ICMR director-general Balram Bhargava at an event in November 2019. Photo: ICMR/Facebook
Every global disaster spawns its share of books, sometimes decades later, to relate events as they unfolded, how we responded, the triumphs and the disasters, and the lessons we can learn, or have learned, for the future. A good example is an account of the Spanish flu pandemic in John Barry’s The Great Influenza. Another is the blockbuster exposé in journalist Randy Shilts’s book And The Band Played On, about the politics and the people behind the delays, the debates and the prevarication that allowed the AIDS pandemic to grow more than it need have grown.
Some books are written in the midst of a crisis, usually by journalists who closely followed key events, or by those who had been involved, for good or ill, in important decisions.
Going Viral, by Balram Bhargava, India’s top doctor in charge of the medical research response to the country’s COVID-19 epidemic, doesn’t belong in either of those categories. Bhargava is the director-general of the Indian Council of Medical Research (ICMR). Billed in its strapline as an account of “the inside story” of the “making of Covaxin”, India’s homegrown and indigenously developed whole-virion vaccine, and developed, tested and marketed by Bharat Biotech, Going Viral is really a book with a meandering purpose.
Does it really deliver on the promise on its cover? Bhargava, the author, doesn’t confine himself to the Covaxin development story, and touches superficially also on such diverse subjects as ICMR’s early success in detecting and isolating the novel coronavirus, the effort to set up a network of diagnostic laboratories, developing testing kits, the early lockdown and the work of hundreds of scientists and thousands of doctors and volunteers. It is page after page of uncritical, self-congratulatory praise of every aspect of the Indian government’s response to the epidemic.
So instead of setting out what the book is, it would be easier, I think, to set out what the book is not.
It is not an “inside story” despite some snippets of interesting trivia – tidbits and factoids we may never have known, such as the description of the virus as “pretty” by National Institute of Virology director Priya Abraham, or the effort to catch rhesus monkeys in the wild (forest department officers finally found some near Nagpur).
It is not, in the author’s words in the prologue, “a thorough analysis of every aspect of India’s responses to the COVID pandemic”. But that doesn’t stop Bhargava from heaping praise on the speed of India’s response in the early days and praising steps such as the first lockdown and the government “taking care of the (healthcare) requirements” of the financially weaker sections of the population.
It is not a detailed exposition of the science behind vaccine development in general or Covaxin’s development in particular. There is a retelling of the well-known Edward Jenner story, and some interesting details about why Bharat Biotech was uniquely placed to develop Covaxin: mainly that it operated BSL-3 facilities and had a track record of developing vaccines from scratch.
But in his zeal to characterise Covaxin as a “completely indigenous vaccine, an epitome of Atmanirbhar Bharat”, Bhargava overlooks the fact that the thing that made Covaxin appropriately immunogenic was the inspired use of a particular adjuvant called Alhydroxyquim-II, under license from an American research company named Virovax. The licensing arrangement between Virovax, funded by the US National Institute of Health, and Bharat Biotech dates to before the pandemic, in 2019, in a collaboration set up at a meeting organised by the Indo-US Vaccine Action Program. The terms were later extended to include Covaxin.
Indeed, the book reads in places like it was written by a government press agency. There is praise for Prime Minister Narendra Modi, for his ostensible “faith in the country’s scientific community”, and for his purported determination to be guided by science. A journalist writing such a book might have examined this claim critically, but apparently not a serving senior medical scientist.
The bit that grated the most for me was an unabashed, below-the-belt attack calling perfectly reasoned scientific critiques as being driven by an anti-India “Macaulay mind-set”. There is even a brief mention of Thomas B. Macaulay’s 1834 plan, to “systematically destroy (India’s) education system, drilling [into] every Indian’s mind that the Indian education system is inferior to that of the British.” This “mindset”, we are told, “is responsible for every Indian critic in India who feels that anything Indian can never work.”
If Macaulay had indeed left an impression on India and Indians, it is evident in the thrill that Bhargava and the team at Bharat Biotech experienced – not merely at the positive results out of Covaxin’s phase 1 and phase 2 but also the fact that “the prestigious international peer-reviewed journal, The Lancet Infectious Diseases, published our results”. Any other scientist would have written: “we were thrilled and gratified at the results and published them to tell the world about it.”
In an interview he gave to to The Print’s Shekhar Gupta on November 20, Bhargava revealed the effect of the Macaulay-based education system when he says that one thing that helped him through a period of isolation, when he himself was infected with the novel coronavirus, was a P.G. Wodehouse novel. So much for Macaulay’s evil designs then.
But such quips aside, there is no mention of the infamous letter from July 2020, in which Bhargava demanded from all doctors and scientists working on Covaxin trials that they should pull all the stops to deliver a vaccine in time for August 15 of that year – or else. In his interview, Bhargava admitted that the letter could have been better phrased. It is only reasonable to assume then that the book was one more opportunity for Bhargava to have set the record straight – to clarify if there was political pressure to announce a vaccine by August 15. But he doesn’t take it.
There is an inexplicable and unhealthy preoccupation in parts of the book with seeing India and Covaxin in competition not with the virus but with other countries, especially the USA and the West more broadly. So the acknowledgement that India had the third-highest number of cases and deaths is followed at once by a rejoinder that, expressed per million population, India’s figures don’t look too bad. And indeed they don’t – but there is in equal measure no inquisitive probing, no inquiry as to the completeness of the numbers that India recorded and reported.
Speculation that Covaxin, being whole-virus vaccine, was “more likely to be effective even if the virus and the spike protein undergo mutations over time, though this theory is yet to be confirmed through further studies”, are at best misplaced and premature, and shouldn’t have been allowed to slip into a book penned by the head of India’s nodal medical research body. A keener editor would also have spotted the internal contradiction within the book when the author tells us elsewhere that ICMR “supplied to Bharat Biotech the variants – whether it be the delta or the delta plus variant – so that they could tweak the vaccine accordingly to meet the challenges of new variants.”
India’s drugs regulator also comes in for praise for setting up “rolling reviews” of vaccine trial data in order to expedite ‘emergency approval’. The controversial approval of Covaxin in early January 2021, when no data was available from its phase 3 trials, is justified by reference to a 2019 gazette notification that allowed ‘emergency use’ based on only phase 2 data. But there is also acknowledgement that the terms of Covaxin’s approval, in the previously unheard-of “clinical trial mode”, left even ICMR experts puzzled.
Those who followed the Covaxin story in the popular press or on social media will find little in Going Viral that is new, startling or original. And those who know little about the science of vaccine development or how India dealt with the many challenges thrown up by the pandemic will get a partial, incomplete and entirely government-centric view of the story. So if you’re going to read the book, do so with an open and questioning mind.
Dr Jammi Nagaraj Rao is a public health physician, independent researcher and epidemiologist in the UK.
This work by The Wire Science is licensed under CC BY-ND 4.0