COVID-19: The Political Economy of a Global Pandemic.

It is two years since a microbe, SARS-CoV-2, a 'novel' coronavirus, travelled through the world to wreak havoc on the lives of humans across the globe. Although the total number of global COVID-19 deaths, currently estimated at 6 million, comes nowhere near the 50 million deaths of the Spanish flu pandemic of 1918‒19 to which it has been compared, the impact of COVID-19 and the measures to control it have been far more devastating to humans and economies. This virtual issue gleans insights from selected papers in previous issues of Development and Change to contribute to the ongoing debate on the COVID-19 pandemic by touching upon its political economy aspects. The articles put together in this virtual issue try to demonstrate that pandemics are not a 'fact of life'. They are very much rooted in the processes of capital accumulation and the ensuing destruction of the global ecosystems that makes zoonoses a recurring imminent threat. In the context of a hyper-connected globalized world, regional and global pandemics could well become the norm. Meanwhile, neoliberal reforms and restructuring have left the health sector unable to handle the public health crisis caused by COVID-19. At the same time, with the waiving and dilution of well-established norms of regulation for testing and marketing of vaccines and drugs, the pandemic has created opportunities for accumulation in the healthcare technology industry, specifically the pharmaceutical sector. It is hoped that this virtual issue will contribute to the ongoing debate on the emergence of 'novel' diseases and pandemics by shifting the current focus from the disease agent (the virus) and broadening the concern to include the larger social determinants which are rooted in the global political economy.

In the name of science: Ethical violations in the ECHO randomised trial.

It was in the 1990s, that the possibility of increased transmission of HIV with the use of injectable contraceptive Depo-Provera®, was first flagged in medical literature. This has posed a challenge for its use in countries, particularly in the African region, where the prevalence and transmission rate of HIV is high. In 2015, a randomised 'clinical' trial, the Evidence for Contraceptive Options and HIV Outcomes (ECHO) was launched in four African countries to resolve the question whether the increased risk was causal. Contrary to expectations, the ECHO trial successfully recruited and randomised the specified number of girls/women participants. This paper argues that this was made possible by exercising undue influence, by using incentives, coercive language, and by concealing the real nature of the clinical trial during recruitment. The ECHO trial is unique in subjecting a group of healthy girls/women knowingly to a contraceptive drug with an intention not of finding out whether it is efficacious as a contraceptive, but to find out how risky or life-threatening its use could be. Thus, the ECHO trial has violated one of the central tenets of the Helsinki Declaration by privileging pursuit of knowledge over the interests of the girl/women trial participants from Africa.

Infanrix hexa and sudden death: a review of the periodic safety update reports submitted to the European Medicines Agency.

There have been a number of spontaneous reports of sudden unexpected death soon after the administration of Infanrix hexa (combined diphtheria, tetanus, acellular pertussis, hepatitis B, inactivated poliomyelitis and Haemophilus influenza type B vaccine). The manufacturer, GlaxoSmithKline (GSK), submits confidential periodic safety update reports (PSURs) on Infanrix hexa to the European Medicines Agency (EMA). The latest is the PSUR 19. Each PSUR contains an analysis of observed/expected sudden deaths, which shows that the number of observed deaths soon after immunisation is lower than that expected by chance. This commentary focuses on that aspect of the PSUR which has a bearing on policy decisions. We analysed the data provided in the PSURs. It is apparent that the deaths acknowledged in the PSUR 16 were deleted from the PSUR 19. The number of observed deaths soon after vaccination among children older than one year was significantly higher than that expected by chance once the deleted deaths were restored and included in the analysis. The manufacturer must explain the figures that have been submitted to the regulatory authorities. The procedures undertaken by the EMA to evaluate the manufacturer's claims in the PSUR need to be reviewed. The Drugs Controller General of India nearly automatically accepts drugs and vaccines approved by the EMA. There is a need to reappraise the reliance on due diligence by the EMA.

Public Report on Health: Development of a Nutritive Value Calculator for Indian Foods and Analysis of Food Logs and Nutrient Intake in six States.

UNLABELLED: The Public Report on Health (PRoH) was initiated in 2005 to understand public health issues for people from diverse backgrounds living in different region specific contexts. States were selected purposively to capture a diversity of situations from better-performing states and not-so-well performing states. Based on these considerations, six states - the better-performing states of Tamil Nadu (TN), Maharashtra (MH) and Himachal Pradesh (HP) and the not-so-well performing states of Madhya Pradesh (MP), Uttar Pradesh (UP) and Orissa (OR) - were selected. This is a report of a study using food diaries to assess food intakes in sample households from six states of India. METHOD: Food diaries were maintained and all the raw food items that went into making the food in the household was measured using a measuring cup that converted volumes into dry weights for each item. The proportion consumed by individual adults was recorded. A nutrient calculator that computed the total nutrient in the food items consumed, using the 'Nutritive Value of Indian Foods by Gopalan et al., was developed to analyze the data and this is now been made available as freeware (http://bit.ly/ncalculator). The total nutrients consumed by the adults, men and women was calculated. RESULTS: Identifying details having been removed, the raw data is available, open access on the internet http://bit.ly/foodlogxls.The energy consumption in our study was 2379 kcal per capita per day. According to the Summary Report World Agriculture the per capita food consumption in 1997-99 was 2803 which is higher than that in the best state in India. The consumption for developing countries a decade ago was 2681 and in Sub-Saharan Africa it was 2195. Our data is compatible in 2005 with the South Asia consumption of 2403 Kcal per capita per day in 1997-99. For comparison, in industrialized countries it was 3380. In Tamil Nadu it was a mere 1817 kcal. DISCUSSION: The nutrient consumption in this study suggests that food security in the villages studied is far from achieved. It is hoped that the new Food Security Ordinance will make a dent in the situation. The calculator for computing nutrients of foods consumed which we developed based on the ICMR defined nutrient values for Indian foods has been made available as freeware on the internet. This is with the hope that more such studies can be carried out at the household level.

Contextualising AIDS and human development: Long-term illness and death among adults in labouring low-caste groups in India.

This study compared evidence from two low caste labouring communities in India: a relatively modernized urban group and a rural group in a backward region. It explored their levels of ill health, their capacities to respond to adult illness and the support they received. In each region, a baseline survey of approximately 1,000 households provided background quantitative evidence with qualitative evidence was collected from about 55 families. HIV infection and AIDS deaths were found to occur in the 'less poor' segments of the study group in both regions. In keeping with the official data, they formed a small proportion of the overall mortality and morbidity in this group. Stigma and discrimination were found to be low but fear of stigma was high, generated by the medical response to AIDS and used opportunistically for personal gains. The study provides insights into the structural determinants of health and coping mechanisms in these communities. The best conditions for a healthy life were found in the group that had a rooted community setting, collective political power, migrant economic support and improved working conditions--the less poor rural group. While improved economic status was associated with better health status, this relationship was stronger when combined with the presence of improved working conditions, with social cohesion at family and community levels and with political power as indicated by levels of organized collective representation and identity formation in workplace, local- and state-level politics. However, the traditional forms of social cohesion are under stress and new forms, moderated by commercial relations, are proving inadequate to meet major household shocks, like adult mortality.

Polio eradication initiative in India: deconstructing the GPEI.

The Global Polio Eradication Initiative (GPEI) promised eradication of polio by the year 2000 and certification of eradication by 2005. The first deadline is already a matter of history. With the reporting of polio cases in 2004, the new deadline for polio eradication by 2004 is postponed further. This article seeks to argue that the scientific and technical bodies spear-heading the GPEI, including the WHO, UNICEF, and the U.S. Centers for Disease Control, have formulated a conceptually flawed strategy and that it is not weak political will that is the central obstacle in this final push for global eradication. The validity of the claims of "near success" by the proponents of the GPEI is also examined in detail. By taking India as a case study, the authors examine the achievements of the GPEI in nine years of intense effort since 1995. They conclude that the GPEI is yet another exercise in mismanaging the health priorities and programs in developing countries in the era of globalization.

Legal rights and wrongs: internationalising Bhopal.

PIP: On December 2, 1984, in Bhopal, India, more than 40 tons of toxic gas escaped from the Union Carbide (UC) factory, an event predicted by an Indian journalist, whose warnings were ignored. This disaster could have changed the nature of the chemical industry and caused a reexamination of the necessity to produce such potentially harmful technologies. Not only has it changed nothing, except for the suffering of its victims, it has practically been forgotten. The immediate reaction of UC was that in the treatment of the victims. In fact, the company has never revealed what was in the toxic cloud that night. Litigation was sparked by the descent of US lawyers who gathered as many clients as they could in Bhopal and filed suits in the US. The Indian government then entered the picture and enacted a strategy which gave them sole authority to litigate on behalf of the victims. The lawsuit was subsequently transferred to India at UC's bequest, and all medical information concerning the disaster was made confidential. An important course of treatment was withheld from the victims, again at UC's insistence, because it would have been a marker of the nature of the exposure. After 5 years with no settlement, the Union of India and UC agreed on a figure of US $470 million, despite gross underestimation of the nature and extent of the injuries and even the number injured (the government estimated 4,000 permanently disabled, while independent analysis gleaned numbers up to 400,000). The settlement also ignored the possibility of longterm effects and unsuspected complications as well as of carcinogenic and mutagenic changes. The event at Bhopal and the 7-year-process of litigation require a reconsideration of the concept of compensation for longterm consequences and the responsibility and liability associated with potentially hazardous substances. The Bhopal experience shows that the origin of rights continues to rise from ownership of property instead of from the needs of individuals. Individual rights are political in nature: freedom of speech, to vote, and to form associations. Thus, there is no right to protection of the environment, which would recognize collective control of common resources. Instead, the state continues to control and own all natural resources. Since ownership of property is linked to rights, all rights can be assigned a monetary value. The value of a life is thus linked to the economic terms of its productive capacity. The environmental movement is presenting a challenge to the structure and operation of law by demanding rights for the earth's life-support systems rather than rights over property. The positive right to protection is being sought, rather than the negative relief of damage compensation.^ieng