Open Minds 2021: The Vanguard

It is not the largest being on earth but the smallest that has the power to send man cowering into a corner. The arrival of an entirely new organism is rare. It is rarer for it to pose a danger to mankind. That it should come with the ability to reach every corner of the earth with blistering speed is so unlikely that civilisation’s default attitude is to ignore the possibility. There might have been specialists who kept studying it in the interim but social and political infrastructure didn’t find merit in the effort involved to be on perpetual guard for 100 years till the new virus struck. We now know different. That supernatural diligence is precisely what was needed. But then, this was a wisdom that we also received after seeing the costs of the Spanish Flu a century ago. Time mellows everything, even the certainty of monstrous threats.

What humanity has had, when possibility does meet reality, is a barebones template on how to meet it. Social distancing and isolation were even a thousand years ago the first line of defence against a contagion. But there is a difference now. Those were the only weapons then. The response of society was entirely dependent on the ruler, usually the king. If he was someone like Emperor Justinian, with the resources that the Roman Empire commanded, political will could be added in helping the empire survive the plague outbreak that goes by his name. If it were minor kingdoms under despots, as a lot of Europe was during the bubonic plague outbreaks, then all that the population could do was wait for the inevitable horrors of death or starvation.

The world is different now. All countries, from mature liberal democracies to tinpot dictatorships, have institutions to mount resistance. At a global level there are organisations, such as the World Health Organization (WHO) and multinational NGOs, to coordinate the supply of resources to those who can’t afford or can’t organise it. To be on top of the science and put it into practice. The WHO’s chief scientist is in fact an Indian, Dr Soumya Swaminathan, and one of the remits of her division is to get on top of all the stray advances that science makes everywhere and see it translated to use against present and future threats.

The giant leaps of medicine also make the response to this pandemic different from those of similar scale in the past. In almost no time of the new virus becoming known, its entire blueprint had been mapped. And then the interface between the market and scientists led to vaccines in time spans no one would have thought possible two years ago. India is an illustration. While it got its second act wrong, in creating adequate vaccine supplies, an error of complacency, we couldn’t have asked for better beginnings. Of the two vaccine manufacturers we relied on, one got its knowhow from abroad and, under his own personal risk, started production much before anyone could predict that the vaccine would be medically viable. It was driven by profit but that is as good a motivation as any if the lives of hundreds of millions are at stake. And if the gamble had not paid off, there would be no one to foot the loss other than Adar Poonawalla and Serum Institute. Covishield is a great example of the market as an instrument and incentive in tempering Covid. Covaxin, on the other hand, manufactured by Bharat Biotech, is half a market story. The other half is government intent. The vaccine was formulated in collaboration with the Indian Council of Medical Research, which also backed up its trials. In Krishna and Suchitra Ella’s producing a vaccine made in India, the ambition of the Government was crucial. But they still had to do all the execution.

Combating a pandemic is a fulltime job for a country. Everyone is part of it because a lockdown only works in totality. Yet, the map of India is peppered with those who had bigger roles to play. Some by virtue of the office they were in. A district collector in Nandurbar—home to a tribal population and far removed from the infrastructure or resources of a Mumbai or Delhi—could, by simple foresight, manage to ensure that no one gasped for oxygen. Rajendra Bharud had a simple calculation—other countries were seeing second waves, a second wave would come to India, Covid affects lungs, oxygen is the prime treatment, there could be oxygen shortfall and so create oxygen plants. He went ahead and built them using the powers his office gave to any of his peers. This could have been the story of every district but wasn’t. When Azim Premji’s foundation gave Rs 1,000 crore for Covid relief, he was not just adding a large drop of water to an ocean of need but setting a model that others in the business community could emulate. At another end of the spectrum, the actor Bhumi Pednekar, using the power of digital reach, organised hundreds of volunteers for Covid relief.

Because the virus is both unknown and lethal, a challenge has been to cut through the morass of information to make sense of the disease. The future of the course of any pandemic is dependent on how well we understand the present one. For long, any suggestion that the virus did not originate in nature was labelled a conspiracy theory. Now the possibility that it leaked from a laboratory in Wuhan is at least being considered seriously and two Indian scientists, Dr Monali C Rahalkar and Dr Rahul Bahulikar, have had some part to play in it. Doctors like Devi Shetty and Randeep Guleria have been instrumental in both advising the Government and in creating awareness among the public.

There has never been any doubt that the pandemic would fade away at some point. All pandemics do. That is the nature of the beast. The endeavour is about containing the damage until then. In the face of the unknown, the steps we take are in darkness initially. If the light is now beginning to spread, then it is because of the enterprise, wisdom, empathy and persistence of a few.

Krishna and Suchitra Ella, 65,57, Biotech Entrepreneurs: Gift of the Jab

When Krishna and Suchitra Ella relocated from the US to India in the mid-1990s to develop bio-technologies to combat infectious diseases in the developing world, they knew it would not be an easy ride. The company they built has over the past year risen willingly and ardently to fight Covid-19, knowing well the criticism and the scrutiny over pricing and scale that would come with being a Covid vaccine maker.

With an efficacy rate of 77.8 per cent and over 2.5 crore doses administered, Covaxin, India’s only indigenously developed Covid-19 vaccine, is now up for evaluation by WHO for emergency use listing. The vaccine, approved for emergency use by DCGI in January based on Phase I and II clinical trial data, is also undergoing trials on children. With a four-month time lag for Covaxin production to translate into vaccination, Bharat Biotech has been busy setting up a large facility in Malur on the outskirts of Bengaluru to produce five crore doses a month from September 2021.

Adar Poonawalla, 40, Businessman: Big Shot

Adar Poonawalla, chief executive officer and owner of the Serum Institute of India, was a successful businessman even earlier, monarch of the unique universe of vaccine manufacture. The pandemic turned him into a household name but it did not come by default. Because of Poonawalla India’s vaccine rollout got going in a substantive way. He took a gamble and began the manufacture of hundreds of millions of doses of Covishield even when there was no certainty that clinical trials would succeed. The handsome dividends he now reaps could just as well have been mammoth losses if the vaccine was found ineffective. Even now, he has to handle extraordinary pressure from all those who want vaccines, from state governments to foreign countries. For what was an enterprise far removed from the grime of Indian, and even global, politics, the pandemic has brought him right to the centre of it. Meanwhile, he is still thinking two steps ahead, with the rollout of numerous other vaccines planned, from Novavax to Sputnik. And now the Government seems to be matching steps with him, as evident in the large advance it gave for future supplies.

Randeep Guleria, 62, Pulmonologist: Emergency Alert

The director of the All India Institute of Medical Sciences (AIIMS) has been a calm and consistent figure on public platforms since the Covid crisis broke out, dispelling rumour, providing information and articulating government policy. As the head of the most sought after medical institute in the country, where he has been for the last 27 years, he is also under constant pressure to deliver in the public eye. Unflappable and indefatigable, he has a great bedside manner and was personal physician to former Prime Minister Atal Bihari Vajpayee. So he knows all about working in a pressure-cooker environment, and balancing scientific truth with political expediency. The son of a doctor, he is often credited with creating the centre for pulmonary diseases and sleep disorders at AIIMS in 2011.

Soumya Swaminathan, 62, WHO Chief Scientist: The Communicator

She has a penchant for being blunt. As the first chief scientist at WHO, the straight-talking Soumya Swaminathan has been at the forefront of efforts to control the spread of the Covid pandemic. She has refrained from giving false hopes to people and has also asked countries to adapt to the evolving nature of the virus. As a result, she has emerged as a reliable voice within WHO as the world fights the disease.

Swaminathan is a stickler for proper communication which she believes helps save lives. She wanted all countries to know which variants are more dangerous than others and which regions need special attention. She has also given top priority to clear communication of the science behind the spread of Covid. The doctor warns countries to invest in primary healthcare and make suitable interventions to save high-risk groups. She has watched the Indian Covid situation closely and has been making statements helpful to health authorities. She was among the first to rubbish the idea that those who had received two jabs of a vaccine won’t have to wear masks. She is a regular at most e-conferences on Covid-19, making her a skilful communicator in disseminating evidence-based information about Covid.

Monali C Rahalkar, 44 and Rahul Bahulikar, 48, Scientists: The Crusaders

This Pune-based scientific couple played a crucial role in strengthening the hypothesis that the Covid-19 virus leaked from China’s Wuhan Institute of Virology. When they started research in April last year, they figured that the Wuhan Institute had collected a relative of SARS-CoV-2, called RATG13, from a mineshaft in Mojiang of Yunnan province in South China years earlier.

The couple came upon information that the Wuhan Institute was experimenting with RATG13. This meant it was also possible that they made some changes in the genome of the virus, which led to the creation of the new virus. As soon as they published the paper, their claims were dismissed as conspiracy theory. But as luck would have it, they were approached by a cyber group called DRASTIC to work in tandem to find out more. Dr Rahalkar is with the Agharkar Research Institute and Dr Bahulikar at BAIF Development and Research Foundation, both located in Pune. The couple went on to gather compelling evidence to support the hypothesis that the virus originated from a lab in Wuhan rather than a seafood market as China had claimed. With the US ordering a probe into it, the plot thickens.

Azim Premji, 75, Philanthropist: The Wealth of Generosity

Wipro may not be mentioned any longer in the same breath as Infosys and Tata Consultancy Services as the top cream of India’s IT revolution but there in one field in which its founder Azim Premji ranks miles ahead of his peers—philanthropy. Last year, when the Hurun India Philanthropy list came out, it revealed that Premji had, through the Azim Premji Foundation, donated as much as Rs 7,904 crore, which comes to Rs 22 crore per day. When the pandemic struck, the foundation marked over Rs 1,000 crore for public relief. The money goes to propping up healthcare infrastructure, providing access to treatment, helping the poorest in a large number of states and more. And this while not compromising on its usual charitable works. Premji has given away a large percentage of his holdings in Wipro and, in this, he is setting a benchmark for others in the world of business. It is an approach to wealth not usually seen in India. As his son had once tweeted, Premji did not think of the wealth as being owned by him, but only something he held in trust. And the end beneficiaries of this trust are now becoming crores of Indians.

Rajendra Bharud, 33, Bureaucrat: Ahead of the Curve

Nandurbar is an overwhelmingly tribal district but it became a model of how the battle against Covid could be waged with success if there was someone at the helm with vision. That man was its collector Rajendra Bharud. Soon after the first wave, just as the rest of the country let its guard down, Bharud saw what was happening abroad with second waves and decided that he would make Nandurbar ready. Last September, he got the first oxygen plant in the district up and running and when the second wave began in March, he installed a second one. As a result, when cities began to gasp under oxygen shortage, Nandurbar was self-sufficient. He used the same foresight to spruce up health infrastructure, making Covid centres of school buildings and buying a fleet of ambulances. When it came to the vaccination drive, he used vehicles to take it to the people. Bharud is also a doctor, a possible reason why he understood Covid management better than his peers. Or it could be that he himself grew up in extreme poverty in a small hut in a village and had empathy fuelling his planning.

Devi Shetty, 68, Cardiologist: Timely Prescription

Whether or not he is inducted into the Union Council of Ministers in a possible reshuffle in July, Dr Devi Shetty will go down in history not only as the ‘Henry Ford of heart surgery’, who pioneered a new business paradigm to deliver quality affordable healthcare, but also as a measured voice that has helped India navigate two waves of the Covid-19 pandemic that saw our public health system come unriveted. There is perhaps no one in policy circles who has argued as vociferously for deploying medical students and young doctors in Covid wards. The Padma awardee, who is on several expert panels to steer India’s response to the coronavirus, including a task force to help Karnataka prepare for the third wave, estimates India will need 1.5 lakh doctors and two lakh nurses to man Covid ICUs in the coming months—and argues that they could be drawn from the pool of young doctors who haven’t made the cut for PG seats.

Shankar Balasubramanian, 54, Chemist: It’s in the Genes

A co-winner of the million-euro Millennium Technology Prize—previous awardees include Sir Tim Berners-Lee in 2004 for his discovery of the World Wide Web—Sir Shankar Balasubramanian could not have known that his discovery of the Solexa-Illumina next-generation DNA sequencing technology that enables accurate, fast and low-cost genome sequencing could help the world understand and fight the novel coronavirus. The discovery happened in 1997 when Balasubramanian was at a beer garden in Cambridge with his colleague David Klenerman; it was turned into an actual tool in 2006. Today, the tool is used in 90 per cent of the total DNA and RNA sequenced in the world. The Chennai-born British-Indian, a professor of medicinal chemistry at the University of Cambridge, is a pioneer in the field of nucleic acids. Early last year, the technology was used to map the SARS-CoV-2 genome at Fudan University in Shanghai and made available online, fast-tracking the development of vaccines like that of Moderna. It also has far-reaching implications for treating cancer and in the early detection of degenerative diseases.

Manu Prakash, 43, Bioengineer: Frugal Science

The IIT Kanpur graduate is the founder of Prakash Labs at Stanford and a vocal proponent of vaccine equity on global platforms. His list of frugal innovations is long: the Handyfuge, a hand-powered centrifuge for SARS-CoV-2 testing in low-resource settings; the PlanktonScope, a kit recreational sailors can use; the foldscope, an optical microscope assembled with easily accessible material; and the paperfuge, for quick malaria diagnosis in rural areas. He is currently working on a water droplet-based computer. Added to all this, he is a key member of the IndiaCOVIDSOS group formed by diaspora doctors to help their home country. A proponent of frugal science, he is currently focused on technological solutions to problems in global health systems, and focuses on development and deployment. He believes science is not in the lab. It is all around us.

Shahid Jameel, 63, Virologist: Follow the Fact

India’s top virologist had warned as early as March 2020 that the virus would hit the rich and poor, royal and commoner alike, and be uncaring of religion, caste, economic status or gender. He had also said that policy without context is meaningless and that he looks at facts and evidence. The Government clearly listened and made him chief of the genome surveillance committee. Shahid Jameel quit it last week because he believed it was not focused on the evidence before declaring that the delta variant could evade vaccines, information that is necessary even if scary. At a time when public health specialists have not always been accurate about the dangers ahead with Covid-19, Jameel is one scientist no one can afford to ignore. What he says on quitting: It just seemed the right thing to do.

Madhukar Pai, 52, Epidemiologist: Doctor of Equality

The Vellore and UC Berkeley-educated doctor is one of the world’s leading tuberculosis specialists, head of Pai Global TB Group, who is collaborating with the Indian government on the eradication of the disease. He is also a key member of the diaspora group IndiaCOVIDSOS that is working on providing material aid, information, and vaccines to India. While focusing on Covid, the doctor believes countries such as India cannot afford to take their eye off the ball when it comes to tuberculosis. Pai is a consistent voice for vaccine equity across a variety of platforms where he is a prolific writer and speaker.

Ved Arya, 62, Coordinator RCRC: First Responder

The IIT Kanpur and IIM Ahmedabad graduate who worked at the World Bank believes you have just one life. It depends on you what you want to make of it. When he quit TCS in 1982, he argued with himself that TCS could hire many Ved Aryas but society would benefit more if it had one Ved Arya. Today, his organisation SRIJAN has already impacted the lives of half a million people. But more than that, last year he coordinated a massive response to Covid called the Rapid Community Response to COVID where 66 organisations, mostly working in rural livelihoods across 15 states with 1.6 crore people, came together in the face of the pandemic and lockdown to help with logistics, mobility and all kinds of aid. Much before most, Arya had predicted that the return of the migrants would trigger a deadly second wave.

Giridhara R Babu, 45, Epidemiologist: Building Confidence

Last year, when he defended India’s low mortality rate based on data from sero prevalence surveys, Dr Giridhara R Babu was accused of taking the Government’s side. In the second wave, he warned of a higher death rate simply for lack of enough hospital beds in the country. Dr Babu has always followed the numbers—from being a part of massive pulse polio eradication drives during his six-year stint with the World Health Organization, when he led the programme in Karnataka, to establishing protocols for measles surveillance to help control the disease burden, and his ongoing cohort study on pregnant women and diabetes. His whole life, he believes, was shaped by a few favourable odds, such as paying government fees to pursue medicine at Kasturba Medical College, Manipal, thanks to a fortuitous government order that year, and getting into the Master of Public Health programme, followed by a fully funded PhD at the University of California Los Angeles with the support of the Public Health Foundation of India. It is not chance, however, that made Dr Babu’s voice stand out from the clutter of opinions in the past year. Few public health experts have inspired such confidence in India’s ability to tackle a pandemic.

Bhumi Pednekar, 31, Actor: Act of Conscience

A Socially conscious actor, she walks the talk when it comes to climate advocacy or providing help to Covid-19 patients. The acclaimed actor runs two important and hugely successful social media advocacy platforms—Climate Warrior, focusing on raising awareness on climate change in India, and COVID Warrior, intent on saving lives. Given her relentless good work, she has been deemed the most aware celebrity in Bollywood and her credibility has been on the upswing ever since. From prominent FMCG brands to positively conscious jewellery, from clothing brands to forward-thinking social campaigns brands, they have all gravitated towards her.

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