Medical journal slams India for ‘false optimism’, questions ICMR’s scientific rigour, authenticity of data

Slamming India for ‘false optimism’ on COVID-19, medical journal The Lancet has carried an editorial stating that despite a strong response at the outset of the pandemic, India is clearly facing a dangerous period.

“As of Sept. 22, India has the world's fastest growing outbreak of COVID-19 in absolute numbers according to WHO, reporting more than 5·6 million infections. Restrictions began to be lifted in June, and this relaxation has continued in the face of a continuing dramatic increase in case numbers nationally,” underlined the journal.

It observed that beneath these alarming numbers, the pattern of COVID-19’s spread in India is nuanced and complex, with marked differences between states, and between rural and urban areas. Citing examples, The Lancet said cities like Kolkata and rural areas in the north of India were relatively spared the outbreak initially, whereas Delhi, with strong international connections, was at the forefront of the first wave.

“India instigated a national lockdown in March, which was praised by WHO. India has also been at the forefront of efforts to develop and manufacture a vaccine, both through domestic vaccine candidates and manufacturers such as the Serum Institute of India preparing production capacity for internationally-developed vaccine candidates,” said The Lancet.

However, difficulties remain. This lockdown, the medical journal underscored, created a parallel crisis for many people as income fell dramatically, hunger increased, and many migrant workers walked long distances home. Highlighting the economic crisis in India even before COVID-19 began, the editorial said India's GDP was already decreasing before COVID-19 but the contraction of almost 25% year-on-year in the quarter April to June could make India one of the worst affected countries economically.

“As the outbreak has spread from its initial foothold in cities to smaller urban areas and villages, pre-existing disparities in health-care provision have become increasingly relevant. Rural health infrastructure in India can be sparse, and some smaller private hospitals have reported equipment shortages, especially oxygen,” stated The Lancet.

The journal stated that the epidemic is far from over in India, where the rapidly growing case numbers, alongside the relaxation of restrictions, have created an atmosphere of fatalism mingled with false optimism that undermined effective use of non-pharmaceutical interventions such as masks and physical distancing.

Critical of India’s response, the journal has also questioned the authenticity and quality of medical and health data from India. The editorial questions the role played by Indian Council of Medical Research (ICMR). It questioned why India’s top research body was insisting on hydroxychloroquine, a malaria and rheumatoid arthritis drug, as a potential preventive and treatment.

“Transparency of the data on COVID-19 cases and deaths, especially those underpinning the case fatality rate, has also been questioned, as detailed in a recent World Report. The Indian Government reports a case fatality rate of 1·8%, much lower than the reported rate in other countries, but it is difficult to know if the numbers are comparable,” pointed out the editorial.

ICMR has been singled out for straying from scientific evidence, appearing at worst politically-motivated and at best overly optimistic. A letter from the Director General of the ICMR, Balram Bhargava, said that the ICMR envisaged launching a coronavirus vaccine on August 15 (a deadline considered unrealistic by most medical experts).

“According to news reports, hours before announcing the national lockdown, Prime Minister Narendra Modi told owners and editors from India's largest media organisations that it was important to tackle the spread of pessimism, negativity, and rumour. This pressure to avoid negative news, and to offer reassurance, appears to have been felt by several professional scientific organisations in India,” the editorial states.

Condemning the false hope combined with a positive spin, The Lancet states that such a situation clouds reality and also hampers vital public health initiatives. Such false reporting and perpetuating unrealistic claims, failing to report honestly creates uncertainty among the public and health-care professionals, discouraging people from taking preventive action or taking public health messages seriously.

Praising India’s expertise in public health, research and medicine, The Lancet concluded that to capitalise on these attributes, India’s leaders must respect “scientific evidence, expert commentary, and academic freedom, and not provide false optimism”.