1. Mixing Covid-19 vaccines

Relevant for GS Prelims & Mains Paper III; Science & Technology

India plans to embark soon on an exercise to investigate if it can immunise people using a “mix and match” of different Covid-19 vaccines. This would mean following up one dose of a particular vaccine with a second dose of a different vaccine. In scientific terms, this is called “heterologous” immunisation.

In India, whose vaccination programme currently uses Covishield, Covaxin and Sputnik V, this practice has not been approved yet. Other countries have already been testing this out.

Why mix and match Covid-19 vaccines?

There are various reasons to try this out.

BETTER IMMUNE RESPONSE: Some scientists believe that using a different vaccine for the second dose could potentially boost the immune response against the virus. This may especially be true for viral vector vaccines like Covishield/AstraZeneca, which use a modified and weakened chimpanzee ‘adenovirus’ (common cold virus) to deliver the genetic code of the SARS-CoV-2 spike protein to the body. Using the same adenovirus could make the vaccine less effective the second or third time around.

“The first time, your body is naive not only to the spike protein, but also to the vector which is injected into your body–in the case of Covishield, it would be the chimpanzee adenovirus. So, while you are developing antibodies against the spike protein, you are also inadvertently developing antibodies against the adenovirus,” said Dr Chandrakant Lahariya, a vaccinologist specialising in public policy and health systems.

This is why Sputnik V uses two different adenoviruses to deliver the spike protein’s code to our bodies, according to Dr Srinath Reddy, President, Public Health Foundation of India.

MUTATIONS & VARIANTS: Mixing and matching vaccines of different technologies — for example, a viral vector vaccine followed up with an mRNA vaccine like Pfizer’s — might encourage our immune system to build a wider response. “They’re all ultimately looking at the same target protein here —the spike protein — but presenting that to the immune system in different ways is potentially a great way of actually generating a better and broader immune response,” the Oxford Group’s Professor Matthew Snape explained during an episode of The Economist Radio’s podcast, The Jab, on May 31. Professor Snape is the chief investigator in the group’s Com-COV trials to mix and match Covid-19 vaccines.

Such combinations could potentially provide wider protection against certain mutations or variants of the SARS-CoV-2 virus. “Theoretically, there is an advantage of mixing and matching in this situation, because the AstraZeneca vaccine has less efficacy against the Delta variant, as seen from studies in the UK,” Dr Reddy said. “If this is true for Covishield in

India, then it makes sense that those who received this vaccine in their first dose receive another vaccine that covers a broader platter of antigens as their second dose. In theory, doing so could extend the body’s immunity spectrum against more antigens,” he said.

SHORTAGES IN SUPPLY: Current Covid vaccine production cannot sufficiently cater to the existing demand, resulting in stock-outs. In parts of India, government vaccination centres for those in the 18-44 age group had closed down due to limited Covishield and Covaxin supplies.

“In the short term, mixing solves your programme problems, because then people don’t have to come again and again to get the dose that they are interested in or the vaccine that they got in their first dose,” said Dr Gagandeep Kang, leading vaccine expert and Professor at the Wellcome Trust Research Laboratory in Christian Medical College—Vellore’s Division of Gastrointestinal Sciences. “If it’s a long-term issue, you want to look at what gives you the best results in terms of what is the best protection that you can get,” she added.

SAFETY CONCERNS: Countries like Germany, France, the UK and Canada have halted the use of the AstraZeneca vaccine in younger age groups due to concerns of rare blood clots. Here, mixing and matching allows the completion of immunization while ensuring safety.

What are the concerns?

Many unknowns: The Covid-19 vaccines in use have received restricted emergency use permissions in the last six months after fast-tracked trials, and tests to mix and match them began only a few months ago. Questions about how safe it is to mix and match, and whether the approach can prompt a better immune response, are still being answered.

Even the order of mixing and matching needs to be closely studied — would giving Covishield before Covaxin, for instance, prompt a better immune response than giving Covishield as the second dose?

UNTESTED COMBINATIONS: Some vaccines like Covaxin have not even been administered in a mix and match scenario — save for an incident in May where 20 villagers in East Uttar Pradesh were accidentally given Covaxin as their second dose although they received Covishield first.

DIFFERENCES IN VACCINES: International bodies like the Coalition for Epidemic Preparedness Innovations, which is looking into mixing and matching Covid-19 vaccines, have highlighted certain complexities. These include differences in the shelf life of these vaccines, their shipment and storage conditions and contraindications — some vaccines may have more side-effects or may not work as well as others in people with specific ailments.

SIDE EFFECTS: Studies such as the Com-COV trials show that some combinations, like AstraZeneca with Pfizer vaccines, could lead to an increase in side effects.

THE SILVER LINING: As of now, there are no issues theoretically that could make mixing and matching of Covid-19 vaccines a major safety threat. “Our immune systems are capable of handling a lot — we are seeing an increase in minor side-effects with mixing, but do not expect major side effects,” said Dr Kang.

Have vaccines been mixed before Covid?

Mixing and matching of vaccines has been tested for decades, especially for viruses like Ebola. However, most combinations had initially been restricted to vaccines that use the same technology.

In India, combinations of rotavirus vaccines have also been used and tested out. “For the last three years, there has been a study looking at combining two rotavirus vaccines… That was a mix and match of a monovalent and a multivalent vaccine,” said Dr Kang. “All the rotavirus vaccines are live attenuated vaccines, but the two vaccines used in the Indian programme are different in that one is a pentavalent vaccine based on a bovine rotavirus and the other is a monovalent vaccine based on a human rotavirus.”

Where has mixing of Covid-19 vaccines been tried?

Most mix-and-match tests currently include the AstraZeneca and mRNA vaccines.

Canada, the UK and countries in the EU have offered their younger population the Pfizer or Moderna vaccine as an alternative to AstraZeneca. Spain and South Korea have also been looking into a mix and match of these vaccines.

The UK’s Com-COV trials are also studying a mix and match of Moderna’s mRNA vaccine and Novavax’s protein subunit vaccine and results are expected by August, Professor Snape told The Economist.

Russia and China, too, are looking at a mix and match of other vaccines. Russia, for instance, has been planning on testing a combination of the AstraZeneca and Sputnik V vaccines.

In the US, the Centers for Disease Control in January allowed a mix and match of the Pfizer and Moderna vaccines — both mRNA jabs — under “exceptional” circumstances.

What could set India apart?

The government expects seven or eight Covid-19 vaccines made using vastly different technologies — viral vector, mRNA, DNA and recombinant protein — to be available by December. This gives India an opportunity to test combinations not tried globally. With some of the upcoming vaccines expected to be cheaper and easier to mass manufacture, successful combinations of these vaccines could especially be useful for low-and middle-income countries struggling to get sufficient supplies for standard vaccinations.

Source: The Indian Express

2. Why petrol and diesel prices are continuing to rise in India

Relevant for GS Prelims & Mains Paper III; Economics

Union Petroleum Minister Dharmendra Pradhan on Monday blamed a “surge in global crude oil prices” for the rising domestic prices of petrol and diesel.

Petrol has crossed the Rs 100 mark in at least six states as a result of a Rs 4.9 per litre hike in its price since the beginning of May. In Mumbai, petrol is retailing at Rs 101.5 per litre, while diesel is retailing at Rs 93.6 per litre after total hikes of Rs 11.6 per litre and Rs 12.4 per litre, respectively since the beginning of the year.

The Indian Express examines the role of rising crude oil prices, and taxes on the recent surge in autofuel prices.

How have rising crude oil prices impacted fuel prices?

The price of crude oil has risen sharply in 2021 on the back of a recovery in global demand as the world economy recovers from the Covid-19 pandemic. The price of Brent crude has risen by 37.1 per cent to about $71 per barrel from about $51.8 per barrel at the beginning of the year. The price of petrol and diesel are pegged to a 15-day rolling average of the international prices of the petrol and diesel.

However, current petrol prices are significantly higher than prices in FY14 when the average price of India’s crude basket was $105.5 per barrel. The price of petrol was decontrolled in 2010 while the price of diesel was decontrolled in 2014.

In June 2013, when India’s average crude basket was at $101 per barrel, petrol was retailing at Rs 63.09 per litre or about Rs 76.6 per litre, when adjusted for the depreciation in the value of the rupee against the US dollar.

Similarly, in October 2018, when the average cost of India’s crude oil basket was at $80.1 per barrel, the price of diesel peaked at Rs 75.7 per litre.

What is the impact of taxes?

Increasing central and state taxes on petrol and diesel are the key reason for the prices of petrol and diesel being at record highs, even though the price of crude oil is only 3.5 per cent higher than at the beginning of 2020, before the Covid-19 pandemic led to a sharp fall in the demand for crude oil.

In Delhi, central and state taxes account for about 57 per cent of pump prices of petrol and about 51.4 per cent of the pump price of diesel. The central government had in 2020 hiked the excise duty on petrol by Rs 13 per litre and on diesel by about Rs 16 per litre to shore up revenues as the pandemic led to a sharp fall in economic activity.

While a number of states including Rajasthan, West Bengal, Assam and Meghalaya have reversed hikes in state levies imposed during the pandemic, the central government has not cut central taxes despite calls from the RBI that taxes on auto fuels should be cut to curb inflation.

Central levies account for 71.8 per cent of total taxes on diesel and 60.1 per cent of total taxes on diesel in the national capital.

Pradhan said on Monday that the government was not currently considering any cuts in taxes on petrol and diesel. “At present, the earning is less. We cannot compromise on the expenditure. The expenditure of health sector has increased,” he said.

Source: The Indian Express

3. A hospital’s misplaced priorities

Relevant for GS Prelims & Mains Paper I; Social Issues

A noted botanist of Indian origin working in the United States, Kamaljit Bawa, had expressed an important idea — that our identity is also determined by our geography. He had gone on to suggest that given the range of life forms found in India due to a variety of climatic zones, we should see biodiversity as part of our identity. As is only reasonable to expect, the botanist might have been motivated by the need to preserve his turf at any cost, but, at any rate, he has opened up scope for imagination. That we should think of the biodiversity of India as an aspect of our identity is not just perceptive but also a constructive suggestion, at a time when the ruling dispensation in India is hell-bent on beating the country into a homogenous mass professing Hindutva.

Before Hindutva was sprung upon us, there was a linguistic majoritarianism project highlighted by the concerted effort to impose the Hindi language on all of India. And it would be naive to believe that the duo of Narendra Modi and Amit Shah, who are prone to addressing this linguistically diverse country in Hindi alone, are the sole champions of this project. The team of Arvind Kejriwal and his Cabinet colleagues, which runs the Delhi government, has now constituted itself into a suitable B-team.

Intolerant attitude

In a curious case, the GB Pant Hospital, which comes under the Delhi government, issued a notice on June 5: “A complaint has been received regarding Malayalam language being used for communication in working places in GIPMER. Whereas maximum patient and colleagues do not know this language and feel helpless causing a lot of inconvenience … it is directed to all Nursing Personnel to use only Hindi and English for communication otherwise serious action will be taken.” The notice was soon revoked after it received a nationwide backlash.

It is mind-boggling that language should be the Delhi government’s first concern during a raging pandemic. The entire country watched, with sympathy, how Delhi struggled without the most basic health infrastructure during the violent second wave of infections. It could neither provide adequate oxygen supplies nor prevent the black-marketing of essential drugs. Instead of supporting frontline workers, which includes doctors, nurses and support staff, it chose to shower a section of them with cultural intolerance.

There is a saying in Malayalam that translates to: “Turning on your mother after losing in the bazaar.” Its relevance in this context is direct. On March 31, Kerala, the home of the nurses of GB Pant Hospital, had a COVID-19 case fatality rate that was only a little more than a third of Delhi’s, and a death rate that was less than one fourth by comparison (deaths per population). Perhaps the political leadership of the capital has something to learn.

Far from being non-compulsory, bedside manner is a necessary qualification for medical workers. It is not negotiable that they should treat their patients with empathy, and language is a part of this human exchange. But it is odd that Malayali-speaking nurses are somehow found deficient in this area in Delhi alone when they have been prized members of the health system in West Asia, Europe and North America for decades now.

Ultimately, it is a failure that Delhi finds itself at odds with a section of its health workers. It can surely learn from the treatment of migrant workers in Kerala. A publicly built housing complex for them in Palakkad is called “Apna Ghar” (our home). There is something hypocritical in accepting a person’s labour but hating their language.

Source: The Hindu

4. In legalisation of Bitcoin in El Salvador, the takeaways for India

Relevant for GS Prelims & Mains Paper III; Economics

El Salvador, a small coastal country in Central America, on Wednesday became the first in the world to make Bitcoin, a digital currency, legal. The El Salvador Parliament approved the move by a supermajority of 62 out of 84. While there are many precedents this sets for global debate on cryptocurrency, we explore what this means in the Indian context.

Not a precedent for monetary policy

The development in El Salvador changes little in terms of Indian monetary calculations around cryptocurrencies. The dynamic underpinning the whole move is that El Salvador has no monetary policy of its own and hence, no local currency to protect. The country was officially ‘dollarized’ in 2001 and runs on the monetary policy of the US Federal Reserve.

What is relevant to monetary thinking, however, is that the move in El Salvador is in part motivated by loose and expansionary Federal Reserve policy. While banks in the US received liquidity with the stimulus, El Salvador did not but lost purchasing power instead. The official bill proposal stated explicitly that “central banks are increasingly taking actions that may cause harm to the economic stability of El Salvador… (and) in order to mitigate the negative impact of central banks, it becomes necessary to authorize the circulation of a digital currency with a supply that cannot be controlled by any central bank and is only altered in accord with objective and calculable criteria,” i.e, Bitcoin.

President Nayib Bukele, however, clarified that he does not believe this constitutes “de-dollarization” of the economy. He believes the dollar will continue to remain the dominant currency in the country and Bitcoin would exist side by side. He also appeared skeptical that Bitcoin would be held in the reserves of the country. Indeed, some analysts have pointed out how bitcoinization might change nothing on ground if “legal tender” is to be considered by its strict legal definition, in which case it places no obligation for merchants to accept the currency in transactions. However, as a result of this development, El Salvador becomes a most interesting case study of how the dollar and bitcoin would coexist side by side, and how that would play out for Bitcoin adoption.

Not merely currency but technology

The overall use of Bitcoin appears less motivated by its use as a currency and much more by the image and investment boost this could give the country towards innovation. President Bukele reiterated multiple times in an appearance on Twitter today, that this move will be good for luring “technology, talent and new ideas” into the country. The President himself tweeted an advertorial to this effect, inviting crypto entrepreneurs into the country.

The move into Bitcoin ties in with larger efforts to revive a stalling economy and bring back growth into the country post-Covid. El Salvador had set up in 2020 a Trust Fund to support in its Covid recovery efforts. Interestingly, this same Trust Fund will house a $150 million national fund that will be used to buy and sell Bitcoin.

Potential shift in remittances

One implication that is relevant to India is the impact this could have on remittances. Remittances make up close to 20% of El Salavador’s GDP with flows approximating $6 billion annually. Many citizens lack a bank account and digital banking has low penetration. In this scenario, there are multiple intermediaries in the remittance chain who take cuts of as high as 20%. The impact Bitcoin has on these remittance inflows would be worth monitoring for India, which is home to the largest remittance market in the world. Although there might not be many lessons from a monetary policy perspective but efficiency, anti money-laundering and other aspects could be closely monitored.

The implication of this move for money laundering is unclear at the moment. Currently El Salvador is not considered deficient under the FATF money laundering requirements.

However, with large scale cryptocurrency inflows and outflows, it would be expected that El Salvador would comply with the 2019 FATF guidance on Virtual Currencies which mandates multiple KYC requirements on cryptocurrency activity. It is unclear if these are in place in El Salvador or would be put in place. It could be that the country faces challenges on this front unless there is a rapid push to put in place the necessary oversight measures.

The overall takeaway for India from the El Salvador case is not in the monetary sense at all but as an example of how far countries are willing to go to attract what they believe is the ultimate prize – innovators and entrepreneurs working on this emerging sector. This is the wealth that India has in spades and has barely protected with policy. While deliberations continue in India on the monetary and financial regulations around cryptocurrency, it is important that attention be paid to incentives for India’s developers working on key innovations in the space.

Source: The Indian Express