Wednesday, April 28, 2021

Studying India's Covid-19 Pandemic Response : Part 2

Continued from the first post in this series...

Studying India's pandemic response won't be complete if we didn't concentrate on the factors taking place on a global level which in-turn affects everything down at a country level. 

Let's start with addressing a fundamental issue at the heart of this crisis.

While it is not necessary to go into the statistics of the rise in cases and deaths around the world, one can easily see that the core mathematical pattern behind these is exponential in nature. So simple, that perhaps most people simply gloss over it, not understanding it's implications. 

A famous lecture on exponential growth by Professor Albert Allen Bartlett, an acclaimed professor of physics at the University of Colorado at Boulder, comes to mind. It is required watching by everyone and I think I'm ready to die on this hill. I'll leave that in the supplementary section below.

That a burgeoning world population has outstripped the carrying capacity of the earth is something every kid is taught in school today. This comes with a loss in bio-diversity, with animals like CoV reservoirs (bats) coming into increasing contact with human habitation. This paper takes a full look at this issue. 

Within this context, it would seem that critical systems should be constructed and managed to rapidly adapt and scale up for exponential rise in illnesses. Why? Simply because the adverse exponentials seems to occurring at an increased frequency. In other words, the extremes are becoming more frequent. 

In March, Chatham House hosted a Global C-19 Vaccine Supply Chain & Manufacturing Summit in which the main participants were CEPI (the Coalition for Epidemic Preparedness Innovations) and industry players. For a "summit" of this magnitude, it was telling that WHO was largely absent from the discussions. Not that WHO's leadership hasn't been questioned in this pandemic, to which this piece is a good (long) read.

An opinion piece in the BMJ noted the following after this summit, from which I quote : 

It is not widely known that current annual production of all vaccines in the world is about 5 billion doses. Yet this year the aim is to produce as much covid-19 vaccine as possible to meet projected demand—the organizers estimated about 9.5 billion doses which has never been done before. To date, production is less than 500 million doses so there is a very long way to go. 

Such a scale up of production will put a huge strain on the producers of the many inputs required to produce a vaccine and get it into the arms of millions of people. One participant in the summit said that their vaccine required 280 separate inputs. These range from the biological materials to grow the vaccine through a wide range of technical kit necessary for production to the vials that contain the finished product. On top of which vaccine production requires a range of highly-skilled technical personnel to manage what is, unlike most conventional medicines, a complex biological process—and such personnel are in short supply. 

Given the complexity of the task, and the myriad of different circumstances affecting the multiplicity of input suppliers, it is very difficult to anticipate exactly which critical supply problems will emerge or exactly how each of them might be dealt with. What is clear is that such problems will likely arise, given the unprecedented scale-up, and producers, regulators and governments need to be alert in addressing them.

Is it a surprise that in April, an Indian pharmaceutical giant at the heart of the biggest vaccine production effort in the world calls out publicly for the USA to repeal it's sudden embargo on raw materials and free up the supply chain? The USA seems to have done what any country at the apex of this crisis would have done. Protecting critical vaccine raw materials became a national defense interest in an atmosphere of shortages. So these issues simply do not occur in vacuum, they are all interconnected.

In summary, we have a simple but large-scale lack of appreciation for the exponential.

With delayed responses, the timeframe within which manufacturing and logistics can scale up to meet an exponential crisis is woefully limited. Countries step in to protect their national interests. But a globalized world means you can't simply lock all doors on those who deal with you at many complex levels.

It would seem that an entirely new top-down management system built to deal with the unique nature of these exponential events and high number of moving parts are the need of the hour. 

Despite having all the fancy systems in place, the question of coordination between different players in this vast system also needs addressed. What's the point in so-called "taskforces" if they're not used to maximum effect?  Moreover, there could be players who are there to help, and players there specially ordained to throw a wrench into the works

We'll need to take a look into those aspects of this multi-dimensional issue. But that's for another post. 


Arithmetic, Population and Energy - a talk by Al Bartlett

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