Covaxin phase 3 trial data published in Lancet and tweeted by NIH Director Francis S. Collins has caused a torrent of demand in the US and elsewhere on Twitter for Covaxin.

Bengaluru: China and India have 18.2% and 17.7% of the world population respectively, that is nearly a fifth of the world population each and a comparison of their differing Covid-19 management under differing political setups provides a good insight into how disaster management differs between autocratic and democratic nations. Autocratic China with civil-military-political fusion imposed a total lockdown of Wuhan with door to door survey and quarantine by sealing persons in their homes to completely eliminate the virus under a zero Covid-19 policy. Deaths and suffering of individuals in Wuhan were considered an essential sacrifice for the common good of the rest of the nation.
A DELAYED, HIGHLY REGULATED CHINESE RESPONSE: In any autocratic set-up, all contrary views are suppressed, especially those that show the supreme leader in a bad light. All problems are blamed on local leaders who are then punished. Hence the initial warnings of a deadly new viral infection and all whistle blowers were suppressed by local leaders afraid of punishment. The delayed response allowed the disease to spread and the problem was compounded by wrongly informing WHO and the world that there was no human to human transmission, no need for masks or banning international travel to and from China. Meanwhile all medical stocks in India and other well-meaning nations were transferred as gifts or by import to China. Once the seriousness of the problem dawned on the top leadership, the entire civil-military-political system moved all human and material resources from all over the nation to handle the problem including setting up temporary hospitals and mass production of medical equipment and disposable supplies. These measures riding roughshod on all human rights with full unquestioned cooperation of the entire nation was possible only due to fusion of civil society with Communist Party functionaries and military apparatus and the fear instilled by an extensive surveillance network with severe punishment for any deviation. All later outbreaks have been controlled similarly and incidence of disease and deaths has been suppressed both actually and statistically. Obviously, this is not an option for democratic nations like India with an open society, a free press and respect for human rights.
AN EARLY, INITIALLY CHAOTIC, LATER EFFECTIVE INDIAN RESPONSE: Taiwan and not WHO was the first to warn the world about the dangers of this new virus. The Indian Prime Minister was a rare world leader to act early by banning flights to and from China for which he was severely criticised by China. India rushed supplies to China and other nations and meanwhile effectively contained the initial outbreak in the state of Kerala. This was possible by early identification and activation of existing local health networks experienced in managing infectious diseases outbreaks. Soon a large number of visitors and Indians returning from Europe and the Gulf region brought the disease in such a large number that an experienced Indian network short on supplies and means to test for and treat this new virus in the absence of vaccines was soon overwhelmed. The world’s largest lockdown of the entire nation on short notice in March of 2020 led to mass exodus by foot of migrant labour from cities which were first affected, to their home states, thus further spreading the infection and leading to starvation-exhaustion deaths. Though the government and others arranged food and shelter to them, and later even transport, false information on social media led to this panic reaction. These and many other problems and shortages that had not been planned for, caused avoidable chaos, misery and loss of life. The economy also took a huge hit till the service industry shifted to work from home; arrangements were made for running essential manufacturing and logistics. Agriculture was affected by labour and logistic problems, but eventually recovered. The second wave, due to a mutant, hit like a massive tsunami and completely overwhelmed parts of the nation where politics took priority over cooperation against a common enemy. A well-oiled Centrally managed free vaccination drive got derailed by multiple doubts raised about Indian vaccines and vaccine shortage worsened by demands to let states and private agencies to purchase vaccines. Social media, certain TV journalists and opposition parties spread disinformation, fake news, highlighted misery and death to undermine the health system desperately trying to control the pandemic. This resulted in contrived shortages, exploitation by greedy crooks, unethical practices, violence against health workers and facilities, vaccine hesitation, fear, misery and death. These merchants of death helped the virus spread and kill. An overwhelmed health system struggled with shortages, managing the sick, testing and quarantine, vaccination, data entry, fighting misinformation and false propaganda. China and western media took full advantage of all this to mock India, even though India had helped them earlier in their hour of need. The saving grace was the massive increase in local manufacturing and funding of medical disposables, equipment, testing kits, drugs and vaccines. Also mobilization of all health and frontline workers, and emergency networking of software, apps, laboratories and health facilities, telecom and logistics saved democratic India against all odds under a very responsive 24×7 hands-on leader who removed all road blocks.
THE VACCINE CONUNDRUM: Mercantile China in a tearing hurry mass produced substandard medical disposables, medical supplies and vaccines to profit from the global misery triggered by it. As mentioned in an earlier article, the Chinese military and CanSinoBIO were the first to apply for a patent for a Covid-19 vaccine on 18 March 2020. When Indian-gifted or exported vaccines were preferred by many nations, China, helped by many in western and Indian media ran a concerted campaign to discredit Indian vaccines, thus playing into the hands of big pharma and delaying emergency authorisation and listing by WHO. Nations who used Chinese vaccines have found them less effective and are now using other vaccines. The mRNA vaccines needing ultracold-storage facilities and logistics have been used extensively by rich nations. These are based on a new technology which was under development for cancer treatment and their long term performance and safety are not known. As these vaccines use an mRNA to message recipient cells in the body to produce the virus spike protein, to then trigger an immune response, they are likely to be less effective if the virus undergoes a mutation altering its spike protein. They are showing a fall in immune response within 6 months, requiring booster doses, especially in those with weak immune response. There is also the doubt that messaging body cells to produce a virus protein may expose these cells to immune attack and autoimmune disorders. Stimulating the immune system against cancer cells is desirable but not against healthy cells messaged to produce virus protein. There have been many reports of inflammatory disorders like carditis. Covaxin developed by Indian researchers and produced by an Indian company based on a time tested attenuated-killed whole virus technology, is hence effective even if a part of the virus mutates and has proved to be effective against mutants, safe even in children, requiring normal refrigeration for storage, longer lasting at room temperature for door to door vaccination and less expensive. The Covaxin phase 3 trial data published in Lancet on 11 November 2021 and tweeted by NIH Director Francis S. Collins has caused a torrent of demand in the United States and elsewhere on Twitter for Covaxin.

Dr P.S. Venkatesh Rao, MBBS (Vellore), MS (Vellore), DNB, FRCS (Glasg), FACS, FICS, FMAS, FAES is Consultant Endocrine, Breast and Laparoscopic Surgeon.