THE IMPORTANCE OF PALANPUR

The coronavirus disease-sparked lockdown has triggered an unprecedented migrant crisis. With no employment, food and housing, migrant labourers and their families have been leaving their host cities in droves for their villages.

This week, we recommend

by Himanshu, Peter Lanjouw, and Nicholas Stern. The economists examine seven decades of data on Palanpur, a village in Uttar Pradesh’s Moradabad district, to understand the impact India’s growth trajectory has had on a village. It describes how changes in Palanpur’s economy since the 1950s were initially driven by land reforms, the expansion of irrigation and the introduction of “green revolution” technology, but since the mid-1980s, migration triggered by off-farm opportunities has been a key driver of prosperity. Palanpur serves as a microcosm of how rural India has undergone a fundamental economic transformation. There is, perhaps, no work which is as important, as comprehensive, and as rigorous in giving a sense of India’s political economy.

Book: How Lives Change: Palanpur, India, and Development Economics Author: Himanshu, Peter Lanjouw, and Nicholas Stern Year: 2018

Most experts say we are 12-18 months away from an approved coronavirus disease (Covid-19) vaccine, and even longer from having one available at scale. Despite vaccine development being at this uncertain early stage, India must immediately start planning how to deliver a Covid-19 vaccine.

When a vaccine becomes available, every onwill have to run the fastest and largest mass vaccination campaign in history. India will have to vaccinate about a billion people to reach the level believed to confer herd immunity for Covid-19. Each day of the virusdriven uncertainty cripples the economy and imposes immense human costs. India should do everything we can to save a few critical days, weeks or months.

A task force on coronavirus vaccine development, drug discovery, diagnosis, and testing exists. This group’s focus is diffuse. Even in the area of vaccines, the group’s focus is primarily vaccine development, not the delivery. Immunising a billion people in a country as diverse as India will be a staggering operational challenge. To be successful, we need a powerful group to plan for vaccine delivery now.

To pull this off, India can draw lessons from two large, successful campaign-style exercises. Every five years, India holds the world’s largest general election, involving up to 900 million voters. Electoral rules state there must be a polling place within two kilometres of every habitation. India employs 11 million election workers to make sure every eligible Indian can vote. Every vote is cast electronically via more than 1.7 million machines. Despite these formidable challenges, India successfully conducts elections, widely considered free and fair.

The polio campaign is the second example. As recently as 2009, India had over 60% of all global polio cases. With an annual birth cohort of 27 million children, high population density, poor sanitation, inaccessible regions, high population mobility and a high disease burden, the obstacles to achieving zero-polio status seemed insurmountable. Nevertheless, India has not had a single case of the wild poliovirus since 2011, and it was officially declared polio-free in 2014. The victory was achieved through government ownership, partnerships with private and social sectors, innovations in programme delivery, technical advances, and massive social mobilisation.

There are over 90 vaccine candidates in trials, six in human clinical trials, with more being added every week. The vaccine candidates range across virus, viral vector, nucleic acid, and protein-based approaches — which means that they will require different technologies and processes to manufacture them. We don’t yet know if an eventual vaccine will require temperature control, ultra-cold temperature control, or not require any cooling to maintain its potency. We don’t know if it will be packaged and administered via conventional syringes or an innovative new delivery mechanism such as a micro-needle patch. We don’t know the duration for which an eventual vaccine will confer immunity. We don’t know its efficacy; of the people who get vaccinated, what fraction will be protected from getting sick? We don’t know how that efficacy will vary across different populations — will it be as effective for older people as for younger people, for populations in north India as in south India?

Despite these uncertainties, there is a lot for a Vaccination Task Force (VTF) to productively focus its efforts on right now.

First, for each of the key uncertainty drivers, VTF can determine plausible ranges and identify the most likely options. These can be used to draw up a set of scenarios for detailed planning. The VTF can then monitor how vaccine development is progressing. As more information becomes available, the ranges on the key uncertain variables can be narrowed and the priority order and details of plans can be revised.

Second, practise through “war games” will allow decision-makers to rapidly and correctly react to changing circumstances. An example: How to react to the possible tragedy of a small cluster of deaths in one state, most likely due to vaccine-related sideeffects? Such “war games” are standard practice for militaries, and are increasingly used by corporates to allow decision-makers to improve their responses.

Third, no matter how fast production can be ramped up, there will be initial periods when only a limited supply of vaccine will be