Political interference in public health science during covid-19
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3878 (Published 06 October 2020) Cite this as: BMJ 2020;371:m3878Read our latest coverage of the coronavirus outbreak
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Dear Editor
Audit efficacy of political interventions like clinical trials
The epistemological issues raised in the editorial "Political interference in public health science during covid-19"(1), are confined not only to the duality of politics and health science but to politics as an instrument of power and science as a liberator of mankind from the darkness of ignorance. For instance, in the 1633 trial, Galileo Galilei was punished for his scientific opinion that the Moon revolves around the Sun by none other than the Roman Catholic Church, which had the equivalent political power of the modern state. It took the latter almost 350 years to officially admit its mistake. Even today science could take decades to recover, and some harm could be permanent (2).
The editorial picking up Donald Trump along with Brazil’s Jair Bolsonaro, India’s Narendra Modi, and the UK’s Boris Johnson, for their alleged idiosyncrasies in controlling Covid-19 pandemic, and describing them as illiberal populists would seem partisan because all of them are considered to be ostensibly aligned with, and espousing right wing political ideology. Here, it could be easily dubbed as bashing the political right and sparing the left. For instance, the Lancet editorial 'COVID-19 in Brazil: "So what?" (3), which overtly advocated for ousting of its President Bolsonaro, has drawn some criticism (4). It pointed out that the editorial fails to compare Brazil to other emerging markets with similar landmass and population, and gave thebexample of Russia. Moreover, in an electoral democracy any debate or discourse in politics is incomplete without an opposition(s), who has a different point of view for solving the problem under consideration. Therefore, it does not behove a science journal to harp on about the problems without presenting possible and potential alternative remedies alongside. While censuring political leaders, journals must also take a critical look at the role played by the nation's scientific bodies and academies in terms of voicing their concern and opposition to unscientific populist measures by governments.
The topic of the political determinants of health has been a subject matter of discussion for more than a decade, and it has almost been clarified why health is political: health is unevenly distributed, many health determinants are dependent on political action, and health is a critical determinant of human rights and citizenship (5). Marcos Cueto (6) in a WHO publication, while referring to promise of "health for all" made in Alma-Ata way back in 1981, recalled Rudolf Virchow's words: the solution to major disease problems resides not only in the best science available but also in brave political proposals for social justice and the improvement of the life of the poor. Recently, WHO's Director-General himself declared on September 23, 2019 that Universal health coverage (UHC) is "a political choice" (7).
It is notable that the 'social determinants of health' have become a part of medical curricula, research, and a project topic for scholarship, and the number of published articles on this jumped from 45 in 2007 to 1092 in 2017 (8). On the other hand, 'political determinants of health' is still a taboo for debate and discussion in class rooms and ward rounds, this is despite the fact that today most science journals are covering politics more than ever. It is time for doctors to tell their patients that solutions for myriad problems of ill-health are to be sought outside the four walls of hospitals. Study suggests that democracies are a better bet for people's health than repressive regimes (9). Hence, patients ought to be encouraged for civic and political engagement, and advised to exercise their right to vote (10). A recent analysis of election manifestos of India's five major political parties from 2014 through 2019, concluded that healthcare is not an election issue (11). The devastation of lives and livelihoods by Covid-19 pandemic has provided an opportunity with immense justifications for citizenry and healthcare advocacy groups all over the world to push the health agenda to the core of political discourse and governance, at local, provincial, national and global level.
It is challenging to establish casual effects of political variables (structures, processes, outputs) because collection of data is likely to suffer from biases due to lack of control over confounding variables like, health behaviours, cultural values, etc (12). This problem could be approached through multidisciplinary research, say including economics, social sciences, etc. It is interesting to note that the Nobel prize for economics in 2019 was awarded to Abhijit Banerjee, Esther Duflo and Michael Kremer “for their experimental approach to alleviating global poverty” (13). They had conducted Randomised Control Trials (RCTs) to test the policy interventions, and then recommended the policy which is most effective.They have shown that by dividing the issue smaller, more precise, questions are often best answered via carefully designed experiments among the people who are most affected. The use of RCT in economics is a novelty for weighing the evidence for or against the efficacy of a particular policy in terms of result in achieving its target. It is a potent tool to test if the avowed results are due to policy or otherwise. More importantly it also debunks any self-serving political gung-ho of success sans evidence.
Authors:
Prof. L R Murmu,
Department of Emergency Medicine,
All-India Institute of Medical Sciences,
New Delhi-29, India
Dr. Sushimta Murmu,
Core Trainee, General Adult Psychiatry,
Pilgrim Hospital, Boston,
Lincolnshire partnership NHS Foundation Trust, UK
References:
Gonsalves G, Yarney G. Political interference in public health science during covid-19. BMJ2020;371:m3878.doi: https://doi.org/10.1136/bmj.m3878
Tollefson J. How Trump damaged science- and why it could take decades to recover. Nature 586, 190-194 (2020) doi:10.1038/d41586-020-02800-9
Editroial. Covid-19 in Brazil : "So what ?". The Lancet. May9, 2020. Vol 395, Issue 10235.doi:https:/doi.org/10.1016/S0140-6736(20)31095-3
Kenneth Rapoza. Medical Journal ‘The Lancet’ Politicizes Coronavirus, Warns Brazil President Needs To Go. May 12, 2020 https://www.forbes.com/sites/kenrapoza/2020/05/12/medical-journal-the-la......
Kickbusch I. The political determinants of health-10 years on. BMJ 2015; 350:h81. doi:10.1136/bmj.h81
Marcos Cueto. The promise of primary health care. www.who.int/bulletin/volumes/83/5/editorial10505
Kittelsen, S.K., Fukuda-Parr, S. & Storeng, K.T. Editorial: the political determinants of health inequities and universal health coverage.Global Health15,73 (2019). https://doi.org/10.1186/s12992-019-0514-6
Mishori R. The SOCIAL Determinants of Health? What About the POLITICAL Determinants of Health? Oct 4, 2018
https://www.themedicalcareblog.com/political-determinants-of-health
Franco A, Alvarez-Dardet, Ruiz MT. Effect of democracy on health: ecological study. BMJ2004;329: 1421-4 doi:https://doi.org/10.1136/bmj.329.7480.1421
Ofri D. Doctors Should Tell Their Patients to Vote. The New York Times. Oct 20,2018. www.nytimes.com/2018/10/20/opinion/sunday/doctors-politics-vote-health-c...
Venkateswaran V. Healthcare and democracy : Can healthcare become an election issue in India.2020 https://healthcare-in-india.net/wp-content/uploads/2020/05/Healthcare... ·
Mackenbach John P. Political determinants of health. European Journal of Public Health. Vol.24, No. 1,2 doi:10.1093/eurpub/ckt183
The Royal Swedish Academy of Sciences. Press release: The Prize in Economic Sciences 2019. 14 Oct, 2019 https://www.nobelprize.org/prizes/economic-sciences/2019/advanced-inform...
Competing interests: No competing interests
Dear Editor,
The article lists our Prime Minister Mr. Narendra Modi alongside leaders such as President Donald Trump of the USA, President Jair Bolsonaro of Brazil and Prime Minister Mr. Boris Johnson of the United Kingdom, as another illiberal populist leader who views scientists as his opponents. The article broadly states that Mr. Narendra Modi rejects science, downplayed the COVID-19 crisis and tried to manufacture good news. The authors also state that Mr. Narendra Modi has clamped down on the media for being too pessimistic about the COVID-19 scenario in India, and that the Indian Council for Medical Research (ICMR) was trying to appease him by announcing a vaccine by the 15th of August, India's independence day. The authors seem to have misunderstood the articles, and seem to be misquoting/misinterpreting these articles quoted with reference to the work done by the Government of India in response to the COVID-19 pandemic.
Reference number 14 is an editorial in the Lancet titled 'COVID-19 in India: the dangers of false optimism', an article which cautions us Indians about being too optimistic, and refers to Prime Minister Narendra Modi addressing media houses and editor’s hours before announcing the nationwide lockdown in March 2020 [1]. The Prime Minister of the world’s largest democracy informing the independent national media, prior to a complete lockdown for 21 days drastically impacting 1.3 Billion citizens, blissfully enjoying complete freedom of movement, could only be to have them (the media) on board with the government. He tried to inform and ensure that they (the media) too could help in preventing the anticipated negativity, rumor mongering and pessimism. This perhaps is necessary and demonstrates respect towards other stakeholders in our federal structure, with multiple states governed by various political parties.
The authors go on to criticize the ICMR for supporting the use of hydroxychloroquine for treating COVID-19 despite insufficient data, forgetting that the ICMR and the rest of the planet probably based this directive on an article published in the Lancet, but was later retracted [2]. I suspect Mr. Narendra Modi had nothing to do with this, and was just following the advice recommended by his scientific advisors.
Reference 15 states that ICMR is trying to please Prime Minister Narendra Modi by suggesting in July that a vaccine would be ready for use by the 15th of August, our Independence day. This reference is a report published by a media house, regarding which the ICMR’s Director-General as well as the Director of New Delhi’s All India Institute of Medical Sciences (AIIMS-New Delhi) have clarified upon [3]. This was only to avoid unnecessary red tape involved in vaccine trials, and to initiate population based trials as early as possible, as there were already two vaccines approved by Indian regulatory authorities for Phase I and Phase II clinical trials [3].
Mr. Narendra Modi’s work is compared with work done by his counterparts in the USA, Brazil and the United Kingdom, then contrasted with statements by obscure philosophers, and again compared with the work done by President Thabo Mbeki of South Africa, referring to all of them as science denialists. I wish to inform the authors that India has been through 4 phases of structured ‘lockdown’, beginning from 25th of March, which was followed by 4 phases of structured ‘unlock’ since 1st of June, and we are currently in the 5th phase of unlock. Mr. Narendra Modi has never been seen without wearing a mask, and is a stickler for social distancing norms during all his official and personal responsibilities. I direct attention of the authors to reference number 4 for information regarding what 1.3 Billion citizens of India have been through [4]. I request them to be sensitive towards the health workers in a nation, doing commendable work with the available limited resources, many working without a holiday since March 2020. None of us here deserve to be disturbed by these misdirected thoughts about our Prime Minister. Many a time, it is this type of thing which makes scientists and health care workers lose hope.
1) The Lancet. COVID-19 in India: the dangers of false optimism. Lancet. 2020 Sep 26;396(10255):867. doi: 10.1016/S0140-6736(20)32001-8. PMID: 32979962; PMCID: PMC7515582.
2) Mehra MR, Desai SS, Ruschitzka F, Patel AN. RETRACTED: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. 2020 May 22:S0140-6736(20)31180-6. doi: 10.1016/S0140-6736(20)31180-6. Epub ahead of print. Retraction in: Lancet. 2020 Jun 5;:null. Erratum in: Lancet. 2020 May 30;: PMID: 32450107; PMCID: PMC7255293.
3) Kumar P. Medical body ICMR's clarification as August 15 vaccine target triggers backlash. NDTV 2020 Jul 4. https://www.ndtv.com/india-news/coronavirus-vaccine-medical-body-icmrs-c...
4) https://en.wikipedia.org/wiki/COVID-19_pandemic_lockdown_in_India
Competing interests: No competing interests
Dear Editor
I am sorry to state that the above article seems to deal less with science and more with personal opinion. Everything about this illness has been altered and even countered since January, and that includes among others, mandated wearing of masks and administration of HCQ. It is absolutely clear that those in the chain of command manipulating public policy had no idea about how to prevent or treat the illness, and these individuals and organizations verily kept contradicting their own statements and directives.
The list is long. Despite wearing masks, distancing and locking down, the infection has not been stopped and most cases have occurred during that time. From the time lockdowns, distancing and masking were introduced (lockdowns in March and the other two in May), cases had been rising steadily until the death rate (which again has been most controversial with phrases like 'dying of CoVID' and 'dying from CoVID') which in many cases have been manipulated to show rising numbers, started declining from July.
Talking of science, a virus measures <300nm and there is NO WAY of stopping the spread of these organisms, mask or no mask, distancing or no distancing. There have been severe outbreaks of viral epidemics in the past 70 years, and most of them were more serious than CoVID-19 in terms of lethality, but none of the measures adopted this time had ever been adopted in the past and there has never been a threat to human civilization compared to what we have been made to understand. The politicization of this illness to deliberately spread indiscriminate and disproportionate fear, panic and despair across the world has not been commensurate with scientific principles which are quite clear in context, and these are: The IFR is <1% in adults and 0.05% in children, Rate of recovery is around 98% in those below the age of 56, >80% of infected individuals suffer mild to no symptoms, the PCR test is highly controversial and results have a high rate of false positivity (Late Dr. Kary Mullis has stated that the test cannot identify a virus and that the test must not be used for diagnosing any disease, and the original n-CoV 19 test kits have displayed the warning too).
Given all these facts, it is of trivial importance to be be engaged in a debate on lockdown, distancing and masking. Also, given the fact that the virus is yet to be isolated and cultured in its true form (not what has been given to us from China), even the constant rallying for the vaccine since February (when no one seemed to know anything about this fabled virus) is highly controversial.
Competing interests: No competing interests
It is understandable that, in today’s world, science and politics[1] are inseparable; even politics and healthcare are intertwined [2] How can democracies be sustained and science progress if public representatives and intellectuals/scientists undermine each other’s role and engage in mudslinging? There have been a slew of publications in leading scientific journals condemning elected public representatives[3].
It is evident from the recent scientific literature that most scientific research and protocols on the management of the pandemic have been studied, tested, published and accepted in so called advanced overseas institutions. So, if a country like India is following suit, there are no scientific reasons for so called intellectuals to get elated. Every country and its democratically elected leader has the right to test the hypothesis, try different strategies--needless to mention grounded in scientific evidence--based on their social, community, population needs. It is incomprehensible that when India imposed lockdowns, a large section of overseas elite economists start condemning vehemently, citing economic breakdown. And when India unlocks and relaxes some of the restrictions, these elite scientific communities again start condemning, saying that scientific knowledge is being interfered with by the state heads. What an irony? Isn’t it incomprehensible why such liberal intellectuals are commenting on the issues which are apparently based on personal biases and political vendetta rather than on scientific research and enquiry? In this time of uncertainty, nothing is absolute, even elite intellectuals don’t have a concrete remedy for present ills and they may also be advocating just another version of a “false optimism” to the world. This is unfair and uncalled for.
I feel that with the advent of research and information we get about the pandemic (mostly the scientific ones), there is more confusion in the minds of the followers of science. Every country has its own share of problems and deficiencies which are being accentuated by the pandemic. So, if some country representatives are testing their hypothesis, why is there a narrative of blame games, without knowing the ground situations in these countries? Testing hypothesis should not be the veto of a chosen few.
References:
1. Editorials, Science and politics are inseparable, Nature 2020;586:169https://media.nature.com/original/magazine-assets/d41586-020-02797-1/d41... Accessed On 8th October 2020
2. Heer-Stavert S. Covid-19: healthcare and politics are inexorably intertwined. BMJ. 2020 Jun 25;369:m2532. doi: 10.1136/bmj.m2532. PMID: 32586789
3. Gonsalves Gregg, Yamey Gavin. Political interference in public health science during covid-19 BMJ 2020;371:m3878
Competing interests: No competing interests
Dear Editor,
The ongoing slogan "Follow the science" is used as if it were a dogma or guarantee of truth. The scientific hegemony we are witnessing where everything true and complete in our lives must be science based is a false world. Political interference in science which this article describes shows some of science's weakness and is the other side of the coin. The lead editorial in Nature today for example- "Why Nature needs to cover politics now more than ever," is like Luther hammering his 95 theses onto the church door in WIttenberg, and is the other side of the same coin - science interfering in politics. Science or medical journals now read like political manifestos. The NEJM would do well as a Democratic news outlet. Science and politics are conflated and one is as conflicted as the other.
As we all know, people are more than molecules and synapses, and their lives are not encompassed solely by any single human science or discipline. To govern fairly and wisely one also has to follow the economics, the education, the social welfare, the humanity of the people. Scientists often pontificate and go way outside their bailiwick explaining "life." Examples are - biologists Stephen Jay Gould, Richard Dawkins, and Edward O Wilson; and physicists Carl Sagan, Stephen Hawking and Steven Weinberg. [1] Celebrity chefs or Ballerinas never do that! Science and politics are human endeavours that should keep to their own areas of expertise. Science should be at the service of humanity and not the other way around.
A quick search of key medical journals for the words Palestine, Kashmir, Israel, Trump, political...shows an enormous volume of medico-political content.
1. Oracles of Science. Karl Giberson, Mariano Artigas. Oxford University Press, 2006. ISBN: 9780195310726.
Competing interests: No competing interests
Dear Editor
I was shocked to see that the name of our UK prime minister was being listed along with Trump, Bolsonaro and Modi as a populist leader who did not listen to scientists.
On the contrary, in the many daily televised Covid-19 briefings from 10 Downing Street, our Prime Minister, Boris Johnson, has usually been accompanied by England’s Chief Medical Officer, Professor Chris Whitty, and Sir Patrick Vallance, the Government’s Chief Scientific Advisor, who give detailed scientific information and advice.
Surely we know better than this article describes about what is actually happening in England?
Competing interests: No competing interests
Dear Editor
I read the opinions of Gregg Gonsalves and Gavin Yamey with interest [1]. I have to admit that I do not know how to resolve the problem. Should the politicians be elected only by scientists from now on, or should we just do away with politicians and the public can elect the scientists instead, or should we just have a self-appointed scientific oligarchy brooking no dissent? As in Brecht’s poem “The Solution” we live in tormented times:
“... the Secretary of the Writers Union
Had leaflets distributed in the Stalinallee
Stating that the people
Had forfeited the confidence of the government
And could win it back only
By redoubled efforts. Would it not be easier
In that case for the government
To dissolve the people
And elect another? “
My own view is that politicians led on by some scientists put too much weight on technocratic solutions with results which have been even more serious than the disease.
[1] Gonsalves & Yamey, ‘ Political interference in public health science during covid-19’, BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3878 (Published 06 October 2020)
Competing interests: AgeofAutism.com, an on-line daily journal, concerns itself with the potential environmental sources for the proliferation of autism, neurological impairment, immune dysfunction and chronic disease. I receive no payment as UK Editor
Dear Editor
Gonsalves and Yamey’s (1) have highlighted the names of several world leaders to bring home the issue of political interference in public health science during COVID-19, however, surprisingly the name of Vladimir Putin is conspicuous by its absence. The Kremlin has faced criticism since the start of the pandemic for downplaying the seriousness of pandemic, underreporting the number of cases and deaths, and delaying the response. Dr. Anastasia Vasilieva, the head of the Alliance of Doctors - an independent doctors’ union - who dismissed as “lies” the country’s low official numbers for SARS-CoV-2 infections was detained in April by authorities for trying to deliver masks, gloves and other supplies to a local hospital in an impoverished rural town (2).
On 11th August, Putin announced that the Russia is the first country to approve a coronavirus vaccine - Sputnik V - for widespread use. This decision was immediately denounced by global scientific community as dangerously rushed. In an open letter (3), a group of researchers highlighted serious gaps in the study (4) that claimed success of Sputnik V and demanded access to the original data. The drug regulator of India is also not satisfied with the phase 2 clinical trial data of Sputnik V conducted in Russia, and has demanded a fresh phase 2 clinical trial in India before a Phase 3 trial is conducted (5).
These incidents suggest widespread interference of the Russian political leadership in science in manufacturing good news and suppressing the truth.
Reference
1. Gonsalves G, Yamey G. Political interference in public health science during covid-19. BMJ 2020;371:m3878.
2. The anti-science leadership of Trump, Bolsonaro, and Putin led to the worst coronavirus outbreaks in the world [Internet]. Business Insider. [cited 2020 Oct 6]. Available from: https://www.businessinsider.in/politics/world/news/the-anti-science-lead....
3. Note of concern [Internet]. Cattivi Scienziati. 2020 [cited 2020 Oct 7]. Available from: https://cattiviscienziati.com/2020/09/07/note-of-concern/.
4. Logunov DY, Dolzhikova IV, Zubkova OV, Tukhvatullin AI, Shcheblyakov DV, Dzharullaeva AS, et al. Safety and immunogenicity of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine in two formulations: two open, non-randomised phase 1/2 studies from Russia. The Lancet 2020;396:887-97.
5. Dr Reddy’s Laboratories to submit a revised protocol for conducting clinical trials of Russian COVID-19 vaccine - The Economic Times [Internet]. [cited 2020 Oct 7]. Available from: https://economictimes.indiatimes.com/industry/healthcare/biotech/pharmac....
Competing interests: No competing interests
Re: Political interference in public health science during covid-19
Dear Editor
The covid-19 pandemic: science versus politics
The covid-19 pandemic has made it clear that scientific evidence and messages to the public by our political leaders are not always on the same page, leading to confusion and eroding public trust. Political interference in public health science has sadly been a spectacle the world has been privy to in the wake of the current pandemic (Editorial, 27 October).
The world is learning as we go through the various phases of this pandemic. Governments are faced to deal with the consequent health as well as economic impact. As much as governments are trying to balance public health and economy, there have been instances where political leaders of nations have been undermining science and evidence for reasons beyond comprehension to common man. The early proclamations by leaders of democratic nations, for example US, India, Brazil, of hydroxychloroquine (HCQ) as a treatment for COVID-19 lead to panic buying of HCQ in some parts of the world. This was shown as having no benefit following the RECOVERY trial, a widely hailed multi-centre clinical trial from the UK. Likewise, monoclonal antibody therapy for covid-19 has come into the media limelight in the wake of it being used by the US president, despite lack of robust evidence and current ongoing clinical trials to find the answer. The quest for a vaccine against covid-19 has become a political supremacy race, with certain nations trying to out beat each other at the expense of undercutting safety and efficacy rigour.
In unprecedented times like this science and politics should build public trust through transparency and synchrony in public messages and policy making. It isn’t about one versus the other, it is about time to win the confidence of the general public. Let science, evidence and informed policy prevail in our collective fight against this 21st century pandemic.
Competing interests: No competing interests