data for public and researchers is not enough, there is also a gag order for various epidemiologists and infectious disease experts.
ICMR representatives have been conspicuous by their absence from the health ministry briefing for the last two weeks after a massive controversy broke out over the overpricing of 5.5 lakh rapid antibody test kits bought from China that were later also found to be faulty and returned to manufacturers. There is an informal order asking epidemiologists and scientists not to speak to the media.
Members of a national task force on COVID-19 and several of its sub groups, which includes infectious disease experts and top doctors from public and private hospitals, have been specifically asked not to speak with the press, several sources told The New Indian Express.
The pattern is being dubbed “dangerous” by some.
“Absolute lack of transparency and one-sided flow of very limited information during a massive public health emergency is ridiculous and even dangerous because this could endanger public safety in multiple ways,” said Dr Antony K R, a public health specialist from Kerala.
“You cannot fight an epidemic without taking people on board and for that building trust through a very effective two-way communication is a must but the exact opposite of that is happening,” he added.
The health ministry, on the other hand, does not seem to like questions–not only from the press but even from scientists.
A sub group on vaccination and drug research for COVID-19 was quietly disbanded a few days back because the chair of the group itself asked some difficult questions to top government officials in a meeting, The New Indian Express has learnt.
(Courtesy: The Wire. Article first published in the New Indian Express.)
