Vaccines In India: I Wish I Could Trust The Government

It's stupid to expect people without any medical training to understand how each vaccine candidate has been evaluated. Public accountability offers an alternative.

Vaccination practice in New Delhi
Vaccination practice in New Delhi
Vasudevan Mukunth

NEW DELHI — Perhaps we have a dilemma.

An anti-vaxxer stance is objectionable — and in any case, I don't believe vaccines are disease-causing agents. Vaccine hesitancy also seems like a deeply discomfiting position. Still, what if I'm reluctant to take a vaccine because I don't trust the checks to which my government has subjected two new COVID-19 vaccine candidates?

Or consider this much more likely scenario: Your grandparents ask you if they should take Covaxin, which is being offered to them. This is Bharat Biotech's COVID-19 vaccine candidate, and the wording of its approval is, frankly, worrying. Are you confident enough to tell them to go ahead?

I'm not.

Come to think of it, the Government of India has pulled off a trick here. It determined that people most at risk of dying due to COVID-19 would get the vaccine first (even as the vaccine candidates themselves weren't tested to see if they would prevent severe forms of the disease, but that is a separate story). Then, it granted "restricted use" approvals – whatever that means – to two vaccine candidates based on checks, deliberations and data known only to a small group of people. As a result, by the time the less vulnerable people like myself, who are rightly at the back of the queue, get the vaccine, we will know if they are really safe.

In other words, by messing up its validation process, the government is virtually experimenting with the most vulnerable who will receive the vaccine candidates first – people like our grandparents – while those who are less likely to suffer for it will have it easier.

And that is wrong, surely.

Even if we discover, at the end of it all, that the vaccine candidates worked just fine, too many potential consequences – potential tragedies – stand between this moment and the bliss of hindsight.

Was the approval process transparent and accountable? No.

Rush the vaccines, by all means – but isn't there a better way to do this? The pandemic forced researchers to tweak the clinical trial process a bit. They could not and did not skip phases. But instead of performing one phase after another, researchers performed two or more phases in parallel and evaluated each one according to data from the previous one.

Second, national regulators that would have to assess this data pursuant to an approval resolved to do so as a priority. They also granted "emergency use authorizations': a vaccine candidate could be approved for use in restricted contexts based on safety and efficacy data from phase 1 and 2 trials. But even as the manufacturer begins mass-producing them, the company has to conduct phase 3 trials and submit the resulting data to the regulator for a review.

Third, vaccine-makers stockpiled doses so that, should the vaccine candidates be approved, the makers could hit the market as soon as possible. Some governments stepped in and promised that if a candidate was not approved, the state would help the maker minimize its losses – effectively creating an incentive for supply to match demand from the get-go.

Finally, but actually in all this time, the government is meant to ensure the process is transparent and that all those involved in it – including vaccine-makers and the national regulator – are accountable to the people. There is a simple reason for insisting on this accountability. It is stupid to expect people without any medical training to completely and perfectly understand how each vaccine candidate might work and how it has been evaluated. Public accountability offers an equally valid alternative: it assures people that whatever the thing they are going to inject into their bodies does to them, they will be treated fairly, with a straightforward path to justice.

The pandemic forced researchers to tweak the clinical trial process a bit — Photo: Mayank Makhija/NurPhoto via ZUMA Press

How much of this did India get right?

Let us work backwards. Was the approval process transparent and accountable? No. Did the government help Serum Institute of India and Bharat Biotech stockpile doses? Perhaps, although there was no formal announcement. Serum Institute also had an unusual advantage: it is family-owned and doesn't have to answer to shareholders, and so can manoeuvre more easily to changing market conditions.

Then, we don't know what data Bharat Biotech and Serum Institute submitted to the Central Drug Standards Control Organisation, or what the subject expert committee and Drug Controller General's (DCGI) deliberations were like. We don't even know who the committee members were. No data about Bharat Biotech's Covaxin trials is in the public domain either, apart from the trials' registrations on the Clinical Trial Registry website.

The Hindu reported that Serum Institute submitted data pertaining to only 100 participants of a phase 2 trial for its candidate, Covishield, to the DCGI's office. Covishield is also saddled with doubts about its efficacy, thanks to the actions of AstraZeneca, its biological parent.

I would really like to take a vaccine for COVID-19 without worrying about whether it is safe, if it works, or if it is just going to jack up my already dispiriting medical bills. I would like to be able to happily recommend a vaccine to my grandparents even more. I definitely don't want to tell them the DCGI said in his approval announcement that his office is approving Covaxin in "clinical trial mode", then explain what clinical trials are. They are already so scared and lonely.

Accountability is a small price to pay.

Last week, when my 82-year-old maternal grandmother and I were talking about COVID-19, she said she would be more than happy to forego immunization so someone else could get the vaccine before her, "like you". She is just as likely to step aside for you, dear reader.

I'm going to take the vaccine when it is my turn, and I'm certain I'm going to be worried when I do. Today – January 4, 2021 – the vaccine candidates are no different from air pollution in India's urban centers, dying rivers and destroyed forests across India's plains and mountains. From the men, women and children languishing in makeshift prisons because they couldn't prove, by an arbitrary rule, that they are Indians. From farmers facing the brunt of climate change and policy change both, from couples in love who can't get married for fear of imprisonment because one of them is Muslim.

According to the Government of India, the vaccine candidate is the by-product of the country's glorious march to greatness, the conclusion of a ‘by Bharat, for Bharat" effort. Even Prime Minister Modi (and home minister Amit Shah) didn't miss the chance to remind us of "the eagerness of our scientific community to fulfill the dream of an Aatmanirbhar Bharat, at the root of which is care and compassion". Accountability is a small price to pay. Forget your dilemmas. Just look the other way, wait for the nurse to poke the needle into your arm, stop worrying, go home and thank the Dear Leader.

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Where Lockdowns For LGBTQ Meant Moving Back In With Homophobic Relatives

The confinement experience could turn brutal for those forced to live with relatives who would not tolerate a member of the family living their sexual orientation openly as a young adult. Here are stories from urban and rural India.

At a Rainbow pride walk in Kolkata, India

Sreemanti Sengupta

Abhijith had been working as a radio jockey in the southern Indian city of Thiruvananthapuram when the COVID-19 pandemic hit in March, 2020. When the government imposed a nationwide lockdown, Abhijith returned to the rural Pathanamthitta district , where his parents live with an extended family, including uncles, cousins and grandparents.

Eighteen months later, he recalled that the experience was "unbearable" because he had to live with homophobic relatives. "Apart from the frequent reference to my sexual 'abnormality', they took me to a guruji to 'cure' me," Abhijith recalled. "He gave me something to eat, which made me throw up. The guru assured me that I was throwing up whatever 'demon' was possessing me and 'making' me gay."

Early in 2021, Abhijith travelled back to Thiruvananthapuram, where he found support from the members of the queer collective.

Inspired by their work, he also decided to work towards uplifting the queer community. "I wish no one else goes through the mental trauma I have endured," said Abhijit.

Abhijith's story of mental distress arising from family abuse turns out to be all too common among members of India's LGBTQ+ community, many of whom were trapped in their homes and removed from peer support groups during the pandemic.

Oppressive home situations

As India continues to reel from a pandemic that has claimed more lives (235,524) in three months of the second wave (April-June 2021) than in the one year before that (162,960 deaths in March 2020-March 2021), the LGBTQ community has faced myriad problems. Sexual minorities have historically suffered from mainstream prejudice and the pandemic has aggravated socio-economic inequalities, instigated family and institutionalized abuse, apart from limiting access to essential care. This has resulted in acute mental distress which has overwhelmed queer support infrastructure across the country.

Speaking to queer collective representatives across India, I learned that the heightened levels of distress in the community was due to longstanding factors that were triggered under lockdown conditions. Family members who are intolerant of marginalized sexual identities, often tagging their orientation as a "disorder" or "just a phase", have always featured among the main perpetrators of subtle and overt forms of violence towards queer, trans and homosexual people.

Calls from lesbians and trans men to prevent forced marriages during lockdowns.

Sappho For Equality, a Kolkata-based feminist organization that works for the rights of sexually marginalized women and trans men, recorded a similar trend. Early in the first wave, the organization realized that the existing helpline number was getting overwhelmed with distress calls. It added a second helpline number. The comparative figures indicate a 13-fold jump in numbers: from 290 calls in April 2019-March 20 to 3,940 calls in April 2020-May 2021.

"Most of the calls we have been getting from lesbians and trans men are urgent appeals to prevent forced marriages during lockdowns," said Shreosi, a Sappho member and peer support provider. "If they happen to resist, they are either evicted or forced to flee home. But where to house them? There aren't so many shelters, and ours is at full capacity."

Shreosi says that the nature of distress calls has also changed. "Earlier people would call in for long-term help, such as professional mental health support. But during the pandemic, it has changed to immediate requests to rescue from oppressive home situations. Often, they will speak in whispers so that the parents can't hear."

Lack of spaces

Like many of his fellow queer community members, life for Sumit P., a 30-year-old gay man from Mumbai, has taken a turn for the worse. The lockdown has led to the loss of safe spaces and prolonged residence at home.

"It has been a really difficult time since the beginning of the lockdown. I am suffering from a lot of mental stress since I cannot freely express myself at home. Even while making a call, I have to check my surroundings to see if anybody is there. If I try to go out, my family demands an explanation. I feel suffocated," he said.

The pandemic has forced some queer people to come out

Sumit is also dealing with a risk that has hit the community harder than others – unemployment and income shortage. He's opened a cafe with two other queer friends, which is now running into losses. For others, pandemic-induced job losses have forced queer persons from all over the country to return to their home states and move in with their families who've turned abusive during this long period of confinement.

Lockdowns force coming out

According to Kolkata-based physician, filmmaker and gay rights activist Tirthankar Guha Thakurata, the pandemic has forced some queer people to come out, succumbing to rising discomfort and pressure exerted by homophobic families.

"In most cases, family relations sour when a person reveals their identity. But many do not flee home. They find a breathing space or 'space out' in their workspaces. In the absence of these spaces, mental problems rose significantly," he said.

Not being able to express themselves freely in front of parents who are hostile, intolerant and often address transgender persons by their deadname or misgender them has created situations of severe distress, suicidal thoughts and self-harm.

Psychiatrist and queer feminist activist Ranjita Biswas (she/they) cites an incident. A gender-nonconforming person died under suspicious circumstances just days after leaving their peer group and going home to their birth parents. The final rites were performed with them dressed in bangles and a saree.

"When a member of our community asked their mother why she chose a saree for someone who had worn androgynous clothes all their life, she plainly said it was natural because after all, the deceased 'was her daughter,'" Biswas recalls.

The Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling

David Talukdar/ZUMA

"Correctional" therapy

In India, queer people's access to professional mental healthcare has been "very limited," according to community members such as Ankan Biswas, India's first transgender lawyer who has been working with the Human Rights Law Network in West Bengal.

"A large majority of the psychiatrists still consider homosexuality as a disorder and practice 'correctional therapy'. It's only around the big cities that some queer-friendly psychiatrists can be found," Biswas said. "The pandemic has further widened the inequalities in access to mental health support for India's LGBTQ community."

Biswas is spending anxious days fielding an overwhelming amount of calls and rescue requests from queer members trapped in their homes, undergoing mental, verbal and even physical torture. "We don't have the space, I just tell them to wait and bear it a little longer," he said.

Medical care is dismal

Anuradha Krishnan's story, though not involving birth family, outlines how the lack of physical support spaces have affected India's queer population. Abandoned by her birth family when she came out to them as a trans woman in 2017, Anuradha Krishnan (she/they), founder of Queerythm in Kerala who is studying dentistry, had to move into an accommodation with four other persons.

Isolation triggered my depression

"I am used to talking and hanging around with friends. Isolation triggered my depression and I had to seek psychiatric help." Living in cramped quarters did not help with quarantine requirements and all of them tested positive during the first wave.

What is deeply worrying is that the Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling, placing more and more pressure on queer collectives and peer support groups whose resources are wearing thin.

During the 10 months of the first wave of the pandemic in India in 2020, Y'all, a queer collective based in Manipur, received about 1,000 distress calls on their helpline number from LGBTQ+ individuals. In May 2021 alone, they received 450 such calls (including texts and WhatsApp messages) indicating a telling escalation in the number of queer people seeking help during the second wave.

As India's queer-friendly mental health support infrastructure continues to be tested, Y'all founder, Sadam Hanjabam, a gay man, says, "Honestly, we are struggling to handle such a large number of calls, it is so overwhelming. We are also dealing with our own anxieties. We are burning out."

Sreemanti Sengupta is a freelance writer, poet, and media studies lecturer based in Kolkata.

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