India and the Inequality of Measuring and Remembering
By Max Lawson
The first wave of the 1918-19 influenza pandemic did not have much impact in India; it was the second wave that was the most devastating. It is now thought that 12 million people died in India during the flu pandemic, the equivalent of 4% of the population at that time. Most of these deaths were concentrated in a few short months from September to December 1918. This quote is from Punjab’s sanitary commissioner at the time:
‘The hospitals were choked so it was impossible to remove the dead quickly enough to make room for the dying….; the burning ghats (cremation site) were literally swamped with corpses; the depleted medical service, was incapable of dealing with more than a minute fraction of the sickness requiring attention.’
Yet amazingly this incredible event was barely recorded. Whilst photographic images are widely available for the1918-19 flu pandemic in Europe, the US and UK, there are no such images for India.
A century later, another deadly pandemic is sweeping India, and watching our screens it feels like the only thing that has changed from a century ago is that the impact of coronavirus in India is not hidden; it is on screens across the world. The Covid-19 pandemic is many terrible things, but at least, unlike the flu, it is being clearly recorded and understood across the world.
Yet in fact I think this is far from being the case, and the brutal historical and existing inequalities are not just shaping how we fight this pandemic but how we remember it and record it too.
Twenty years before influenza hit India, there as an outbreak of bubonic plague. Whilst it did not take nearly as many lives, it was still very serious. Unlike the influenza epidemic there is a relatively strong photographic and written record of this outbreak.
One of the obvious differences was that, unlike the flu, other countries were not impacted. I wonder whether part of the reason events in India today are getting so much coverage in the Western press is because widespread vaccination in rich nations has meant Covid deaths at home have collapsed to very low levels.
Perhaps events in India are so terrible that they would have broken through even during the height of the pandemic in the US and Europe. Yet the pandemic has been as bad in Latin America from the beginning as it has been India, but this has barely registered. Queues for oxygen; overwhelmed graveyards; deaths on the street. Privatised health systems leaving the poor to die. All have been a pretty much a constant in much of Latin America for most of the last year.
This also says a lot about our colonial ties and historic connections. That news from Latin America barely registers time and again partly because of a linguistic and cultural gap that itself is a product of colonialism.
The other main similarity with the influenza pandemic is something that is perhaps the ultimate inequality; lives and deaths that are not even recorded at all. The official numbers of those testing positive for Covid-19 in most countries have been hugely underestimated- not least because rich countries bought almost all the tests. In Kenya the government is still testing about 3000 people a day, and tests cost $100. The UK is testing a million a day.
The Economist magazine estimates that the true death toll from Covid-19 so far is more like 10 million people, not 3 million, and that two thirds of these deaths have not been in rich nations but in poor and middle-income countries. In Egypt the level of excess deaths is 13 times the number of official deaths from Covid-19. Yet the story of the last year has been dominated by deaths in rich nations, and the history of the first year of this pandemic is likely to be so too.
This inequality in reporting and measuring, leading to the sense that this pandemic was not very serious in the developing world over the last year has in turn had a major impact on the response. The drive to get vaccines to the developing world has been criminally inadequate and continues to be so. The scenes in India, in contrast to a rich world now rapidly heading towards full vaccination, are only now finally making the issue of global vaccine apartheid and the suffering in developing countries bigger news.
Part of the reason the dramatic scenes in India are getting more coverage is in turn a result of inequality. It is because they are happening in Delhi, where the worlds media are based, and the middle classes are being impacted so tragically. The huge suffering in the countryside where there is literally no hope of any medical care of any substance is once again being barely recorded. Independent epidemiologists believe India could be seeing not the official 4,000 deaths a day but in fact as many as 32,000.
Without hard facts, the void is filled by anecdotes and personal stories. It seems likely to me for instance that Coronavirus is also raging across Kenya as we speak and is probably more serious now than at any point in the last year. Not because the official numbers show this but simply by the number of people I know who have lost loved ones or been sick themselves in recent weeks and months.
When my friend Doreen died suddenly and tragically from Covid-19 earlier this year, I found out by WhatsApp. I woke up one morning and sent a message to her husband Stuart to see how she was doing. Only the day before her oxygen levels had been stable and things were looking positive. Stuart’s reply was short and devastating, ‘Max she is no longer with us’. I was reminded of this this week when I heard an activist from India who lives in the UK speak at a rally I attended. He said everyday he dreads switching his phone on in the morning, wondering who will have died in the night. It made me reflect on the many thousands of heart-breaking messages being sent each day, each one bringing with it sadness, loss, rage and disbelief. Beyond the selective headlines, maybe it is this most personal and intimate communication that is in some ways the more accurate record of this terrible moment in our history.
There is no doubt that Covid-19 is a huge global trauma, operating on a personal, family, community, national and global scale all at once. Its ramifications and implications will be felt for decades to come. In her book on the 1918 influenza pandemic, Pale Rider, the author Laura Spinney asks how we can have forgotten the most lethal episode of the 20th century. I don’t think there is the same danger of humanity forgetting Covid-19.
But I do think that inequalities in the way we measure and record this pandemic have direct implications for how it is understood at the time, how it is responded to and how it will be remembered.
It is frightening to think that after all the world has been through in the last year, that unless something dramatic changes the majority of deaths from Covid-19 are yet to come. A year ago the main barrier to beating this cruel disease was science. Today it is inequality.
Lies, recipes and racism- the talking points of Big Pharma
In the campaigning world, in my experience at least, winning things, especially big things, is not something that happens very often. The moment when Joe Biden decided to support a waiver on intellectual property rights for Covid-19 vaccines a couple of weeks ago was one of those moments.
It is of course far from complete victory, if such a thing is indeed possible. But it was still a stunning move, one that took much of the mainstream world by complete surprise. Alan Beattie, the hard-bitten world trade editor at the Financial Times summed it up. ‘BOOM… well that was a surprise’.
The scale of the move can also be measured in the fury of the response. We have been battling the pharmaceutical Industry and their multiple arguments against the lifting of Intellectual Property for months, but the intensity of the pushback since the US move has been something altogether on another level.
The talking points circulated by Phrma, which is the industry body, to law-makers in the US were actually leaked, but we already knew most of them.
Many of them involve a simple move: ‘its not the patents, its…… a, b, c’ is the most common, which is simple misdirection. A common one there is the lack of raw materials, notably some incredibly clever plastic bags that are in short supply.
Of course, the response to that is no one is saying patents and intellectual property are the only barrier. Of course, there are other things that need to happen. But that does not in anyway mean that breaking the monopolies of firms on these vaccines is not incredibly important.
Ironically, it was revealed earlier this week that the super clever plastic bags are in scarce supply because they themselves are subject to monpolies (only a few firms make them globally) and more than 1800 patents. On a plastic bag.
We did some polling earlier in the year on the patents and monopoly issue in many countries to measure public support for lifting monopolies. I was involved in finalising the questions with YouGov who are very robust in ensuring questions were not leading. We found and average of two-thirds of the public supported lifting monopolies on Covid-19 vaccines. It seems the Pharma industry are not subject to the same levels of scrutiny. This poll, with the headline ‘Majority oppose lifting of patents on Covid-19 vaccines’ for example:
Up there with, ‘Do you support letting your children walk to school, even though they might die horribly in a car accident on the way?’
Early in the campaign, we were working out how best to express what is quite a complex issue in simple terms, and my colleague Anna came up with the idea of talking about sharing the vaccine recipes with vaccine producers around the world. It was a great idea, and we have been using it ever since.
It is clearly working as Pharma felt the need to tackle it head on. I was watching Thomas Cueni, the somewhat hapless and ubiquitous spokesperson for Phrma on the TV when to my surprise he brought up the recipe analogy.
In the UK one of our most famous TV chefs is a woman called Mary Berry. She is what we call a national treasure, beloved by the nation.
Cueni was trying to make the point that making a vaccine was complicated, and it would not be easy to share the recipe. ‘Think how hard it is to replicate the recipes at home of Mary Berry’ he said to the newscaster.
Now that was a really poor choice. Mary Berry is the peoples’ cook. Her cake recipes are replicated in households across the nation. I wonder whether Mr Cueni himself is just a bad baker. I pictured him in his large kitchen in Geneva at the weekend in an apron with a burning set of buns, cursing Mary and her confounded recipes.
But this did not stop the talking points doing the round. The next thing was a BBC news anchor interviewing UNAIDS boss Winnie Byanyima who said he had heard this interesting analogy from undisclosed ‘researcher’, comparing the recipes to those of the wonderful Mary.
In Brussels in the same week, officials fuming at the US move on patents, were also deploying the same analogy, but instead of TV cooks, they were saying that vaccine recipes were the equivalent of the recipes of Michelin starred chefs- fiendishly complicated and impossible to replicate.
Behind this amusingly leading poll and the back and forth on recipes is something altogether more sinister. The deliberate exploitation of racist stereotypes and prejudice, masquerading behind false concerns about ‘safety’ or ‘complexity’.
These firms know of course that 60% of the world’s vaccines are made in India, which has world class capacity and personnel. That WHO qualified vaccine producers exist on every continent, capable of producing vaccines to the highest safety standards. They know that because they often like to subcontract to these very same producers.
They also know, because they have proven it in the last year, that new factories to make vaccines can be brought online and produce hundreds of millions of doses within months. Moderna retrofitted a Polaroid factory in the US. The UK government has paid to refit and repurpose a factory that was formerly being used to produce fish food, now ready to produce millions of vaccines- a fact celebrated by the leading fish industry website.
But by dressing this up as safety concerns, and by discussing the fiendish complexity of these new fangled vaccines, they are of course implying that only clever white men in rich countries are able to do this- something that has been described as scientific racism. I spoke to one senior journalist at the Economist about an op ed we were organising and he said, ‘Well the even made mistakes producing these vaccines for Johnson and Johnson in plants in the United States [there was cross-contamination that ruined millions of doses] so they are hardly going to be able to do this in Burundi.’
On a different but related theme, Merkel herself expressed her dismay at India backing the waiver at the WTO when Europe had ‘allowed’ India to develop its own Pharmaceutical industry:
‘We now have a situation with India where, in connection with the emergency situation of the pandemic, we are worried whether the pharmaceutical products will still come to us,’ observed Merkel. ‘Of course, we have only allowed India to become such a large pharmaceutical producer in the first place, also from the European side, in the expectation that this should then also be complied with. If that is not the case now, we will have to rethink.’
This racism is all too familiar to activists who campaigned for HIV/AIDS medicines only to be told that Africans were simply not organised enough or understood time to take these medicines regularly. It is discussed in our new episode of our EQUALS podcast too where we talk to three amazing activists, Priti, Tahir and Asia who are have been fighting these arguments for many years.
The fight for Peoples Vaccine continues.
Max is theHead of Inequality Policy at Oxfam International & EQUALS Podcast co-host. He is also Chair of the global Peoples Vaccine Alliance.