Unfortunately, Lancet has fed into public hysteria, instead of offering sage advice based on objective evidence

The Lancet is a reputed medical journal published from the United Kingdom that has been in existence for more than a hundred years and occupies a place of respect among the global medical fraternity. However, a recent editorial, titled India’s Covid-19 emergency (May 8, 2021) regarding India’s second Covid-19 wave leaves much to be desired. This leader article is an egregious rant that is misplaced and misinformed; one that blatantly distorts data and indulges in sweeping unsubstantiated conclusions. In parts it reads like a political hatchet job rather than a scholarly observation. It is an embarrassment to medical academia.

The editorial mounts a scathing attack on the Narendra Modi government labelling India’s second wave as a “self-inflicted national catastrophe” stemming from crass gubernatorial complacency and negligence.

The premise that India’s second wave is primarily due to government lapse is a cursory half-baked assessment that may pass in layman publications but to grace the editorial of a scientific journal is preposterous. A meticulous scientific analysis of India’s second Covid wave posits a completely different narrative.

Central to the course of India’s second wave is the B.1.617 variant. In a short period, the B.1.617 variant has become the dominant strain across India and has spread to about 40 countries including the United Kingdom. Preliminary studies indicate that B.1.617 is a distinct newly identified lineage with mutations that facilitate better transmissibility into the host cell, decrease binding to antibodies effecting their neutralization potential and may enhance the ability of the virus to evade antibodies induced by infection or vaccination; all of which contribute to rapid spread. Animal experiments demonstrate more severe lung inflammation with this variant.

While the contribution of super spreaders like large religious gatherings, the farmers’ protest and the election campaign cannot be discounted it would be scientifically naive to overlook the possible role of the B.1. 617 variant as a key player, as evidenced from emerging data.

Conclusions derived from some data, however preliminary is more acceptable than whims and fancies which this editorial subscribes to.

The near vertical slope of India’s second curve made preparedness next to impossible. India’s traditionally shaky health system was expectedly pushed to the brink-oxygen shortage, dearth of hospital beds and insufficient medications became the norm. India’s predicament however is no different from what even New York, a city with a robust health network underwent in March last year. Stretchers lining the corridors of hospitals, cafeterias taken over to accommodate critical care beds, ventilator shortages, dearth of medical supplies and refrigerated trucks serving as impromptu morgues became commonplace. Therefore, to expect complete preparedness for such a catastrophic calamity is a bit too over optimistic and unrealistic.

The characterization of India’s vaccination program as a “botched” vaccination campaign flies in the face of evidence. India began its vaccination program on January 16 (roughly a month later than the United States and the United Kingdom) and followed the standard global practice of targeting the most vulnerable population first. India’s first phase included healthcare workers and front-line workers while the second phase, that was initiated on 1 March 2021, focused on India’s most vulnerable group—people above 60 years of age.

As of May 30, India had administered 208 million doses and stands second only to the United States (294 million). When we analyze these numbers within the framework of effective targeting, they are quite impressive for a country of India’s size. Of the 270 million people in the vulnerable age group (45 plus), 113 million (41%) have received one dose and another 27 million (10%) have received both doses as of May 19.

To camouflage this fact, the Lancet editorial advertently or inadvertently distorts the picture by matching India’s vaccination numbers against the entire population (including the less vulnerable below 18 age group) to project a disappointing and paltry figure of 2%. Such statistical juggling is deceptive and misleading and tantamount to scientific chicanery at its worst.

Further, the editorial claims that at “the federal level, India’s vaccination plan soon fell apart” and referring to India’s decision to expand vaccination coverage to all over 18 years avers, “government abruptly shifted course without discussing the change in policy with states, expanding vaccination to everyone older than 18 years, draining supplies, and creating mass confusion.”

None of this is true. The decision to expand the vaccination drive to all over 18 years of age was taken on April 19 following a meeting of Prime Minister Narendra Modi with pharma companies, doctors, Cabinet ministers in charge of health, drugs and officials spanning multiple nodal ministries. (Vaccines for all above 18 from May 1; States can buy directly. The Hindu. April 19, 2021.)

Second India’s vaccination program is not falling apart. After a temporary dip in the daily vaccination rates in early May an occurrence that many countries have experienced, there has been a sustained uptick. On May 30 India administered more than 3 million doses.

The uncharitable remark that, “Prime Minister Narendra Modi’s Government has seemed more intent on removing criticism on Twitter than trying to control the pandemic” is outright misrepresentation.

The intention of the government was not to suppress any embarrassing information or stifle dissent but to avoid unnecessary panic and misgivings about the vaccine.

Sai Prasad, an executive director at Bharat Biotech, which makes Covaxin, the country’s other Covid-19 vaccine remarked, “This (vaccine hesitancy, my insertion) is literally due to disinformation or misinformation… Adults are more finicky than children: They change their minds thanks to WhatsApp University and Twitter on a second-by-second basis” (Cohen J. Why is the world’s largest Covid-19 vaccine campaign faltering? Science 2021. May 19.)

If the Lancet had full faith in its own convictions, then it should not balk at publishing an opposing view. However, when this author submitted a rebuttal replete with medical references, the journal rejected his submission and even refused to entertain a request for reconsideration that all authors are eligible for.

Scientific journals are mandated to bring knowledge and a sense of balance to the unsubstantiated rhetoric that crowds the public and political arena. Unfortunately, in this instance, the editorial has fed into public hysteria, instead of offering sage advice based on objective evidence.

Finally, the editorial pontificates that, “India must now restructure its response” with “science at its heart”. That is a dictum which is more applicable to the journal’s stance.