Covid Compendium by Synergia Insights

COVID-19 COMPENDIUM

PANDEMICS ARE HERE TO STAY www.synergiafoundation.org

THELEGITIMACY OF OUR THINK TANK ISIN THE POWER OFOUR IDEAS

Synergia Foundation is an independent and strategic think tank whose purpose is to augment decision-making at a policy level while enriching individual discourse and public dialogue. With fact based insights, the Synergia Foundation provides impactful solutions that challenge the status quo, turning risks into opportunities.

Executive Summary

andemics have always been an

If pandemics come back in fresh avatars,

adjunct to human society since

our

counter-strategy

should

also

the viruses that cause them are as

much a part of nature as other species on

The post COVID-19 world is going to

earth. Therefore, humanity has to learn to

be one full of disruptions. The economy,

live under the shadow of the pestilence, as

geostrategic landscape, human security

one follows the next.

and the very concept of how we live and

If pandemics become the new normal

work will change. Frugality will be the new

in our lives, we must know them to defeat

norm for some time to come. The cyber

them. The lack of our understanding of

world will be under great stress and a host

the contagion is a serious limitation to

of new mitigating strategies to deal with each of these threats will be required.

combat them. An integrated national action plan, supported by the WHO and global data

Collaboration and not competition is the way

forward. The pandemic has

forced humankind to come together to

sharing is the need of the hour, as is the need for evolving a strategy against the

it as a divine signal and try to incorporate

threat in all its dimensions - medical,

the spirit of cooperation in all aspects of

social, economic, geopolitical, and cyber.

their transactions.

| COVID-19 COMPENDIUM |

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INTELLIGENC IN E T |E ILNL TI G EE RN VC EN E T| I O I NNT E | RI M VE PN AT C ITO N | I M P A C T

Synergia Insights is a strategic affairs, foreign policy, science and technology magazine authored by experts at the Synergia Foundation. We provide nonpartisan and evidence-based analysis and assessment of geo political events based on real-time information. Insights is circulated amongst opinion leaders in government , corporates and academia around the world.

SYNERGIA FOUNDATION SYNERGIA FOUNDATION SYNERGIA FOUNDATION

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ROBIN NIBLETT DIRECTOR AND CHIEF EXECUTIVE, CHATHAM HOUSE

CREON BUTLER DIRECTOR, GLOBAL ECONOMY AND FINANCE PROGRAMME CHATHAM HOUSE

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EXPERT INPUTS

EXPER T INSIGHTS

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EXPERT INSIGHTS EXPERT INSIGHTS EXPERT INSIGHTS AROGYASWAMI PAULRAJ AROGYASWAMI PAULRAJ AROGYASWAMI PAULRAJ PROFESSOR EMERITUS, STANFORD PROFESSOR UNIVERSITY; EMERITUS, STANFORD PROFESSOR UNIVERSITY; EMERITUS, STANFORD UNIVERSITY; WINNER OF THE MARCONI PRIZE WINNER & OF THE MARCONIWINNER PRIZE & OF THE MARCONI PRIZE & IEEE ALEXANDER GRAHAM BELL IEEEMEDAL ALEXANDER GRAHAMIEEE BELL ALEXANDER MEDAL GRAHAM BELL MEDAL

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EXPER T INSIGHTS

VINTON RF GRAY CERF RS ForMemRS

AJAY PRAKASH SAWHNEYAJAY PATRICK PRAKASH NICOLET SAWHNEY AJAY PRAKASH PATRICK NICOLET SAWHNEY PATRICK NICOLET SECRETARY, MoIT SECRETARY, CHIEF TECHNOLOGY MoIT SECRETARY, CHIEFMoIT TECHNOLOGY CHIEF TECHNOLOGY GOVERNMENT OF INDIA GOVERNMENT OFFICER, Capgemini OF INDIA SE GOVERNMENT OFFICER,OF Capgemini INDIA SE OFFICER, Capgemini SE

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EXPER T INSIGHTS

ETHAN ZUCKERMAN

FORMER DIRECTOR OF THE CENTER FOR CIVIC MEDIA AT MIT, ASSOCIATE PROFESSOR OF PUBLIC POLICY, COMMUNICATION, AND INFORMATION AT THE UNIVERSITY OF MASSACHUSETTS

EXPER T INSIGHTS

ETHAN ZUCKERMAN

FORMER DIRECTOR OF FORMER DIRECTOR OF THE CENTER FOR CIVIC THE CENTER FOR CIVIC MEDIA AT MIT, MEDIA AT MIT, ASSOCIATE PROFESSOR ASSOCIATE PROFESSOR OF PUBLIC POLICY, OF PUBLIC POLICY, COMMUNICATION, COMMUNICATION, AND INFORMATION AND INFORMATION AT THE UNIVERSITY AT THE UNIVERSITY OF MASSACHUSETTS OF MASSACHUSETTS

GEORGE COOKE DEPUTY DIRECTOR OF BANDARANAIKE CENTRE FOR INTERNATIONAL STUDIES, SRI LANKA

EXPERT INPUTS

COOKE RAO GEORGE COOKE VALSAN GEORGE VALSAN PRABHA PRABHA RAOVALSANI. RADHIKA PRABHA RAO I. RADHIKA DEPUTY FORMER VETHODYDEPUTY VETHODY VETHODY FORMER FORMER JOURNALIST JOURNALIST DIRECTOR IPS OF OFFICER AND FORMER DIRECTOR FORMERAND IPS OF OFFICER ANDFORMER IPS OFFICER AND AND BANDARANAIKE BANDARANAIKE SRI LANKAN SRI LANKAN DIRECTOR OF DIRECTOR OFSRI LANKAN DIRECTOR OF POLITICAL POLITICAL FOR ASIAN DIPLOMAT CENTRE FOR DIPLOMATCENTRE SOUTH SOUTH ASIANDIPLOMAT SOUTH ASIAN COMMENTATOR COMMENTATOR INTERNATIONAL INTERNATIONAL INSTITUTE FOR INSTITUTE FOR INSTITUTE FOR BASED OUT OF BASED OUT OF STUDIES, SRI LANKA STUDIES, LANKA STRATEGIC STRATEGIC STRATEGIC SRI LANKA SRI SRI LANKA AFFAIRS AFFAIRS AFFAIRS

PALESTINE:CRY MYPA BE LE LO ST VE INE: D CRY MY PALE BE ST LOINE: VEDCRY MY BE LOVED COUNT RY COUNT RY COUNT RY FALLOFPAULRUSEFA SALLOFPA BAGINAULRUSE FASA LLOFPA BAGINA ULRUSESABAGINA

I. RADHIKA JOURNALIST AND POLITICAL COMMENTATOR BASED OUT OF SRI LANKA

FORWARD BY

Pandemics are Here to Stay

umankind shares its space in the

magnitude of the disaster, and strengthen

biosphere with many life forms,

public health infrastructure for now and for

and viruses are chief among them.

the future.

Viruses have shaped human history, created

Synergia Foundation has four decades

pestilences, and remain formidable foes. Man may counter them with vaccines and drugs, yet they come back, deadlier than

nuclear, biological, and chemical (NBC)

before. It would be easier to mitigate their

warfare, and pandemics. With a close

devastating effects by an understanding of viruses and the forecasting of their patterns

foundation has been closely monitoring

of emergence.

the progress of the virus, right from its

Diverse groups of viruses with varying

inception.

We believe that pandemics

are here to stay. COVID-19 is only one in global virome. So far, the human race

the series of pandemics that humankind

has encountered only 1 per cent of the

is destined to face in the future. A deep

trillions of viruses. A lethal virus emerging

understanding of the contagion is critical to deal with the virus.

from the jungles of Africa, the

wet markets of Asia, or the

this

endeavor,

Synergia

rainforests of the Amazon is not a

is being helped by a network

distant threat in this era of global

of experts from public health,

interconnectedness. Viruses can

disaster and crisis management,

overcome species barriers, down

Nuclear, Biological, and Chemical

host

defences,

and

effectively

adapt to new species. Installing viral listening posts, enhancing

TOBBY SIMON Founder and President, Synergia foundation

global surveillance, and ensuring bio-security are some steps to deter the next viral emergence.

Warfare (NBC), a wide range of virologists, experts in infectious disease and, economists as well as social and political scientists, both

from India and abroad. COVID-19

took

world

leaders

and

Though pandemics have transformed

international organisations by surprise and

history since time immemorial, sadly, this

clearly demonstrated the deep divisions in the global political and economic

a new threat as no two viruses are the countries showed was not solidarity and vaccines developed to deal with one, may

coordinated action, but national egoism

not be applicable for the next. There is no all-

and a burning desire to husband medical

purpose universal vaccine for a pandemic

and other resources with no thought

of this proportion.

for those who were worst affected. We

However, COVID-19 has sent a powerful

hope better sense prevails and a more

message to humanity. Mankind must

collaborative approach is adopted to deal

understand the disease, estimate the

with the challenges of a post-COVID world.

| COVID-19 COMPENDIUM |

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Acknowledgment The SYNERGIA FOUNDATION would like to express special thanks to the following dignitaries for their contribution.

Alex Thomas

Deng Hongping

Laurence Brahm

President, AHPI

Head of Vascular Surgery Department, Wuhan Renmin Hospital

Founding Director, Himalayan Consensus

F R Singhvi

Director of Cyber Security, Information System Authority of Estonia

Andrew Harris MD - Director Emergency Medical Department, Richland Hospital

Anthony Kalliath Haematologist & Oncologist Consultant Clearview Cancer Centre, Alabama

Arvind Gupta Director, VIF & Former Deputy NSA, GOI

Joint Managing Director Sansera Engineering Pvt Ltd

Fu-Kuo Liu Research Fellow at the Institute of International Relations (IIR), National Chengchi University

Gifty Immanuel, MD, PhD. Medical Director, Synergia Foundation

Arvind Kasturi Head Community Health Care, St Johns National Academy

Boon Hui Khoo Former President of INTERPOL

Chas Bountra

Gopi Hanumanthappa Managing Director ThyssenKrupp Aerospace India Pvt Ltd

Jacob Kalliath Physician Internal Medicine, Swedish Covenant Hospital

Pro-Vice-Chancellor – Innovations, Oxford University

Jake Moore

Ciaran Liam Martin

Emergency Medical Physician, Rush Oak Park Hospital, Chicago

CEO, National Cyber Security Centre, GCHQ United Kingdom

Deepansh Somani Graduate in Behavioural Economics

Devi Shetty Chairman, Narayana Health Care

www.synergiafoundation.org

Jayant Sinha Chairperson, Parliamentary Standing Committee for Finance, GOI

Kuni Miyake Former EA to the Prime Minister of Japan

Lauri Aasmann

M K Narayanan Former National Security Advisor, GOI and Governor to West Bengal

Mathew Kalliath Chief Surgical Resident University of Pennsylvania

Maxim Vilisov Associate Professor, Lomonosov Moscow State University, Russia

Michael Chertoff Former US Homeland Security Commissioner

Mukund Thattai NCBS -TIFR

Naresh Shetty President, M. S. Ramaiah Memorial Hospital

Nikita Konopaltsev Director at Russian Internet of Things Research and Consulting Center

| COVID-19 COMPENDIUM |

AUTHORS Maj Gen Ajay Sah (Retd) Chief Information Foundation

Maj Gen Moni Chandi (Retd) Synergia Foundation

Sambratha Shetty Chief Operating Synergia Foundation

Seher Dareen Research Associate, Synergia Foundation

TM Veeraraghav Consulting Editor, Synergia Foundation

Tobby Simon Founder and President, Synergia Foundation

Nirupama Rao

Sanjay Jaju, IAS

Former Foreign Secretary of India and Former Ambassador of India to China and the U.S.

Additional Secretary, Ministry of Defence, GOI

Pankaj Patel Chairman, Cadila Health Care & Chairman of IIM Udaipur

Patrick Mendis Former American Diplomat & Visiting Professor, National Chengchi University

Prasad Chandran Founder Chairman SEEGOS, Former CMD, BASF India Limited

PS Raghavan Chairman, National Security Advisory Board, GOI

Emergency Medical Physician, Mt. Sinai Hospital, New York

Sharad Tyagi MD Boehringer Ingelheim India Pvt Ltd & President OPPI

Sudhir Kapadia President, Bombay Chamber of Commerce & EY India National Leader – Tax

Sun Yuxi Former Chinese Ambassador to India

Tapan Singhel

R Balasubramaniam

Managing Director & CEO, Bajaj Allianz General Insurance Co. Ltd

Harvard School of Public Health and Founder, Swami Vivekananda Youth Movement and GRAAM

TM Vijay Bhaskar,

Lt Gen Rajesh Pant (Retd)

National Cyber Security Coordinator, Government of India

Rajesh Sundareshan Professor, IISc, Bangalore

Ranjit Shahani Former Managing Director & Vice Chairman, Novartis India Ltd.

Richard Fontaine CEO, Center for a New American Security

Richard Garcia Medical Director Ferry County Memorial Hospital, Washington

| COVID-19 COMPENDIUM |

Shameeke Taylor

IAS

Chief Secretary Government of Karnataka

Udayant Malhoutra CEO and Managing Director Dynamatic Technologies Ltd

K Vijay Raghavan Principal Sci Government of India, GOI

Ye Baixin Chief Medi Renmin Hospital, Wuhan University

Wang Feng Editor-in-Chief, Financial Times, China.

Wang Huiyao President, Centre for China and Globalisation, Beijing

www.synergiafoundation.org

C O N T E N T CHAPTER 1

CHAPTER 3

Understanding the Disease

Economics of a Post-Covid World

Page 2

Page 58

CHAPTER 2 Mitigating Strategies Page 11

CHAPTER 4

CHAPTER 5

Geopolitics in the Time of a Pandemic

Cyber Domination Post-Covid-19

Page 94

Page 122

www.synergiafoundation.org

COVID-19 COMPENDIUM

CHAPTER 1

UNDERSTANDING THE DISEASE Our lack of understanding of the contagion is a serious limitation to

Emerging Viruses Viruses are an enigma. They are a minuscule biomass of unique organisms that existed on Earth even before our arrival. Viruses have played a pivotal role in shaping our

INPUTS BY P S RAGHAVAN, CHAIRMAN, NATIONAL SECURITY ADVISORY BOARD, GOI

genomes. The annals of human history would be incomplete without a deeper discourse on viruses. Adapted to extreme

replicate their progeny. Viruses emerge

parasitism, viruses lack cellular organisation

and re-emerge from their habitats and

or machinery. They hijack the host cell to

reservoirs when conditions are favourable.

2 | COVID-19 COMPENDIUM |

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Once Inside a Human Host, They Replicate

viruses. The SARS CoV-2 virus causing the

Nearly 70 per cent of infectious diseases in

previously unknown in bat coronaviruses.

Ebola, rabies, and HIV/AIDS. Our increased

Viral Evolution

contact with animals (wild as well as

Viruses have shorter replication times. In

viruses doing a species jump. Once inside

of proofreading is inherently error prone.

a human host they replicate and spread

Hence, a high number of mutants arises

as the naïve human host offers very little

due to the mistakes in copying. This results

immunological resistance to these invaders.

in the production of drug-resistant and

Same as in the case of SARS CoV-2 causing

vaccine-escape

COVID-19. This coronavirus is understood to

virus that jumps from an animal reservoir

be a descendant of an ancestor bat virus

and causes a pandemic in the human

that jumped into an intermediate host

population will generate more mutants.

like the pangolin (anteater) and then to

Such a pool of mutant viruses increases

animal vendors in the wet markets. Though

the odds of success against host defences.

cooking can thermally inactivate it, the

Under natural selection, viruses evolve

act of butchering and de-skinning these

faster than their hosts do. This makes it hard

animals in the wet markets poses a great

to treat or prevent a viral pandemic.

risk. Bats, pangolins, badgers, palm cats,

current pandemic exhibits such properties

mutants.

Therefore,

ferrets consumed as delicacies expose the

Viral Habitat & Ecology

human population to exotic viruses.

Viruses are incapable of living in isolation;

Virus Chimeras

they can only sustain life inside another living reservoir. Each virus is

host-

Different species of viruses are known to co-infect animal hosts like bats, palm cats etc. During such an event, two different viruses that infect the same target cell could swap

its

material

genetic through

predominantly

infects

only

chimps. However, in the absence of the original host or the abundance of

alternative

viruses a

hosts,

might

leap

over

take the

re-assortment.

species

barrier.

Such

Several

factors

process

recombination

between viruses can

aid in this kind of transfer. One is the

result in a chimera.

spatial proximity of

Such a chimerical or

a new host, human

recombined virion has properties

previously

unknown to the parent

www.synergiafoundation.org

infringement in a virus ecosystem, exotic animal foods, game meat, and

| COVID-19 COMPENDIUM | 3

contact with wild animals. A reservoir is a sanctuary for a virus to live and selfpropagate while the host itself might have adapted to co-exist with the virus as in the

Man-Made Viruses as Vectors of Warfare

case of bats and SARS CoV-2.

MAJ GEN AJAY SAH,

Virus-Host Interaction

GEOPOLITICAL AND STRATEGIC ANAYLST, SYNERGIA FOUNDATION

Humans share a very close relation with viruses. Our own cells make copies of the invading virus under the right genetic command. The interaction between a virus and its human host determines the outcome of the disease. In the case of

nfectious biological warfare uses biological toxins such as bacteria, viruses, insects, and

fungi, with the intent to kill or incapacitate

SARS CoV-2, it can create an abnormal host

humans, animals, or plants as an act of

immune response resulting in cytokine

war. An analysis of historical attempts at

markers. The delicate interaction between

in distinguishing between a naturally

the virus and the human immune system

occurring epidemic and one triggered by

determines the intensity of disease and

bio-warfare. This dilemma continues today

death.

as amply highlighted by the COVID-19

Virus Mediation Extinction

pandemic. As early as 600 BC, infectious

A virus is only focused on self-propagation; it

misery on the enemy and their population.

will endlessly replicate itself even if it means

When the American West was being

exhaustion and death of the human host.

opened to settlers, it is alleged that in 1763

The resultant extinction of the human host

Native Americans were “gifted” smallpox

is neither foreseen nor does it matter to a

infected blankets. Sir Jeffrey Amherst,

virus.

commanding the British forces in North

Antiviral and Vaccines

America, was able to generate fomites when smallpox broke out in Fort Pitt. These fomites were then used to infect blankets

brief history of vaccination, the smallpox

that were ‘gifted’ by one Captain Ecuyer to Native American tribes in the Ohio

vaccine discovered by Edward Jenner

River Valley. Confederate forces adopted

in 1798. Immunisation eventually led to

the same tactic in 1863 against the Union

the eradication of smallpox by 1979. Louis

soldiers during the American Civil War.

Pasteur developed a rabies vaccine by

Nineteenth century advancements in microbiology enabled the isolation and

synthesised around 1963. Till date, more than 100 antivirals have been produced.

In World War I, there were allegations that

Still, we are in need of a cure for many viral

Germany resorted to biological warfare

diseases.

by trying to spread cholera in Italy and

4 | COVID-19 COMPENDIUM |

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plague in Russia. Germany denied these allegations, and in 1924, a League of Nations panel absolved Germany. During

World

War

II,

Japan

and

Germany were accused of conducting

Estimate of casualties produced by a hypothetical biological attack* Agent

Downwind reach (km)

Number Number Killed incapacitated

Rift Valley fever

400

35,000

Tickhome encephalitis

9,500

35,000

Typhus

19,000

85,000

Brucellosis

500

125,000

Q-fever

>20

150

125,000

12 of his subordinates in 1949 for preparing

Tularemia

>20

30,000

125,000

and using biological weapons.

Anthrax

>20

95,000

125,000

intensive biological warfare research. The notorious Japanese ‘Unit 731’ was active in Manchuria. The Soviets tried Maj. Gen. Kawashima, the head of Unit 731, along with After the

calling the experiments “most regrettable from the viewpoint of humanity”. The Nazis

vector, in uninhabited islands off the coast

were not accused of a biological offensive

of Scotland, and these islands remained

though there were many instances of

contaminated until 1986.

German scientists infecting concentration

The U.S. War Reserve Service was

camp inmates with disease-producing

formed in 1942 to supervise the American

organisms.

bio-warfare

programme

Maryland.

The western allies were also not beyond

Today, it is known as the U.S. Army Medical

suspicion. Joseph Goebbels accused the

Research Institute of Infectious Diseases

British of spreading yellow fever from West Africa in India. The British were also known to be experimenting with Bacillus anthracis,

viable

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biological

warfare

COVID-19. After the end of World War II, many other countries were reported to be pursuing

| COVID-19 COMPENDIUM | 5

active

biological

weapons

research,

including Canada, Britain, France, the Soviet Union, and later China. During the height of the Cold War, the Soviet bloc spread the

itself in the armoury of some nation or terrorist group.

International Safeguards The ‘Convention on the Prohibition of the

in 1957 were using biological weapons, while

Development, Production, and Stockpiling

the Chinese blamed the U.S. for the cholera

of Bacteriological (Biological) and Toxin

epidemic in Hong Kong in 1961.

Weapons

and

Their

Destruction’,

was signed by 103 countries in 1972. It

A Weapon of Choice

prohibits the development, production,

Two characteristics make bio-weapons

and stockpiling of pathogens or toxins in

an ideal choice for an aggressor — their invisibility and their delayed effect. They

prophylactic, protective or other peaceful

can infect the target population, escape

purposes.” Unfortunately, this treaty does

undetected,

not provide for inspections and coercive

and

leave

panicked

population and an administration, which is

measures

prevent

paralysed, in their wake. Sickness and death

adherence to protocol.

armament

and

is not the goal, but fear and uncertainty aimed to breakdown state authority.

good example is the so-called ‘anthrax

CONCLUSIONS

letters’ after the September 2001 attack,

Bio-warfare is no longer in the

which created a huge psychological impact

recognised and incorporated into

despite infecting very few people. Choices for bio-weapons are: anthrax, because

can

released

quietly;

smallpox, frozen stocks of which are still maintained by the U.S. and Russia;

To face the threat with calmness, the medical fraternity and the public must be educated in epidemiology

tularemia, known as rabbit fever; and botulism, which is caused by exposure to toxins made by C. botulinum — the most toxic substances known to humankind. It attacks the nerves

The COVID-19 pandemic has been the closest thing to a mass bio-attack, and it is clear that even advanced western nations are far

and can lead to respiratory failure.

6 | COVID-19 COMPENDIUM |

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Post-Lockdown Expectations Synergia Foundation webinar on ‘Coping INPUTS BY T.M. VIJAY BHASKAR, IAS

Strategies for COVID-19’ held on April 22.

CHIEF SECRETARY, GOVERNMENT OF KARNATAKA

develop a strategic vision to combat the

“A

s Karnataka inches towards lifting of the lockdown on May 3, the government has a variety of plans

The objective of the webinar was to contagion and work on a calibrated postlockdown plan on the medical, social, and economic fronts. The Vijay

panellists Bhaskar of

comprised

(IAS-Chief

T.M.

Secretary,

on the table for an exit. Owing to differing

Government

Karnataka);

opinions by experts in both the medical and

Kasturi (Head Community Health Care,

Arvind

St. John’s National Academy); Naresh balance them, in a phased manner. While

Shetty (President, M.S. Ramaiah Memorial

all are focused on the pandemic from the

Hospital);

and

medical standpoint, the government’s

(Founder

SVY.M

biggest concern at this point is the

along with the team at Synergia. T.M.

economic challenges”, said Karnataka’s

Veeraraghav

Chief Secretary T.M. Vijay Bhaskar, at the

former resident editor with The Hindu,

www.synergiafoundation.org

Balasubramaniam GRAAM,

(Independent

Mysuru), journalist,

| COVID-19 COMPENDIUM | 7

Prepare ourselves for some amount of

Sr. Editor CNN-News18) was the moderator.

human cost.

First to speak were the medical experts. Dr. Arvind Kasturi expressed caution

Dr. Balasubramaniam, was on the

moving forward and suggested a detailed

same page, saying the more there is for

step-by-step procedure.

people to learn about the virus, the better. His worry was over the ticking time bomb

The uninfected should remain so by

-- when migrant labourers stuck in urban following hygiene, avoiding gatherings,

India, go back to their native villages,

etc.

where the spread of the disease has been Medical

services

for

people

minimal.

with

Mr. Vijay Bhaskar too said that the

comorbidities and other illnesses should

immediate fallout of the post-lockdown

continue. Facilities should be set up for those who

would be migration of people to their

can’t be isolated at home due to space

homes. Further, people would want to

restrictions.

move around. The main concern then is how we ensure that this doesn’t cause

Put in place early-warning systems for

movement of infection also.

treatment using social media and other forms

communications,

Dr.

spread

Balasubramaniam

envisaged

that the Centre and the State could see a

awareness on the steps to take if one falls sick.

optimisation. He offered his strategies:

The pandemic should be tackled with a teacher-with-a-stick model. At the same

Set up a ‘real-time response body’ to allow

time, we must remember that migrant

for the “accumulative cross-pollination” of

workers are our people, and we have to

experiences from all over. This would give

be the ones to get the message across to

people a better idea on how to tackle the

them.

pandemic.

THE SIZE OF CORONAVIRUS LOCKDOWNS Number of people placed on enforced lockdown due to the coronavirus pandemic per country

1380

Ongoing

At height of outbreak * At least partly enforced Source: Media reports

760

(In Million people)

8 | COVID-19 COMPENDIUM |

rg e

in a

Sp ai

bi a

C ol

fr ic a

al y

ut h

Fr an ce

pi n lip

P hi

100

142

h es

B an

at es St

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ni te d

165

297

www.synergiafoundation.org

Mobilise resources; ensure short-term liquidity for the poor and vulnerable; keep

New Normal On the strategic front, Maj. Gen. Moni Chandi (retd.) felt that the post-lockdown

economies (MSMEs and others); and

could have three outcomes: a professional

leverage global support in the short term.

win, where the containment is successful,

Smaller Lockdown?

and we restore economic activities and get a vaccine. Or, the situation could spiral out

Post-COVID will be a different way of living

of control and the pandemic would rage

altogether, said Dr. Naresh Shetty, and

through. Herd immunity would set in, but

there could be the possibility of a smaller lockdown after this one. He also wondered

result in living a new way of life altogether,

why we are so focused on COVID, when

where new measures are put in place, with

there are many other harmful diseases that

no vaccine available. He suggested a ways-

still exist. Is it because it is affecting the rich?

and-means path:

His pointer to the government:

Play for time and wait for either the virus to

Hospitals will have to cope with the

mutate until it dies, or delay the pandemic

possibility of spread of infection when

for as long as it is possible through social

patients, relatives, and non-COVID patients intermingle.

www.synergiafoundation.org

To work towards a controlled infection,

| COVID-19 COMPENDIUM | 9

which would give rise to herd immunity,

Corroborating Dr. Naresh Shetty’s view

allowing the lockdown to be lifted slowly

that the healthcare system has never been

while the most vulnerable (children and

at its best in India, and if it had at least 5%

elderly) stay at home.

of the defence budget, it would have been

Control the time and place of when we

a completely different story. Dr. Arvind

expose people to the virus, and marshal our

Kasturi pointed out that this pandemic

resources.

is a good lesson to improve the medical

Maj. Gen. Ajay Sah (retd.),

system from the grassroots

however, cautioned against

- both institutional care and

inculcating immunity, as there

general public hygiene. He

were cases of re-infection in

said the government spends

those who had recovered. He

just 1.4% to 1.5% of the GDP on

also highlighted the morbidity

healthcare, which is very low

and mortality aspect of the

compared to other countries.

disease. With the morbidity factor, it is important to keep

Here to Stay

in mind that COVID can be

All the speakers felt that

transmitted through a variety of ways. More importantly, he said we must be aware of

‘superspreaders’

the

spreading of the infection to many more through one person who is highly infected. Without a vaccine or a drug right now, there is only the option of herd immunity and controlled infection said Sambratha

Shetty,

Chief

outcome could result in living a new way of life altogether, where new measures are put in place, with no vaccine available

Foundation, adding that there

pandemics

were

here

stay and this would translate to a different way of living altogether. Looking forward, Dr. warned

Balasubramaniam of

increased

polarisation, an increase in the rural-urban split, and a change in our interconnected economies. He also said that if we don’t come up with a solution that addresses all of it, it would just be a band-aid and not a systemic solution.

are different factors to consider here -- the

In conclusion, Tobby Simon, Founder

density of a population (it would be harder

and President, Synergia Foundation, said

to control in metro cities), and hospital-bed

there was a need to look at overarching

capacity in the cities. A good way to also

issues of eating habits, especially the

ramp-up testing was through pool testing

wet markets in China. After SARS, it was

or antibody testing.

established that the disease was coming

But on the matter of controlled infection,

from bats. It is important that this be

Mr. Vijay Bhaskar stressed that medicines

controlled, else we would have more

for COVID could be found faster than the

outbreaks of SARS. After all, there are only

vaccine for it. Projections showed that it

two things that can end mankind -- nuclear

would happen within a few months.

war and pandemics.

10 | COVID-19 COMPENDIUM |

www.synergiafoundation.org

CHAPTER 2

MITIGATING STRATEGIES

SYNERGIA FOUNDATION RESEARCH TEAM

Management of the crisis, to date, offers contrasting examples. The success stories of South Korea, Taiwan, and Singapore serve as

ill Gates, during his TED Talk in

a model for others. Within Europe, Germany

2015, said, “When I was a kid, the

offers a positive contrast to Italy and Spain,

disaster we worried about most was

who were slow to respond and hence

a nuclear war. Today, the greatest risk of

have many casualties. The U.S. response is

global catastrophe doesn’t look like this. If

widely acknowledged as eccentric and

anything kills over 10 million people in the

personality-driven.

next few decades, it’s most likely to be a

In the absence of a vaccine, containment

highly infectious virus rather than a war. Not

was the primary focus the world over. While

missiles, but microbes. Part of the reason for

we scramble to contain this pandemic,

this is that we’ve invested a huge amount in

the next one may be in the making. In the

nuclear deterrents. But we’ve invested very

tropical rainforests; in deep jungles; in wet

little in a system to stop an epidemic. We’re

markets trading exotic animals; and in a

not ready for the next epidemic.”

hunter’s bush meat, an unknown pathogen

Origins of the COVID-19 bear stark similarity to the SARS outbreak of 2003. SARS

originated

the

Guangdong

could be evolving. It is time we prepare for it.

Medical Coping Strategies

province of China, and COVID-19 from

Governments are recognising the frailty of

Wuhan in the Hubei province. Early cases

their healthcare systems. While the state

at the end of 2019 were concealed so that

of healthcare infrastructure in developing

the opportunity to localise the contagion

countries like India is severely wanting,

was lost.

developed countries such as the U.S. have

www.synergiafoundation.org

| COVID-19 COMPENDIUM | 11

also been exposed. India needs to realign

Lessons from the Past

priorities so that healthcare infrastructure is

Taking into account the genetic similarities

enhanced and its reach extended.

between

Coming to GRIPS with the Enemy

SARS-Cov-2

and

COVID-19,

scientists are trying to rejig drugs that proved effective at the time. The biotech industry had made considerable progress in making drugs for SARS and MERS.

antibiotics, they are useless against viruses

Anti-viral drugs target the virus, its

as they hijack the metabolism of the host

enzymes and surface proteins, without

to create clones of themselves. According

damaging the host. It tries to weaken the virus, preventing its ingress into cells

and immunology at the Johns Hopkins

or stopping its replication.

Remdesivir,

produced by Gilead Sciences, worked with that target the virus, but don’t damage the

SARS Cov-2 and is being used against

cell as well.”

COVID-19. Protease inhibitors, like Lopiavir

The virus can remain inside the host and

and Ritonavair, HIV anti-virals which attack

continue to replicate itself and infect others,

the enzyme of the virus to make it inert, have

even when the host is asymptomatic. The

been found effective in some countries.

delay is due to the body taking time to create

Another

new antibodies to deal with the threat, and

researched is the creation of antibodies

defensive

mechanism

being

collected from engineered animals or recovered patients. By then, either the host would be on the

These antibodies strengthen the human

recovery curve, or if old and weakened by

immune system, enabling it to quickly

other ailments, it may be too late.

identify the threat and start generating its

BACTERIA VS VIRUS Are single celled

Acellular, meaning it has no cell structure

Around 1000 nm

Around 20-250nm

Reproduce asexually by division

Needs a host ot survive. They invade a cell and force the cell to reproduce the virus

Contains Peptidoglycan or Lipopolysaccharide cell wall

Contains no cell wall but a protein coat is present instead

cytoplasm

DNA or RNA enclosed inside a coat of protein

Most can be treated with antibiotics

No known cures but some can be prevented with vaccines

Fewer than 1% of bacteria cause diseases in humans Some famous bacteria include E.coli, Salmonella, Tuberculosis and Tetanus

virus Some famous viruses include the Zika virus, Ebola virus, HIV and smallpox

12 | COVID-19 COMPENDIUM |

own

antibodies

before

getting

overwhelmed. Interferons are drugs which help trigger the human immune system and have proved to be effective against persistent infections. The most effective vaccines are those that coach the human it can infect the cells.

AI to the Rescue Companies like Inovio have used the Chinese viral sequence through a machine learning system to generate a DNA-based vaccine called INO-4800, now in preclinical trials. Moderna Therapeutics also used AI to create a vaccine, also under clinical trials. It too used the genetic blueprint, posted online,

www.synergiafoundation.org

scientists are able to identify similarities in

trials on humans. The earliest a vaccine is

various viruses and their characteristics, machine-learning algorithms can detect

2021. Once the danger of COVID-19 was

correlations in the huge amount of available

fully revealed in January, researchers the

data, expediting the design of vaccines. Deep

world over had launched clinical trials to

learning is also being used to investigate the

test existing medications against the new

potential of available antiviral drugs for use

threat. So far, the data collected does not

against COVID-19.

give conclusive answers. Some treatments

The Prognosis

appear promising in individual cases, but not as a universal cure. Critically-ill volunteer

A new vaccine has to follow time-tested

patients are already receiving experimental

protocols: identifying its genetic structure;

drugs through the compassionate-use

ensuring against collateral damage; pre-

programme.

Failed Drugs, Fizzling Vaccine Every death is a failure of medicine GIFTY IMMANUEL, MD, PHD, MPH, FFPH MEDICAL DIRECTOR, SYNERGIA FOUNDATION

and adds to the downfall of science. This pandemic has brought to attention how unprepared we really are. Advancements in science, combined with leaps in technology has instilled a sense of invincibility in us. The

“W

templates we devised for the containment hen orthodox medicine and

of emergent diseases appear fallible, while

its great professors abandon you to the most horrible

novel virus. Science is repurposing old and fossilised drugs.

Vaccines

and

biologicals

long

a miserable virus despite their phenomenal

abandoned are being repackaged and

research budgets, how can you fail to go after

this reiterates our desperation. There is no

a last glimmer of hope no matter where, in hell if necessary.” Josef Stein

www.synergiafoundation.org

breakthrough biological in the horizon. It

| COVID-19 COMPENDIUM | 13

success are slim. These are drugs which were developed for some other disease and redirected to COVID-19 almost seems as though our arsenal against

redirected to COVID-19. This kind of disease-

SARS CoV-2 is redundant and antiquated.

hopping orphan antivirals dominate the

Recycling Old Therapies

COVID-19 scene. There is a sudden interest in anticancer drugs, particularly monoclonal antibodies

against COVID-19 was the old antimalarial

like (Tocilizumab and its analogs) to

hydroxychloroquine (a derivative of Quinine

target the cytokine storm, or increased

or Jesuit’s Bark- from a Peruvian tree).

cytokine levels, a major reason for fatality

Once hailed as an effective antimalarial,

in COVID-19. The second approach is to use

it has lost its ground due to resistance from

the convalescent plasma of a person who

the parasite. Further, hydroxychloroquine

has recovered from COVID-19. Though both

has

side-effects.

these experimental methods have shown

Unfortunately, it is still the core drug in

some anecdotal success, there are adverse

many guidelines around the world in the

reactions which are not well highlighted.

management of COVID-19. This dangerous

The cost factor makes it impossible for a

trend is continuing despite conclusive

large population.

serious

cardiac

evidence that hydroxychloroquine has no

India has the capacity to successfully mass produce antivirals and vaccines that

NEJM, Lancet). The sine qua non of medical

can heal the globe. Any vaccine or drug against COVID-19 designed anywhere in this

curious case of hydroxychloroquine, the

world must eventually be mass-produced

prevention and treatment seem to be

in India.

worse than the disease.

Hope was generated when Oxford’s

Orphan antiviral Remdesivir was touted

Jenner Institute projected an 80 per cent

as one that specially targets the viral

success rate for their Chimp Adeno Viral

multiplication. However, it failed with Ebola

Vector-based vaccine against COVID-19.

and Lassa virus infection. It was repurposed

Disappointingly, the primate study did

for the management of COVID-19. The drug

not yield protection against the aerosol

did not make the mark in early trials although

challenge.

a minimal reduction in the number of days to recovery was observed. Favipiravir another

A Trinity of Lethal Viruses There is no effective vaccine against SARS2003 and MERS-2012. Both viral diseases

of success are slim. These are drugs which

are caused by viruses similar to SARS CoV-

were developed for some other disease and

2 causing COVID-19. If there was a SARS

14 | COVID-19 COMPENDIUM |

www.synergiafoundation.org

HERD IMMUNITY

ORPHAN ANTIVIRALS

Drugs developed for some other disease and redirected to COVID-19 Remdesivir-Minimal reduction in the number of days to recovery observed

Allowing natural infection in

70% population can be devastating in a disease like COVID-19

Without immune memory protection cannot be longlasting

RECYCLED CANCER DRUGS

Monoclonal antibodies such as Tocilizumab to target the cytokine storm

HYDROXYCHLOROQUINE

Convalescent plasma - high cost-factor

Lost ground due to resistance from the parasite. Has serious cardiac side-effects

large population

CoV-1 vaccine it could have been

vaccine that could only partially

rapidly deployed for COVID-19. It is

protect against tuberculosis. The

highly plausible that such a vaccine

polio vaccine is successful, but the

could have at least afforded partial

polio virus is unrelated to the SARS

immunity against SARS CoV-2. The

CoV-2 virus. Both these vaccines are

reason for not developing a SARS 2003 or

being phased out as polio is on its endgame and the resurgence of tuberculosis has led to the development of BCG-II. Both these

two things: a missed opportunity and

vaccines cannot protect anyone against

developing an effective vaccine against

COVID-19.

SARS viruses could be a daunting process. Proponents of the BCG and polio vaccine are shooting in the dark. BCG is a bacterial

www.synergiafoundation.org

Unheard Immunity Herd immunity is an interesting lecture

| COVID-19 COMPENDIUM | 15

FATALITIES DURING MAJOR PANDEMICS SINCE THE START OF 20TH CENTURY Spanish Flu 1918-1920

Asian Flu 1956-1958

HIV/AIDS 1981-present

SARS 2002-03

Swine Flu 2009-10

MERS 2012-present

Ebola 2014-2016

Covid-19 2019-Present

50 Million

1.1 Million

35 Million

770

2 lakh

850

11,300

228,872

topic at schools of medicine and science,

pandemic died a natural death without

but executing it can have unforeseen

much intervention. Are we expecting a

consequences. The archaic theory has

similar end?

attracted a lot of attention. If 70 per cent

In the absence of a drug or a vaccine,

immune

public health methods are the last resort

against a disease, it is likely the remaining

to save us. Simple, effective, and universally

30 per cent will be protected. However,

applicable, these methods were quickly

the

population

becomes

there are two routes to it. One is allowing 70 per cent people to acquire the infection

Lockdowns, isolation, quarantine, social

naturally and become immune to it. The

distancing, prevention of public gatherings

second is to use a vaccine to obtain the

have proven effective when strictly adhered

same endpoint. In both the approaches,

to. However, due to implications on the

allowing the natural infection route can be

economy and human mobility, they cannot

devastating in a disease like COVID-19. This was a strategic mistake the UK made in the beginning of the pandemic and had to regress its policy later. Similarly, proponents of innate immunity believe in bolstering it. Unfortunately, without immune memory,

| CONCLUSIONS AN EXTINCTION PATH? There are important lessons to be learnt

the protection cannot be longstanding.

certainly on a mass extinction path and death. Tweaking it should be done judiciously.

Spanish Flu 1981 and Covid 2019

pernicious cycle of infection and reinfection can eventually catch up with the majority of the global

The Spanish Flu pandemic of 1918 was by a similar pathogen, similar transmission dynamics and caused around 500 million infections and 50 million deaths.

health centres, surging cases and exhaustion of resources, we would

hundred years later we are in no better

is a testament of faith we look up to

position. With all our advances are we not expected to fare better? The 1918

16 | COVID-19 COMPENDIUM |

www.synergiafoundation.org

Potential Candidates WHO reported in the second week of July that there are 23 candidate vaccines in clinical evaluation and 137 candidate 23 are currently undergoing human trials, promising contenders so far, and looking to start human trials, are: Sinovac (Sinovac Biotech Ltd. in China) based on a SARS platform. Sinovac says its inactivated vaccine protected monkeys

The Race for a Vaccine

against the virus, using weakened forms of the COVID-19 virus.

ChAdOx1-S

(University

Adenovirus

Type

Biological

Vector

Inc./Beijing

Oxford/ (CanSi

Institute

Biotechnology in China) based on the Ebola SYNERGIA FOUNDATION RESEARCH TEAM

research. It has been approved for military use in China. LNP- encapsulated mRNA (Moderna/

here is a global race against time to

NIAID in the U.S.) based on RNA from the COVID-19 virus.

the coronavirus. While the urgency is

The U.S. government’s ‘Operation Warp

well appreciated, there is no way a vaccine

Speed’ programme is expected to name

for such a deadly virus can be fast tracked without going through the established and

billions of dollars in federal funding, even

time-proven protocols.

before there is proof that the vaccines work. This is aimed at fast tracking the whole

into three phases: phase 1 focuses on the safety of the vaccine on a small group of

process. In India, two vaccines are in the works for phase I/II trials: Covaxin by Bharat

determining the required dosage for an

Biotech and another by Ahmedabad-

effective immune response; and phase 3

based Zydus Cadila. According to Zydus,

puts the vaccine to the test on a larger scale,

the potential vaccine showed a “strong

across age and population groups.

immune response” in animal studies, and

Generally,

after

pre-clinical

studies,

the antibodies produced were able to completely neutralise the wild type virus.

to 18 months. Once proved to be safe

Different methods are being employed

and successful, licences are issued for

in making the vaccine for COVID-19.

commercial release.

Considering that there have been no

www.synergiafoundation.org

COVID-19 COMPENDIUM

| 17

vaccines for other coronaviruses such as

There is also the risk that accelerated

MERS or SARS, it is still largely an unknown

tests could lead to missing potential sideeffects. A vaccine for dengue fever, and one for SARS that never reached the market, were abandoned after some respondents

One of the methods is based on our immune system producing antibodies

were found to be more susceptible to severe forms of the diseases, not less. Vaccine making needs sophisticated

place, scientists realised that they did not

equipment.

Microsoft founder Bill Gates

need to inject the entire pathogen — just

has warned of a critical shortage of a vital

the fragment that triggers this reaction.

yet forgettable component: medical glass.

These are now used against hepatitis B

Without enough supplies of the glass, there

and shingles. Scientists can add a gene

will be too few vials to transport the doses that will be needed by billions.

making a viral vector, which then stimulates the immune system to make antibodies.

Big Player India

This is a method being employed with the

The recent announcement by the Indian

ChAdOx1-S.

Council of Medical Research that a vaccine

Some groups are injecting pure DNA

will be released by August 15 created a furore.

and RNA, which then is read by the cells protein-building factories, and they make a viral protein. The protein, in turn, comes out of the cell, where immune cells make Moderna in the U.S. has used.

Pitfalls of Accelerated Trials Writing in the journal Vaccines last month, vaccine developer Stanley A. Plotkin and Arthur L. Caplan, bioethicists at NYU Langone Medical Center, proposed starting challenge trials for the COVID-19 vaccine, which

involves

volunteers

with

infecting the

vaccinated

coronavirus.

The

procedure might cut months or years off the vaccine research, but would put test subjects at risk.

18 | COVID-19 COMPENDIUM |

www.synergiafoundation.org

On July 2, the council’s Director-General Balram Bhargava told 12 institutions to

MIGHTY RUSH

“fast-track all approvals”. While some said the date paints a slightly nationalist agenda to the pandemic, others objected to the recently was simply in pre-clinical trials, when vaccines that had been under more advance phases had not yet announced an However, in an interview with Indian

159

in development

Express, Lokesh Sharma, a scientist with ICMR, said: “It is not to be interpreted as a deadline. This is our aim, which depends on the cooperation of institutes. If we are going to start work, we should do so with an aim, and it should be of success.”

in phase 2 trials (dose testing in humans)

Pharma sector

$ 100 billion by 2020

Medical devices

$ 25

billion by 2020

Soumya Swaminathan, Chief Scientist with the WHO, has expressed doubts about the vaccine being available by August 15 in an interview with India Today. “Most vaccine development projects take years

in phase 1 to 2 (safety and

Pharma exports

$ 19.14 billion by 2020

to complete. But since we are in the midst of a pandemic, we have shortened the timelines. A very optimistic estimate is that it will take about 12-18 months to develop a vaccine against Covid-19, from the time you start your vaccine development process.”

in phase 1

Pharma exports

$ 19.14 billion by 2020

The unlisted Indian vaccine maker Bharath

Biotech’s

Covaxin

received

regulatory approval to start human clinical

to have a head-start on manufacturing

trials for its experimental shot. It is lined

and to have enough doses available. The

up to be tested on over 1,100 people in two

distribution of the doses will only commence

phases from July.

once the trials are successful”.

Serum Institute of India (SII) has already

There are high expectations on India

started production of the vaccine candidate even

key players in the global vaccine industry.

though the drug has not been licensed yet.

SII is the worlds largest vaccine producer.

developed

Oxford

University,

Hyderabad-based Bharat Biotech has so far SII, told the German TV channel Deutsche

commercialised 16 vaccines, including one

Welle (DW-TV) that “the decision [to start

against H1N1, and sells products in over 65

production of the vaccine] was made solely

countries.

www.synergiafoundation.org

| COVID-19 COMPENDIUM | 19

Accelerating the Development of Novel and Affordable Therapies BASED UPON VIRTUAL FORUM DISCUSSION PARTICIPATED BY

Chas Bountra,

K Vijay Raghavan,

Pankaj Patel,

Sharad Tyagi,

Pro Vice Chancellor at the University of Oxford

Advisor to Govt of India

Chairman of Cadila Pharmaceuticals

MD Boehringer Ingelheim India

he high cost of therapies is due to the

more effective therapy, rendering their

cumulative effect of research, cost

investment redundant.

of production, cost of raw products

Due to the all-pervasive sense of rivalry

and labour. While only 20 percent of the

in the industry, there is intense secrecy in

research cost is what is done

cutting edge research and

in laboratories and while 80

IPRs are jealously guarded.

percent is spent on clinical

As a result, there are multiple

trials, this makes the cost of

research

development prohibitive. To

conducted at any point in

make matters worse, over the

time by different agencies on

years the clinical trials have

the same drug and therapy,

gone haywire, requiring huge

which leads to duplication and

quantities of proving data

avoidable waste of resources

with many parameters to be

and time. Government

measured, a large number of biomarkers to be found out, that the cost of research has gone up exponentially in the last two decades. For the private industry investing in new drugs and therapies, there is no surety that the product will sell, no guarantee of an assured market, and the nagging fear, that someone else has beaten them to an even

20 | COVID-19 COMPENDIUM |

projects

Investing in new drugs and therapies, there is no surety that the product will sell, no guarantee of an assured market

governing

drug

being

regulations research

also have an inhibiting effect. Regulatory authorities across the world have created a maze of rules and regulations that create hurdles rather than be supportive of expeditious research. Is there a need to generate a huge volume of data to support new drug research if a reasonable amount of data can lead to equally effective

www.synergiafoundation.org

therapies? In the past, effective drugs have It is understood that there are concerns of

E X P E D I T E D TREATMENT FACTORS

patient safety and fear of side effects, but

Quality Infrastructure

been invented with much less data mining.

researchers and companies are sensitive to

Create and maintain quality infrastructure which would ensure that the tasks needed to be carried out are done

this. There is a need to focus more on data on the premise of “Must Have” rather than the present concept of “Good to Have.” The pandemic has exposed the state of the health care system in almost all countries across the divide between the

Policy framework Need for a policy framework that supports innovation as the top agenda of government across the world

rich and the poor. The health care system

Sound regulatory system

is crippled, facing a major challenge of

Authorities need to differentiate between the ‘must-have’ and the ‘good-to-have’ in the quantum of data generated before a novel therapy is accepted for mass usage

making two ends meet, despite working day and night. It is feared that many in the health care business will go bankrupt. Overall we need to invest in people, in innovations, creating therapies and in ensuring that ultimately the patient is cured- this is the most important part of the health care system.

Strong linkages Needs to be a strong link between academica, industry and governments. Research hubs where there is an interaction between people, industry and the tools for innovation,

Government Initiatives For accelerating therapies, we need an

expensive and has inherent risks of the entire investment coming to a nought. For

the University of Oxford.

greater risk-sharing, since funding cannot

The government has to take the lead in

be done solely by the pharma industry or

creating this environment. The environment

the government or by academia by itself, but all put together not only generate more

physical infrastructure within India, a holistic

resources but also spread the risk.

policy laying the framework to support

The government has to create hubs

innovation, putting innovation at the top of

for drug research where academia, govt

its agenda, creating an enabling regulatory

research labs and the pharma industry

system and last, but not the least, providing

come together and work in a conducive

a platform for strong linkage between the

environment in a spirit of togetherness.

academia, industry and the government, as

Here innovations will take place once clear

illustrated by Oxford University. The Oxford initiative pools resources to share the cost, working with nine large

Such an organised environment will have its

pharmaceutical companies, several patient

payback in motivated researchers working

organisations, funds from private trusts and, the UK Govt. Drug research is exorbitantly

www.synergiafoundation.org

timelines.

| COVID-19 COMPENDIUM | 21

10ml

VACCIN E

COVID-19

VACCINE 10ml

The Oxford initiative pools resources to share the cost, working with nine large pharmaceutical companies, several patient organisations, funds from private trusts and the UK Govt A word of caution; large scale drug

health care costs-insurance, reimbursement

manufacture can impact the delicate

by the government and, from own pocket.

environmental balance, and the regulatory

The situation is quite acute because it is the

authority has to be mindful of this. The

out of pocket model, where most patients

objective should be to ensure sustainable

end up paying themselves, that is used

growth without damaging the ecology and

largely. However, more than the cost is the

the environment.

access to healthcare. How do you get a

The government will have to play a

patient to be able to afford the medicine without having to shell it out of the

affordable. Many countries take on the

pocket? Insurance is one solution. Public

expenditure of high-cost therapies as in

private partnership with the government

the case of HIV. The prices can be further

supporting

brought down by encouraging multi-source

infra support and funding is another. The

supply for which collaboration will have

Ayushman Bharat model has great promise

to be intergovernmental to bear pressure

provided it is taken forward in an effective

the

private

industry

with

manner and has the medical health care government has to take a call whether

infrastructure to support its objectives.

to pay for all therapies for the poor or pay

The government must create a single

only for those which are very expensive.

regulatory authority for approval and

There are examples in India where private

a transparent procurement system. All

companies treat cancer patients from

countries have their individual regulations

below the poverty line with support of the

that act as barriers to worldwide usage

state government who bears the cost.

of drugs, thus adding to the overall cost

There are different models for paying the

22 | COVID-19 COMPENDIUM |

of the drug. If a drug has been proved

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to be effective in one country, should it

Initiatives by the Industry

again undergo the scrutiny of multiple

The scientists in the industry must focus on

regulators and obtain approval multiple

processes which answer to the creation of

times before it can be introduced in the

new drugs and therapies that will not only

Indian market?

be state of the art but also due to reduced

Internationally, there has to be an agreement to streamline the regulatory process

for

doing

away

with

cost of research, more affordable across the globe.

the

The Oxford experience has shown

cumbersome, and expensive legal process,

that collaboration and not competition in

of seeking clearances in multiple countries once the same has been obtained in one

forward. The key lies in pooling resources to

nation under internationally accepted

share risk and focus only on entirely novel

norms. This will not only bring down the

ideas, as is being done in a study being

cost but will also ensure the new drugs

conducted in Oxford.

are made available to patients in low and

Every day scientists working at Oxford

middle-income group countries in the

are creating novel genes or proteins to

same time frame as their more developed

generate tools as starting points for drug

counterparts.

discovery,

for

producing

molecular

The supply chain of essential drugs

inhibitor or antibody etc. These very high-

must not be dependent on one company,

quality tools are being provided to nine

one country or even one region. Encourage

very large pharma companies thus driving

new entrants, reduce the risk, ensure the

innovation while keeping down the costs.

stability of policy and reward enterprises that create affordable medicare. Governments have to change the way they look at the progress made by their respective countries. The state of a community or a country should be measured by the health

Where people are most optimistic about the vaccine race % who agree that a Covid-19 vaccine will be available before the end of 2020 Agree

Disagree

China

India

economic practices. This will modify the way

Brazil

countries invest in health care; this should be

Russia

in a more holistic manner, not just through

France

pharmaceuticals or therapies but overall. They should ensure the entire humanity is

Spain

United States

South Korea

United Kingdom

COVID-19 showed the relevance of the

Canada

public health care system in the service

Germany

of its citizens. This sector demands the

Japan

getting healthier and is better cared for.

greatest attention from the government in terms of budgetary support, research, multidirectional approach and collaboration at an international scale.

www.synergiafoundation.org

Source: Ipsos MORI

COVID-19 COMPENDIUM

| 23

All these tools do not draw IPR; Oxford does not patent them. These are freely available and as a consequence are being used in over 300 academic labs all over the world, including India. This is the best example of crowd sourcing science. Crowd sourcing has the advantage of avoiding duplication. There is no need to conduct research in an area which is already being done somewhere else or which has already been done; this is just a waste of time. To sum up, the lessons emerging from Oxford University are; (a) Pool resources to

A group of highly talented persons have been working with the govt and the regulators and funders and with AstraZeneca to create a partnership to generate a billion sample of vaccine as quickly as possible

share risk (b) work in novel impossible areas to drive innovation, (c) make everything freely available to crowd source science, (d)

health data-based company. Technology

release everything to the world immediately

must also enable early diagnosis of the

waste.

disease akin to onboard diagnostic systems

Collaboration is the primary central theme

in highend cars. Scientists in the health

reduce

duplication

and

here. Why do we need a disaster to tell us about the importance of cooperation and to

indicators that will help in setting up such

make us work in a much better manner? It

an early warning system. This is greatly

should become the norm. Sharing data and

required for the treatment of cancer and

knowledge will reduce the cost of therapies.

rare diseases.

This collaborative effort being run by

The industry has to focus on major

Oxford University is called the “Moonshot

global problems and come out with

Programme”.

comprehensive solutions. Today there are

A group of highly talented

persons have been working with the government, the regulators, funders and,

dollar conglomerates such as Apple and

with AstraZeneca to create a partnership

Microsoft. These are all data tech companies.

to generate a billion samples of vaccine

Within the next decade, we shall witness

as quickly as possible. AstraZeneca will

the rise of trillion-dollar health care data

now give a licence to the Serum Research

companies. Today Johnson & Johnson is the

Institute in India to generate another billion

largest health care company but is worth

samples. The single goal is to generate a

only about US $ 400 B.

vaccine which is effective and safe and is

The

message

that

with

better

made as quickly and as cheaply as possible.

management and innovative application,

Technology has to be developed to

the health care industry will attract higher

have the health care equivalent of an early

investments and partnership across other

warning system in diagnostics; technology, which will ultimately create a trillion-dollar

24 | COVID-19 COMPENDIUM |

given a boost to this sentiment.

www.synergiafoundation.org

VACCIN E

COVID-19

COVID-19 1 0m l

COVID-19

VACCINE 10 m l

lm01

E NICCAV

10 m l

91-DIVOC

1 0m l

VACCINE

lm01

E NICCAV

COVID-19

91-DIVOC

Charting the Path for Vaccine Rollout

As we stand at the cusp of another great event,10mthe rollout10m ofl COVID l VACCIN E VACCIN E COVID-19

COVID-19

will ensure a fair, safe, affordable and timely distribution for all.

looming ahead- manufacturing in scale, MAJ GEN AJAY SAH, GEOPOLITICAL AND STRATEGIC ANAYLST, SYNERGIA FOUNDATION

distribution in an ethical way, persuasion of wary citizens to take what has been an incredibly speedy process and develop and sustain trust in the process.

Multilateral cooperation o reach so rapidly, the coveted goal

The COVAX Facility forms a key part of

of inventing a vaccine for a deadly

the COVAX pillar (COVAX) of the Access to COVID-19 Tools (ACT) Accelerator, a ground-breaking global collaboration to

achievement. With three different sets of

accelerate the development, production,

clinical trials in the western world showing

and equitable access to COVID-19 tests,

surprisingly effective results, this affords the

treatments, and vaccines. This was created

perfect reason to assume that in a mere

almost overnight with over 180 countries

matter of months, vaccinations will begin.

now committing to it, covering over 90 per

Under normal circumstances, the average

cent of the world population with over 2

time to develop a vaccine is around 7 to 8

billion dollars allocated to subsidise some of

years.

the payments for the poorest countries.

However, the battle is far from over.

The coordination was started just a

The obstacles faced in its discovery pale

few weeks after the viral sequence was

in comparison with the humongous task

www.synergiafoundation.org

| COVID-19 COMPENDIUM | 25

vaccine candidates are being developed with over 50 in clinical trials. These are based on all types of vaccine development

VACCINE HESITANCY: THE NEXT CHALLENGE IN THE

platforms ranging from the old inactivated

Concerns regarding COVID-19 Vaccine

virus technology to the latest.

340

Quality control Side effects

The Race Leaders

167 148

Associated COVID-19 illness Wait until tested by others

tweeted, “Covishield, a low-cost, logistically manageable & soon to be widely available,

in the other dosage regime.” Covisheild is

In India, vaccine research is being done by Dr. Reddy’s Labs (collaborating with

Gamaleya

Research

Institute

167

13%

Disease is mild

(133)

Other

(167)

11%

Concerns by category

CORNCERNS BY GROUPS Safety 70% General popultion

being developed by the University of Oxford, in collaboration with AstraZeneca.

(984)

Physiological immunity is better

COVID19 vaccine, will offer protection up to 90% in one type of dosage regime and 62%

76%

Pregnancy COVID-19 symptoms are mostly mild

Poonawalla, CEO of Serum Institute of India

Safety

Wait for next year

Covid 19 vaccines have reported around 95

264

Safety 70% 20% 10%

Disease is mild

19%

Doctors 11%

Disease is mild

Concerns among responders regarding potential COVID-19 vaccines. A list of concerns regarding potential COVID-19 vaccines. Venn diagrams combining the concerns into three main categories

Epidemiology and Microbiology, Russia) and Bharat Biotech (in collaboration with the University of Wisconsin, USA). Zydus Cadila India has its own vaccine ZyCovi-D,

The data is analysed from 1941 anonymous questionnaires completed by healthcare workers and members of the general Israeli population, regarding acceptance of a potential COVID-19 Vaccine

Panacea Biotec is in partnership with the U.S. company called Refana based in Ireland, Indian Immunological has an alliance with E in Hyderabad is partnering with Baylor College of Medicine, Texas.

Global Equitable Distribution Manufacture of vaccines is a complex

the vaccine will work, ensuring that several

process, needs know-how and technical

hundred million doses will be available

infrastructure and takes time – typically one

around the time the vaccines are formally approved.

scratch and 6 to 9 months if facilities are

The task of manufacture, distribution

already established. It takes time to scale

and application is so huge that it is amply

up production and that is why a group of

clear that all will not be delivered the vaccine

countries have commenced the production

even in 2021. To narrow this gap, the world

at their own risk without knowing whether

is looking up to India, the worlds vaccine

26 | COVID-19 COMPENDIUM |

www.synergiafoundation.org

factory that produces 60% of vaccines for the

However, international organisations can

world– both from the angle of production

try to moderate both. Many

and delivery, India is important.

International delivery options

wealthy

and

middle-income

countries are doing what is rational and politically

understandable

under

the

circumstances – protecting the interests delivery of the vaccine from the factories to

their

citizens,

hoarding

economic

the homes of the citizens around the world.

resources and manufacturing capacities.

First is the “Free Market“ approach that

Some governments are hedging their bets

allows the companies to sell the vaccine to

- putting money on COVAX and also doing

the highest bidder. This is the normal course

side deals with a lot of vaccine candidate

of action, but these are not normal times.

companies.

Second is “Vaccine Nationalism” wherein

The volume left for a more rational, ethical

the inventor and producer vaccinate their

and public health-oriented distribution system through COVAX may ultimately be

free market in that the citizen of such a

too small to meet everyones needs even by the end of 2021 or beginning of 2022.

they themselves have been vaccinated. The third is adhering to the “COVAX partnership” which opposes a free market and vaccine nationalism.

It advocates

equitable distribution around the world and to members of COVAX, which includes low and medium-income countries. All countries will receive a proportional amount – initially 3 per cent and later 20 per cent of their population. Fourth is the “Fair Priority” model – distributing to those countries that need it the most as they are those with a massive outbreak. India, where younger people are dying, will have higher priority.

THE NATIONALITIES MOST EAGER % who agree/disagree they would take a Covid-19 vaccine if it was available* 97

China Brazil

India

Fifth, and last, is the “Open Licensing”

United Kingdom

model which will get rid of patents

South Korea

permitting anyone around the world to

Canada

Japan

produce the vaccine in quantity as a generic drug. India and Brazil will be major players if this is allowed.

approaches. It is impossible to overcome either free-market or vaccine nationalism.

www.synergiafoundation.org

Spain

15 16

United States

Germany

France

a combination of two or more of these

Russia

59 54

41 47

*May not add upto 100% due to rounding n=19,519 adults in 27 countries (Jul 27-Aug 07, 2020). Source: Ipsos MORI

| COVID-19 COMPENDIUM | 27

Even if COVAX ensures an equitable

Vaccine Production

distribution, which agency will monitor

Production can be at a very high level.

the internal distribution within a country

Still,

depending

upon

the

nature

vaccine produced, or procured from the vaccinated and not the ruling elite and their

international market, the challenges will

coterie of friends and supplicants and the privileged ones? Vaccines are emerging not just as a

vaccine will require minus 70 degrees cold

public health tool but more as a strategic

chain storage. Even the Moderna needs

asset to shore up geopolitical relations and

minus 20 degrees. While India does have

alliances. Out of 11 candidates in phase 3

the capacity for minus 20 degrees, it is

trials, four are being developed by Chinese

unlikely to be picking up vaccines which

organisations and companies and one

require an extremely low cold chain storage

by the Russians. It is much harder to get

for its large scale vaccination programme.

information on what their volume and processes are.

vaccine produced by an Indian

manufacturer or based on an Indian

The regulatory approval of these vaccines

manufacturer using a licence from an

by WHO will be critical for shoring up

international developer would be ideal for exploiting the vast Indian production base.

WHO must also ensure the pedigree and

As per the Indian Health Ministry, the

security of the supply chain. For example, in

target is to immunise about 300 million

the past, the validation of three top Indian

people by Sep 2021, with the anticipation

companies for anti-viral drugs internationally

that the immunisation programme will begin by Feb or March.

allowing many companies to come in and manufacture without much validation, it

Vaccinating the Billions

will have enormous consequences both

The vaccine supply chain will depend upon

politically and health-wise.

the production volume, the procurement

28 | COVID-19 COMPENDIUM |

www.synergiafoundation.org

volume and the availability of the cold chain

response and yet be free of any inadvertent

requirements, which are already being

transmission of viruses.

enhanced.

The universal immunisation

programme had established a countrywide

Potential side affects

cold chain network which is being ramped

Every vaccine in the world has an adverse

up.

reaction. When a protein is injected in a A big challenge is in terms of the health

human body, it creates a unique response;

workforce as, unlike earlier immunisation

it can also create any adverse effect being

campaigns which targeted much lower

alien to the human system. Post-vaccination

numbers, this time an entire population

fever, myalgia, headache, rash and even, life-

worldwide is the objective.

threatening anaphylactic shock resulting in

The Oral Polio vaccine oral drops were much more comfortable to store and

death are some potential risks. Therefore,

the

need

for

transport, but in this case, it may require an

Pharmacovigilance and vaccine adverse

intramuscular injection, and if two doses

reaction reporting gains importance. This

are needed, then it will double the number of not only the doses but also the effort

vaccination system and address the adverse

that goes into immunising each person.

reactions in real-time.

Mobilisation of not only nurses and doctors

The trials done so far are on a limited

but also medical students and trainee

population except for one or two vaccines,

nurses and paramedics would be required.

so obviously we do not know at this stage the long term adverse effects– some are theoretical while some could be very real.

not aware of their health status. Therefore,

Medical management of these adverse

age criterion may have to be applied–say

reactions will be crucial before we even go into launching the vaccine.

assembling, administrating both doses on time and to follow up for potential adverse reactions will be a task of gigantic proportions. Strict

hygiene

with

needle-based

concern in populous countries like India. There

are

pathogens

vast like

levels

hepatitis

bloodborne C

and

transmissions of these pathogens can happen as it has happened in the past. You may get protected against CORONA but in the process get infected with hepatitis C! It would be advisable to use a vaccination jet or transdermal vaccinator or even nasal vaccines which can trigger the immune

www.synergiafoundation.org

HOW EFFECTIVE ARE THE Estimated effectiveness at Covid-19 prevention based on interim data from latestage clinical trials* mRNA-1273 (Moderna) BNT 162b2 Gam-COVID-Vac sputnik V

Nov 16

95%

Nov 18

95% 92%

Nov 11

Research Institute)

ChAd0x1 nCov-2019

(University of Oxford/ AstraZeneca)

Nov 23

70%

*As of Nov 23, 2020. Phase III trials for BNT162b2 are complete. Sources: Respective companies, Russian health ministry

| COVID-19 COMPENDIUM | 29

vaccine escape mutants. This has happened A vaccine is designed to create a correlate of protection which in simple terms means

in hepatitis B and other viral diseases. This is a zoonotic disease which came

the quantum of antibodies formed and the

from animals;

it had recombined within

length and duration of protection afforded.

animals before it struck human immune

For instance, all these vaccines are claiming

systems. Recently we had what was called Mink infection with SARS COVID 2. After

encouraging. Conventional vaccines like the

passing through the mink, it became much

hepatitis B vaccine have not been able to cross

more virulent. Normally after passing through

80 per cent despite having four generations

animals, the virus becomes attenuated and

and a huge vaccination history. Similarly, with

less virulent but not in this case. Such a comeback can threaten your vaccine strain.

not been able to cross even 60 per cent.

Antibody-Dependent

Enhancement

The point is whether COVID vaccines

(ADE) is another threat. This has been seen in

really are able to reach the claimed

cases of Chikunguniya and similar related viral diseases. If there is a prior antibody or if you

in a sustained manner. It’s quite likely that

immunise someone against a disease some

six months down the line, the vaccine levels

time because of adding to the mix of the

may drop to 50 per cent. We need a plateau

immune system and the viral components

and not a downward spiral that can happen with vaccines that initially show very high levels of response.

It is for this reason;

vaccines use a prime and boost system. A shot is given on day zero, and after 30 days, the booster dose is delivered – a double

THE CASE FOR INTRANASAL VACCINES Intranasal

vaccines

are

excellent

vaccination system. If it is going to be an annual vaccination scheme we are not sure if it is a double dose again or just a single dose. In the past,

of the population as one year they get vaccinated and skip the next. The Darwinian evolution principles apply to the virus equally. When under the selection pressure of a vaccine, the virus is bound to become resistant. Right now the virus is immune system literally feeding on it, but the

Nasal vaccines stimulate both mucosal and systemic immunity which gives better Nanoemulsions are an ideal vehicle for the delivery of intranasal vaccines backed by SBS patent-protected platform to deliver vaccines intranasally is available. The advantages of this delivery system for the COVID vaccine are: Long-lasting immunogenicity Strong immune response Increased potency, sustained release of

day an effective anti-viral vaccine is injected

Stability on storage (may not require cold chain)

into the virus and host ecology, the virus will

Protection from degradation

30 | COVID-19 COMPENDIUM |

www.synergiafoundation.org

of the related viruses there can be some kind of enhancement so that the next time it can

| CONCLUSIONS

become very severe. If you are infected with

For the future, the issue of global

one strain of dengue virus the next time you contract dengue it could be very severe There are theoretical risks that this vaccine can create such a milieu and when you have

rules and money put on the table so that when the next pandemic hits, the world is not scrambling in

an actual infection again, there could be a hyperactivated immune system leading to lung disorders and other complications, Another issue is whether people already contracted COVID will need the vaccination.

Securitisation of global health is making the vaccine as much an issue of national security and national diplomacy as national

There are three categories of such people; those hospitalised, those not hospitalised

polarised world where decisions are

with mild symptoms, and those who were detected purely on antibody-based serological surveys.

Some could have

been positive but remained asymptomatic. In most cases, it isn’t easy to assess the duration of immunity based only on the

Trade-offs between the vaccine that the host country needs and what are the requirements of multilateral organisations will remain a muchcontested issue at home and

antibody levels. Cellular immunity may last longer than three months or six months, or even longer, no one can say with certainty how

It is not important for every individual to rush for the vaccine; it depends upon the priority and

protected these individuals are from reinfection. There are already some reported

most pandemics have vanished

incidents of re-infection based on the genetic signature of the second virus

individual’s work or life does not involve exposure to infection such

So we have to proceed on the assumption that there is still vulnerability, even if some antibodies were produced affording some

of wait and watch may be advisable

cellular immunity, it might not be strong enough to last a long time. It depends upon the viral load they were exposed to and what the body’s capacity to produce lasting immunity is. In

infections

caused

coronaviruses like the SARS 1 virus, the immunity lasted up to 2 to 3 years, but the common cold corona viruses have immunity lasting for only a few months.

www.synergiafoundation.org

| COVID-19 COMPENDIUM | 31

Evolving a Medical Strategy

With the limitations on bed capacity in India, a graded approach to patient care has to be adopted so that only the most deserving cases reach COVID hospitals. “In about 90 per cent cases, COVID-19 only

SYNERGIA FOUNDATION RESEARCH TEAM

causes mild illness which does not require hospital care and can be cured at home, with remote medical supervision,” says

he aim should be to create a

Arvind Kasturi, Head Community Heath

responsive

system

Care, St. John’s National Academy. Naresh

pandemics.

Shetty, President, M.S. Ramaiah Memorial

designed

healthcare to

tackle

Hospital, is of the view that it is critical to

National Disaster Management Agency and the Public Health Foundation of India, a

the patient is admitted. Hospitals should

public–private partnership would be critical.

have a fever clinic outside, where blood

A well-integrated

strategy should be

test and X-rays can be done. A rapid test

based upon 3Cs: convergence of policies between government, local administration,

The supply chain for PPE should be robust,

public

proper

particularly in private hospitals for they

communication strategies; and coordination.

continue to attract scores of patients who

and

private

hospitals;

While public healthcare is ideal in a pandemic, the private sector should not be left out.

are relatively well-cared for, the greater

The Aarogya Setu app has failed in its

worry lies in rural areas, where people are

objective. Its widespread usage would have

dependent on local-level care such as

generated useful data to track the infection

ASHA workers and PHCs. “It is here where

and supplement it with other containment

the battle needs to be fought and won,”

measures.

says Arvind Kasturi, Head, Community

32 | COVID-19 COMPENDIUM |

www.synergiafoundation.org

Heath Care, St. John’s National Academy.

Fatigue & System Failure

As R. Balasubramaniam (Harvard School of

‘Prevention fatigue’ can set in due to long

Public Health) rightly put, social distancing

hours of work in an overloaded system. The doctor or nurse could lower their guard,

activities. In rural areas, lack of water makes

resulting in exposure. The second aspect is the ‘bystander effect’. When healthcare

and social stigma of the disease is also a big

workers

issue.

among their infected colleagues, it can

Sundareshan

from

the

IISc.

for COVID-19, in consultation with foreign universities. By factoring varied population sizes and types, living conditions, rates infections,

and

fatalities

judgment.

Bangalore, has been working on simulators

illness

lead to mental exhaustion and poor clinical

Simulator Models Rajesh

observe

hospital

capacities,

The Private vs Public Debate

simulation can give us an idea of morbidity/

Tobby Simon, Founder and President, Synergia Foundation & R Balasubramaniam,

mortality rates. After this, a variety of interventions can be applied to mitigate model should cover the smallest possible scale, i.e., at the local level, proposes Mukund

Harvard School of Public Health and Founder, Swami Vivekananda Youth Movement and GRAAM, Mysuru

Thattai of NCBS-TIFR. The results would be easier to re-calibrate on a larger scale. However, evolving a model for COVID-19 is

t has emerged clearly that the delivery

like earlier viruses, especially in how it has created symptomatic ‘super-spreaders’.

of healthcare, either by the private or the State-run system, is a national priority. All

such resources are “public goods” to be

shared equitably for the common good. global

Most countries have a dual system of

response lies within the network of hospitals.

private and public healthcare, yet the public

Shortage of PPE shows the lack of alternative

system is most accessible to those with

manufacturing options. The rising demand

lower income. Public hospitals get quickly

for ventilators and a diminishing stockpile of

overwhelmed while catering to all segments

oxygen can have devastating consequences.

of society. But, private institutions are

Pre-designated

and

inclined more towards super-specialisation

decontamination sites are not routinely

and hence, are expensive. Consequently,

incorporated into hospital design. Further,

they are not well-equipped to intervene

shutting down hospitals as contaminated

during pandemics. Responding to public

sites, even temporarily, deprives the citizen of

health emergencies is resource-intensive

routine health services.

and is not commercially attractive.

Orchestrating

national

isolation

www.synergiafoundation.org

and

venues

| COVID-19 COMPENDIUM | 33

Systems Around the World

A robust public healthcare sector, on the

Though Italy and Spain have excellent

other hand, can ensure proactive responses

public healthcare systems, they were not

at the national and local-level, making

equipped to handle a pandemic. Chinese

it easier to handle crises.

authorities, on the other hand, operating

response usually demands a multi- and

under a centralised system, took quick

interdisciplinary approach to management

decisions to stem the tide by building new

and many times, it goes even beyond a

COVID-19 hospitals overnight.

The U.S.,

medical approach to the problem. Private

largely dependent on a private healthcare

hospitals usually operate on commercial

system, found itself poorly equipped to deal

principles and there may be no space for

with the pandemic. Deterred by expensive

free services during public emergencies.

healthcare

But, they have a role to play by continuing

and

absence

adequate

insurance cover, people chose not to go to hospitals. This compounded the infection

Public health

to address regular health issues. Governments

also

need

build

rates and stretched the public health

complementary partnerships with private

system beyond its limits.

and civil society. It is only when all players

In India, the response to the pandemic

work together that such situations can be managed.

healthcare. Some private hospitals have been directed to treat symptomatic patients,

Fight Forward, Fight Local

but due to limited testing facilities and

Japan, South Korea, Singapore and Taiwan

higher cost, the number of such patients

had endured the most of SARS and knew

has so far been low. In semi-rural areas, the

what was brewing. They operated on the

private sector hospitals are not comparable

belief that the virus can be defeated if local

to those in the cities. They only have basic

governance fetched up. Herein lies the

infrastructure. It is also worrisome that

mantra for waging a successful campaign

many smaller private hospitals and nursing

against this insidious virus — empowering

homes in cities have closed down their out

local

and inpatient facilities.

panchayat, and ward-level to carry out the

34 | COVID-19 COMPENDIUM |

governance

district,

tehsil,

www.synergiafoundation.org

59,481,313 1,404,542 Deaths

Source: World Health Organisation

plan conceived at the national level.

support, isolation wards, and creating

The district administration is key in

additional ICU beds and monitoring the

successful implementation of the national

available ventilators in the district to ensure

plan. Districts that have activated their crisis management groups and control centres in

in charge will have to urge private hospitals

a proactive manner will be able to confront

and practitioners to be available to pitch in.

the developing situation well. The national

Kerala learnt from its Zika experience

directive of COVID-19 is clear: surveillance,

and quickly tracked down clusters of infections. They used anganwadi and Kudumbashree workers to conduct door-

then treat. Risk communication is critical, as a large

to-door surveys, and used digital mapping

part of the population may be illiterate and

to ‘break the chain’ of infections. Karnataka

would not know the stark dangers posed

created a Municipal Corporation War Room

by this virus.

to track cases using mobile tracking.

The community worker is

the frontline soldier in this war. The local populace has to be taught the basics of

Centre and State Coordination

social distancing and home quarantine.

State governments must expand their

Constant vigilance has to be maintained

hospital capacity by decongesting hospitals

to detect symptoms. The tehsil and district

and converting public accommodations

bodies would need to prepare for a large

into makeshift holding areas and isolation centres. The existing staff must undergo a

focus has to be on enhancing laboratory

www.synergiafoundation.org

crash course in epidemiology. Final-year

| COVID-19 COMPENDIUM | 35

trainees (doctors/paramedics/nurses) must

should be reorganised looking at a longterm battle.

timely sharing of information hampers the

It is essential to set up kiosks in hospitals for fever checks and monitoring

good example was the mass movement of

suspect cases among the staff. Contact

migrants from megacities.

has

minimised

through

strict

visitor protocols, patient protocols, tele-

The American Experience

medicine, postponing elective surgeries,

There is a need to re-engineer COVID

and changing medication to make visits of

treatment spaces with negative pressure

patients to hospitals less frequent. Matthew

as no hospital is designed to handle

Anthony Kalliath, Chief Surgical Resident,

pandemics:

University

Richard

Garcia,

Medical

Director – Chief of Staff, Ferry County

Pennsylvania

Medical

Center, Harrisburg, advised upgrading air-

Memorial Hospital, Washington. In U.S., too, frontline doctors faced the shortage of PPE.

However, doctors are

effective against the virus. Jake

Moore,

Emergency

Medical

learning on the job along with the progress

Physician, Rush Oak Park Hospital, IL,

of the pandemic. There is scope for

stressed the importance of regular and accurate messaging about the pandemic. “Everyone appreciates knowing the hard

patient management. Shameeke Taylor, Emergency Medical

truths about the pandemic,” he says.

Physician, Mount Sinai Medical Center, New

People should be informed about the

York, described the innovative ways used

risks and stigmatisation should be nipped in the bud.

construction workers and 3D printers used

for

making

face

shields.

Dynamic inventory management

| CONCLUSIONS

should be practised to anticipate

Protecting Healthcare workers Human

Resources

should

look

into

rotation

shifts,

employment

volunteer staff, and ensuring

correct

An integrated national action plan, support by WHO, and global data sharing is the need of introduced a drivethrough testing method to get as many people tested and Germany also followed broad

wearing of PPE by the staff.

Work

shifts

36 | COVID-19 COMPENDIUM |

www.synergiafoundation.org

Countries and Pandemics TOBBY SIMON, FOUNDER AND PRESIDENT, SYNERGIA FOUNDATION

One represents danger, and the other represents opportunity

John F. Kennedy, he world, irrespective of political ideologies of ruling dispensations, has been brought

short list of countries that have experienced remarkable success are Vietnam, Cuba, South

chief strategy was early detection, followed by free treatment and care to anyone with an infection. Private healthcare systems have been found wanting, especially in India.

Is Socialism the Vaccine?

mortality rates and a new drug, Avifavir, to

It may be true that the socialist approach to governance brings greater focus on public

healthcare

and

social

support

As an example of nationalistic bravado, Alexander Lukashenko of Belarus, president since 1994 and ex-Soviet soldier, has

communist dispensation could be worse

dismissed corona as a “psychosis” and said,

has focused on public healthcare. The key

that ice hockey is “better than antiviral

differentiator may not be ideology, but a

medication”; and asking people to “wash

responsive, empathetic administration.

their hands with vodka”. With no lockdown,

Russia, from among the lowest caseloads

no border sealing, and among East Europe’s

in March, soared to world number two, till

highest caseloads, the situation is being

it was replaced by Brazil. The country was

called a “viral Chernobyl”.

weighed down by inexperience and an

Here we look at four success stories where leadership can stall an epidemic’s

talking points now: allegations of fudged

www.synergiafoundation.org

passage.

| COVID-19 COMPENDIUM | 37

Cuba For a country nicknamed ‘El Cocodrilo’, there’s one thing Cuba is not: being cold-blooded when it comes to healthcare. Its renowned free public healthcare system is in the limelight again, aplomb. Cuba has the highest ratio of physicians to population, a key factor in its low caseload of 2,173, with just 83 deaths. It called on nearly 28,000 medical students who went door-to-door across the country. Cuba also made headlines with its ‘medical internationalism’— sending doctors and support staff to crisis-hit Italy. Integral to reducing the number of deaths globally is a Cuban antiviral drug, Interferon alfa-2b. The Canadian pharma major BetterLife is now taking up this 30-year-old invention for trial and mass production.

New Zealand The expeditious and

South Korea

calm reaction of New

It was

Zealand Prime Minister

evident

Jacinda Ardern to the

that South

Christchurch shooting

Korea had begun

New Zealand’s

stockpiling

commitment to

coronavirus

remain a liberal country. It’s with the

testing kits

same spirit she took on the COVID-19

long before the outbreak in its cities.

battle. New Zealand met the goals of

Providing close to 10,000 tests a day,

mandatory quarantines, countrywide

and supplementing it with a mobile

lockdown, and social distancing without

app for citizens to keep themselves

being draconian. On June 8, New

constantly updated, the country was

Zealand cleared its last active case.

on the ball.

Vietnam Vietnam and China share a land border stretching about 1,444 km. With a population of 95 million and a relatively low per capita income, Vietnam is an outlier success story. The country is beginning to lift the strict lockdown measures it imposed in February. It has yet to generate the global applause it for a success story. There was a touch of authoritarian surveillance built into its control strategy, but the difference with more ‘democratic’ countries tackling the pandemic was not much and there was wide social consensus for the same.

38 | COVID-19 COMPENDIUM |

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Responsiveness Begins in the Beginning. Look at Kerala

what must be done in the face of a 21st century pandemic,” leadership consultant Mark Nevins wrote in Forbes. An inclusive,

case arrived from Wuhan in the end of

cohesive society, one not polarised on

January. Its signature moves: participatory

ideological, racial, ethnic, or religious

contact tracing; a supportive quarantine

faultlines, cannot harm the cause. Africa is

for nearly two lakh people; feeding and

largely caught between a stark leadership

supplying provisions to some 87.28 lakh ration card-holders and 1,50,000 migrant

end, Tanzanian President John Magufuli

labourers; daily public dissemination

ridicules testing kits, saying even “a goat

of information; and a hands-on health

and a pawpaw” had tested positive. At the

minister. The approach was empathetic

other, a French scientist said on TV, “If I

and grassroots-oriented. In a country of

can be provocative, shouldn’t we be doing

India’s scale and inequities, a bottom-up

this study in Africa...”, prompting outrage.

approach that ensures economic

Among the angry decrials: the Ivorian

and social security, proved the best

football star Didier Drogba memorably

pandemic shield.

proclaiming that Africans are “not guinea

“There’s no playbook for leadership when the stakes are high, no playbook for

pigs”. What one needs is collaborative, people-oriented leadership.

RANKING GLOBAL PANDEMIC PREPAREDNESS This pre-COVID-19 report found that no country was truly prepared to manage a pandemic The Global Health Security Index measures the state of health security around the world. The index is composed of 6 categories:

Prevention

Detection and Reporting

Rapid Response

Health System

Prior to the COVID-19 outbreak, China had a plan in place to deal with communicable diseases with pandemic potential.

Americas Europe South-East Asia Eastern Mediterranean Af rica

Italy ranked 126th in the Emergency Response Operation indicator and 59th in Emergency Preparedness and Response Planning.

A cholera outbreak has infected over 2.2 million people in Yemen since 2016.

www.synergiafoundation.org

25,223,599 17,516,493 10,524,941 3,899,741 1,464,106

Situation by Country, Territory or Area

Iran ranked 108th in Emergency Preparedness and Response planning.

73%

Risk Environment

Situation by WHO Region

of Indicators including: Epidemiology Workforce, Biosecurity and Emergency Preparedness and Response Planning.

of the world’s population lives in countries that scored below 50 in the Health Secuity Index.

Compliance with Global norms

The report found that most countries lack foundational health systems capacities vital for epidemic and pandemic response.

USA India Brazil Russian Federation France Spain The United Kingdom Italy

12,276,834 9,222,216 6,087,608 2,162,503 2,115,778 1,594,844 1,538,798 1,455,022

| COVID-19 COMPENDIUM | 39

Destroying Dissent in Democratic Frameworks democratic framework is under enormous duress. Brazil’s President Jair Bolsonaro’s

TM VEERARAGHAV,

administrative campaign against COVID-19

CONSULTING EDITOR, SYNERGIA FOUNDATION

has been plagued by sackings of a string of Health Ministers. Luiz Henrique Mandetta, a paediatric orthopaedist, was sacked from his post by

clutch of powerful world leaders,

the president in early April after he defended

at the helm of some of the most the pandemic, in opposition to the line

demonstrated their intolerance for dissent

advocated by the president. His successor

and the spirit of democratic debate during

Nelson Tich, a practising oncologist, fared

the pandemic. Their ability to dismiss

no better.

opposing

voices

has

grown

He too quit in disgust after

stronger

because of their power to outshout them

with the president’s brazen disregard for

on social media and during a calamity

containment measures. He was replaced

like a pandemic, giving them enormous

by General Eduardo Pazuello with zero

‘emergency’

health-care experience.

powers.

U.S.

President

Donald Trump is a prime example of such

Democracy

all

about

accepting

leadership. His method is clear cut: remain

differences along political and ideological

silent or leave the corridors of power.

lines and building consensus through

Health Ministers as Casualties in Brazil But POTUS is not the only one. From Washington

Rio

Janeiro

and

Hungary to India, the space for dissent in a

40 | COVID-19 COMPENDIUM |

debates.

However,

with

polarisations

gaining deeper roots amidst the disruptions caused by falling national incomes and the pandemic, the resistance to engage with opposing points of view is growing stronger in ruling establishments.

www.synergiafoundation.org

The enormity of the pandemic in India

Vietnam

and the lockdown measures only intensify

Vietnam launched an aggressive response.

the barriers to a factual exchange of

Communications

thoughts and reduce the impact dissenting

through clear public messaging and real-

voices could have on the administration.

time sharing of data. It was equally prompt

Liberals fear that during the postCOVID

in isolating and tracking individuals and

period, which could last for a long time, the

their second- and third-hand contacts,

situation may get more extreme.

quarantining

were

travellers,

transparent

and

enlisting

In Hungary, Prime Minister Viktor Orban

services of all medical professionals —

used the pandemic to pass a ‘Coronavirus

students, retired doctors, and nurses. The

Bill’ that gives him enormous emergency

outbreak was contained, without resorting

powers with no end date and arguably

to mass testing as Vietnam does not have

makes him the government judge, jury,

the capacity. Lockdown was enforced in

and executioner of the European nation.

pockets, instead of a blanket ban.

Unfortunately, the overarching feeling is that allowing dissent is a sign of weakness

South Korea

and debate could lead to indecisiveness. But,

South Korea’s model of ‘trace, test, and treat’

the true art of statesmanship is to balance

has been unique and allowed it to control

decisiveness with dissent and democracy.

the infection rate without a lockdown. Yet,

National and global emergencies are what

in April, there were cases of viral reactivation.

put leaders on the line, and crushing dissent

Since most of its new

may often lead to catastrophic decisions,

imported,

whereas lending an ear to a naysayer may

stricter measures. Short-term travellers

indeed save the day.

without a place of residence are allowed

SE Asia, Surge and the Covid Strategy

Korea

has

enforced

to use the quarantine facility provided by the government for a fee. Routine updates are still in place, with the Korea Centres for Disease Control and Prevention issuing daily on infected people’s movements. Testing

SYNERGIA FOUNDATION RESEARCH TEAM

South

cases have been

has been free and those quarantined are treated in hospitals that are stocked

outh

East

Asia

represents

kaleidoscope of governance, with both democratic and autocratic systems,

China

and different levels of economic and social

Current indicators show that China has

indices. Perhaps it is this diversity that has

managed to contain the contagion, but has

shaped their strategies against COVID-19.

seen a second wave. There were many gaps

Singapore, South Korea, Taiwan, and Vietnam

in its strategy, both in sharing of data and ensuring an adequate supply of masks and

Indonesia, Malaysia and the Philippines stand

sanitisers. However, manufacturers soon

out for their laggard and chaotic response.

rolled out PPEs and other essentials in huge

www.synergiafoundation.org

COVID-19 COMPENDIUM

| 41

Current indicators show that China has managed to contain the contagion, but has seen a second wave. There were many gaps in its strategy, both in sharing of data and ensuring an adequate supply of masks and sanitisers numbers, and today China is supplying to

accommodations. Singapore commenced

other countries.

its preparations the moment the Wuhan

Taiwan Taiwan has had better results. It has not

fever

was

revealed

December.

immediately began research, increased border control and surveillance, and started

closed its borders, although quarantining of travellers is still on. SARS taught them to

healthcare system, wisely well equipped

be better prepared with a national health command centre, stockpile of supplies, and restricting the price of masks. To ease screening, it merged peoples’ international travel history with digital health-insurance access. Those violating quarantine were

Japan During the early stages of the pandemic, Japan appeared to have a grip on things; infection and mortality rates were low. It did not go for a complete lockdown. People were advised to work from home and stay indoors, but this was not strictly enforced. week of April, a second wave came, spiking

imposed.

Singapore: Highs and Lows Singapore with its controlled, meticulous, and focussed approach, showcased its degree of preparedness. However, in the surge, mostly from dense migrant worker

42 | COVID-19 COMPENDIUM |

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with PPE and ventilators, enabled it to save the lives of patients, keeping its morbidity rate low. The government also established an online app called TraceTogether (akin to our own Aarogya Setu) to enable tracing and tracking through smartphones. Lisa Ng, the senior principal investigator of the Agency for Science, Technology and Research’s Singapore Immunology Network, stated that SARS-2003 served as a “wake-up call,” based on which they increased R&D and were equipped to adopt a more stringent approach to COVID-19.

A Measured Approach Dwelling on Singapore’s fall from the ‘gold handling the pandemic, Boon Hui Khoo, Senior Deputy Secretary of the Ministry of Home Affairs in Singapore, blamed the sharp second surge to employing unsophisticated contact-tracing methods as a deliberate choice. Singapore abides by two inherent principles: preserving individual privacy and rights, and giving equal opportunity and care to all. When Singapore was hit

| CONCLUSIONS In future, humanity will face new challenges, so we must build an inclusive, cohesive society that can help leaders to be effective during a crisis. There is no playbook for leadership when the stakes are high, and there’s certainly none for how to face a 21st century pandemic. ‘Effective crisis leadership’ involves leaders crafting a roadmap that helps clarify the problem and unite the population. Many of the challenges of global governance are rooted in the tragedy of global commons, in that no country feels motivated to make sacrifices for the common good. Healthcare is a global common, a global good. Russia’s strategy against the pandemic has been proactive. Though saddled with an ageing and archaic public health system, the network of healthcare facilities is widespread, providing one of the largest per capita bed availability. There is hope that African countries, being more resilient, could avoid a rapid spread of COVID-19, despite their trade trajectory with China. Every country has a lesson for India. In the absence of mass testing, India opted for a total lockdown to flatten the curve and gain time to build up medical defences. It does, however, need to increase its testing capacity, up imports of PPE and ventilators. Public healthcare systems have withstood the challenge well, especially in countries which had invested wisely upon them. Even Italy, while it may have suffered huge fatalities, was able to put up a gallant fight against COVID-19 thanks to its world-class public health system. In India, we have seen that private healthcare, has near-zero capacity to handle an epidemic of this nature. India could establish a national command centre for disease control. The National Disaster Management Authority has proved ineffective, and creating a separate entity to deal with pandemics would be effective in future.

by SARS, there were only 238 cases and 33 fatalities. The police had helped the Ministry of Health contact trace. “But, this time around, we didn’t opt for technologies that are more intrusive because it was an issue of privacy and rights. We shut down That’s the price we had to pay because we didn’t want to be perceived as a state where the police could have overarching powers,” says Mr. Khoo. Singapore also prides itself in treating everyone on its shores equally. Both foreigners and residents are being given free treatment in the same hospitals, and get equal access to equipment and medicine.

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| COVID-19 COMPENDIUM | 43

Data Sharing Crucial During a Pandemic to allow for the sharing of information across INPUTS BY YE BAIXIN, CHIEF MEDICAL OFFICER , RENMIN HOSPITAL, WUHAN UNIVERSITY

borders between medical professionals, as he has managed to achieve from China.

Containing the Spread in China The COVID-19 pandemic originated as a in Wuhan, the capital of Hubei province. As

the pandemic, and there is much to

the number of cases grew, the potential for

be learnt from how they managed

an outbreak was discovered by the National

to do so. This is something Dr Ye Baixin

Health Commission (NHC) in Beijing after

highlighted in his talk at the panel hosted

sending experts to Wuhan. On the same

by Synergia Foundation in cooperation with CCG. In an interview, he says, “Having gone

Health Organisation.

through all the hardships and eventually conquered the epidemic, Wuhan doctors

sequence of the virus was published on an

are like an internationally recognised brand

open-access database. The Wuhan seafood

name to overseas health workers. We

market was closed down by Jianghan

cannot only provide them with experience

District’s Health Agency and Administration for Market Regulation on January 1st. On

In the panel, he stated three things that

January 20th, the NHC set up a group

worked for them, which were namely the

to deal with pneumonia caused by the

containment of spread and disease action,

coronavirus, which then went to other

good procedures for disease management

provinces and cities to supervise the control

and avoiding medical resource wastage (all

of the epidemic. The mainland also stepped

of which was free to people in China), and

up its production of masks from 10 million per day to 116 million daily. Delivery drones,

emphasised on the need to set up resources

44 | COVID-19 COMPENDIUM |

AI, and facial recognition systems were

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used to keep a check on the epidemic. Makeshift hospitals were also built that resembled those made for the 2003 SARS outbreak in Caidian, Wuhan. to go into a full lockdown - on January 23rd - by its own and not on the suggestion of the WHO. A lockdown of this scale had never been seen before. Caught

off-guard

the

epidemic, China received help internationally, from places like Japan, Guinea, and even the Bill Gates Foundation. Many cities limited the number

people

going

Patient-level COVID-19 data is also not publicly available. The data available is said to “lack comprehensive information beyond typical registry resolution.” To deal with the virus

out per household, with only one person permitted for purchasing necessities every

China’s prompt response be credited with curtailing the spread of the virus, along with the willingness of citizens to adhere to protocol. China now has sent medical equipment and PPE all over the world to help other countries still working on slowing down their cases. While there have been issues raised about the quality of the PPE and the chance that China could have hidden the exact number of cases, the effort put in by the doctors on the ground cannot be negated in controlling the

spread of the virus.

are now necessary and commonplace at

The Case of Information Sharing

each entrance. There is round the clock

Some databases offer data on COVID-19

surveillance through contact tracing apps,

through public-private partnerships such

CCTV usage, and check-in by doctors. Dr Ye

as databases by Dawex, Parexel, and

also stated that what they learnt from their

the EU’s ERA vs Corona Action Plan. But

battle with COVID was that even though

this kind of data-sharing is done only in

they asked suspected cases to stay at

certain circles, with no one governmental

home, the number of cases still increased,

organisation

which then had to be controlled through

Patient-level COVID-19 data is also not

community containment.

publicly available. The data available is

1-3 days in February. Temperature checks

having

taken

the

lead.

The lockdown was lifted in May after

said to “lack comprehensive information

76 days, and an ambitious testing regime

beyond typical registry resolution.” To deal

was introduced in Wuhan after new cases

with the virus, there is the need to create a

emerged, raising fears of a second wave.

unifying multinational COVID-19 electronic

Wuhan states that it has now tested nearly

health record which can be accessed by

seven million people in 12 days.

researchers globally.

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| COVID-19 COMPENDIUM | 45

The non-existence of this is not due to the absence of technology. One such example of a publicly-available, anonymous, electronic health record is the MIMIC-III (Medical Information Mart for Intensive Care III), present since 1996. It contains roughly 40,000 patients in the Beth Israel Deaconess Medical Center (BIDMC). It offers insights into a critical care cohort, allowing clinicians and computer scientists to address research questions and build

weapons against spread of infection, the

predictive models.

complete dynamics will change if the

Much of what is known about COVID-19

virus becomes aerosol borne.

Similarly,

comes from how it has spread in different

its presence in stool can make hygiene of

countries, based on which doctors make

common spaces, especially in rural areas,

their assumptions. Creating large scale

important.

COVID-19 Real World Evidence (RWE)

The Second Wave:

studies that take in data from a variety of real-

strict curfew, the spread of infection will

world sources — like patients being treated

be far more rapid in the second wave and

in the hospital — could help accelerate

may overwhelm hospital facilities. The

the development of treatments in a more

government has to plan for a surge in

patient-centric and patient-friendly way.

hospitals.

The need for open-source hardware and

In the absence of

A New Normal: Social-distancing norms

software that allows for national and subnational health systems to collect and share

masks mandatory.

live and updated data in a timely manner,

should be adopted. Based on emerging

while being mindful of privacy laws has

infection patterns, selective quarantine

never been more topical. This would allow

should

already overburdened healthcare systems

requiring hospitalisation must be kept

around the world to quickly adjust in their

within the established bed capacity. In the

Enhanced testing

imposed.

New

infections

event of an uncontrolled surge, complete

The Exit Strategy SYNERGIA FOUNDATION RESEARCH TEAM

shutdown should be ordered. Testing: India’s population makes largescale testing unaffordable until a cheap indigenous test kit is found. The criterion on symptomatic patients and healthcare

here are certain outcomes which

workers on the frontlines.

must be looked into for the exit

Cure:

strategy of a lockdown.

take more than a year to be available, by

Even if a vaccine is found, it may

New Vectors For Transmission: While

when the pandemic may have passed.

social distancing and masks are the primary

Other options include anti-malarial drugs

46 | COVID-19 COMPENDIUM |

www.synergiafoundation.org

which cannot be relied upon for universal

assets of the Armed Forces already have a

application; possible ozone therapy; use of

heavy load of military personnel for tertiary treatment. However, in an emergency, each

Graded: Treatment Distinction must be

can create special facilities for COVID-19,

made between patients and use of precious

which can be used as a general medical

medical resources as per this protocol.

reserve.

Bottom-Up Approach

Long-Term Strategy

Fight locally at the PHC level: Empower

What we have learnt from the COVID-19 is

health worker/ASHA to track, trace, isolate,

that the world needs a resilient, robust, and

and treat patients. Shift attention from metros to rural areas.

Making Hospitals COVID Proof: Indian

Protecting Medical Staff: Trained and

government

experienced health workers need to be

for their standards of cleanliness and

protected.

general hygiene. Without delay, COVID

Reserves have to be trained.

hospitals

are

notorious

Since pandemics are here to stay, this must begin now. Meticulous Implementation: The Indian

air-conditioning;

Containment Policy for COVID-19 issued on

which automatically screen and disinfect

March 4 by the GoI is a document which

entrants. Selected private sector hospitals

and

have

entrances

lays out broad guidelines for infected geographical areas, both in an urban and

government to become COVID-proof.

rural areas. These need to be implemented with sincerity and ingenuity. Build Up Our Healthcare Resources: Total capacity for hospitalisation in India is about 7,13,986 government beds, of which 5-8per cent are ICU beds, and assuming that 50per cent of these ICU beds have ventilators, we arrive at an estimate of 17,850 to 25,556 ventilators in the country (Source: Data from National Health Proile–2019). Support from the Armed Forces: Armed forces have a pool of trained personnel and can provide basic training to core body of trainers from each State and later provide teams for on-site quality-check and advice. Field medical hospitals of the Army are airportable, and if equipped with COVID-19 related kits, they can be mobilised to hotspots anywhere in India. The medical

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COVID-19 COMPENDIUM

| 47

INVESTING IN A ROBUST PUBLIC HEALTHCARE SYSTEM The share of public healthcare in the national budget has to go up to make it capable of

(a)

Hospital

Surveillance – infection-control teams and

Infection Control – inclusion of hospital

intra-hospital and inter-hospital disease

bio-safety as a standard feature in every

surveillance can help in identifying the

hospital

sudden appearance of disease clusters (like

Hospital

Biosafety

infection

control

programme.

SARS-like pneumonia in Wuhan). written standard operation protocols.

(h)

( b ) Hospital Design & Construction -

a basic programme of routine training

any new health facility has to consider the

and frequent drills provide a reasonable

possibility of treating pandemics. Previously

deterrent against any unknown pathogen.

built structures may be remodelled.

Simulants and surrogates can be used to

( c ) Hospital Ergonomics & Rostering

train hospital staff.

(i)

Hospital

workforce

should

not

Hospital Training & Drills - Even

Hospital

overburdened; duties should be cycled.

Disinfection

Facilities

workforce

disinfection of hospital sites pose a serious

comfort and address fatigue prevention.

challenge. Based on the characteristics of

Mental health issues should be addressed.

the pathogen, plans for various forms of

(d)

Hospital Stockpile, Biological &

decontamination with approved biocides

Antidotes - Pharmacies can store an

and surface disinfectants should be in place.

added stockpile of experimental drugs,

(j)

antidotes

should

and

enhance

monoclonal

antibodies.

Many repurposed drugs can be given as

Decontamination Decontamination

and

Hospital Laboratory Network - A

chain

allied

hospital

microbiology

laboratories can act as sentinels in the time of an outbreak. They can greatly aid in early

( e ) Hospital Expansion & Annexation - to address the surge of patients, neighbouring

Forensic microbiology could be used to

sites and large storage areas should be ( k ) Coordinated Responses -The recently such spaces during biological emergencies

passed National Medical Commission Act

should be in place.

should be amended to include coordinated

(f)

responses in such a crisis. It could function

Hospital Early Warning System

- disease forecasting and early warning

virtual

applications

as the command centre. Central and State agencies should be placed

could be integrated into

under this commission.

hospital

( l ) GPS Uses - Geo-tagging,

management

systems. It will provide time

for

pre-emptive

action.

QR codes for medical services, and mapping strategies can help

local

governments

( g ) Hospital Epidemiology & Disease

48 | COVID-19 COMPENDIUM |

operations.

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| CONCLUSIONS While designing an exit strategy, it must be remembered that while we can borrow best practices from other countries, a single ‘gold standard’ does not model’ will need to be re-engineered for a hilly, underdeveloped State like

HOWEVER, OUR RESEARCH POINTS TO FIVE MAJOR FOCUS AREAS: Proactive Leadership Inspiring Leadership. At the apex level must encourage trust in the is achieved that contact tracing, aggressive testing, and building need to build cohesiveness within our cultural and economic

healthcare too is an insurance COVID-19

has

clearly

driven

Leveraging Digitisation to Combat Pandemics. Countries with superior digital access can muster its resources in a coordinated and effective footprint in the digital domain,

Quality of Nursing Care and Primary Health Workers. The

R&D. Home-grown R&D in the

health workers and professionals

the economics involved would

been one of the contributory factors behind Kerala’s low death

have to pitch our R&D for cures at the global level, coordinating and cooperating with the best

Healthcare as an Investment. Like national defence, public

www.synergiafoundation.org

| COVID-19 COMPENDIUM | 49

Pandemics: A National Security Concern society,

emerging

diseases

and

their

TOBBY SIMON,

pandemic potential pose perhaps an even

FOUNDER AND PRESIDENT, SYNERGIA FOUNDATION

spread more rapidly than the previous eras.

greater national security threat, disease can Preparedness not prevention is the solution to this escalating problem. Thirty

four percent of all deaths worldwide are tating that preparedness is the only

now attributable to infectious disease, while

key solution in addressing outbreaks,

war only accounts for 0.64 percent of those

Tobby

Simon,

founder

and

chairman, Synergia Foundation, highlights

killed approximately 5,00,000 Americans,

that the genesis of national security is the

more than all wars fought in the 20th

preservation of the state from physical

century. Consider the effect of smallpox on

threats.

the indigenous peoples of North America.

Thucydides,

his

5th-century

Many argue that they were not conquered

the

by superior weaponry or forces, but by

Peloponnesian War, mused about the

their lack of natural immunity to European

profound effects of the plague of Athens

diseases. Even recently, the Ebola outbreak

publication,

The

History

led to the collapse of the national health the war between the Athenians and the

care system in Liberia.

Peloponnesians. He describes how, during the Peloponnesian wars, disease demoralised the Athenian people, undermined the political leadership, and weakened the army, preventing it from achieving key military objectives. It is not only the general population that is threatened by disease, but the military as well. Ingenuity, knowledge, and organisation alter

but

cannot

cancel

humanity’s

vulnerability to invasion by parasitic forms of life. Infectious disease which antedated the emergence of humankind will last as long as humanity itself, and will surely remain, one of the fundamental parameters and determinants of human history. The genesis of national security is the preservation of the state from physical threats. However, in today’s globalised

50 | COVID-19 COMPENDIUM |

Article written by TOBBY SIMON, published in BioSpectrum, October 2014 issue

www.synergiafoundation.org

Improving detection through bio surveillance is the key to stopping epidemics and India must increase its funding and focus on improving both domestic and global bio surveillance capability. While surveillance and developing early warning sensors are effective deterrents to combat pandemics, we would recommend the following:

Strong Leadership: Multi stakeholder and

multi-sectoral

coordination.

Command and control should be based on existing infrastructure and continually strengthened. Appropriate Funding: Multi resource resources, and preparation of advance vaccine

purchase

agreement,

technology, surveillance and ability to assess risk dynamically.

Broad and multi sectoral-level stake holder

representation,

communication

channels

effective across

sectors, planning both at a regional (South Asian) and International level

healthcare professionals and public

and developing platforms that permit interoperability with countries and

Effective

strategies

regions.

implementation

for

successful surveillance,

monitoring, risk assessment and an Effective

communication

among

The Synergia Foundation is a Bangalore based multi-disciplinary think tank that has over three decades of experience in strategic security. It has worked with several International organisations in the past including Medicines Sans Frontiers (Nobel Prize 2000) and The World Health Organisation in developing affordable treatment regimes for Malaria, Tuberculosis, and AIDS for

with their research partners, the Massachusetts Institute of Technology and the Indian Institute of Management, Bangalore

www.synergiafoundation.org

| COVID-19 COMPENDIUM | 51

Adapting to New Lifestyle Mores Those who would give up essential liberty to purchase a little temporary safety, deserve neither liberty nor safety

SYNERGIA FOUNDATION RESEARCH TEAM

Proximity and Covid Dangers

As per India’s 2011 Census, 65 million people (17per cent) of urban population live in slums. The most threatened are the low-income ghettos, with little access to basic sanitation and water supply. With

ural societies and those in remote

community water taps and community

mountainous areas, where space is

toilets, crowding is a way of life.

not a constraint, are showing a much

slower pace of spread, but closely packed

Differing Exposure Risks

urban slums are not so fortunate. The

The nature of employment of the inhabitants

most central and dense cities are the ones

have a bearing on the risk of exposure.

that have been most affected. In India, the

Sanitation workers, municipal cleaners,

highest number of cases are in Maharashtra,

hospital garbage disposers, and others,

Delhi, and Tamil Nadu — States with cities

who keep our city clean and liveable, are in

that are metropolitan hubs. Vast slums like

harm’s way. There is little effort to address

Dharavi in Mumbai are ticking time bombs.

these threats as reported by the Coalition

While all densely populated areas are

of Human Needs, a collection of national

at risk, the difference is in the nature of

organisations working together to promote

the density. A report by CityLab shows

public policies. Many slum-dwellers are

that in New York, the cases are not high in

closely connected with the transportation

uber-dense Manhattan, rather in the less

business, be it the porters and other staff

dense outer boroughs such as the Bronx

at the railway station, the bus station, and

and Queens. It is essentially the rich and

the airport. Mumbai has the second busiest

poor divide which ultimately exposes their

airport, and a sizable number of Dharavi

vulnerability to the spread of viruses.

inmates work there.

52 | COVID-19 COMPENDIUM |

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Lockdown, Stay Home and Pause SYNERGIA FOUNDATION RESEARCH TEAM

most

common

method

reduce the spread of infection is by

shutting

down

non-essential

services, restricting congregations, allowing government facilities to function in a

skeletal capacity, and ensuring hospitals and grocers stay open. lockdown policy. A week’s worth of paid leave was offered to everyone, and people over 65 years were told to stay indoors. Free transport passes were cancelled to ensure this. Australia closed its borders and enforced a lockdown, but left schools open,

stop’ of lockdowns is the best way to control

asking parents to use their discretion in

the pandemic, so that people can also

sending children to schools.

build immunity after being exposed to it in a weaker form. It also suggests that two or

the way they enforced a shutdown, causing hardship to lower economic classes who

stretch the slow down longer. However, the

could not access rations and resources in

virus would still return.

time. Use of water cannons, rubber bullets, and lathis came under severe criticism.

In Theory

Counterpoint Andrew Napolitano, a former U.S. judge,

A 2005 report by Proceedings of the National

state, and local — of “totalitarian impulses”

Academy of Sciences of the U.S. on H5N1

and argues that “no matter the state of

in its birthplace (China) for nearly 10 years

Constitution protects our natural rights,

and had been repeatedly introduced into

and its provisions are to be upheld when

neighbouring regions, turning Asia into a

they pinch, as well as when they comfort”.

pandemic threat zone. In such cases, is a

If liberty and freedom can be taken

simple lockdown an effective measure in

away in times of crises, is it truly liberty?

the future?

While it is essential to maintain social

A study by Cambridge University has suggested that a method of ‘stop-start-

www.synergiafoundation.org

distancing, severe policing is equivalent to a fascist state.

| COVID-19 COMPENDIUM | 53

Keeping Mental Equilibrium stay busy, make a schedule and follow it, be involved in the housework and distract

MAJ GEN AJAY SAH,

yourself from negative emotions by listening

GEOPOLITICAL AND STRATEGIC ANAYLST, SYNERGIA FOUNDATION

to music, reading, watching entertainment programmes, revive hobbies, etc.” Amir Khan, GP, NHS UK, says, “Take control over your mind and have a clear structure for

ever

your day, allowing worry only at certain before

the

history

times.”

mankind has entire populations felt

Experts recommend three levels; get

intense anxiety. Fully appreciating

your nerves under control, respond to the

the extent of the threat, the WHO has

situation rather than react, and do not let

issued a worldwide advisory accepting that

lack of knowledge compound your fears.

the COVID-19 crisis is generating stress. The

Breathing exercises, meditation, yoga,

most common emotions faced by all are

restricting your screen time, and the

fear, anxiety, and panic. Every one cannot

amount of information you are exposed to

handle social isolation or social distancing.

can be the key to your mental health. Apps,

A suspected COVID-19 patient, isolated

online games and social media platforms

at the Safdarjung Hospital in New Delhi,

are connecting people with friends and

jumped to his death. In another incident,

support groups, reaching out to vulnerable

a 56-year-old man, who suspected he had

segments and creating self-help groups.

the coronavirus, ended his life in Udupi

Mobile apps are playing a big role in remote

district of Karnataka.

medical counselling. Some useful apps in

Frontline workers have to handle the social stigma attached to working with

and Wysa (created by a Bangalore-based

infected persons. Isolated from their family,

company) AI now enables remote diagnosis and

they are the most vulnerable group. After the SARS epidemic in S. Korea,

monitoring. Researchers in the University

20-25per cent of health workers had

of Colorado Boulders are applying machine

heightened

learning AI to psychiatry.

anxiety,

depression,

and

A speech-

something akin to Post Traumatic Stress

activated mobile app could categorise a

Disorder (PTSD). Once we have defeated

patient as per his/her mental health. Peter

COVID-19, the health workers will require

Foltz, research professor, Institute of

psychiatric care.

Cognitive Science, said: “We are not in

Coping Strategies

any way trying to replace clinicians, but we do believe we can create

People want to know

tools that will allow them

how to deal with it, and

to better monitor their

experts say, “Stay positive,

54 | COVID-19 COMPENDIUM |

patients.”

www.synergiafoundation.org

Working from Home. Is the Shift Permanent? SYNERGIA FOUNDATION RESEARCH TEAM

been part of their planning and work culture, which is tested and changed annually. After that a lot of work can be done from home,

orking from home (WFH) used

leading both managers and employees to

to be at best, something workers took once or twice a week to only option

necessary. However, it has also opened a can of worms

novo need to look at how we work to make

with

corporations

questioning

the need for workers at all.

Kai-Fu Lee,

the experience more enjoyable.

Yeas and Nays

and Google’s erstwhile top executive in China, opines that AI developments will

WFH is a good option in times of a pandemic,

be more disruptive to people than other

but the concept holds up even when public

technological developments. Yet in some

health is not at risk. It allows for a better

cases, automation may be the solution. For

work-life balance, reduces commute time,

instance, Toyota is working on autonomous

and is better for the environment. On the

driving technology, yet not replacing the need for a driver altogether, at least for the

employees working less or not giving their best, while employees miss collaboration and brainstorming.

time being.

A Cost-Effective Option

The reason MNCs have been able to

Research done on WFH by a set of Stanford

quickly shift to WFH is that this has always

University researchers, Nicholas Bloom

www.synergiafoundation.org

| COVID-19 COMPENDIUM | 55

and his colleagues, on a company in China, showed that there was no difference in productivity among the WFH group and people found it easier to concentrate at home. Additionally, employee attrition decreased by 50per cent among the WFHs, and they took shorter breaks, fewer sick days, and less time off. The company also saved nearly US$ 2,000 per space needed. The study also found that in 2012-13, managers in the U.S., UK, and Germany were allowed to WFH for nearly half the amount of time, showing that this could now be a mainstream practice.

Frugality, the New Normal SANJAY JAJU, IAS AND DEEPANSH SOMANI, SANJAY JAJU IS FROM THE INDIAN ADMINISTRATIVE SERVICE, VIEWS EXPRESSED ARE PERSONAL. DEEPANSH SOMANI IS A GRADUATE IN BEHAVIOURAL ECONOMICS.

hile those living in the margins have to count each paisa, it is interesting to look at how the

so-called elites are coping. The impact on the mighty looks equally strong and

Administration in 2017 saw that the country

real. Before the pandemic, the majority

used 391.40 million gallons of gasoline daily.

of elites were leading globe-trotting, fast-

Employees

reduced

paced lives. But these experiences that give

gasoline consumption, thereby reducing

meaning to their lives have disappeared

greenhouse gas emissions.

with the COVID-19. Once this life “meaning”

working

remotely

gets

Missing Social Touch

snatched

away,

what

happens?

Humans have an unfortunate tendency of to

not appreciating the good that may follow

implement in the service sector and the

a calamity. While COVID-19 wreaks havoc

unorganised

beings,

on the economy, could it have a sobering

humans working without any interaction

effect on the general consciousness of this

would feel cut off. It could also make them

planet’s elite?

Naturally,

WFH

would

sector.

harder

social

prone to taking on more work than is needed, as employers sometimes use the

The Good that Comes from Evil

WFH option as a bargaining chip to get

This period of quarantine has given us an

people to do more in exchange for the

opportunity to introspect and meet our

comfort of working from home. Women

demons face to face, and attempt to address

are also more likely to be affected by WFH

them. With strong positive implications on

possibilities as they still have the added

both the physical and emotional well-being

responsibility of taking care of the home,

of people, this period has seen an extensive

especially in India. On the plus side, those

rise in people also getting their life together.

with children would get more time to spend with them.

56 | COVID-19 COMPENDIUM |

Many have started reading books, auditing eating habits, taking up new

www.synergiafoundation.org

hobbies, and tapping into creative reservoirs.

commercial and business activities, without a

We could even call it a blind spot, as never

thought of nourishing and nurturing it.

did such important, but often overlooked

Evidence of wild animals and birds taking

aspects of our lives seem so clear. We all

to the streets is a sign that they were unhappy

needed a course correction in the form of a

with our monopoly of the planet. With more

break from the pace of our existence to re10,00,000 automobiles on the roads spewing

Mother Earth in Revival

poison into the air, it seems that by a miracle, the virus has given the earth a break. Who

Empowered through technology, we have

knows, this might be the change that

reduced this planet into commodity for our

humanity has been seeking for a while now.

| CONCLUSIONS Basic precautions like social distancing will be the new normal if mankind has to

We need to take inspiration from the frontline workers who are stoically

that the poor are given the maximum

too need to visualise our contribution in the larger framework against

collection from community taps and use of public toilets; volunteers/local leaders could regulate the use of facilities; public messaging to drive home the criticality, are some ad hoc measures that need to become the

We should also get a chance to build immunity against the virus if it’s here most democratic way of handling a pandemic, and a more thoughtful, people-centric approach would be

The human race is resilient; that is how it has not only survived but risen

in on the trend and come up with contingency plans that prepare them must ensure that work gets done in a more congenial work environment, should be organised periodically for

We are experiencing a phase of change, a phase of disruption, uncertainty and of time, as we settle down in our new routines, we will regain our mental

www.synergiafoundation.org

WFH needs world-class infrastructure — high-speed, dependable broadband, and uninterrupted power supply, which

| COVID-19 COMPENDIUM | 57

CHAPTER 3

ECONOMICS OF A U.S. President Donald Trump’s ‘America

SYNERGIA FOUNDATION RESEARCH TEAM

First’ policy and demonising of international

he concept of globalisation was

of adequate funding. The U.S. withdrawal

already under a cloud due to

from

increasing income gaps in the

besides the nuclear deal with Iran, and

global market. Capitalism, viewed as the

Trump’s undermining of the WTO has

institutions has led to them being deprived international

trade

agreements,

adversely impacted global trade. Trump’s main malaise. The wave of migration from

unpredictable negotiating style and his threat of tariffs has alienated allies in Europe.

and North America cannot be separated

Tariffs on steel and aluminium on Germany

from economic migration. Migration is thus

are a clear refusal to recognise that the

being viewed as abetting stress on limited

European Union (EU) is a single trading

resources. Such fracturing of societies

block. The U.S.-China trade war has seen

has given rise to nationalistic movements

only a temporary reprieve with the Phase 1

that thrive on parochialism. Right-wing

agreement in January this year.

governments have found favour across continents.

58 | COVID-19 COMPENDIUM |

American

withdrawal

from

the

international arena has given rise to a

www.synergiafoundation.org

fractured geopolitical landscape. Rivalry in a multi-polar world has witnessed a more belligerent China impose its writ in East Asia. Russia, in its quest for the glory days of the Soviet Union, has openly challenged the West, particularly in Eastern Europe and the Middle East. The fractured relationship between the Organisation of the Petroleum Exporting Countries (OPEC) and Russia, that is presently playing out with regard to oil pricing, has the U.S. in focus. Massive stimulus spending after the economy that was already staring at a global slowdown. The leadership void created by the U.S. withdrawal from the

GDP rating for India has been revised from 5.3 per cent to 2.5 per cent. Growth

global stage adds to a least conducive environment to respond to crises like the COVID-19 pandemic. As professor Sridhar Venkatapuram stated in the Indian Express, “[It is] unfortunate that the coronavirus pandemic has plagued the international community

its

weakest

moment

quarter ending March 2020 paint a bleak picture. All major economies have slid severely

where national politics and economic parochialism are upending the idea of one global village”. The coronavirus arrived

Medium and Small Industries, the world

into a near-perfect storm.

over, have been severely impacted. The

Dire Predictions

natural fallout is massive job losses. In India, the massive informal job sector has resulted

Rating agency Moody’s has now forecast

in a huge exodus of migrant workers to their

a contraction of global GDP for the year.

villages. Supply-side economics, the world

Rating for India has been revised from

over, has thus been severely impacted. The crisis can be understood through

just out for the quarter ending March 2020

different faces of the economy. On the

paint a bleak picture. All major economies

demand side, a combination of low

have slid severely. Stock markets have at

income; fear of contagion shifting spending choices; and lower levels of consumption.

straw of positive news in terms of rate cuts

On the supply side, a sudden stop in

and stimulus package announcements.

manufacturing has caused massive supply-

The obvious impact of the total lockdown,

chain disruptions, which cannot be met

as in India, is the shutdown of all productive

by inventory stockpiles. Manufacturing

activity, save for essential goods and services.

shutdowns, if continued for longer than

www.synergiafoundation.org

| COVID-19 COMPENDIUM | 59

two months, will result in worldwide

Supply Chain unaffected. The impact of

bottlenecks as no major manufacturer

COVID-19 is bound to call for its review. The

builds all components inhouse. They rely on

initial impact of the virus on China affected

supply-chain hubs like China, South Korea,

supply of components and commodities to much of the world.

in the foreign exchange market. This

Shaping the Political and Economic Environment

pushes

emerging markets to become

Rebecca Solnit in the New York Times states

more vulnerable to the consequences of

that “every disaster shakes loose the old

the crisis as fresh capital will be diverted

order. What replaces it is up to us”. There are

away from them.

many examples that are emerging: industry

many markets, and volatility has increased

On the demand side, the shutdown of

realigning businesses where automobile

nonessential services and stay-at-home

manufacturers are rolling out ventilators

measures have killed demand in general. Joblessness has constrained liquidity. The

manufacturing masks. There is, however,

retail sector has been severely impacted.

little else to cheer about in what is turning

India, which is largely a consumer-driven

out to be an increasingly protectionist

economy, is naturally staring at a serious

environment. James Crabtree, in the Asian

impact on GDP. Even the U.S., a huge

Review, argues that complex supply chains

exporter of primary goods like aircraft,

and just-in-time production methods are

weapons, oil etc., is essentially a consumer-

vulnerable to shocks. In the current crisis,

driven

with

he opines that it will “hasten decoupling

countries like Germany, Japan, and China,

between the U.S. and China and accelerate

which are export-driven. The demand side

the collapse of the trade-dependent model

of the economy, like supply, is adversely

of globalisation upon which so many Asian

impacted, a double whammy unlike any

economies rely”. Companies are rethinking

other. The travel industry, which includes

their vulnerabilities. The pharmaceutical

airlines and hospitality, will be in a prolonged

industry in India, dependent on China for

crisis.

70per cent of its inputs, is an extreme case

economy.

This

contrasts

Financial markets have been in turmoil

that would naturally come up for review.

with investors withdrawing close to US$

It need not, however, swing to the other

85 billion, at last count, from emerging

extreme where the genuine advantage of cross-border trade is surrendered for

ever recorded, with investors seeking refuge

political considerations. The system that

in the U.S. dollar. Interest rate cuts freeing liquidity and massive stimulus packages

political leadership in the major economies.

have become the norm across the globe. Its

Pointers to what could be a post

effect on what is already a global debt crisis

COVID-19 era are already emerging. Will

is not being factored at this stage.

the U.S. and China be able to set aside their

The fractured geopolitical environment

differences and initiate high-level talks? The

had, by and large, left the existing Global

American administration should bear the

60 | COVID-19 COMPENDIUM |

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burden of responsibility for having disrupted

dependence on China’s supply chain

an established, if imperfect, world order. The

linkages and exports. Chinese tourist fall

capacity and means to reform the system

could cost the Thai economy about US$ 3.05

exists, but will leadership stand up to the

billion, according to The Tourism Authority

challenge? China is a global supply chain

of Thailand, not counting other nationalities

hub, and disruption there undermines

choosing to stay away.

output elsewhere. Along with Hong Kong, the Chinese trade surplus is US$ 301 billion,

European Tremors

which accounted for 16per cent of the global

Europe is more dependent on China for

exports. Even if the outbreak

trade than the U.S. Automotive

wanes

negative

sectors and have stated that

demand and supply shocks

they are weeks away from

fade into memory, the damage

stopping

depleting component supply.

and

China

these

and

the

global

repercussions would be lasting.

production

with

Germany’s exports to China

Epidemiological estimates state that the global GDP is

(US$ 101.6 billion). These levels

likely to shrink by US$ 500

are impossible to match this

billion, which is the economic price tag of the coronavirus.

The China-Centric Ecosphere South an

Korea

has

economic

declared

emergency

to limit the damage to the economy deeply intermeshed with

China.

Its

electronics

companies, automakers, and electrical

equipment-makers

face a problem of getting parts from China for

their

factories. In Japan, Toyota and

China was to lower its tariffs for the import of millions of dollars’ worth of American farm products as a goodwill gesture to resolve the trade war

Nissan have had their output

year and the price will be paid by its already stressed manufacturing

sector.

Before the coronavirus, Italy’s economy was contracting at 0.3per cent and a recession was looming. Chinese tourists are a major source of earning and premier fashion brands are particularly exposed.

The United States The U.S. appeared relatively resilient by comparison, but GDP growth in the fourth

disrupted while inbound Chinese tourism has reduced immensely. Japan’s economy

China exported US$ 539.5 billion in goods

has contracted at an annualised rate of 6.3per

and services to the U.S. in 2018, according to

cent in the fourth quarter of 2019. A recession now seems likely. Japan, scheduled to host

which is more than 21per cent of all imports

the 2020 Olympics in July, has spent more

into the country. Chinese tourists to the U.S.

than 1.37 trillion yen on preparations.

have increased 13 times since 2002. A report

Vietnam

suffering

www.synergiafoundation.org

due

its

from the Tourism Economics states that it

| COVID-19 COMPENDIUM | 61

Saudi Arabian crude supply to China for March has been reduced by 500,000 barrels per day. As the virus spreads around the world, oil prices have sunk to US$ 50 a barrel is expected that the U.S. will lose about 1.6

also spend on accommodation, food, and

million visitors from mainland China. China

other expenses. Fishing and tourism have

was to lower its tariffs for the import of

also been affected.

millions of dollars’ worth of American farm products as a goodwill gesture to resolve the

Indian Landscape

trade war. This is now likely to be affected.

The most severely impacted segments of the economy in India, which will face

The Middle East

a long and uphill struggle to recover are

China is the largest consumer of petroleum

automobile, entertainment (multiplexes,

products in the world and a slump in its

restaurants, bars etc.), tourism, hospitality,

industry will directly impact oil-producing

and jewellery.

nations.

Saudi Arabian crude supply to

will take a severe hit with the RBI predicting

China for March has been reduced by

an increase of about 10.5per cent in

500,000 barrels per day. As the virus spreads

NPAs by the end of the Q3 of 2020. The

around the world, oil prices have sunk to

airline industry is in grave danger of

US$ 50 a barrel, with fears of the situation

insolvency.

getting worse.

1.5per cent to India’s GDP, an economic

In the UAE, Chinese tourists make up

The banking sector too

The

contribution

industry U$

contributed billion,

and

supported 6.2 million jobs. renowned high-end shopping and resorts are seeing falling footfall. Iran’s emergence

Stock Markets

as a hot zone for coronavirus has made

That the world is one big market was made

it complicated for the economy which is

amply clear by crashing stock markets in all

sliding deeper into recession. U.S. sanctions

major economies as investors sensed the

have worsened Iran’s medical sector, which

impending economic fallout of the virus.

has struggled to keep up with soaring prices

The organisation, resources, labour, sourcing,

of medicines and medical instruments.

and logistics are the key components that

Australia

and move them to the end customer. The

Australia is the world’s most reliant

coronavirus has put limitations at all levels,

economy on China, with about one-

and could create a further lag in the process

third of its exports going there. There are

timeline as quarantine guidelines get stricter.

1,60,000 Chinese students; one-third of

80 per cent of the world’s goods move by

the total fee of Australian $32 billion came

ship, and demand for shipping is starting to

from them alone. International students

slip noticeably.

62 | COVID-19 COMPENDIUM |

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Economic landscape Post-Covid-19

SYNERGIA FOUNDATION RESEARCH TEAM

across the globe, the impact on low-income countries in Africa, Central America, and South-East Asia will be severe. It is unlikely

he duration of the contagion will

that the economic losses suffered by all

decide the shape of the economic

segments would have been offset after the

landscape; the longer it lasts, the

pandemic slows. This is where governments

more severe will be the impact, and more

will have to step in through guarantees,

painful will be the recovery process. In

liquidity support, short-term work schemes,

China, reports say that almost 60per cent of

and a moratorium on loans. If effective

companies resumed operations between

policy

March and April. The Eurozone economy

immediately, the recovery will be V-shaped.

has shrunk by almost 3.8per cent, the

This

interventions scenario

are

implemented

based

upon

the

highest since its creation, and it has no

assumption that there will be no second

option but to resume economic activities at

wave of the pandemic for at least one more

the earliest.

year. In case a viable antiviral treatment is

The Prognosis

found or a vaccine created by the end of the year — together with more widespread

Two scenarios are being considered: the

testing protocols, higher surge capacity

best case is a return to normalcy within

created in healthcare, and more disciplined

the next three months i.e. by August 2020.

approach to life and work through social

The worst-case scenario is a full year of the

distancing and hygiene — full lockdowns

pandemic, and the world yo-yoing between

can be avoided even if some infection re-

lockdowns and short windows of controlled

emerges in the winter months. Tourism

activities.

and its ancillaries are unlikely to revive in

While the economic cost will be spread

www.synergiafoundation.org

the next 12 months, which will have a huge

| COVID-19 COMPENDIUM | 63

impact on the overall recovery. Recession

The way forward

would be experienced by most economies,

Some

but by 2021 growth would accelerate.

unprecedented steps to tackle the economic

countries

have

already

taken

If there is a second wave sometime in

consequences of the crisis. Immediate/

December-January, the world would be

short-term measures include direct-cash

wiser and better prepared in managing

transfers to citizens as unemployment levels

it. While some areas would again see a

skyrocket, and lowering of interest rates by

total lockdown, containment measures would be more tailor-made, ensuring that

moratorium on payment of EMIs or on credit

some regions/sectors are kept running. In

card dues. To save businesses that have run

this case, the economic recovery will get

dry of working capital, governments are

pushed into the spring of 2021.

promising bailout packages.

Pre-crisis level recovery in most

Estimates through the Global

segments will not be possible

Policy model suggest that

before late 2022.

national incomes may rise by

In the worst-case scenario,

U.S.$ 1.4 trillion for developed

major economies, including

countries because of these

India, will be constrained to

expensive packages, however

impose lockdown measures until the end of 2020, at least. Then,

economic

activities

would reach pre-crisis levels only in the second quarter of 2021. By then, hopefully, a vaccine would be available as

well

tried

and

tested antiviral regimen. A considerable number would have acquired herd immunity. Even if the virus makes a return,

To save businesses that have run dry of working capital, governments are promising bailout packages

it can be dealt with without a

there is fear that developing economies may not be able to meet the crisis head-on. Comparison

between

the Global Financial Crisis (GFC)

and

the

consequences

economic COVID-19

have already begun. However, unlike GFC, we still do not know when this crisis will end. An uncertain future can cause delay in taking effective policy action, and even the massive

lockdown. Even air travel and tourism would

packages announced may prove to be too little and too late.

However, one must not rule out the

Many countries do not have the effective

extreme economic, social and political

mechanism to bounce back like the last

turmoil which we will be seen in the whole

time. China’s large stimulus and increased

of 2020. Most economies will experience

global south-south trade had positively

impacted growth in many parts of the

unprecedented

contraction.

The

rebound in the second half of 2021 would be muted, and we can assume that pre-

capacity, and the global nature of the

crisis levels in economies will not be

crisis constraints us from using the same

reached until 2023.

methods. Due to increased fear of future

64 | COVID-19 COMPENDIUM |

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supply-chain disruptions, countries and companies will rethink their supply-chain strategy, and this will cause longer delays in rise in global trade. While

developed

countries

have

protection schemes, a decline in revenue constraints, even as people demand increased

welfare

schemes.

Currency

depreciation causes an increase in the cost of importing essential products, and lack of administrative ability increases the toll on the healthcare system. This is a vicious cycle that developing countries will struggle to conquer, creating an opportunity for social unrest. A

recent

pledge

taken

G-20

countries to inject US$ 5 trillion into the global economy to mitigate the crisis is commendable, but more can be done. This crisis could be the right time to discuss

A recent pledge taken by G-20 countries to inject US$ 5 trillion into the global economy to mitigate the crisis is commendable, but more can be done. This crisis could be the right time to discuss changing the rules of Special Drawing Rights

changing the rules of Special Drawing Rights (SDR) practised by the IMF. SDRs are like a current account held by the

A third possible policy decision is to

IMF; countries can use this mechanism

have a temporary halt on loan repayments.

to obtain hard currency and as a means

This can happen when creditor countries

of payment between countries. Each

choose to extend debt repayments for a

country has a quota, which is directly

couple of years. During this time, creditor

proportional to the amount shared with

institutions should not take legal recourse

the IMF. Developed countries have better

for repayment of debts.

access to these funds than developing

Stimulus packages are a necessity

countries. This time IMF can allocate more

now, but it results in an alarming rise in

funds to developing countries based on

global debt. Coupled with low commodity

their need and ability to recover.

prices, emerging economies will be the

Another solution is globally endorsed

hardest hit. The absence of a vaccine in

capital control measures. This move can

the immediate future may translate to a bleak economic performance in the

depreciation of currencies and asset

forthcoming quarter. Under-performance

prices. This must be legitimised globally

in two consecutive quarters is clearly a

and needs to be assisted by international

recession that looms. Some experts even

organisations like the IMF.

fear a depression on the horizon.

www.synergiafoundation.org

COVID-19 COMPENDIUM

| 65

Reviving the stalled economy

0.1per cent, while the Federal Reserve of U.S.

SYNERGIA FOUNDATION RESEARCH TEAM

has brought interest rates down to 0.25per cent. The RBI is still maintaining the REPO

t this juncture, companies and

rate at 4.4per cent!

individuals leveraged by debt are

The RBI should adopt the ZIRP (Zero

the most disadvantaged. Despite

Interest Rate Policy) for the duration of

the absence of income (because of the

the economic recovery. By adopting ZIRP,

lockdown), they are required to pay back

economic activity should take-off, because

both principal and interest. The RBI had issued instructions to banks to postpone

cheap

credit.

Extraordinary

measures

repayment of loans, from April 1 to May 31,

are needed to deal with extraordinary

2020. However, all banks, without exception,

challenges. However, there is a downside

have offered only delayed repayment, with

with ZIRP. The RBI would no longer be

additional interest. Some economists call

able to reduce interest rates, rendering

interest as rent on capital. When economic

conventional monetary policy ineffective.

activities are stopped by government

However, it could employ quantitative easing, and in extreme situations, even offer

continue to charge interest on capital invested in the stalled economy? Interest

rates

change

over

time,

negative rates.

Inspire the Consumer

depending on market conditions. Central

Another

banks of nations, use interest rates as

consumer demand even as the coronavirus

monetary tools, to stimulate the economy

persists. Governments should not hesitate

unique

challenge

reviving

to inspire people to learn to live productive lives in a COVID environment. The same are Switzerland (-) 0.75per cent, Denmark (-)

agencies (public health and police) who

0.6per cent, Japan (-) 0.1per cent, Sweden

implemented

0per cent, and Spain 0per cent. The Bank of

advocate the resumption of normal lives

England has dropped their interest rate to

with pragmatic precautions.

66 | COVID-19 COMPENDIUM |

the

lockdown

should

www.synergiafoundation.org

Private Sector Responsibilities in a Pandemic

moderator Andy Mok (Senior Fellow, CCG) focused on the private sector and COVID-19. The speakers were Dr Kevin Kang (Chief Economist, KPMG China), Jason LU (Vice President, KORRUN Group), Gina QIAO (Senior Vice President and Chief Marketing (Managing Director of ThyssenKrupp).

INPUTS BY GOPI HANUMANTHAPPA, MANAGING DIRECTOR, THYSSENKRUPP AEROSPACE INDIA PVT LTD

The two main topics covered pertained to how supply chains could be made stronger, and how corporate responsibility helps in navigating a pandemic as well. This piece shall focus on the latter. Responsible

capitalism,

where

n the “India and China: Two Asian giants

companies seek to act quickly and have a

amidst a pandemic” webinar hosted by

backup plan for a backup plan, now faces its

Synergia foundation in collaboration with

biggest test yet. Today’s CEOs are faced with

CCG (Center for China and Globalization),

multiple choices and decisions in the face

www.synergiafoundation.org

| COVID-19 COMPENDIUM | 67

of the pandemic, ranging from how to deal

this problem doesn’t last too long. There

with losses in their business, handling the

are those who hesitate, though. The main concern with using other companies as

customers, staff and suppliers - the list goes

manufacturers is that there could be large

on. Since no one saw COVID turning into

differences in the manufacturing process.

as to what is the best way to deal with the scenario. Naturally, it will be impossible to

How do Companies Deal with a Pandemic

keep everyone happy.

Pandemic preparedness for one’s company can be only as good as the experience,

Shifting Gears The focus of any company during a

the coworkers. It would be even better if

pandemic is (or should be) to protect their

there was the collective experience of all

workforce and ensure continuity of output.

the companies in the world—if they were

This has seen companies change, for the

willing to share.

time being, the products they produce, to

Michael T. Osterholm, an American

keep production going along with creating

infectious

disease

epidemiologist

and

necessary equipment for the pandemic.

director of the Center for Infectious Disease

Jason Lu, VP of the KORRUN group, a

Research and Policy at the University of

business travel company, did just the same.

Minnesota, states that, “We see frightfully

In the webinar, Mr Lu spoke about how his

little private or public sharing of creative

company contributed their services in making masks to donate to healthcare workers, especially to Indonesia and India. Their factory in Bengaluru,

approaches or experiences wrestling with tough preparedness issues. No

one

has

comprehensive from

collection companies—

Karnataka, was also given clearance

to operate due to this.

not trade associations, other

KORRUN isn’t alone. Londonbased

boutique

liquor

brand 58

plans

assembled

business groups, nor the federal government.”

Gin stopped making gin and started making hand sanitizers. maker

Vacuum-

Dyson

took

an order of 10,000 ventilators from the UK

government.

While the drastic change in products did

create

certain

hurdles in sourcing materials, navigating alternatives in the supply chain ensures that

68 | COVID-19 COMPENDIUM |

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Surviving and Thriving in the Pandemic

companies have been able to survive the onslaught of the economic crisis unscathed. Even fewer were not a part of the industries that saw an increase in demand due to the pandemic (such as facemasks, sanitizer, etc.). It seems almost unfathomable that a company involved in aviation, one of the

INPUTS BY UDAYANT MALHOUTRA,

hardest-hit industries, could become a rare success story.

CEO & MANAGING DIRECTOR, DYNAMATIC TECHNOLOGIES LTD

In this dystopian situation, very few

Proactive and Innovative Measures Dynamatic’s decision to manufacture their

ow can the right decisions and rapid

products locally turned out to be the correct

responses help a company emerge

one under the current circumstances.

unscathed from the pandemic?

As a producer of high tech equipment

Udayant Malhoutra, CEO and MD of

for several aviation majors, their demand

Dynamatic Technologies Ltd was a panellist

is of a global nature.

They built their

in the 81st Synergia Forum’s 17th Virtual

manufacturing plants in the countries of

Forum on Supply Chain & Core Resilience

their principal customers, saving a great

Capabilities. This article is based on his views

deal on transportation. While this also

expressed during the discussions.

meant a possible loss due to paying higher

“It’s a really challenging moment [...] For

wages (than if they were manufacturing

risk mitigation, and to have that sole supply

in China) and due to economies of scale,

dependency of the big OEMs on us, we

it made their supply chains resilient to

had local manufacturing [...] In a sense, that business was not really disrupted (because of this)” The

pandemic

has

proved

highly

disruptive to the Indian economy, and resulted in estimates that this would be the worst recession since the economic liberalization of the 1990s, and possibly even since Indian Independence. 140 million people lost their jobs, while many more endured salary cuts . Up to 53% of businesses were projected to be had their operations temporarily suspended or reduced . Many smaller companies were forced to shut down due to a lack of funding caused by the pandemic.

www.synergiafoundation.org

| COVID-19 COMPENDIUM | 69

disruptions. Spreading manufacturing over

nature of the virus. In March, all of

different countries is rare, but it can serve as

their 3000 employees were tested for Covid,

a reliable hedge against disruptions in the supply chain. Dynamatic is a sole supplier for certain

collaboration with the Indian Institute of Science to develop testing protocols that

products to major companies, like Boeing. In Udayant Malhoutra’s own words, ‘being a sole

the state governments, it was ensured

supplier means risk’. Any disruption has the

that production could go on undisrupted.

potential to cripple an entire company ahead

They even invested in innovation to create

of them in the supply chain. Accordingly,

the cheapest ventilator in India, costing

the sole supplier has to be responsive and

as low as Rs.2500. As a result, they have

proactive if it wishes to survive in the industry,

managed to emerge from the crisis not

especially when confronted with disruption

just intact, but indeed better than many of

as destructive as the pandemic.

their competitors. They were able to survive without the aid of the Reserve Bank of

Taking Care of Suppliers, Customers & Workers

India, while ensuring the safety and security,

Sensing the potential for disruption, in

customers and their employees.

January itself, Dynamatic prepaid all of

The story of Dynamatic and of Udayant Malhoutra is a unique one.

Their ability

quarters. As early as February, they began to

to mitigate risk, both before and during

prepare (sooner than many governments)

the current crisis, as well as their culture

by training their employees to continue

of innovation, can serve as a blueprint

to work with new guidelines that could

for others that wish to survive the next

protect workers from the contagious

economic crisis.

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‘Pharma, the Knight of the Pandemic’ for Promotion of Industry and Internal

INPUTS BY RANJIT SHAHANI,

Trade (DPIIT) set up a control room, with the

FORMER MANAGING DIRECTOR

respective

State

drug

controllers,

providing operational data on a daily basis. “There’s a lot going on in this space

NOVARTIS INDIA LTD PRESIDENT OF THE

[pharma], which will hopefully give some

OF COMMERCE, INDIA

succour. Indian companies have upscaled

their

manufacturing

for

HCQ,

clinical

trials for which are still going on to see its have

usefulness; there are companies which are

been extending a helping hand

producing re-purposing medicines to see

whether they can help in the pandemic.

harmaceutical consumers

companies facing

economic

There’s a lot of creative work going on,” says

Eli Lilly, a U.S. company, has offered support

Ranjit Shahani, a former president of the

Organisation of Pharmaceutical Producers

many

insulin-dependent

diabetics

whose loss of income has left them unable to access life-saving medication.

of India.

measures to avoid supply-chain disruptions

The Many Layers of Drug Marketing

A major issue is the licensing protocol

The Indian government took proactive the

pharma

industry.

monitor

transportation and delivery of essential

for newly introduced drugs.

commodities in real-time, the Department

Remdesivir was sanctioned the ‘orphan

www.synergiafoundation.org

Recently,

COVID-19 COMPENDIUM

| 71

drug’ status by the USFDA, which was quickly revoked due to severe criticism. An ‘orphan drug’ tag is given in situations where the disease affects fewer than 2,00,000 patients, whereas in the U.S. far more people were infected. This status comes with a seven-year market exclusivity to the company, which means Gilead would have had an exclusive right to manufacture and market the drug, giving it a monopoly. ‘Doctors Without Borders’ has urged global leaders to accord patents to privately developed COVID-19 treatments to “ensure availability, reduce prices, and save more lives”. Creating a vaccine for a virulent virus is extremely hard work, and ensuring it is accessible to all will

be even harder.

Shahani explains the dilemma: “Access has more than one dimension. People focus on it only in relation to price. Access also relates to availability and quality. You may have the product, but not the right quality, then that’s poor access.[...] Now, either the government

Americans pay the highest amount for innovative products, followed by the Europeans where the pricing is 20-30per cent less than the U.S., followed by Asia where the price drops by around 50per cent. When it comes to India, it is

does the research, and a pharma company

globally.

does the manufacturing to distribute it. But if you are a listed company, and you are my shareholder, then you’ll want a reasonable return on the investment. This is always the challenge. Americans pay the highest

The API Conundrum

amount for innovative products, followed

In fact, in 2014 the present National Security

by the Europeans where the pricing is 20-

Adviser Ajit Doval had warned that India’s

30per cent less than the U.S., followed by

dependence on China for APIs could be a

Asia where the price drops by around 50per

national security threat. Shahani cites the example of Switzerland,

of the pricing sold globally. Yet, we have

which follows a rule of maintaining a

six hundred million people here who have

two-year stock of critical supplies. “79%

an income of about two dollars a day or

dependency on one country, China, is just

less. Now, that’s the challenge. One way is

not on,” he says. In sum, Shahani feels that

to distribute these through government

there is great opportunity for the pharma

outlets, like ration shops. The government

industry in coming times. He says, “Pharma

can buy these in bulk and sell it to them, or

is going to be the White Knight as we go

give it for free.”

ahead”.

72 | COVID-19 COMPENDIUM |

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Why was India Way Behind

competitively produce APIs with a 3per

The 1970s was momentous for the growth of

cent variance for labour cost, but Chinese

the Indian pharmaceutical industry. To help

exporters have the capacity to obtain low-

compete with multinational companies,

interest credit and invest in high capacity

the government revised its patent law to

infrastructure. While Chinese plants can be

focus on process and shortened the life

set up in one year, in India, it would most

of the patents. Through the 1990s, Indian

likely take 3 to 4 years.

chemists were able to reverse-engineer manufacturing processes, hold domestic

Chokepoint with Covid-19

prices, and compete to eventually hold

India, the U.S., Nigeria, and the EU are

20per cent of the market share in exports.

admitting the dangers of allowing China

China, however, became a formidable

a monopoly in the manufacturing of

competitor and overtook India in API

essential raw materials. Sourcing of APIs

manufacturing

companies

became a serious issue once the supply

enjoyed subsidised infrastructure and low–

chains from China collapsed at the onset of

interest credit. In the 1980s, India was one

the pandemic.

Chinese

of the largest producers of semi-synthetic penicillin

Chinese

of the Central Drugs Standard Control

strategically reduced the cost of Penicillin G

Organisation (CDSCO) had to step in with

by over 80per cent which led to the closure

a package to replenish the API industry.

of some of the largest bulk drug plants for

The

antibiotics such as Gujarat Lyka Organics

of Commerce and Industry (FICCI), has

and Kopran. Over time, India shifted focus

recommended incentivising manufacturers

to formulated drugs and turned to imports

to tackle the disruptions and position India

for API. Penicillin, a revolutionary antibiotic

as an alternative source to China. The

discovered 80 years ago, is now in scarce

disruption has already increased prices

supply.

of basic drugs in India like paracetamol

The

the

biggest

world.

the

In March, the Joint Drugs Controller

challenge

Federation

Indian

Chambers

Indian

by 40per cent and some antibiotics by

manufacturers to produce APIs is low

70per cent. In a country, where more than

capacity utilisation which is pegged at 30-

75per cent expenditure of out-of-pocket

40per cent compared to the Chinese, at

expenditure is on healthcare, this could

65per cent. Studies show that India can

deeply impact the poor.

The biggest challenge to Indian manufacturers to produce APIs is low capacity utilisation which is pegged at 30-40 per cent compared to the Chinese, at 65 per cent www.synergiafoundation.org

COVID-19 COMPENDIUM

| 73

The disruption has already increased prices of basic drugs in India like paracetamol by 40per cent and some antibiotics by 70per cent. In a country, where more than 75per cent expenditure of out-of-pocket expenditure is on healthcare, this could deeply impact the poor A strategic initiative to consider would be to revive public sector drug manufacturers

waste enters waterways resulting in the

and further their capacity to produce

development of multi-drug pathogens. In

API and formulations.

Indian PSUs like

November 2016, German scientists found

Hindustan Antibiotics Ltd. and IDPL used

that all of the specimens collected from

to play a key role in ensuring uninterrupted

sites around the bulk drug manufacturing

supply of basic raw material, but withered

facilities

due to lack of State support.

villages,

known

Environmental Challenges and Drug Resistance

Bollaram with

Hyderabad as

the

zone, were

and

nearby

Patancheruontaminated

antimicrobials. They also found

95per cent contained worryingly high

The pharmaceutical industry emits 48,550

levels of bacteria and fungi resistant

kg of carbon-dioxide-equivalent (CO2e)

to antibiotic drugs. These discharges have

per million dollars, which is about 55per

polluted river sediment surface, ground,

cent more than the automotive industry.

and drinking water.

74 |

COVID-19 COMPENDIUM

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Social Security Umbrella for the Marginalised SYNERGIA FOUNDATION RESEARCH TEAM

and an additional $500 for every child in the family. But, there is also rising opposition to this scheme. The debate is whether to expend the funds on individuals or on industries that employ them. America was losing 8,00,000 jobs per this time around, millions of jobs have been lost in a week. It is in a bind as it confronts a providing bread and butter to the millions

be focussed on the bottom layers of

of poor, but also has to spend billions on

the economic pile: the daily-wage

strengthening its medical defences against

earners in the informal or unorganised sector. This includes the rickshawallah,

the virus.

porters, street vendors and the like. The

Is this the Best Solution Yet?

sudden and complete halt in all kinds of

Critics of UBI say that a direct cash transfer

economic activities may well push many,

might help if the economy is running

already in the abysmal depths of abject

and picking up. But if the economy is at a

poverty, towards starvation, if COVID-19 was primarily seen as a supplement to the Of the many solutions suggested, the most logical one is the Universal Basic Income (UBI) — direct cash transfer to all eligible individuals by the government.

income of the household, but not as the income in itself. The

second

issue

how

many

instalments of the UBI should be given

Developed countries like Canada, the

to the needy — a one-time package, or

UK and the U.S., which already have an

should it be spread out once we are clear

extensive social security umbrella in place,

how long the crisis is going to last? The

are now toying with the idea of universal

third biggest concern is identifying who

distribution of cash subsidies to the weaker

is eligible. Many developing countries still

sections. The U.S. government is planning

do not have effective bank penetration or

to give $1,200 per adult for families with

digital access. Governments cannot dump

annual income below the $75,000 mark,

cash into bank accounts if people do not

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| COVID-19 COMPENDIUM | 75

have the facility. Data is also crucial in

Still Better than Most

identifying who the real victims are; people

UBI is still considered by many as the most

Developed countries, which already have unemployment insurance (the dole), have

its success. The Jan Dhan accounts (cash

a clear picture of those under the poverty

transfer to farmers every six months) have

line or the unemployed. India has no such

shown that this system is handy in identifying

database; Aadhaar is the

the

primary database, but it

Internet

does not list the citizen’s

and

economic

have increased, but other

status

right

recipients. connectivity

bank penetration

methods, such as linking Due to low demand and

the

many

companies

eventually

lockdown, run

will

bail

already

out.

stressed

not be able to face this

meltdown.

government

The now

caught in the horns of a dilemma: support the poor citizen or the private sector?

considered.

out

of money and would require

ration cards could be

If production

stops and there are no longer essential goods being produced, of what use is the UBI?

Once operational, the

In a deposition by the Government of India before the Hon’ble Supreme Court, it was revealed that around 5.7 million migrant labourers were involved in this abrupt migration spurred by the lockdown

Interest rates have been

cut

since

the

‘one nation one ration card’ (ONORC) system would

the

best

solution as migrants can use this card anywhere in the country, and since the enrolment process for the ONORC would be stringent enough to render eligible only the poorest of the poor, the ONORC would be the basis for distribution of UBI. Government welfare schemes

generally

collapse due to the high

beginning of this crisis, by pumping in

marginal cost of public funds (MCPF), i.e.

more money into the system, countries

the amount spent by the government to

will have to face the risk of mounting

provide Re. 1 of goods to its citizens. India has an MCPF of 2.5 to 3.5, which means the government needs to spend an extra Rs. 3 for providing goods worth Re. 1. UBI avoids this as it cuts through layers of bureaucracy

cent of GDP (Union and States included),

and corruption by putting money directly

so the cost of the UBI is then not viable.

into the pockets of the people.

76 | COVID-19 COMPENDIUM |

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Systems and Solutions to the Migrant Labour Crisis

the size of France migrates from one state to another within India, with a large section that migrates and returns annually, in search of seasonal work and daily wages. Of that 30 percent are labourers, and of those labourers, 30 percent are casual labourers. based on the data provided by Prof Amitabh Kundu

TM VEERARAGHAV, CONSULTING EDITOR, SYNERGIA FOUNDATION

Research

and

Information

Systems for Developing Countries, it is estimated that there are about 65 million inter-State migrants in India. A study conducted by the Azim Premji University concluded that 29 percent of

the population of big Indian cities are nderstanding the magnitude of

predominantly interstate and intrastate

the crisis and addressing it as a

migrants. For instance, a typical Indian

socio-economic issue from the

metro with a population of 80 to 100 million

perspective of the states, the migrants and

would have up to 30 million such migrant

the industry is the only way forward. The size

workers.

of the informal or unorganised workforce

When India announced a sudden and

in India is staggering; a population almost

strict lockdown to counter the COVID-19

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| COVID-19 COMPENDIUM | 77

spread, it is these teeming millions who

two categories; the intrastate and the

were exposed, caught between the devil

interstate migrants.

and deep, far from the safety net of their

manage to get better access to resources

rural homesteads amidst the uncaring

of their home state, it is the latter who are

urban chaos. TV images beaming visuals

left to fend for themselves with no social

of their pathetic journeys across the baking

security cover of any kind, neither food from

hot Indian plains, on foot, cycles and an

the public distribution system nor access to

assortment of modes of transport, gave

other social schemes run by the state.

While the former

an indication of their size and the unsung

A research study by Alpa Shah of London

service they perform behind the façade of

School of Economics and Jens Lerch of

a rising India.

the University of London estimates that

While this unorganised or informal

Adivasis and Dalits, who form the lower

sector of the economy plays a major role

socio-economic strata, from States like

in the agriculture, transport, realty and

Jharkhand, Chhattisgarh, Odisha, Madhya

warehousing industries, their presence

Pradesh amount to around 40 per cent of

is critical in other sectors too. Changing

the seasonal migrant workforce. States like

demographics and uneven pace of growth

Uttar Pradesh, Bihar and West Bengal too

in the country over the last three decades

contribute to the migrant labour force.

has triggered these migrations, resulting in a chaotic situation which accords almost

as ‘Sender’ states. The destination is

zero social security cover to these workers,

industrially developed States in south India,

unlike their counterparts in the organised

Maharashtra, and bustling cities like New

or the formal sector.

Delhi and they can be termed ‘receiver’

In a disposition by the Government of

states. Agriculturally rich states like Punjab

India before the Hon’ble Supreme Court,

are also heavily dependent upon these

it was revealed that around 57.72 lakh (5.7

migrants for the sowing and harvesting.

million) migrant labourers were involved

While such studies reiterate a common

in this abrupt migration spurred by the

notion of ‘Sender’ or ‘Receiver’ States,

lockdown. However, it is suspected that the

they reveal little more. The need is for an

actual numbers are much higher as record

exhaustive exercise to collate detailed

keeping was poor.

data of every migrant worker and his or

Sender and Recipient States

her family. And, then formulate targeted solutions for diverse segments, like State-

Daily wagers can be broadly divided into

The Confederation of All India Traders, an apex association of traders in India, announced a nationwide boycott of Chinese products from June 10

78 | COVID-19 COMPENDIUM |

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A Universal Ration Card as a Solution To understand the magnitude of the problem, precise data of their numbers and movements is critical.

The government

in consultation with the sender and the recipient states have to set in place processes to register and track this workforce. A large scale, “mobile-based survey could generate good ideas about the post lockdown recovery from both the employer and migrant” point of view, suggests Mr Sanjay Mitra, a former secretary to the Government of India. Migration by itself is economically

nearest ration stores could also enhance data gathering to reveal the real-time

distribution of cheap labour from labour-

geographic spread of migrants and help to target the delivery of relief, subsidies, and

boosting employment while keeping input costs low. Mr. Mitra suggests that targeted

assistance to them in a crisis.

for migrants” and not try to mitigate

Addressing the Economic Model

migration itself, which he feels is the result

There is a counterview that such massive

of “a functioning economic model where

movement of populations from rural to

resources move where demand is high and

urban centres on a regular basis does not

returns are higher”.

give much credit to the stability of such

measures

should

look

“protection

an economic model and needs a deeper have hurt the migrants and that post lockdown

effects

will

analysis.

“temporary”.

Mr E.S.L.Narasimhan, former Governor

However, there is a need to assess

of Telangana and Former Director of the

the recovery process through precise

Intelligence Bureau says, “It’s time we look

information and ensure that the lessons

at the underlying cause,” and adds that, “We

from the crisis that followed the lockdown lead to systematic solutions. A “universal ration” card could enhance

a hub of activity for the rural populace”.

social protection for migrants; he points

Mr. Narasimhan suggests that like smart

out. The concept of ‘one nation one ration’

cities, we could look at “smart rural regions”

is one solution for providing social security

as a possible solution and proposes to “semi

for migrating, lower economic strata of the

urbanise rural areas, so wealth spreads

population in terms of subsidised food and

evenly.” However, this would require an

health care.

accompanying push for education and

In fact, aligning ration card to the

www.synergiafoundation.org

other infrastructure in rural areas.

| COVID-19 COMPENDIUM | 79

There are compelling arguments for a

travel, it is an ordeal for interstate workers

social net for the migrant labour, including

to return to their job sites. While easing

a national urban employment guarantee

interstate movement may restore some

programme, on the lines of NREGA, and an economic focus to contain massive

systems and solutions. Mr. Mathew points

migration. Without a concerted effort, the

out that key learning for the industry was

situation will only deteriorate, even without

that the need for migrant labour was “very

a pandemic.

evident” and the receiver state must treat

Who Bells the Cat?

its “guest” labours at par with the locals. As a long-term solution from the

Each state has a unique demography, and

industry, Mr. Mathew proposes the following

a ‘sender’ state is in the best position to

measures: A registry of migrant workers,

understand the needs of its population.

transfer of wages online so that there is an

However, the ‘receiver’ state is better placed

electronic trail, on-site housing for labour

to track the number of migrants with their

before large projects receive clearances

exact locations. It would be morally binding

like in the Gulf along with ancillary services

on the receiver state, which is reaping the

like medical and counselling and lastly dedicated special trains to facilitate mass

cater to their social needs too. The centre at best could act as a regulator by ensuring laws safeguarding the rights of the migrant labour are enacted and acted upon. Mr. Mitra warns that a “centralised intervention would be disastrous” and argues that the break was a result of the pandemic and the system did not crash on its own.

movements.

In a post lockdown economy, measures have to be put in place to facilitate the return of the millions of migrant workers

The Industry View In a post lockdown economy, measures have to be put in place to facilitate the return of the millions of migrant workers so that the wheels of the economy start turning soonest. According to Roshin Mathew, Executive Director and President Engineering at Brigade Enterprises, Bangalore “the labour situation today is at around 55 per cent of what it was before the lockdown. It was at around 32 percent on the day lockdown was lifted”. Amidst restrictions on road and train

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However, many global products are today sourced from multiple agencies and then either assembled or produced locally. Are MAJ GEN MONI CHANDI, CHIEF STRATEGIC OFFICER, SYNERGIA FOUNDATION

those local or foreign? In free markets, consumers should be empowered to make their own choices on criteria such as price, availability, and quality, no matter where the products are made or sold. Is India’s commitment to free-market

n May 12, 2020, Prime Minister

and globalisation now in question? BJP

Narendra Modi in his address to the nation, urged Indians to be

that there would not be a government

‘Be vocal for local’, suggesting that Indians

directive to only buy local products, but

should buy local products with pride.

that people may themselves see merit in

The main problem with the ‘buy local’

buying items of good quality, made in our

theme is that it suggests discrimination of

country. He also stressed that the PM’s

What exactly is a local product? A product

just about products made by domestic

manufactured locally from local resources.

companies, but that any item, as long as it

Moreover, a product manufactured abroad

was manufactured in India, fell within the

with foreign resources is a foreign product.

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‘Make in India’ Policy ‘Make in India’, is the name for the ‘swadeshi’ movement launched by the government on September 25, 2014, and initially covered 25 sectors of the Indian economy. The intention was to encourage companies to manufacture their products in India so as to promote investment in Indian manufacturing. A year later, India had emerged a top destination for FDI (Foreign Direct Investment) attracting US$ 60 billion. As per current policy, 100per cent investment is now permitted in 100 sectors of the Indian economy, with exceptions for space (74per cent), defence (49per cent) and news media (26per cent). On April 1 this year, the empowered committee

secretaries

issued

Boycott of Chinese Products On June 7, 2020, the Confederation of All India Traders (CAIT), an apex association of

Linked Incentive (PLI), to further encourage

traders in India, announced a nationwide

FDI. In addition to providing additional

boycott of Chinese products from June 10.

incentive on exceeding production targets

The organisation’s aim was to bring down the value of current Chinese imports from

contentious clauses to make investment in

US$ 75 billion to approximately US$ 13 billion

India more attractive. It is hoped that this

by December 2021. Chinese exports to India

push will pave the way for Apple, Samsung,

constitute mainly manufactured products

Foxconn, Oppo, Vivo and Flextronics to

— electrical machinery, electronics, and

commence local production of next-gen

plastics. India’s exports to China constitute

smartphones in India. The vision is to

mainly raw materials and industrial inputs,

make India an export hub for next-gen

including chemicals and cotton.

smartphones. The ‘Make in India’ initiative was a

Attracting FDI

grand proposal, with ambitious targets,

According to the UNCTAD (United Nations

particularly

manufacturing

Conference on Trade & Development),

sector. Five years after its launch, many

in 2019, India was amongst the top 10

of the initial targets have slipped. The

destinations of FDI in the world. The U.S.$

national

the

economic

slowdowns,

poor

implementation of the policy, and global adversely

(hardware & software), telecommunications,

affected its implementation. Despite this,

trading, automobiles, tourism, construction,

trade

protectionism

have

companies dealing in services, computers

the policy still holds prospects for India in the long term.

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report, Singapore and Mauritius were

www.synergiafoundation.org

the top sources of FDI, followed by the

FOREIGN DIRECT INVESTMENT INFLOW

Netherlands, U.S., and Japan. Singapore and Mauritius are attractive sources for

Financial Year 2020-21 (April to August, 2020)

FDI because they provide favourable tax regimes for companies investing in India.

During April to August, 2020,

The India-Mauritius Tax Treaty was signed

US$ 35.73 billion

in 1982, while the India-Singapore Double Tax Treaty was signed in 1994; both the treaties have been periodically updated. Investments originating from Singapore

31.60 billion).

and Mauritius are more likely to be foreign companies, with business presence (shell

(April to August, 2020) is

companies) created to take advantage of

US$ 27.10 billion

the good business environment and tax

India, possibly through this route. Indian companies like OLA, Hike, BigBasket, Byju’s, Delhivery, Dream-11, Oyo, Paytm, Snapdeal, and Zomato now have sizeable Chinese equity holdings.

Emphasis on Self-Reliance

industries. Government tenders, up to Rs.

The government has periodically raised

200 cr., are now only reserved for Indian

import tariffs in critical sectors to promote

bidders. The FDI policy has been amended

domestic manufacturing. In November

2019, India decided to forego joining the

“opportunistic acquisitions”, by introducing

RCEP (Regional Comprehensive Economic

scrutiny under the Ministry of Commerce

Partnership) citing negative impact for

and Industry, for countries sharing land

farmers, MSMEs, and dairy products. In the

borders with India.

wake of the COVID-19, the government has stressed the importance of self-reliance by

protect

After

the

Indian

reforms

companies

1991,

from

many

economists suggested that tariff protection,

announcing measures to support home

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| COVID-19 COMPENDIUM | 83

will make the domestic industry less and not more competitive. India’s globally competitive info-tech, automobile, and pharma sectors were forged through international competition and now require no further protection.

Police Canteens On May 13, 2020, the MHA issued a directive that all police canteens, including those of central police organisations, will only sell goods that are ‘swadeshi’. In a later

into three categories: those purely Indian, those manufactured or assembled in India,

demonstrated commitment. ‘Be Indian – Buy Indian’ should not mean citizens

categories would be permitted for sale

are required to buy more expensive and

in canteens, the third category was to be delisted. On May 29, an order was issued

they are produced by Indian companies.

delisting more than 1,000 products from

In fact, protection of domestic industry,

sale in canteens. However, on June 1, the

under the garb of nationalism, has been

order was withdrawn, stating that it had been erroneously issued and that more

work standards, corruption in business

deliberation was required.

dealings, and nepotism in accumulation of

With this logic, an imported Mercedes-

wealth. There is little merit in misquoting

Benz and Levi’s jeans should be delisted

nationalism to justify poorly-designed, over-

from sale in police canteens. But, if the

priced, and poor-quality products.

same products are assembled or made

From a purely nationalistic perspective,

in India, they could still be available in the canteen. With the proliferation of MNC

brand-name,

production-in-India,

and

Indian ownership. However, in modern discern purely imported items from those

India, with its integrated economy, the

that have been assembled or produced in India. This is perhaps where the serious

‘Indian-ness’, only in terms of production-

challenge lies.

in-India. In the 1920s, Mahatma Gandhi led

In a Nutshell

a successful people’s movement to burn Lancashire textiles in favour of homespun

Governments are obliged to enable citizens

and hand-woven substitutes. In the 21st

to get the best value for their money.

century India, it may not be so easy to

There is also the promise of free trade and

discern ‘foreignness’, with the multitude of

open markets, to which our leaders have

goods and services available in our country.

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Think and Act Local, with a Global Perspective

workers to report to duty. Even post-COVID, workers will have to be equipped with essential PPE and the distancing.

Gradually, increased use of

technology in production will minimise

INPUTS BY PRASAD CHANDRAN,

human intervention, but at a social cost. Management has to have two sets of

FOUNDER & CHAIRMAN SEEGOS, FORMER CHAIRMAN & MANAGING DIRECTOR, BASF INDIA LTD

collapse of the supply chains and inability of

teams. One team should look at the here and now, and the other should look at the long-term opportunities and solutions. The short-term group would be focused on upstream suppliers and downstream

he chemical industry is the crux of

distributors and how to create alternative

most sectors, be it general chemicals,

supply chains, while the long-term think

speciality chemicals, petrochemicals,

tank could focus on how to turn the sector

chemicals

used

agriculture,

medication. But, during the lockdown, the industry suffered inertia as it was not

into an alternative market to China, for the U.S., Australia, and Europe.

Agricultural Push

chemical factories in the USA, Germany,

India has been fortunate that, so far, the

Japan, and China continued functioning.

impact on its food supplies has been

Even if the industry had its machines on full

controlled. The rabi harvest closed with

throttle, it would have shut down due to the

a record food production of 225 million

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| COVID-19 COMPENDIUM | 85

tonnes of foodgrains. The worrying factor is the exodus of migrant labourers, who felt uncared for in guest States. When will it be safe for them to return to agricultureintensive States in the west and the south? Local labourers seem an unviable prospect for farming. On the legislative side, the newly introduced reforms in the agricultural sector could help revive it. These are amendments to the Essential Commodities Act, the dismantling of the APMC (Agricultural Producers’ Marketing Committee) offering more

competitive

pricing,

and

the

introduction of contract manufacturing. People talk about farmers having onetwo acres of very small holdings, but that doesn’t matter. We can have contractual manufacturing where a huge value chain in agriculture can take place.

Government Control vs Entrepreneurship The

Indian

government,

through

its

has tried to ensure a smooth exit from the lockdown. Yet, bureaucracy and babudom could negate the full impact. Deep control

without strings attached. As far as the

and licensing should be done away with.

government is concerned, the important

While the government’s plan has been

thing is to reset our thinking and it must

to promote a self-reliant India, there is

be from a collaborative, cooperative and

much work to be done to make this a reality.

together approach.

India has a long history of a dominant State Bharat’ may seem like a dream when the

Revamping the Agriculture Sector

Centre seeks to control the way production

The agriculture system is in dire need of a

works. Vulnerable citizens end up having to

new legislation to replace those crafted in

fend for themselves, while those who can

the 1950s and 60s. The need of the hour

afford it, seek better prospects overseas to

is direct linkages between farmers and

bypass regulations. When money is being

corporates bypassing the age-old,

given, for example, MSME support given

entrenched middleman system. If you can

by the banks, it’s important that it comes

get large industries like the ITC to come in

and vast swathes of poverty. ‘Atmanirbhar

86 | COVID-19 COMPENDIUM |

well-

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use for bio-waste within the next one and a ITC can get into an NPO and get a price

half years, India can have an energy system

that the farmer wants. So, the farmer is

which completely changes our need to import oil. So, “think global, act local” will

the middleman gets cut off. So be it. That

change to “think and act local” but, with

will change India.

a global perspective. There will be more

The post-COVID period will change the

conservation and savings as people look for

way business is done. The focus will now

safety in their transactions. Consumerism

be on nationalism, localism, and WTO

will change, and the American dream

globalisation, which is both a risk and an

is going to change with it. There will

opportunity. India could have changes in its imports as well. For example, Punjab and

1 per cent phenomenon where this 1 per

Haryana have sugarcane, rice, paddy, and

cent population owns about 85 per cent of

wheat waste; if the government can put consumerism is.

Insurance Dovetailing with Changing Consumer Behaviour home to the world’s biggest car market,

INPUTS BY TAPAN SINGHEL,

which was paralysed by the pandemic-

MD & CEO BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.

the China Automobile Dealers’ Association,

induced economic freeze. According to about 99per cent of China’s auto showrooms

was at 66per cent of normal levels.

and perhaps tragedies due to deaths from the virus, people are now looking to

Consumer

preferences

across

the

world are changing. Transactions have

insurance companies to make good their

moved

promises.

products have taken a hit as customers

The

pandemic

has

fundamentally

remain

online. obsessed

Non-essentials/luxury with

COVID-related

changed the way the world works, and

essentials — hygiene, sanitation, cleaning,

how people live and think. The changes in

and staples. People are once again buying

lifestyle have long-term implications for the

local, patronising small corner shops.

market and industries.

Understanding this shift in consumer

In Wuhan, the sale of private vehicles

behaviour, the market has to be sensitive

went up after the lockdown eased. People

to their emotions in these trying times,

want to use private vehicles; nobody wants

going that extra mile to be with them

to use public transport anymore. China is

[customers].

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Risk Mitigation in a Post-Covid World

as the damage caused has been drawn

With crises and natural calamities occurring

distress.

out, with immense losses and prolonged

regularly, insurance covers are becoming

Today, industries have moved online,

increasingly important. It also calls for

employees are working from home, and

individuals as well as businesses to reassess

the majority of work is being done remotely.

their risk exposure, to better protect

With these changes, new risk factors

themselves in the future. But, do individuals

come into play, like cybersecurity. With

and businesses invest in insurance covers in

dependence on digital platforms, there has

the wake of disasters? Based on previous

been a spike in cybersecurity threats, with a

experience,

consider

reported rise in phishing attacks, malspams,

insurance to be a cost rather than an

and ransomware attacks. These threats are

investment. The human brain is not wired

prompting insurance companies to match

to see risk; otherwise, we would be staying

their pace with evolving risks. Organisations

in.

are reviewing their cyber risk management

people

generally

measures, remote work processes, and example, conversation about insurance

downsizing.

takes place while a disaster, natural or

On the brighter side, the changes taking

otherwise, is already taking place, and there

place now could be great opportunities

is a dip in interest as soon as normalcy is

for industries to become more resilient in

restored. However, there could be a shift

the future and emerge stronger than ever

in attitudes with the COVID-19 pandemic,

before.

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Status of the GIG Economy SYNERGIA FOUNDATION RESEARCH TEAM

enable easier contracting. This was proven by the market success of gig platforms on ride-sharing platforms, economy hotel rooms, home deliveries, etc. at the expense of big corporations.

by Tina Brown, the then editor of The

The gig economy companies, such

New Yorker in 2009. It was used for

as Uber, Airbnb, Lyft, Etsy or TaskRabbit,

workers engaged in the knowledge-based

connect the worker and the consumer.

projects, consultancies, and part-time bits

quick, temporary job (a gig), which can

and pieces while they transacted in a digital

include any kind of work, depending on the

marketplace”. Since then it has been used

industry.

to describe a labour market with short-term contracts or freelance work.

A Mastercard survey found that the global gig economy generates US$ 204 billion in

In fact, Ronald Coase, Nobel laureate,

gross volume, with transportation-based

predicted the demise of traditional large

services (eg. ride-sharing) taking 58per cent

companies in favour of gig workers if there

of it. Gig workers are not employed solely by

are low costs (money or time) to a customer

people; companies also outsource tasks to

in the search for alternative suppliers who

trained workers, which also gives workers

are small scale, can assure quality, and

the option to work for multiple companies

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in temporary positions. In a report in the New York Times, Google employed 1,21,000 contract-based freelancers in its global

COVID IMPACT 2 in 5 employees are facing

operations in March 2019, compared to

39%

1,02,000 full-time employees. There

one

distinction

here

—

freelancers can be seen as those who mostly associate themselves with companies that

15%

Salary cuts have been planned/ announced

Layoffs have been planned/ announced

have an economic turnout themselves, while gig workers are those who are associated with companies who simply connect workers to customers.

Their Fragility The fragile situation of gig workers stands exposed by the pandemic.

Lacking the

innate protection provided by traditional employment vulnerable

they

lot.

are

Businesses

54%

No impact it’s business as usual

Company might close down

extremely like

public

have advocated “contactless deliveries”

transportation (Uber, Ola) are bleeding,

and have offered free medical consultation

and the victims are these workers. These

for workers. Uber suspended pool rides

human-based businesses depend on real

in the U.S., India, and Canada, and offered

people providing services from end to end. Work from home (WFH) is not a possibility

they test positive for the virus. There have

for most in this segment.

also been tie-ups with other retailers to

What is disconcerting is that this

help keep the gig economy working — with

segment involves huge numbers. In India,

Flipkart, BigBasket and Spencer’s Retail —

close to 1.5 million drivers work for platforms

to provide essentials. Swiggy, Dunzo, and

such as Uber and Ola. According to a report

Amazon have also done the same. Possibly,

published by Invest India, the share of the

a similar reorientation of business models

gig economy is as high as 25per cent in

could have been done to stem the migrant

the services sector in an urban labour force

exodus from urban centres.

totalling over 35 million. During the 2008

Despite these moves, there has been

recession, gig-economy steamrollers like

many lay-offs. Of the approximate 450

Uber and Airbnb emerged and turned

driver centres, Uber operates worldwide,

successful, but this pandemic is defeating

40per cent may shut down. Lyft Inc., the

their business models.

alternative to Uber in North America, is

Mitigating Strategies

said to be dismissing 17per cent of staff and cutting salaries. Airbnb Inc. has said it

It’s not that all gig businesses have

would be cutting a quarter of its workforce.

abandoned their workers; efforts have been

Swiggy plans to lay-off nearly 1,100 people in

made to protect them. Swiggy and JustEat

India, while providing them a few months

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of salary based on their tenure. Reportedly, the Indian government is seized of the matter and is ramping up plans to bring gig workers in unorganised sectors within the ambit of social security schemes.

Projected Gross Volume of the Gig Economy The Gig Economy is projected to grow to $455 B by year-end 2023 in Gross Volume Transactions. (Billions USD) 500

and Work

400 300

gig workers has led to their exclusion from

200

the extended coverage of labour laws and

100

protection. The counter debate is that modern

work realities demand labour laws that have

204.0

2018

R= CAG

248.3

2019

% 17.4

296.7

2020

347.8

2021

401.4

2022

455.2

2023

Ultimately, the pandemic has given most digital platforms an opportunity to show With the prevalence of the pandemic,

that there is the long-term necessity of a

workarounds must be found to keep people safe and employed. This can be done by

industries, such as Uber and Flipkart, shows

minimising contact between consumer

how there can be an inherent support

and workers, providing safety equipment,

network in the gig economy itself, which

and ensuring medical assistance in case

can work towards providing for its workers

they test positive.

and consumers.

| CONCLUSIONS The global economy is staring at a

for intelligent, data-driven supply chain systems for faster and effective

‘World’s Factory’ touches the life of hailed as a miracle of globalisation, it this experience will act as a further dampener on globalisation and “outsourcing” will only be known once voices against globalisation, especially in North America and Europe, are

and machine learning foundation can trigger real-time alerts based on proactively take measures to avoid the

The virus has surfaced when there is erosion of trust within and between occurring at a greater frequency, and the world has to jointly devise global

A global epidemic reinforces the need

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| COVID-19 COMPENDIUM | 91

Global leaders have to rise to meet the challenge by not only tackling the crisis in their own countries help can come through debtrelief measures, postponing debt repayments, lowering tariffs, or entering into trade agreements with developing countries will have to make watertight commitments and ensure 100 per cent transparency in utilisation of economic support rendered by richer countries at great

Aviation has become the sinews of

The government has to provide more support to the pharmaceutical Industry to establish an ecosystem There must be more use of bioremediation, a technology that can treat environmental pollution using microbes, plants, or their xenobiotic and recalcitrant pollutants through physical and chemical

Fear of pandemics will ensure that healthcare emerges as a singular

The industry cannot recover unless the commercial aviation business and greater commercial outreach to Travel phobia may keep most non-

pharma

industry,

coupled

with

Hence, it will be a long, hard, and a

The airline dialogues

industry must have on post-COVID-19

Post-COVID the Indian pharmaceutical industry has the potential to expand both regionally and globally by investing more in R&D and supporting research in Indian

set of standard practices that can be The devil of the API dependency has As the rate of unemployment has increased, families are under acute

the

right

technology,

92 | COVID-19 COMPENDIUM |

teams must start research from basic chemicals upwards, and not from advance intermediates, and give impetus to in-house manufacture

adequate

www.synergiafoundation.org

would be critical through tax sops, dedicated zones for chemical industries, and fast-tracking of

Considering the ballooning Indiapresence of Chinese investments in India, it may be challenging to

Already saddled with an adverse balance of trade, there are fears that many sectors of the Indian industry are not ready to face international disruption caused by the pandemic, it is perhaps prudent to delay the exposure of Indian industry to protection should be temporary, and our long-term commitment should remain focused on free trade (minimal tariffs) and open markets

The Green Revolution changed the face of Indian agriculture, raising it from a subsistence level to a driver

chains will need re-designing, there will be a rebalancing of assets base and supplier mix, and a trend towards trend had, in fact, started earlier, and

The insurance industry could use its experiences from the COVID-19 crisis to evolve for the better, by studying altered consumer preferences marketing of insurance will grow, as customers will increasingly prefer online channels to enquire, assess, interact, and buy insurance, just like providers will have to invest in state-

Innovation is the route to survival and risk management teams need to keep reviewing external and internal risks to stay a step ahead and be prepared for potential and

The pandemic could well be the Considered as a high consumer of natural resources to generate much lesser value; susceptible to climate

of savings in terms of direct and indirect costs that the gig economy offers, it could well become the new

supply–demand variables, it is long

In these disruptive times, building operations resilience will be critical

www.synergiafoundation.org

date, been more successful in the arena of knowledge work, there is a risk of over-reach and too much

COVID-19 COMPENDIUM

| 93

CHAPTER 4

GEOPOLITICS IN THE TIME OF A PANDEMIC ‘GLOBAL ORDER NO MORE’

The West has made its fair share of

INPUTS BY M.K. NARAYANAN,

mistakes, especially in the invasions of Iraq and Libya, the handling of the Syrian

FORMER NATIONAL SECURITY ADVISER, GOI AND GOVERNOR TO WEST BENGAL

of 2008. Yet, the most glaring one as of now seems to be the way the pandemic has

he swing of the pendulum may veer

been handled, especially by the U.S. and the

in favour of China vis-a-vis India, if one

UK.

goes by the sheer display of state

The U.S. healthcare system is not

craft by China in handling the pandemic.

designed to meet the challenges of a

While the West appeared to maintain its

pandemic. The public health system has

lead in terms of economic development,

seen

neglect

with

private

healthcare

education, social welfare, public health, military

people. The initial cavalier approach to the

power, its dealing with the pandemic has

pandemic, claiming that everything was

been suboptimal. The decline in the primacy

under control, when the reality was quite

of the U.S. in the global power equation has

different, added to the crisis. The throwaway

been evident — from President Barack

remarks of the President, and going on the

Obama’s

withdrawal

offensive when it was prudent to seek advice

of an overstretched military from Iraq,

and cooperation from other countries, has

Afghanistan, and the Middle East, to

turned the U.S. inside out.

technological

innovation,

initiation

and

the

President Donald Trump’s mixed signals in

Europe has not fared any better going

Syria allowing for a vacuum to be exploited

by the mortality rates and the sheer lack of

by competing powers. Trump was forced to

direction. The British Prime Minister started

conclude a deal with the Taliban, with few clear gains, and this further diminished the

that herd immunity was the only way out

shine on Pax Americana.

in the absence of a vaccine, but confronted

94 | COVID-19 COMPENDIUM |

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with rising deaths, he lost his way and took resort to a total lockdown, albeit as a way out and not as a well-thought-out strategy. Though the British National Health Service (NHS) is a formidable institution, years of neglect in funding was evident when its lack of preparedness to face an epidemic was cruelly exposed from the lack of basic PPE. Sadly, many of the NHS health workers themselves were struck down by the virus. The one country which was the black swan and is attempting to masquerade as a white swan is China. The Chinese regime could enforce a severe lockdown over a vast swathe of its population, something the liberal democracies could implement only when the situation became desperate, and that too with marked reluctance and against strong public resistance. China is well on the path of recovery with its economy back in action.

However, questions are

now emerging about its transparency at the onset of the pandemic. In its efforts to appear as a responsible world power, China is now sending medical experts, protective masks, and respirators all over the world. Most other Asian countries, such as Taiwan, South Korea, India, and Singapore, have shown great control over the disease. The East is appearing to be the one led by science and quick action, while the West pushes aside the science.

EU COVID Deal Euro 1.1 trillion

Euro billion

EU budget for the next seven years

grant to the worst affected economies.

Euro 360 billion meant for low-interest loans for the most severe victims of the COVID-19 mayhem 170 countries will see their GDP per capital fall by the end of the year. With research showing that 79% of companies with high-performing supply chains achieve revenue growth greater than the average within their industries. According to Forbes Insights, 44% of respondents state that the Amazon effect (the assumption that all e-commerce sites must provide customers what they want, when they want it and at a lower price) is having a dramatic impact on their logistics, supply chain and transportation operations. By the end of 2020, 50% of all manufacturing supply chains will have the capability, either in-house or outsourced, to enable direct-to-consumption shipments and home delivery. (IDC) 48% of supply chain and transportation executives say they are experiencing the need to reevaluate warehouse locations due to shifting trade patterns resulting from changes in the U.S. economy. (Forbes Insights) Businesses with optimal supply chains have 15% lower supply chain costs, less than 50% of the inventory holdings, and cash-to-cash cycles at least three times faster than those not focused on supply chain optimization. (Logistics Bureau)

Post-Covid World

50% of respondents say advancements in technologies are exerting a strong impact on their company’s logistics, supply chain and transportation operations. (Forbes Insights)

Post the pandemic, the world is going to be

The Institut Pasteur in Dakar, Senegal has been

very different. Which country in the world is in a position to stand up? Most of the areas we mentioned are hit by terrorism. West Asia is about to implode because of they have. In the U.S., people are starting

Mologic to develop a new form of rapid test kits for the COVID-19 virus, to be made in and distributed across Africa from their custom-built DiaTropix facility. Similarly, researchers at the Kenya Medical Research Institute have joined the race with their colleagues from across the world in developing new vaccine candidates to meet the COVID-19 challenge.

to talk of it in terms of a declining power,

www.synergiafoundation.org

COVID-19 COMPENDIUM

| 95

etc. Most of the countries in the world are

share their collective resources.

in deep depression of one kind or the other.

This is not to say that the East holds all the

So, many of the measures we could have

answers. With leaders in the East, whether

implemented if the governments around

it be Xi Jinping in China or Putin in Russia,

the world were strong enough like the

the current so-called ‘successful’ leaders

past, but are not. We are going to face the

are those who are practitioners of, for lack

biggest depression the world has ever seen,

of a better word, personal authoritarianism.

with vast numbers of people without jobs,

There is now a willingness to restrict a

huge numbers without health. I think few

degree of securities in the belief that public

governments are prepared for this and the

good takes precedence over everything

only country which has come out of this and

else. This, undoubtedly, raises the question

is preparing to take over the world in some

of what is the perfect balance between

ways is China. Countries like the U.S. and

authoritarianism

Western Europe are going to take a long,

whether when emergency services are put

long time to recover from the pandemic.

in place, is there the trust that they would be

The world will have to decide how we

rolled back after the emergency fades?

are going to deal with this new situation,

and

democracy,

and

where a country that doesn’t believe in

The Counterpoint

international rules and conduct is going to

Naturally, it would not be that easy to

be a dominant power at least in this part of

dethrone the West. Above all, leadership in

the world.

global governance requires a combination

East or West, What is Best?

of performance, diplomacy, and principles. It is not that the West lacks these. It is just that the pandemic brought out the instability of

the West has been questioned. The appeal

its capitalistic practices. The West still stands

of the American model was also sullied by

for upholding a world-class education

gun violence and the mismanagement

system. Most of Europe has nationalised healthcare, and the Scandinavian countries

After the 2008 Great Recession, most of Asia

are examples of the balance between public

was relatively unscathed, while the U.S. and

welfare States and democracies. There

also

concern

about

the

most countries keeping their resources for

violation of people’s rights in the East

themselves due to the fear of shortages at

under authoritarian regimes, and rightly

home. After long talks, emergency packages

so. The Uighur Muslim crisis, along with the subduing of free speech in India has raised

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concerns about whether authoritarianism

The whole concept of the international

can be an option at a time when people’s

community is coming under question. The

identities and personal beliefs are louder

point we need to realise is that if there is no

than ever. There is the concern that once

global community, there is no globalisation.

these regimes employ such powers, would

The only way a global community exists

they also, then equally pull back these

is if the East and West play off each

measures when the time comes? The State

other instead of trying to be one-up on

knows best is the answer to most questions.

each other.

No Man is an Island INPUTS BY MICHAEL CHERTOFF, FORMER SECRETARY, U.S. DEPARTMENT OF HOMELAND SECURITY

the Czech Republic had announced bans on the export of protective gear to avoid shortages at home in March. Although under pressure, India as well as some countries in the European Union did indeed lift the ban, the situation highlighted the fragility of supply chains, which could so easily be broken when national interests overtake cooperative international trade.

f there is one thing that the COVID-19

‘Extraordinary Measures Should be Extraordinary, not Ordinary.’

pandemic has proven, it is that we live in

There’s always a risk that people will

an increasingly interconnected world — of

exploit this opportunity to cement their

goods, services, capital, people, and ideas —

authoritarian tendencies. President Jair

for mutual advantage. However, what has

Bolsonaro of Brazil is trying to use this

become starkly clear are the dangers of this

crisis to push back on his own limitations

very reliance on one another. But, cutting

on power. Chinese President Xi Jinping is

ourselves off from the rest of the world is not

attempting to consolidate his power. The

a realistic option. This issue will surely be part

Chinese, in many ways, tried to overplay

of the political discourse in the years to come.

their hand to minimise the extent of the

Most countries are linked through supply-

pandemic. That has caused a backlash

chain dynamics. When the pandemic hit the

as there is much more cynicism and

United States, Americans discovered that

questioning. It requires us to be mindful

72per cent of its pharmaceutical needs were

and conscious that extraordinary measures

mostly from the European Union, India, and

should be extraordinary and not ordinary.

China. Worse, of this, 97per cent were for

In Hungary, Prime Minister Viktor Orban

antibiotics. It was the dire need to battle

has been granted, by vote, extraordinary

this unknown virus that drove President

powers for an unlimited period to tackle

Donald Trump to threaten India well nigh

the virus, and there is fear he might misuse

to lift the ban on her considerable stock of

it. There is a perception that modern-day

hydroxychloroquine. Germany, France, and

western democracies such as the UK and the

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| COVID-19 COMPENDIUM | 97

U.S. have been reactionary in their approach

not have any wasteful capabilities. The

and have faced the brunt of the calamity.

problem is when one hits a bump on the road. Resiliency is about having a margin of

Data Surveillance

error, an extra layer of fat in the system on

On the debate over using data surveillance

which one can rely upon when winding up

to track the infected, there are long-term

in dangerous times. We need to build our

measures that countries should take. It

systems with that in mind.

consists of building contingency plans,

Second,

global

world

will

applying time-limited emergency measures

affected by global issues, like pandemics,

with clarity over how such measures will be

climate change or massive international

implemented, and by whom.

disruptions on the internet.

The U.S. did this post 9/11. In

A global approach is needed

the

extraordinary

to respond to it. No country

situation, world leaders must

can do it alone, because no

balance the principles of civil

one can have borders that will

liberties

authoritarian

keep out all germs and the

tendencies until we chart a

internet, unless they wish to

clear way forward, and should

be completely disconnected.

present

and

not exploit the situation. China has been in middle of internal and geopolitical disruptions — the upsets in Hong Kong, and the election in

Taiwan.

Unhappiness

also manifests itself in the population over censorship, and in the way they have managed information with respect

the

pandemic.

There are hints of fragility: The

Chinese

always

acted

regime

has

upon

the

Americans discovered that 72 per cent of its pharmaceutical needs were mostly from the European Union, India, and China

There is a category of issues that we need to work on together and come up with

some

understanding

of how we will police these multinational threats. Finally,

countries

themselves

need

take

responsibility of their own health and security. That would mean building a contingency plan and stocking up supplies. This does raise the question of how supply-chains would

assumption that their legitimacy comes

then work. Another part of resiliency is to

from performance. You have economic

have alternative supply chains so that one

damage and the way they have handled

can turn to others in times of need.

the pandemic — there is fragility there.

Resilience, Extra Layer of Fat

The bottom line is this: national security needs to take account of interdependence in a global world. People may not like what

three

they call globalisation, but the reality is that

things. First, the importance of resilience.

given technology, weather, viruses and

The general expectation of a normal society

bacteria, we live in a global environment

The

pandemic

has

highlighted

and it requires concerted efforts.

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On a United Front SYNERGIA FOUNDATION RESEARCH TEAM

n an era of globalisation, many countries

have integrated to form regional Free

their public through trade. Sadly, in the face of the pandemic, as each country husbands

its resources, the common interests of the bloc are suffering. This was well enunciated by the Italian Prime Minister when he

estimated that the EU may see its GDP

called for a coordinated response across the world’s largest trading blocs and reminded

due to the combined effect of a slowing

all that European Union (EU) leaders faced

global economy and the aftershocks of the

an appointment with history that they

pandemic. The landmark Economic Recovery Deal

could not miss.

was signed by all 27 member-countries

Europe Leading the Charge The status of collaboration within the

much political contention.

Negotiated

EU was succinctly summarised by the

alongside the EU’s upcoming budget, or

Commission President, Ursula von der Leyen. She conveyed a “heartfelt apology”

the deal allows for the infusion of funds

to Italy on behalf of Europe for failing to

into European economies over a seven-

come to their aid at the most perilous

year period, helping to recover from

times. She went on to claim “Europe has

the economic tailspin threatening the

now become the world’s beating heart of

Eurozone.

solidarity”. She was referring to fresh joint

First, the deal: it has three principal

initiatives of member countries to share

elements to it. A Euro 1.1 trillion EU budget for the next seven years, a Euro 360 billion

worst affected countries, and initiating the

meant for low-interest loans for the most severe victims of the COVID-19 mayhem

The European Union (EU) has been

and a Euro billion grant to the worst affected economies. To get a perspective of the deal,

economic carnage of COVID-19. With many

it may be interesting to note that it is almost

EU members like Italy, Spain, Greece and

as large as 75% of India’s GDP!

Portugal already in the throes of extreme economic discomfort even before the

deal?

It may be recalled that after the

pandemic struck, the recovery package could not have come any sooner.

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It is

growing disinclination amongst member

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WORLD BLOC RESPONSES

burden of their poorer and worst hit comembers. Weaker economies like Greece were asked to improvise through austerity

THE EUROPEAN UNION EU Solidarity Fund: assistance of up to € 800 million to the worst affected countries € 750 billion in a Pandemic Emergency Purchase Programme, along with € 120 billion in the Asset Purchasing Programme (APP) € 140 million mobilised to develop vaccines, new treatments, diagnostic tests and medical systems.

ASSOCIATION OF SOUTH EAST ASIAN NATIONS After the SARS epidemic, the bloc had carved out a common mechanism for pandemics. Aims to intensify the “timely sharing of information, experiences and best practices and enchance cooperation around regional food security, including through utilising the ASEAN plus Three Emergency Rice Reserve.”

SOUTH ASIAN ASSOCIATION FOR REGIONAL COOPERATION COVID Emergency fund was proposed by the Indian Prime Minister, which April. This is more of a “virtual fund” with no central pooling of money and without a central administrator.

and higher taxes on its citizens. This led to what was called euro-scepticism and calls for the breakup of the union gained voice to these sentiments through its BREXIT move. In what is seen as a move to perhaps save the political idea of the EU, the richer countries have now stepped forward to shoulder a greater burden. The fact that the deal was concluded despite huge differences is itself an achievement.

of the past against debt mutualisation, Germany and France will shoulder the Four’— Austria, Denmark, the Netherlands, and Sweden — have also managed to secure important concessions, such as rebates for their contributions to the EU budget. Member states will have to draw up national recovery plans while pledging

BRAZIL, RUSSIA, INDIA, CHINA AND SOUTH AFRICA (BRICS) BRICS New Development Bank (NDB) issued a 3-year RMB Coronavirus Combating Bond to raise 5 billion yuan

to reform their economic and political systems to be able to gain access to their share of the funds. integration, the recovery fund will allow Brussels to borrow €750 billion on capital

ASIA-PACIFIC ECONOMICS COOPERATION (APEC)

markets and parcel it out in terms of budgetary

released, but is a focus on dealing with the impact on SMEs including lending facilities, lowinterest loans, etc.

core proposal Next Generation EU stipulates

support to countries on a need-basis. The that about €390 billion will be distributed in the form of grants and €360 billion in low-

NORTH AMERICAN FREE TRADE AGREEMENT (NAFTA) The NAFTA bloc is in the middle of a transition to United States-MexicoCanada Agreement (USMCA).

interest loans as a core component of the EU’s Recovery and Resilience Facility. For countries such as Spain, Italy, and Greece, the hardest hit by the pandemic, this fund will provide much-needed economic relief.

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ASEAN

BRICS

After the SARS epidemic, the bloc had

For the BRICS countries, the OECD predicts

carved out a common mechanism for

a potential GDP decline at constant prices

pandemics. This had seven components —

of over 20per cent in Brazil and India, 23per cent in Russia, about 19per cent in China,

Operations Centre Network (Malaysia); Field

and 17per cent in South Africa. The BRICS

Epidemiology Training Network (Malaysia and

New Development Bank (NDB) issued a

Thailand); Bio Diaspora Virtual Centre for Big

three-year RMB Coronavirus Combating

Data Analytics (Philippines); Risk Assessment

Bond to raise 5 billion yuan (US$ 706 million).

& Risk Communication Centre (Malaysia);

The NDB has also approved an emergency

Regional Public Health Laboratory Network

assistance loan of 7 billion yuan (US$ 1 billion)

and Public Health Laboratory Network for health hazards. These mechanisms did not

BRICS countries are yet to come together

meet the expectations as the suddenness

to form a joint strategy, although, during

of the pandemic allowed little space for

the recovery phase, they may collaborate to

coordination.

expedite the recovery process.

ASEAN sought cooperation from China, Japan, and South Korea in “timely sharing of

information,

experiences

and

APEC

best

practices, and enhance cooperation around

Cooperation convened in Malaysia to

regional food security, including through

discuss strategies for the surveillance

utilising the ASEAN plus Three Emergency

and

Rice Reserve”. The ASEAN Risk Assessment

APEC economies are also examining

and Risk Communication Centre, hosted

supply-side

by Malaysia, has now taken the lead in

vaccine-based public health responses.

risk communication initiative for public

“Saving lives is obviously what matters

communications throughout the bloc. An

most right now,” said the Chair of the

ASEAN Response Fund is proposed.

APEC Business Advisory Council (ABAC),

management

strategies

the to

outbreak. strengthen

Dato Rohana Tan Sri Mahmood. “This

SAARC

demands

The COVID emergency fund was proposed

region on the knowledge and the tools

by the Indian Prime Minister, which had

we need to combat the health impacts

accumulated US$ 21.8 million by April. This

and mitigate the most severe economic

is more of a “virtual fund” with no central

consequences in the short term,” she

collaboration

across

the

pooling of money and without a central administrator. Each member would take

not yet been released by APEC, the focus

its own decision on implementation of

is on dealing with the impact on SMEs,

their commitments. India has also offered

including lending facilities, low-interest

assistance in material and services to

loans, moratoriums on rental payments,

neighbouring countries, if required, an

tax deferrals, and wage subsidies for three

Armed Forces Humanitarian Assistance

months. This is guesstimated to amount

Teams have been placed on standby.

to US$ 471 billion.

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NAFTA

MERCOSUR

The North American Free Trade Agreement

Member

bloc is in the middle of a makeover, trying to

Paraguay and Uruguay, and later joined

change its image to the U.S.-Mexico-Canada

by Venezuela and Bolivia. Also called the

Agreement. While Canada and Mexico

Southern Common Market, MERCOSUR

have come on board with the plan this year,

has approved US$ 16 million for the

the U.S.’s stance on the agreement has to

multinational project “Research, Education

emerge. The NAFTA 2.0 deal does, however,

and Biotechnologies applied to Health,” to

countries:

Argentina,

Brazil,

emphasise an “enforceable biotechnology chapter,” as per the council. The deal has taken a backseat during the crisis.

5.2%

According to World Bank forecasts, the global economy will shrink by

Post-Covid Geopolitical Equations and India SYNERGIA FOUNDATION RESEARCH TEAM

North and the South to vitalise multilateral contributor to the budget of multilateral agencies like the WHO, and the IMF, its the activities of these institutions, and over the years have earned considerable goodwill. This is the time to strengthen WHO and IMF, and India must put its weight behind like-minded

OVID-19 has reinforced the need

countries. India must push for a coordinated

for a collaborative action plan and

and global economic rehabilitation plan, strengthen international institutions and

agencies. International governance can still

multilateral dialogue, and give a boost to

redeem itself by a coordinated response

globalisation.

and tempering the tensions between geopolitical rivals like the U.S. and China.

United States

Better still, with a collaborative approach, we can prepare better for the next pandemic. India can act as a bridge between the

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been diminishing, and the crippling effect of COVID-19 may further damage its standing.

www.synergiafoundation.org

However, the U.S. is still the most

Macron has been playing a leading role by

powerful nation and will remain so for some

trying to use the G7 and G20 to deal with the

time to come.

economic and geopolitical consequences

India’s strategic partnership with the

of COVID-19.

U.S. remains strong, despite a few minor

India is in a good position to act along

hiccups, and India should endeavour to

with European countries, led by Germany

strengthen it further post-COVID-19. India’s

and France, to build up a relationship with

gesture of meeting the U.S. requirement of

South Korea and Japan as part of the post

Hydroxychloroquine and its formulations

COVID-19 “alliance for multilateralism”. A

was a step in the right direction. A new

weakened EU would need India’s markets. Europe too may look for alternative supply

pandemic blows away. The pandemic

chains. Post-BREXIT, bilateral trade, and

could trigger resentment and antagonistic

investment opportunities with the UK are

sentiments in the West against China amd

there to be exploited.

whether that could be turned to India’s advantage is something India has to

The Middle East

incorporate in its geostrategic calculations.

Oil-producing countries face an uphill battle to recover from the economic fallout.

Europe

Iran has been most severely

Europe will emerge bruised

impacted by the pandemic

and

and crashing oil prices. It

battered

from

the

COVID-19 having topped the 1962, approached the IMF for

charts in morbidity, mortalities, and the manner in which the whole crisis has been dealt

isolated in the Middle East.

with. Coming so soon after BREXIT, it may trigger a further weakening of the EU with rightist

movements

within

individual States. Propped up by fears of the renewed migrant crisis, these right-wingers may seek stronger border controls, disrupting the freedom of movement so important for the idea of the EU. However, Europe can play a vital role in acting as the bridge between the U.S. and China to bring back globalisation and multilateralism into play. French President Emmanuel

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The OECD expects global GDP to return to its pre-pandemic level by Q3 2021, however, economic output is expected to remain below late-2019 levels in many countries.

proxies, there is a danger that the regime could try to provoke external crises in the political pressures. India must join other nations to seek a relaxation of sanctions on Iran to enable import of critical medical supplies. It is critical that the falling oil prices do not

trigger

economic

collapse in the Middle East as millions of Indian ex-pats would be affected and India’s remittances would drop.

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‘Humanitarian’ Silk Route China-based Alibaba Foundation donated INPUTS BY PATRICK MENDIS,

PPE (personal protective equipment) and

FORMER AMERICAN DIPLOMAT & VISITING PROFESSOR NATIONAL CHENGCHI UNIVERSITY

but also to the U.S.

other medical supplies, not only to Europe, China is displaying proactive leadership through its already established HSR. Of course, there have been adverse reports of its medical equipment not being up to

standard. he Health Silk Road (HSR) dates back

In the post-COVID-19 scenario, China

to 2017 when Chinese President Xi

is likely to leverage the goodwill earned

Jinping signed a memorandum

through its

HSR for its commercial

of understanding with the WHO for the

enterprises, like Lenovo and Huawei, who

construction of the HSR, with a promise

are now marketing ventilators and other

of over of US$ 30 million. The aim was to

medical electronics to members of the BRI

improve public health in countries along

in Europe.

the Chinese belt.

This diplomatic heft would help China

Since the beginning of the pandemic,

achieve its mission to become the most

China had tried to turn the concept into

prosperous nation in the world by 2049. Of

reality through diplomatic engagement

greater interest to India would be China’s

and despatch of medical aid. The aid

strong bilateral relations with South Asian

provided to Italy was its major activity,

countries, and the willingness to open its

which was given wide publicity. Even the

purse strings in these desperate times.

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Disrupted Supply Chains China was able to compete ahead of every other country in supply-chain dynamics to western countries. In a post-COVID-19 scenario, if other countries like India are for global supply chains, then they would

immensely from supply chains aligned to western markets, it is an irony that the West is now suffering from a disrupted global supply chain. A global supply chain is for everybody. China now has been through a discussion on whether it should focus on domestic supply chains themselves. This re-thinking has been based on the principles of Tao

and

Confucianism.

The

western

concept of competitive supply chains has overwhelmed all countries, including China and India, and it is not a sustainable feature.

BRI investments show highest share of renewable energy investment, amid a 50% decline in total BRI investments [Green Belt and Road Initiative Center]

There are, however, some to whom China’s COVID-19 aid seems to have a more intrusive bearing. Chinese supplies to

for delaying the acknowledgement of a

countries like Spain, Italy, the Netherlands,

new deadly virus amongst its citizens, and

and India, have turned out faulty by local

allowing its spread during the Lunar New

standards. Severely affected countries have

Year exodus of the Chinese all over the

termed Chinese supplies as “paltry” when

globe. Also is suspect the strong Chinese

compared to its massive manufacturing

hold over the WHO, which was clearly

potential.

hesitant

undertaking

independent

The world is unlikely to forget or forgive

investigations of the developing crisis

China for its lack of transparency, the

and accepting, at face value,

second time over (after the SARS epidemic),

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Chinese statements.

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‘Globalisation with Localisation’ INPUTS BY BOON HUI KHOO, SENIOR DEPUTY SECRETARY, MINISTRY OF HOME AFFAIRS, SINGAPORE AND FORMER PRESIDENT OF INTERPOL

everyone on its shores equally, whether a foreigner or a resident. All are being given free treatment in the same hospitals, and get equal access to equipment and medicine on a par with citizens. We have Chinese tourists; then from Malaysians who travel to Singapore to work; third from

ingapore’s fall from the ‘gold standard’ pandemic is attributed to employing

students overseas who returned home; and

unsophisticated contact tracing methods

Globalisation

as a deliberate choice.

Unfettered globalisation would no more be

Singapore abides by two inherent

the norm. Instead, there would be a move

principles — preserving individual privacy

towards

and rights, and giving equal opportunity

— starting supply chains domestically —

globalisation

with

localisation

and care to all. When Singapore was hit by SARS, there were only 238 cases and 33 fatalities. The police

possibly also lead to geopolitical tensions.

had helped the Ministry of Health in contact

However, Singapore is a price taker, it

tracing. That was quite an achievement.

does not set rules, it follows the rules. It needs

But, this time around, we didn’t opt for

globalisation, and so follows appealing

technologies that are more intrusive because

strategies to overcome the crisis.

it was an issue of privacy and rights. We shut

As for China’s perceived global might, there is a feeling that businessmen in

That’s the price we had to pay because we

Singapore are looking towards China, as

didn’t want to be perceived as a State where

that is where the money is. However, the

the police could have overarching powers.

Singaporean government and its people

Our country also prides itself in treating

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are well informed and wary.

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Change of Guard enterprise’ within Chinese socialist thinking, and opening up to foreign investment.

MAJ GEN MONI CHANDI, CHIEF STRATEGIC OFFICER, SYNERGIA FOUNDATION

According to the IMF, in terms of purchasing power parity, China’s GDP is the largest followed by the EU and then the U.S. China’s competitive advantage stems from three factors. First, lower wages to workers

n the last 75 years, the liberal world order

because of lower cost of living standards.

strengthened

institutions

Second, the Chinese yuan enjoys a low

(UN, WTO, IMF, World Bank), promoted

exchange rate with the U.S. dollar, making

multilateral

democracies around the world, developed

their

the open-market system of trade and

the Chinese government’s collaborative

attempted

support to big business.

create

rules-based

international order. From 1978 onwards, the economy of the

exports

price-competitive.

Third,

The Rise of the EU

People’s Republic of China (PRC) grew at

The vision of the EU was to ensure free

an astonishing rate of 9.5per cent annually.

movement of people, goods, services and

From a per-capita GDP of less than US$

capital, within its region. This has been largely

300, it grew to more than US$ 18,000. Deng

accomplished with the abolition of passports

Xiaoping was the architect of modern China

within the Schengen region, the creation of a

and he is credited with the introduction of

single internal market and a standard system

many reforms; including, strengthening

of laws with voluntary participation. The

university

economic performance of the PRC and the

education,

making

new

constitution for the Chinese Communist Party

(CCP),

institutionalising

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‘free

challenged U.S.’s otherwise pre-eminence.

COVID-19 COMPENDIUM

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By not paying their dues to the UN

only helps to control appreciation of the

and the WHO, reneging on the Palestine settlement, and walking out of the UN

nations. Since 1900, Argentina, Hungary,

convention on climate change, the U.S.

Iceland, Venezuela, Zimbabwe, Germany

appears to have voluntarily stepped back

amongst others, have all experienced runs

from global leadership.

on their respective national currencies.

US Dollar is Still King

If despite quantitative easing, the US dollar continues to rise in value, the U.S. government may request the G-7 to release

and investors prefer to hold US dollars. While drawing down on credit, they prefer

their dollar holdings to meet the demand.

to receive US dollars. To preserve wealth,

Largest Debtor Nation

they prefer holding US assets, which needs

“The dollar is our currency but it is your

US dollars. Banks and even central banks of

problem,”

nations take in more US dollars than they

Treasury Secretary was famously cited

would otherwise need. Thus, despite the

during his address to G-10 Finance Ministers

pandemic, the US dollar has appreciated in

in 1971.

John Connally, the then US

value, against most currencies. As on April 7,

Debt rises when one spends more than

2020, the US dollar had gained 6per cent in

one earns. As of April 2020, U.S. national

value from its lowest point in the previous

debt was estimated at US$ 24 trillion. Due

month. Even against the Euro, the US dollar

to the coronavirus pandemic, the U.S.

has appreciated 3.5per cent, since January 1, 2020.

a record US$ 3.8 trillion (18.7per cent of GDP)

However, most U.S. economists are not happy with the appreciation of the

this year. The U.S. public health system is known

dollar because it makes U.S. exports more expensive though it also makes imports

increases in life expectancy, there are

cheaper.

growing numbers of senior citizens who

In response to the surge in dollar demand, the U.S. Federal Reserve has

Shortfalls in budget have been met by

resorted to quantitative easing, by printing

increasing

and releasing more than US$ 700 billion

interest. While the government may have

into the market. Quantitative easing not

some control over domestic interest rates,

federal

debt,

which

costs

Despite the pandemic, the US dollar has appreciated in value, against most currencies. As on April 7, 2020, the US dollar had gained 6 per cent in value from its lowest point in the previous month

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the U.S. has committed interest payments on international debt. Both PRC and Japan each hold more than a trillion dollars in U.S. debt. The federal government does not have income to meet its expenditure. Cheap imports from the high-value dollar has made domestic production uncompetitive and populist tax measures have curbed government revenues. Cost of public health, increasing federal

The US-China Growing U.S. trade balance with China from 2014 to July 2019 (in billion U.S. dollars) U.S. exports to China -367.33

-344.82

483.20

468.47

U.S. imports from China -347.00 462.54

-375.58 505.47

Balance

-419.53

debt, and shortfall in national income are recent but have progressively aggravated over decades. The bottom line is that U.S. national debt is increasing every year and at

-167.04

539.68

219.04 123.65

115.87

2014

2015

129.89

115.54 2016

2017

120.15 2018

52.00 H1 2019

Source: United States Census Bureau

some point in the future, bills will be called for payment.

encouraging US customers to buy more

Bedfellows: US and China

expensive but US-manufactured products. Any policy that makes US customers

has consistently exceeded US$ 300 billion

pay more, merely to eliminate foreign

annually.

mobile

competition, violates the open-market system

phones and manufactured products were

of trade that has been the cornerstone of U.S.

the major US imports from China, totalling

foreign policy for over seven decades. In terms

US$ 452 billion, while aircraft, soybeans and

of free trade, the US needs to increase exports

were the major US exports to China, totalling

to China to match their demand for imports.

a mere US$ 106 billion. The PRC’s consistent

After years of tit-for-tat tariffs, the January 15,

trade surpluses over decades has helped it

2020 US-China trade agreement, offers little

to accumulate the largest foreign exchange

clarity except making for a truce during the

reserves in the world, estimated at US$ 3.9

US Presidential campaign.

2019,

computers,

trillion (March 2020). been concerned with the situation. On

Chinese Perspective & the Mandate of Heaven

one hand, he could try and force China

The PRC would like yuan to replace the US

to appreciate the yuan against the dollar,

dollar as the world’s popular global currency.

but that could make the same imported

In order to achieve this, it has a monetary

Chinese product more expensive to U.S.

and infrastructure plan. The monetary plan

customers. Alternatively, he could impose

encourages both the use of the yuan in

additional tariffs on Chinese products

international contracts and the holding of

(which he has done) but that would also

part reserves in the yuan by international

make the products more expensive at

banks. Both these measures are expected

home. Perhaps the President’s intention is

to make the Chinese less dependent on the

to make Chinese imports more expensive,

US dollar.

President Trump has understandably

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In 2013, the PRC launched the Belt & Road Initiative (BRI) to connect Asia, Africa, and Europe with a network of land and maritime corridors. The plan promises to improve regional integration, increase trade, and stimulate economic growth. It involves trillions of dollars of investment for ports, roads, railways, and tele-communication networks. Created in 2016, the Asian Infrastructure Investment Bank (AIIB), is a multilateral development bank structured Beijing, it has 102 approved members,

on federal debit, balance of trade, and

including India. While Nirmala Sitharaman,

monetary policy. China, with its ample

Finance Minister, is a governor of the bank,

foreign exchange reserves and export-

Atanu Chakraborty, Secretary Economics

focused economy, will be in a better position

Affairs, is an alternate governor.

to assist recovery of the global economy in

The BRI is key to PRC’s emergence on

the aftermath of the pandemic and the BRI

the world stage. It provides an investment

and the AIIB unlikely to face competition

opportunity for China’s foreign exchange

for infrastructure projects. China is also

reserves, most of which are tied up in low-

likely to use the opportunity to transfer

return U.S. treasury bonds. It also provides

funds from U.S. treasury bonds to more

new markets for China’s high-speed railway

remunerative infrastructure projects. The current scepticism for BRI is likely to give

steel and metal exports. Further, it provides

way to more pragmatic embracement, in

China with the power and prestige it has

Asia, Europe and Africa. Bretton Woods

sought since the humiliation of the Opium

institutions (IMF and World Bank) as well

Wars.

as the UN and WTO, should become more

No matter who wins the U.S. presidential election in November 2020, the incumbent

representative of Asia (China and India), in the emerging world order.

Further, with remarkable increases in life expectancy, there from the decrepit system

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India and China: Ancient Bonds Need Fresh Stimulus INPUTS BY NIRUPAMA RAO, FORMER FOREIGN SECRETARY OF INDIA, FORMER AMBASSADOR OF INDIA TO CHINA AND THE UNITED STATES

he India-China relationship, despite

almost inconceivable crowd” turned up to

differences, is too important to

greet him at the station, he was felicitated

squander. The future should be

by a gathering of scholars led by Liang

built on a balanced partnership that works

Qichao, who spoke of Indians and Chinese

for a world order that is inclusive, open,

as brothers, anticipating the slogan of the

compassionate,

development-oriented,

and respects diversity

Old Bonds between China and India

depth and feeling. In Liang’s words, “We are brothers, India is our elder brother and we are the younger. This is not only an expression of courtesy. We have got

While there would be ups and downs

ample proof of that statement in history…

in geopolitics, with regional and global

Indians did not covet anything from China.

competition between nations, there are

They gave us the sadhana (contemplation,

certain threads that bind them together.

meditation, and focus) of freedom, and

India and China, two of the world’s ancient

maitri (friendship). .... Rabindranath has

civilisations, have always shared a cultural

come to us from the country of our elder

bond. This two-nation connect was never

brother.” Tagore responded saying that

more highlighted than in the reverence of

India felt a “very great kinship with China”,

Rabindranath Tagore. The joint celebration

sraddha as he called it, which translates to

of the birthday of this great poet, artist,

mutual respect, awareness, and kinship.

novelist and musician -– a true Renaissance

Tagore’s ideal was the universal human

man – both in India and China with equal

spirit linked by reason and rationality

fanfare, is a manifestation of such bonds. When Tagore visited China in 1924, he

nationalism. Today, as every corner of the

said: “Where is the difference between

world is ravaged by a virus, the world needs

China and India?” In Beijing, where “an

to be reminded of the need for rationality, for

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the respect of universality that rises above the

Challenges of the Pandemic The world is on edge. It is on the brink of what could be a cataclysm that is both societal and economic which tests human resilience. And yet, nations act as if it is business as usual, continuing to pursue outstanding

differences,

unresolved

problems, old grievances, and rivalries, in the race towards global leadership or regional supremacy. Insularity, the chase of narrow ambition, jockeying for spheres

The Chinese-Indian Trade Relationship Trade in goods between China and India in 2018* Chinese exports to India Electronics and machinery Chemical products Metals Textiles Plastic and rubber Indian exports to China Mineral and Oil Chemical products Textiles Electronics and machinery Metals

$ 36.8b $ 12.8b $ 5.9b $ 4.0b $ 3.2b Total exports $ 4.8b $ 3.6b $ 1.9b $ 1.4b $ 1.2b

$ 75.5b

$ 16.6b

China to India

India to China

Source: UN Comtrade/BACI Internatinal via OEC/MIT

seem to be the preferred route. The speed with which the disaster, the by French President Emmanuel Macron recently) that is COVID-19, has overwhelmed all nations and it should induce much greater sobriety in the way nations think. pointing, and countries such as the United States and China, the leading powers, have also succumbed to this exercise, infusing the current situation with even greater complexity. The grammar of so-called diplomatic language has descended into depths that reduce it to street insults. This only compounds the tragedy because

chart a vision and plan a strategy. What is

“grown-up nations are supposed to behave

the future we want? It is not about kicking

like grown-ups”. Where there should be

the can down the road. Two to three years

convergence, there is divergence and

from now, what is the world we want to see?

dissatisfaction.

Populism,

protectionism

and the retreat to isolationism is the natural

The Complex Equation

backlash from the dislocation. Many worlds

India

are colliding.

relationship. Both are Asian giants, but with

and

China

have

complex

What is diplomacy without a strategy,

an irksome frequency, their interaction is

without a vision? And a vision must be

fraught with tugs and pulls, with repetitive

We have to think about a future when we

resolution despite all the positive outcomes

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that capture media headlines when our leaders meet, informally or formally. This year commemorates 70 years of diplomatic relations between the two countries. While a pandemic rages, there is news that we are engaging in confrontations along our shared borders. New generations of young Indians and Chinese have grown up on a diet of strong nationalism, quite different from the vision of Tagore, and despite the processes of globalisation that like a tide, have lifted up boats in both nations. Historically, both nations are not known to have practised hegemony, or indulged in armed conquest,

India-China relationship, despite their differences, is too important to squander. The issues that should determine our future are questions of

rather we are purveyors of civilisational values, or peaceful commerce, and rich cultural traditions. But looking back over

avoid ‘the Thucydides Trap

the last 70 years, both are seemingly intent on charting a course more in line with habits and practices imported from

modernisation,

development,

freedom

the Western playbook, the precepts of

from bondage and equality for all. The

Westphalia seems to override the principles

present generation too must be guided by that spirit, of constructive cooperation

peaceful coexistence of all beings that the

rather than mutually wasting and narrow

great Sakyamuni preached 2,500 years ago. Will the pandemic teach us lessons? The India-China relationship, despite their

The Future Path

differences, is too important to squander.

First and foremost, both nations have

The issues that should determine our

to ensure that there are self-correcting mechanisms

that

are

built

into

our

Both have to avoid ‘the Thucydides Trap’,

relationship that will prevent it from

although in the present context it has not

becoming prey to self-destructive threats

been applied precisely; the war between Athens and Sparta cannot be a paradigm

relationship built over the last two decades

for a 21st century Asia.

must serve the cause of the peoples, not

The May Fourth Movement was an anti-

just mercantilist interests. The aspirational

imperialist, cultural, and political movement

youths of both countries must not be denied

which grew out of student protests in

livelihoods, skill enhancement, access to the

Beijing on that day in 1919. The spirit of the

fruits of technological advancement and

young men and women of China, who led

progress. Public health and education must

that movement, is remembered to this

become the new frontiers of cooperation.

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COVID-19 COMPENDIUM

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changing direction and the need of the hour technologies that have mass application and

is moral leadership.

Multilateralism that

eschews hegemony, needs strengthening and mass transportation, environment

and preservation.

protection and pollution control, climate

Organisations such as the WHO cannot

change and renewable resources, bio-

be dismissed just because its work during

tech,

and

the pandemic could have been better.

communications should form part of our

WHO is relevant to the process of coming

bilateral relationship.

up with sensible strategies to combat the

pharmaceuticals,

electronics

Hundreds of global leaders and opinion

pandemic, and to develop global protocols

makers have advocated the absolute

for mitigation, treatment and prevention of

need for a COVID-19 vaccine, which when

the disease as also against future biological

developed, would be available to all --

threats.

patent-free -- and produced at scale, at

The future should be built on a balanced

no cost to people any where. This ‘people’s

partnership between India and China, as

vaccine’ should be a common goal towards

mutually responsible countries, that work for a world order that is inclusive, open,

talents, resources both human and material.

compassionate, development-oriented and

There is also a need to institute an impartial

respects diversity and the rule of international

inquiry into the origins of the pandemic so

law. Both must build middle ground in a

that its cause and spread can be unravelled

polarised world and stress on the core values

and fool-proof protocols can be developed.

as a humanity. It could perhaps be the start

As the Canadian historian Margaret MacMillan said recently, the river of history is

We Can Win this Battle by Working Together: Sun Yuxi

of a ‘Himalayan Consensus’ between India and China that can apply to the world.

My three years as Chinese ambassador in India left me deeply in love with the land and its people. During my tenure here, China and India established a strategic, cooperative partnership for peace and prosperity. Since then, I think our people have enjoyed more in-depth exchanges and cooperation, and

INPUTS BY SUN YUXI, FORMER CHINESE AMBASSADOR TO INDIA

our two governments have coordinated more on major international and regional affairs. Now, the COVID-19 outbreak is posing a severe challenge to mankind. While global efforts have come to a crucial point, I think

am here to talk about cooperation

solidarity and cooperation are the most

against the COVID pandemic.

epidemic.

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Viruses are enemies of mankind. They respect no borders, and epidemics do not distinguish between races. We are now in the same boat. I would like to focus my attention mainly COVID-19. We can win this battle by working together. China has taken responsibility and provided support to the international community. We have worked closely with international and regional organisations, especially WHO. We have sent many medical teams to other countries and provided huge amounts of medical supplies. What we have done is based on the belief of building a community of a shared future for mankind. China and India are both ancient civilisations, with populations accounting for more than one-third of the world. So, I think that we have all the reasons to strengthen cooperation. So far, China and India have been maintaining close communication and cooperation on the pandemic and control. The leaders of our two countries have exchanged

messages

and

telephone

calls. We both believe in strengthening international cooperation. This reminds me of the touching story of Dr. Kotnis who went all the way to China during the Second World War to support the war of resistance against the Japanese aggression in China, carry forward his spirit of internationalism against the epidemic.

Mutual Medical Assistance I have noticed that at a critical moment government provided medical supplies to

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SINO-INDIA TRADE RELATIONS It is estimated that Chinese manufacturers make around 40% of all APIs (active pharmaceutical ingredients) used worldwide and that China and India are the source of 75% to 80% of the APIs imported into the U.S. India relies on China for about 70% of its supply of APIs. And for some well known drugs, such as paracetamol, amoxicillin and ibuprofen, India is almost 100% dependent on China. India is the third-largest producer of pharmaceuticals in the world by volume. The country’s Department of Pharmaceuticals reported that it supplies 20% of global exports of ‘generic’ drugs. India also produces 65% of the World Health Organisation’s requirement of DPT – diphtheria, pertussis, and tetanus – and tuberculosis, as well as 90% of its measles vaccines. March 18: India provides 15 tonnes of medical supplies to coronavirus-hit China comprising masks, gloves, and other emergency medical equipment at a cost of about Rs. 2.11 crore. April 14: Indian companies and government entities place orders for 15 million Personal Protective Equipment (PPE) kits, including gowns and masks, and 1.5 million rapid testing kits from China. April 16: Of 1,70,000 PPE kits that arrived in India on April 5, about 50,000 failed quality tests.

BILATERAL TRADE

85.17

BILLION YUAN

TRADE DEFICIT FOR INDIA

$56.77 BILLION As of Feb 2019

| COVID-19 COMPENDIUM | 115

The Chinese people, and the Indian people

with India, strengthen medical and health

have shown their support in various ways. All this valuable support and assistance will be

However, in a crisis like this, I feel very sorry

greatly appreciated and long remembered.

to hear leaders or politicians complaining,

And since the outbreak of COVID-19 in India, we in China have shared the same feeling and

game. Such moves will likely divide the

have also extended a helping hand. China

international community, lead to prejudice

has, in a timely manner, shared experiences with the Indian side in epidemic prevention

hurt the shared interests of the world. At

and treatment. Some Chinese provinces

present, I have learned that the Indian

and cities have donated medical materials,

government has taken strict prevention

and many Chinese companies and charities

and control measures, which has delivered

have provided India with a large number

positive results. India’s victory in epidemic

of medical supplies, such as facial masks, protective suits, gloves, and ventilators. I’m sure that China will continue to jointly work

Seeking Harmony from Shared History

sincerely wish India an early victory.

I would just like to say that China and India really have so many similarities and so many ways that we could collaborate closely. Firstly as Ambassador Sun said we have a long civilisation - India is a long civilisation and China has a long civilisation - we really have a long tradition of working

INPUTS BY WANG HUIYAO,

together. One of the early Chinese returnees

PRESIDENT, CENTRE FOR CHINA AND GLOBALISATION

brought Buddhism from India. So we see

was an Indian of the Tang Dynasty and he a lot of cultural heritage as well. We have a lot of similarities in terms of urbanisation, rural

development,

infrastructure,

think we had a very excellent discussion

telecommunication, and now particularly

this

we have to share with each other on public

afternoon.

really

appreciate

Ambassador Rao and Ambassador Sun.

It’s very positive, it’s very constructive, and it’s

As Wang Feng said, Indian experts

very forward-looking. And we are backed up

are actually really those leaders that are

by so many distinguished panelists - from

collaborating with India. We have a TATA in China, we have a lot of Indian companies

share experiences, and how we can support

in China. There’s a huge potential. In the

each other. The global value chain that

future, we should have more student

we’re in, where we are in the same situation

exchanges. I understand there are some

and can help each other.

Indians studying in China, there should

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also be more Chinese studying in India. We

friend Tobby Simon as a counterpart to co-

should have more tourism. India is such a

organising this and my staff for putting this

nice, big, civilised, traditional country with

together. It’s been a great exchange. And

many historical sites to be seen. China had

so many people have viewed this, and we

150 million outbound tourists before the

hope we have more to generate on this. So

coronavirus. So we hope more tourists go

thank you again for participating in this.

to India and more Indian tourists come to China. I think there are many ways we can work - we should simplify visas, have more airline connections - we should have more close collaborations. Being the two most populous countries neighbouring each other, we have every reason to collaborate and work together. As we said at the beginning, if China and India combined, it

Chinese Opening Gambits SYNERGIA FOUNDATION RESEARCH TEAM

some historical misunderstanding, but I think

now,withtheeconomyandallthethingsgoing

military moves made by China have left

on, we have all the reason to work together. If

the world with a degree of unease. With

we really think about the two biggest giants

the pandemic still on, China watchers have

in Asia we should really set good examples of

been surprised by its aggressiveness so

collaboration. This webinar is a good example

soon after its Wuhan crisis. Recent Chinese

of how China’s and India’s businesses,

gambits send signals that the pandemic

public, academics, and think tanks can work

has in no way slowed China’s relentless

together and is a good way to exchange.

march to global primacy.

would be 1/3rd of the world’s population. we’re a peace-loving country. There may be

hile geopolitics is not hostage to pandemics or any other act of nature and tends to have

its own dynamics, the recent political and

I hope that in the future we can continue the dialogue. We should try to seek common

by the National People’s Congress (NPC) of

ground

the PRC of a new national security law to be

and

minimise

the

differences.

I think the economic dividend between the

extended to Hong Kong.

two countries will unleash more desire to collaborate for both countries, we need each other.

stand-offs during the summer months are

China has a lot of experience gained

not extraordinary, it is the scale and choice

from its dense population. That experience

of location that has caused ripples amidst strategic circles. These two incidents are not in isolation. The Chinese have been

I’m glad we had a very good discussion

active in the South China Sea too, sinking

this afternoon. I want to thank Ambassador Rao and Ambassador Sun, and all the

Malaysian offshore oil platform and have

distinguished panelists. I want to thank my

been admonishing Taiwan.

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| COVID-19 COMPENDIUM | 117

Vice on Hong Kong It has always been Beijing’s contention that the unrest in Hong Kong has its roots overseas. With the new security law for Hong Kong, it intends to plug the “foreign interference” in the politics of Hong Kong. With the Chinese proclivity not to dither once a decision has been made, it is feared by those who cherish the unique freedom enjoyed by Hong Kong despite being part of an authoritarian state, that within a few months, the new law would be effective.

systems’ is China’s basic state policy, the

The bill will permit Chinese national security

Central Government has all along fully

organisations to set up their agencies in

and faithfully implemented (the system)...

Hong Kong, thus extending their reach over

in which the people of Hong Kong

Hong Kong.

govern Hong Kong with a high degree of

When China regained sovereignty over Hong Kong from its colonisers, the British, ‘one country, two systems’ principle. This

autonomy,” he said.

Tensions along Himalayan Frontiers

ensured that Hong Kong, for at least the next 50 years, would continue to have

intruded into the Galwan Valley in Ladakh

separate

in June 2020. This area is well within the

legislature, and freedom of speech and

Indian side of the Line of Actual Control

political activities. Vide article 18 of Hong

(LAC), which although not demarcated or

Kong’s

delineated yet, is accepted by both India and

restricted from applying its mainland laws

China as a working international boundary.

on the territory, except those related to

In response, India also staged forward its

national defence and external policy.

troops and upgraded its alert levels to deal

independent

judiciary,

mini-constitution,

the

PRC

The dual standards for Hong Kong have

with any contingency. However, there are

suited China’s economic interests as Hong

other intrusions at multiple points along

Kong was the ‘golden goose’ that attracted

the LAC. Mechanisms exist to deal with such stand-offs.

law spell the doom for the ‘one country

However, the size, composition and level

two systems’ principle? In any case, China

of preparedness of Chinese troops in the

has been assiduously nibbling away at the

Galwan Valley indicate their intention to dig

autonomy of its city-state for some years

down and hold position.

now and perhaps, the unending mass protests have forced its hand.

International Reactions

Chinese Premier Li Keqiang assured the

There has been widespread criticism in

international community that principles

the western media on the Chinese action.

would remain intact. “’One country, two

The U.S. was especially vociferous in its

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criticism, claiming that “the NPC’s decision

has imposed a massive 80 per cent on

means Hong Kong is no longer politically autonomous from mainland China”. It has

due to Australia pushing for a coronavirus

threatened to revoke the special status

investigation to establish Chinese culpability

afforded to the city-state. This, married with

in its rise.

further U.S. sanctions, is a threat to China’s

viewed by China as defensive to safeguard

economy. Worse still, it would be fatal to

its national interests.

Hong Kong’s standing as one of the world’s

These actions are apparently

With regards to the LAC, force is not the solution. The Indian External Affairs Ministry

the recently released U.S.-China strategy,

spokesperson Anurag Srivastava stated,

addressing the military threat posed by

“We are engaged with the Chinese side

China, including its economic espionage.

to peacefully resolve it”, while his Chinese

India’s response to the intrusion has

counterpart Zhao Lijian said, “We are capable

been muted as obviously the government

of properly resolving the issues between us

is keen on de-escalating at the earliest and

through dialogue and consultation. We do not need the intervention of the third party.”

virus. President Trump’s offer on Twitter to

India has over the years upgraded

mediate surprised both parties and neither

infrastructure along its northern borders

responded to it.

to make it compatible with its rapid deployment strategy. This has not escaped

Timing of the Move

China’s notice, and the recent culmination

While these brash encounters may seem

of a strategic road project in the Shyok

as if China is trying to utilise the scenario

Valley leading to a forward Landing

offered by the pandemic to her advantage,

Ground at Daulat Beg Oldie, close to the

the overall picture is more complex. China

Galwan Valley, could have been the trigger

too has its plate full, and it is illogical to

for the Chinese intrusion.

burden itself with additional challenges.

skirmishes and stand-offs with India seem

“The military

President Xi Jinping is on record reasserting still increasing Covid-19 infections, coupled

the same. Are

these

sudden

aggressions

with its economic downturn, places it in

smokescreen for the larger looming issue of accountability for the origin of COVID-19

according to

and

Indian Centre for Policy Research.

concealing

its

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presence?

Beijing

Brahma Chellaney of the

| COVID-19 COMPENDIUM | 119

| CONCLUSIONS The pandemic was the perfect opportunity for the ‘global village’ to pitch in with all their combined skills, resources, and technical expertise to wrestle with a virus that does not the world powers, the powerful multilateral agencies, and even

The East has shown a stronger face mostly due to the authoritarian

establish the shift from West to East in the short term, yet the way the pandemic has been handled by Asia does pose a challenge to the long established western dominance in

The pandemic has demonstrated the fragility of supply chains and prompted countries to protect national interests rather than There is a need to establish contingency plans for natural as well as man-made disasters, and applying time-limited emergency

Post-COVID-19, there is a need to look into how systems are built, make them resilient, ensure alternative

Trade blocs help by providing a safety net of sorts and work towards building stronger relations, which

Trade bloc policy should enhance the effectiveness of public health should be taken of trade-health linkages, and those that deprive buyers of medical supplies must be

The self-centred approach in dealing with the pandemic has It has exposed the deep social inequalities and animosities members fail to come to the aid of the worst affected members now, then it affects the quest for long-term prosperity through integration,

Multilateral institutions have to step up to prevent restrictive trade year up till March 21, 46 export curbs on medical supplies have been introduced by 54 governments, creating a shortage of essential

India delivered hydroxychloroquine of sources, and create a portfolio of global crises that would require all

120 | COVID-19 COMPENDIUM |

the export ban two weeks after

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public consciousness and “market itself” to potential investors, who may be looking for alternatives to

are already heavily dependent upon international aid agencies and donor governments for food, agencies need to leverage their ensure coping strategies against COVID-19 are implemented in these with bio-weapons in their labs have an immense responsibility to secure

The new undermine

Chinese law may Hong Kong’s legal,

trade during trying times is key to ensure that no one country gets left

threaten to jeopardise its ranking as

BIMSTEC during the last two decades has failed to live up to

China has no doubt that the unrest in Hong Kong is being fuelled by external forces and fanned by a

millions of its citizens despite the proximity and huge markets shared to make a realistic assessment of the impediments and draw up

BIMSTEC has generally remained in the background of regional

tighten its reins over the city-state before it is too late and the virus of

The LAC tensions with India may be China’s way of sending a strong message to its neighbour over the abrogation of Article 370, which changed the autonomous status of J&K, and hence the dynamics of the territorial disputes in Aksai Chin and

focus on enhancing its visibility in

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CHAPTER 5

CYBER DOMINATION SYNERGIA FOUNDATION RESEARCH TEAM

Absenteeism and Cross Dependencies The outcome will depend predominantly

ritical Infrastructure (CI) entities are

on the extent of absenteeism, the degree

bound to feel the aftermath of the

of know-how required to maintain utilities,

pandemic. It is estimated that up to

and the proportion of the community

40per cent of a company’s employees could

that can be rallied into action as required.

be sick, quarantined, or might stay home

Statistics attributable to seasonal and

to care for ailing family members. Vendors and suppliers that companies rely on could

Labour Force concluded that absenteeism

experience similar shortages. Given the

rates

were approximated at 12per cent

protracted impact of a pandemic, it would 2008-09, and 13per cent for the two H1N1 mutual assistance programme that would

pandemic waves. It is now predicted that

help utilities restore service after natural

the rate for COVID-19 could be as high as

disasters.

20- 50per cent.

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In the last 100 years, there have been

manufacturing, etc. The challenge often is that there is a relatively small population that

architecture, and interdependency of our

can execute these specialised functions. The

critical utilities. Before electricity generation,

industrial sector tends to react differently to

transmission, distribution, and consumption

high absenteeism, depending on the skill

operated in silos, functioned at different

sets required.

cities and immediate suburbs. Today, the

Cyber Vulnerability to CI

interdependency of goods and services i.e.

In a pandemic, governments need to be

water, electricity and power, transportation

vigilant about cybersecurity threats to critical infrastructure. Terrorists and hostile

emergency services, food and agriculture

nations are already looking to leverage more

and public safety, with the healthcare sector

than one attack vector at a time. A cyber-

is critical. While the interdependency of the

attack at the time of a disaster becomes far more crippling.

agriculture is the safety net for inpatients,

For instance, if a hostile group were to

and public safety provides for patient

attack the power grids of a nation during a

transport and triage assistance.

pandemic, the emergency response would

Electrical

power

grids

are

highly

be hampered to the point of damaging the overall effectiveness of the counter-

Further,

there

are

major

cross-sector

interdependencies like that of the energy sector to power equipment operation;

VECTORS OF ATTACK

the chemical sector to provide required

Which of the following types of security incident has your organisation experienced over past 12 months? Select all that apply

materials to treat water supply; and the

Percentage of survey respondents

transportation sector to deliver critical supplies from the chemical sector. Over

the

years

privatisation government ensured

there

has

utilities

following

deregulation.

that

commercial

been

This

has

companies

now operate under different protocols of budgeting, coverage, upkeep, monetary, and continuity of operation plans. This often advocate a course of action rather than stipulate one. Many

infrastructure

information

sectors

technology,

today

machine

learning, robotics, communication skills, pharmaceutical

specialisation,

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additive

Cyber incursion into IT/data systems

Physical incursion into IT/data systems

Incursion into OT/ control system via IT/data system

Physical incursion into OT/control systems

Physical incursion into non-IT/OT facilities

Another type of incursion into our OT/control systems

An unintentional incident We have experienced none of the above

14 7

| COVID-19 COMPENDIUM | 123

strategy. This is the catalyst for a perfect

of multiple systems. The 2017 WannaCry

storm. With an antiquated infrastructure,

ransomware attack on the UK’s National Health Service is a prime example. Lasting

a cyber-attack. A targeted attack on the

over several days, it disrupted the entire NHS

electricity supply of any major electric grid

functioning with over 19,000 appointments

for 48 hours can cause inconsistencies in

being cancelled. Similarly, in Denmark, the

the supply of potable water in any major

headquarters of Maersk was brought to a

city in the subcontinent.

standstill by NotPetya malware, causing disruptions at ports worldwide.

An Estonian Perspective

Trust Building

“COVID which required physical

The World Economic Forum’s

distancing proved that Estonia

Global Risks Report of 2019

had made a wise choice in

ranked cyberattacks among

investing in digital services,” said Lauri Aasmann, Director of Cyber Security, Information System Authority of Estonia. “Even today, all the public sector is working successfully all the public services are up

and

running.”

Estonia

also managed to detect the 50per cent increase in the Cert incidents triggered by hyperactive

scamsters

and

hacksters under the guise of COVID-related themes. A

remote

work

environment will add another layer to CI. This environment will

grow

size

surprising then that the value

Estonia also managed to detect the 50 per cent increase in the Cert incidents triggered by hyperactive scamsters and hacksters under the guise of COVID related themes

and

of the cybersecurity market is estimated to grow from US$ 112 billion in 2018 to US$ 281 billion by 2027. Without effective security measures in place and the cooperation of the public to use them, cyberthreats would undermine

the

stability

modern-day societies, making digital technologies a source of risk rather than development. Security in this form, for users, should not be at the cost of their privacy or wallets. The responsibility for developing

and improving new cybersecurity methods and value.

Inter-Sector Dependency

for the services and products they offer, along with collaborating with the public sector. When it comes to building a functioning

While the internet has made CI more

digital society, Aasmann draws on the

complex, the impact of a single point

Estonian experience. “Trust will be the

cyber-attack could be spread over various

cornerstone, and unfortunately, it is very

interdependent sectors of the economy/

fragile. [.. ] security cannot be achieved at

business/ government, leading to a collapse

the cost of the liberties.”

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Resilience in the New World of Cybersecurity the report states that it detected 4,67,825

INPUTS BY CIARAN MARTIN,

email attacks, 9,116 of which were related to COVID-19.

CEO, NATIONAL CYBER SECURITY CENTRE, GCHQ UNITED KINGDOM

The WHO has reported increased attacks on its staff. In the fourth week of April, it saw some WHO staff email addresses and passwords being leaked,

of critical infrastructures (CI) as the

along with thousands belonging to those

changing perceptions are giving

working on the coronavirus. Hammersmith

rise to totally new threats. For example,

Medicines Research (HMR), which carries out tests to develop the Ebola vaccine and

rang alarm bells right up to the top

performs early clinical trials of drugs and

because, located just next to the nightclub

vaccines in the U.S., was also attacked by

was a building that housed the systems to

ransomware that broadcasted personal

run ATMs for servicing over three million

details of former patients after HMR

citizens. This gives rise to another principle

declined to pay a ransom.

of cybersecurity — dependency. Similarly,

Cyberattacks

the logistics systems of food supply chains

targeting

have also become CI during this period.

intellectual

report

Barracuda

Networks,

vaccines

have

will

change.

property,

and

increased,

and

Healthcare,

pharmaceuticals,

forth

will

become

cloud-enabled

vulnerable, but who’s carrying out the

security and data protection solutions,

cyberattacks and why are they doing

states that there has been a variety of

it? The mixture of economic, strategic,

phishing campaigns using the pandemic

and propaganda advantage will majorly

as a distraction to distribute malware,

remain the same. Nature of vulnerabilities

steal credentials, and scam users out of

too will change, as critical infrastructure

money. Between March 1 and 23, 2020,

migrates towards different sectors.

leading

provider

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| COVID-19 COMPENDIUM | 125

Resilience of Security

to break the myth that cybersecurity is

Cyber resilience is part of cybersecurity. While

too technical for normal leadership teams.

cybersecurity deals with the overarching

It is the responsibilty of any State, which is

concept of security, cyber reliance is the

serious about defending itself, to have some

concept that is focused on adaptability

level of government capability, appropriate

to changing conditions and preparation

laws and proportionate action plans to

to withstand and rapidly recover from

defend themselves.

disruption.

Cyber-resilient

Organisations must also realise the

organisations

interdependent

do not depend on traditional technology

increasingly

relationships

complex

their

networks.

Key

user and access management controls) to

relationships to consider should include

achieve this; they focus on resilient leadership,

all players, not just the core partners.

networks, and readiness of change to create

Intelligence

a sustainable advantage over cybercriminals

cybersecurity activities are good ways to

and other malicious actors.

build and collaborate approaches in larger

sharing

and

coordinated

organisations, which can lead to a resilient

There is a lack of understanding of

ecosystem around their supply chain.

cybersecurity by top leadership. We need

COUNTRIES WITH HIGHEST SHARE OF USERS ATTACKED WITH RANSOMWARE FROM 2017 TO 2018 Which of the following types of security incident has your organisation experienced over past 12 months? Select all that apply

PERCENTAGE OF SURVEY RESPONDENTS

9.57%

Thailand

8.67%

United Arab Emirates

8.47%

Iraq

7.62%

Bangladesh

6.17%

Vietnam

5.45%

Saudi Arabia

5.36%

China

4.28%

India

3.59%

Algeria

3.22%

Turkey 0%

10%

11%

Share of users attacked with ransomware out of all users encountering malware

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Local and Global Threats Different countries have different risk both nationally and together, where an

The Changing Face of CI Security

attack in one country is an existential threat to a whole bunch of countries, then we have got it wrong. This is because we need to be mindful of localised threats.

PPP in Cybersecurity In the UK, the private sector is built into our model and our model of cybersecurity cannot work if it does not have the in-built partnership with the private sector. If the cybersecurity of a bank is not compatible with its business model, then it is not going to work. It is not going to be of the same posture for an energy company as it has industrial control systems, variations, and so on. In UK, the partnership goes beyond routine

commercial

ventures

and

embedded even in strategic plans. In our

INPUTS BY LT. GEN. RAJESH PANT, NATIONAL CYBER SECURITY COORDINATOR, GOVERNMENT OF INDIA

you

clearly

distinguish

between critical and non-critical infrastructures

the

modern

world when everything is interconnected?

own government organisation (National

With technology changing so rapidly,

Cyber Security Centre), over 100 staff working

its intervention in almost every aspect is

on cybersecurity are paid for by the private The U.S. has 14 sectors that fall under has actually originated from the private

critical infrastructure (CI). The U.S. Homeland

industry. The partnership contributes to

Security guide on CI states that natural and

national well-being as a well-protected

manmade incidents have the potential to

industry/business is more productive.

incapacitate CI. In the Netherlands, along

Democracy and Cybersecurity There are challenges that democracies face in

with a few other countries, it considers ‘Heineken’ a CI! In India, under the National Critical

managing cybersecurity. There are two parts

Information

to this; one is transparency and the second

Centre (NCIIPC), created under Sec. 70A

is that democracies have to show that their

of the Information Technology Act, 2000,

net footprint on the internet is a positive one.

there are six critical sectors: transport, oil and

We have to show that sometimes our law

natural gas, power, telecommunications,

enforcement agencies need special access

government, and strategic (related to

to get bad people misusing technology for

critical defence sector). The health sector

harmful ends. We need to show that we are

never merited this attention.

trying to protect and secure technology.”

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Infrastructure

Protection

It is best to focus on all threats, including

| COVID-19 COMPENDIUM | 127

environmental

and

biological,

which

would allow for better planning and utilisation of resources. There is also the

Top 5 causes of cyber disruptions >50% of the organisations reportedly affected in 2017

57%

question of interdependence between

41%

sectors. Tomorrow, it could be a sector as

30% 20%

19%

that has undergone immense digitisation, thus rendering it highly vulnerable to cyberthreats.

Phishing and social engineering

Malware

Spear Phishing

Denial of service

Out of date software ransomware

Threats during Covid-19 Cybercriminals are exploiting the COVID-19 outbreak to send phishing emails claiming to have important updates, encouraging donations,

impersonating

trustworthy

organisations, according to the advisory by the Computer Emergency Response Team of India (CERT-In). There are many IoT devices that are being used —Alexa and your camera. All these are now coming as a part of your

are especially vulnerable and need robust

home environment. Now, that’s a cause for

protection. Financial online transactions

concern as these can become entry points

have ballooned with over 50 lakh new UPI

when you are working from home. Then, if

handles being opened.

you are using a VPN, there is something else. There is a VPN aggregator with the optical

Managing Security of CI

switch operator. So, the whole security

The end-point security is not the laptop

architecture has changed. From there we

on which an individual works, but his

come to cybercrime. Globally, it has shot up

mind. Every individual needs to develop

by 500per cent. That is the change in data

an inherent sense of cyber hygiene and

that is now being accessed. This was bound

security. The concepts of security remain

to happen when more and more novices

the same, whether physical or cyber. You

are entering the cyberworld.

cannot address everything with the same

A large number of apps are being used in

level of security. So, the concept is to protect

millions of smartphones, with users having

the core areas with whatever you have. In the

little idea about their security.

Further,

COVID era, our strategists are saying that we

almost every piece of electronic equipment

are entering an era of e-globalisation. Threat

is today linked, be it medical devices

intelligence sharing is very good. There is

used by the healthcare sector or systems

also a need to look into security threats at

managing critical supply chains, and few of

different levels of engagement, such as the

them are protected against cyberthreats.

individual level, enterprise, sectoral, national,

Labs looking for a vaccine for COVID-19

and international levels.

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PPP Model

least in the critical sectors we would be

There is no doubt that without Public-

comfortable.

cybersecurity solutions. But, even in the

Changing Face of Security

public sector, some industries are private.

With work from home being the norm, how

Solutions are also provided by private

are we going to implement cybersecurity

parties. With the start-up culture and the

solutions? We in India do not understand

incubators in educational institutions,

the value of data. Facebook paid the

there is no doubt that the private sector is

Federal Trade Commission of U.S. $5 billion

playing an increasing role in cybersecurity.

for the data that had gone to Cambridge

As long as the solutions are indigenous,

Analytica. So, I don’t know what it will take

and the servers are within the country, at

for us to realise the value of data.

SYNERGIA FOUNDATION RESEARCH TEAM

midst the panic set by the COVID-19 spread,

the

hardpressed

U.S.

Health and Human Services (HHS)

Department faced a different threat — a

cyberattack falsely proclaiming a national

beetle infestation caused crop damage,

quarantine in the U.S. While the authorities

and the country’s leadership was quick to

quickly went into damage-control mode,

blame the U.S. However, the most widely

experts are warning of a “steady stream”

disseminated misinformation campaign

of phishing attacks with cybercriminals

was orchestrated by the Soviet KGB in the

preying on the information void. This is a

1980s, code named Operation Detrick,

new front in the war against the pandemic:

which blamed the U.S. for the AIDS virus.

combating rumours, misinformation, and

Similar conspiracy theories are doing the

fake news swamping the internet. The

rounds with the coronavirus now, with

extent of misinformation has compelled the

uninformed and scared social media users

WHO to launch a website dispelling fake China and the U.S. have been pointing false posts or removing them. Rumour mongering goes back in

created as a bio-weapon. The U.S. has also

history to the great plague, which killed

accused Russia of the same. A study by the

millions in Europe. The ‘Black Death’ was

U.S. State Department said that about 2

attributed to the Jews provoking ostracism

million tweets were on conspiracy theories

and violence against the community. In

about the virus. Amidst the hype, useful

1950 in East Germany, a Colorado potato

nuggets of accurate information get lost.

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| CONCLUSIONS COVID-19 pandemic has spurred a global discourse on pandemics, More broadly, it has forced nationstates, corporations, think tanks, individuals, and a host of other

By undertaking a critical appraisal of all sectors affected and identifying international best practices, the world can prepare itself for a similar public health emergency when it arises next, for rest assured, this is not the last pandemic that

This Synergia Foundation Compendium is a collection of thoughts, ideas, prescriptions and policy recommendations garnered over the last ten months that endeavours to create the basic

130 | COVID-19 COMPENDIUM |

database generated through our discussions, virtual forums, research and interactions with experts of all

As a continuum, we plan to launch a succinct monograph on Biosecurity covering natural and intentional epidemics, the Biopreparedness for it, and the science behind

Since the need of the hour is a collaborative approach, the Synergia Foundation has collated insights from experts around the world, which can serve as a useful

We hope you enjoy reading this compendium as much as we did

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| COVID-19 COMPENDIUM | 131

132 | COVID-19 COMPENDIUM |

+91 80 4197 1000 & www.synergiafoundation.in @synergiafoundation @synergiaimpact @synergiafoundation