* Editorial 2

While efforts to develop an anti-COVID-19 vaccine are encouraging, safety issues are paramount

“The race for developing an anti-COVID-19 vaccine has begun.” A researcher works on a vaccine against COVID-19 at Copenhagen University’s research lab in Copenhagen, Denmark. AFP

The novel coronavirus has infected more than 4,00,000, people worldwide and led to the deaths of more than 17,000. The epicentre of the pandemic has shifted from Wuhan district in China to the highly developed Western world. Countries such as Italy, Spain, France, Germany, the U.K. and the U.S., which have some of the most advanced health systems in the world, have come under tremendous pressure and seem unable to deal with this health crisis. With no specific therapy or vaccine available at present, it is imperative that we fast-forward the development of efficacious vaccines and drug therapies against COVID-19. However, it must be emphasised that because vaccines are given to large populations, safety issues are paramount. The world is dealing with an unprecedented and unimaginably serious crisis. Therefore, the speed of vaccine development is crucial.

Encouraging developments

The race for developing an anti-COVID-19 vaccine has begun. Reasonable scientific rationale and the information needed for vaccine development are available to all stakeholders in academia and industry. A large number of candidate vaccines based on different vaccine platforms, including delivering the virus genetic materials (RNA, DNA) or using synthetic biology to produce key viral proteins, have already been developed. In fact, Phase-I safety trials of an experimental vaccine, jointly developed by scientists at the National Institute of Health and at Moderna, a biotechnology company, has already been administered to healthy volunteers for its safety and immunogenicity. Although based on some earlier experience of vaccines of other coronaviruses such as SARS and MERS, the speed with which the experimental vaccine has entered safety trials is unprecedented. Another vaccine jointly developed by China’s Academy of Military Medical Sciences and CanSino Biologics has reportedly been cleared for early-stage clinical trials in which more than 100 healthy volunteers are scheduled to receive the vaccine. The Serum Institute of India has also recently announced its readiness to start safety trials following animal experiments. According to a World Health Organization (WHO) report, more than 20 vaccine candidates are in advanced stages of development and will be ready for Phase-I safety trials. While these developments are encouraging, several questions will need to be answered for these candidates to move further.

Although it is quite evident that humans mount a strong immune response and clear the viral load, the nature of the immune response and how to trigger it safely through vaccination will be key questions to address. Some early, but limited, studies from China have suggested that monkeys can be infected with this virus but can be protected from reinfection. How long the acquired immunity in humans will last is another important question to be asked before experimental vaccines move forward. We will need to know this because if the immunity is transient, then humans will be susceptible to reinfections. Before moving to Phase-II trials in a large number of healthy volunteers, we also have to ensure that the immune response induced by vaccination does not lead to any disease enhancement, as has been observed in cases of some experimental vaccines against the dengue virus, and in animal studies with an experimental vaccine against the SARS virus.

It is absolutely imperative that anti-COVID vaccines are developed as fast as possible and by pushing all reasonable vaccine candidates through animal and human clinical trials. However, it is also clear that it will not be possible to roll-out any efficacious vaccine for at least another year. An all-out effort to develop a vaccine against COVID-19 must continue if we have to stop its spread.

With COVID-19 playing havoc across the world, therapeutic interventions, not only for curing severe cases of the disease but also for protecting all front-line healthcare workers, are urgently needed. Since developing new drugs is a complex and lengthy process, scientists and pharmaceutical companies have rushed to investigate and use drugs that have already been approved by regulatory authorities. Using available molecular and structural biology information on the virus, a group of scientists have analysed all interactions of the viral proteins with human proteins that are crucial for the virus to enter human cells and use the host cell machinery to rapidly reproduce itself. Of the nearly 70 short-listed molecules that may interrupt these key interactions, 24 happen to be already approved drugs which can now be tested in laboratory animal models as well as humans. However, the re-purposing of several drugs, alone or in combinations to treat COVID-19 patients, have already been reported. There are many success stories of curing patients of COVID-19 doing the rounds in different parts of the world, but these have managed to create more confusion than hope. Without any appropriate controls, careful dosing and safety concerns, such small experiments can only do more harm than good.

Controlled randomised trials

Given the urgency of finding a cure, it is absolutely necessary to find out unequivocally what works well and what does not. For that conducting carefully controlled randomised trials is the only way to go. In a welcome move, the WHO has announced clinical trials called the ‘Solidarity Project’. Under this four drugs or drug combinations will be tested in many countries around the world. These candidates include the anti-Ebola drug, Remdesivir, Chloroquine, anti-HIV drugs, and the Ritonavir/Lopinavir combination, with or without Interferon-beta. Many countries have already signed up for these trials and all drug companies, including CIPLA from India, have agreed to supply sufficient quantity of drugs needed. The European counterpart of the trial, Discovery, will conduct these trials in countries including France, Spain, Germany and the U.K. The pharma company Roche has also decided to initiate large, randomised Phase-III trials of its arthritis drug Actemra for its safety and efficacy in adult patients with severe COVID-19 pneumonia. It is complex and tedious to conduct randomised, large multi-centric trials. Quickly getting all the stakeholders together is laudable and underscores the notion that everyone needs to fight the deadly virus together. Hopefully, these trials will lead to tangible drug therapies against COVID-19.

It is most heartening to see scientists in academia and industrial partners coming together to fight a monumental public health crisis. The battle between pathogens and humans will continue but let us hope that we win the present one sooner than later.

Virander Chauhan is former Chairman of UGC and former Director of the International Centre for Genetic Engineering and Biotechnology where he currently holds the Arturo Falaschi Chair

Similar to health workers, delivery workers are the new front-line force keeping citizens’ lives running

The ‘ferrymen’ of Wuhan, who have been providing groceries, food and medicines to citizens isolated in their homes, have been the backbone of cities that have been most hit by the novel coronavirus. In China, ride-hailing company Didi and others have a dedicated workforce and resources to provide free transport to health workers. Delivery infrastructure or digitally enabled micro-logistics are key to how citizens navigate their ‘social distanced’ lives during the pandemic.

Delivery technologies are providing a key form of infrastructure that can be mobilised at short notice, dynamically and at scale. The mix of multi-side market economics, an on-demand workforce, and algorithmically managed tasks make this mobilisation possible. This is what enabled Didi to launch food delivery in 21 cities in response to the pandemic. Delivery workers, similar to health workers, are the new front-line force keeping citizens’ lives running.

New protocols

In India, how are companies navigating the threat their delivery personnel are under? Major delivery players in India have responded by publicising consumer awareness, restricting dynamic pricing (Amazon and Flipkart) and contact-less delivery protocols. Ola offers ₹1,000 a day for lost income for up to 21 days for drivers or their family members who contract the virus. Flipkart is reportedly mapping impacted areas to ensure that delivery agents are aware and least affected as they continue to offer relief to elite and middle-class households who have been the first-wave of likely infected citizens.

However, company follow-through is in question. Reports show that delivery platforms have not yet implemented some of these protocols. Indian mobility platforms have not yet offered to extend or waive loans and rental fees for lease drivers like Didi did for China in the month of February.

Digital delivery infrastructure is novel in form because of its socio-technological nature. Companies like Uber, Didi and Swiggy have pushed out a notion that their responsibility is to maintain the ‘technological’ half — hygiene on their apps, keep their algorithms working and offer ‘decent’ payouts to their flexible, contracted workforce. Like with other kinds of infrastructure it appears mute, working efficiently in the background. However, the bodies of delivery personnel remain unnoticed, invisible. Companies use this rhetoric to make consumers like us believe that they can’t do more than these tasks, obfuscating the fact that they can and we can hold them accountable for more than they claim.

Facing risks

It is only when such infrastructure breaks or is in decay that public concern around it grows. The COVID-19 pandemic exacerbates the risk faced by delivery agents. They are unable to take a break from work, work from home, or access the superfluous resources that white-collar and professionals in other fields are deriving from their employers. Delivery personnel face severe exposure to the virus without paid sick leave, without work, and daily payouts. Gig Workers Rising says delivery personnel don’t choose to work during the pandemic but rather, they are being forced to, potentially putting the public at risk. Daily-wage workers in construction will possibly receive compensation from the U.P. government for their lost wages. Yet, platform delivery personnel, who are vital to allowing urban life to continue, have no proposed protections or rewards for their work.

Acknowledging the mix of delivery personnel and app-based delivery companies as infrastructure rather than the sole mandate of private companies can deliver better outcomes for personnel. It nullifies corporate marketing and propels the services into public governance. Indeed, government orders noting the lock-down of many districts note delivery as an essential service in most metros. Recognising the key infrastructural role that delivery personnel are playing in the pandemic opens up a set of responsibilities for the government to take on.

A new reality?

If governments around the world are ready to nationalise key infrastructure (like Spain’s private hospitals), can we use the food delivery workforce to deliver tests or essential medicines to those affected? With the Delhi government banning all dining-in and allowing only delivery, is the pandemic a time to think about a new form of regulation that brings private, socio-technological infrastructure into the public fold in times of crises, eventually to be released back into the forces of the market? Can the app service and app worker’s status as public infrastructure bolster a better interpretation of social protection that lasts beyond this crisis?

Aditi Surie is a sociologist at the Indian Institute for Human Settlements

How the virus is changing the world and lives

The public health crisis enveloping the world has spared no city, and Washington, DC, where I am normally based, is no exception.

Soon after returning from his trip to India, the city’s most high-profile resident, U.S. President Donald Trump, held his first COVID-19 press briefing. He announced that Vice President Mike Pence would lead the effort against the virus. That Mr. Pence had been criticised for his public health record as Governor of Indiana added to the growing sense that Mr. Trump was taking things too casually and not responding adequately to the challenge. In the days after the briefing, more changes came to Washington, DC — it was as if people were finally and officially allowed to worry about COVID-19.

“It’s coming towards us,” one man was heard telling his companion on the Circulator, a local bus, referring to a case that had emerged in Rhode Island. Just the day before, the administration had announced a ban on travellers from Iran, and travel advisories for South Korea and Italy.

Spread of the virus

There was an awareness that the virus was stalking DC by the end of the first week of March, as reports of infections at the Conservative Political Action Conference and American Israel Public Affairs Committee emerged. Across the county, in Washington State, schools had closed, leaving many parents, especially those on a lower income or those without family support, wondering what they would do about childcare. By the time schools closed in DC and teleworking had kicked in, another problem had emerged: how would parents work from home and also home-school their children?

While it was only during the week before last that a significant number of offices in DC started moved to teleworking, not everyone could practise social distancing as the virus spread. Some workers did not have a choice about their interactions at work – for instance, the store cashier, the concierge at an apartment building, the cab driver. People in these positions are often minorities or have low incomes, adding to their risks of making it through these times unscathed.

Some who could practise social distancing apparently chose not to. Groups of younger Washingtonians, dressed in green for St. Patrick’s Day, were seen on the streets. Younger people have been criticised in the U.S. for a ‘business as usual’ approach to socialising and taking their Spring Break.

Grey clouds and silver linings

People working in the gig economy or running small business have also been impacted. For instance, Uber drivers reported a loss of passengers and small business owners have had to grapple with letting go of employees to keep their businesses afloat.

At supermarkets, people jostled for space in the aisles, some buying what looked like a month’s worth of groceries, emptying out certain categories of food. Department stores ran out of hand sanitisers, thermometers, and even toilet paper. Notices limiting purchases were seen at several stores in the city.

Last week, Mr. Trump appeared to step up the use of what some have called xenophobic language to describe the pathogen, making references to the “foreign” or “Chinese” virus. This has some foreigners in DC worried. A woman in her early forties, Ellen (last name withheld), whose senior citizen parents were visiting DC from Belgium, told The Hindu that her parents had decided to return to their home, despite Europe being the epicentre of the pandemic. “They didn’t trust the health care system here and the political response,” she said, concerned that ventilators, which the U.S. does not potentially have enough of, would be reserved for U.S. citizens.

However, there are some silver linings to the many grey clouds. People are stepping up to help. For instance, with restaurants closing, Chef Jose Andreas is converting his outlets into community kitchens. “People have to eat,” Mr. Andreas said, as per The Washington Post. Some stores have reserved hours for those above 60 and other more vulnerable groups.

The virus is changing the world and lives, and DC is no exception.

sriram. lakshman@thehindu.co.in

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