It may not be possible to bring all Australians with COVID home from India. But we can do better than we are now


Catherine Bennett, Deakin UniversityA 47-year-old Sydney man has died in India after contracting COVID-19.

This news comes amid anger after the first repatriation flight from India following the controversial travel ban arrived in Darwin half empty on Saturday. Some 40 passengers tested positive for COVID-19 meaning neither they, nor their close contacts, were allowed to travel.

There’s no suggestion the Sydney man was due to board that flight, or any subsequent repatriation flight. But his case puts a spotlight on the current situation in India, where countless Australians are imploring the government to bring them home from a country in deep COVID crisis.

I would argue we can, and should, bring home at least some COVID-positive Australians — particularly those at highest risk of needing hospital-level care.

Weighing up the risks

Since Saturday’s repatriation flight, there’s also been controversy over the reliability of the tests which deemed so many passengers ineligible to travel. It’s critical the Australian government irons this out to ensure pre-flight testing is as accurate as possible.

Although, even if all passengers do test negative before flying, we still can’t guarantee a flight out of India, or any country, will have no positive cases on board. There’s a blind spot in testing between the time a person is exposed and when testing will reveal the infection. This gap could be up to ten days, but for most would be two to three days.

We know even with pre-flight screening requirements up to 1% of passengers are positive by the time they arrive in Australia.

At least if we know certain passengers are COVID positive at the time of boarding, we can manage the risk of transmission in transit.




Read more:
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Flying COVID-positive Australians home safely

Despite our best efforts, we can’t rule out the risk of transmission if there are COVID-positive travellers on a flight.

However, transmission on planes appears to have been relatively infrequent. Recent reports of high positive rates on arrival and in quarantine may signal high rates of pre-flight exposure and transmission in transit — it’s hard to assess to what degree on-board transmission is a factor.

Although we know being in an enclosed space with someone with COVID-19 for a long time is high risk, the air in the cabin is filtered and turned over very regularly and therefore protects against viral spread. This could be why transmission on flights is not as common as we might expect.

That said, if we do knowingly put COVID-positive people on a flight with other passengers and crew, it would be important to take extra precautions.

A woman sleeping on a plane, wearing headphones and a face mask.
In the age of COVID, there’s always some level of risk associated with taking a flight.
Shutterstock

All crew on repatriation flights should be vaccinated regardless. To minimise the risk further, all crew dealing directly with COVID-positive passengers should be wearing full personal protective equipment (PPE).

COVID-positive passengers should be seated in a separate section of the plane to those who have tested COVID negative. An analysis of possible on-board transmission during a flight from London to Hanoi demonstrated most infection risk was restricted to the business class section, with attack rates dropping when people were two or more seats apart.

Commissioning large planes with more space to spread passengers out and group them according to risk would help in this regard.

It’s already a requirement that everyone on board must wear a mask unless eating or drinking. Of course, none of this eliminates the risk completely, just as negative tests might still allow someone incubating the virus on board.

It would also be important to consider end-to-end safety including using separate buses from the airport for COVID-positive patients.




Read more:
How can the world help India — and where does that help need to go?


Another option would be dedicated flights for COVID-positive passengers.

Either way, it’s essential to have medical staff on board to provide care for travellers, if needed, and oversee infection control.

Accommodating COVID-positive returned travellers in quarantine

At present, Howard Springs, the Darwin quarantine facility housing returned Australians from India, is aiming to keep the number of COVID-positive residents at 50 or below.

Over time, COVID cases are increasingly likely to be asymptomatic or have mild disease if more people are vaccinated, and therefore shouldn’t need high levels of medical care. If most can stay in normal quarantine accommodation, maybe this could see the number of positive cases Howard Springs can accommodate increased.

If there’s a sound reason for this cap to remain as is, we should still use this capacity to enable evacuation of known cases at high risk of needing hospital care in India.

Sticking to a cap of 50 would likely mean we couldn’t accommodate every COVID-positive Australian who wanted to return home. But we could prioritise those at greatest risk of serious COVID disease, such as older people and those with underlying illnesses. Medical professionals would be on the ground to decide who qualifies as the highest priority.

We need to shift our mindset

Would we feel we had balanced the risks well if our thorough off-shore screening were to result in only a few positive cases in Howard Springs this month, while some people left in India were to die as a result of the virus and inadequate hospital care?

We pat ourselves on the back for what we achieved in containing the first wave by moving hard and fast, and rightly so. But as we’ve learnt more about the virus, we have become more determined to simply keep it out rather than use our knowledge and increased public health response capacity to control it.

We are now vulnerable and are resorting to inhumane steps to protect ourselves. Given the devastating situation in India, I believe it’s time to step back and weight up the true costs of the “zero tolerance” strategy underpinning our approach to repatriation.




Read more:
Why variants are most likely to blame for India’s COVID surge


The Conversation


Catherine Bennett, Chair in Epidemiology, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What is mucormycosis, the fungal infection affecting COVID patients in India?


Shutterstock

Monica Slavin, Peter MacCallum Cancer Centre and Karin Thursky, The Peter Doherty Institute for Infection and ImmunityThis week we’ve seen reports of an infection called mucormycosis, often termed “black fungus”, in patients with COVID, or who are recovering from COVID, in India.

Fungal infections can be devastating. And in this case mucormycosis is adding to the burden of suffering in a country already in a deep COVID crisis.

As of March this year 41 cases of COVID-19-associated mucormycosis had been documented around the world, with 70% in India. Reports suggest the number of cases is now much higher, which is unsurprising given the current wave of COVID infections in India.

But what is mucormycosis, and how is it linked with COVID-19?

What is mucormycosis?

Mucormycosis, formerly known as zygomycosis, is the disease caused by the many fungi that belong to the fungal family “Mucorales”.

Fungi in this family are usually found in the environment (for example, in soil) and often associated with decaying organic material such as fruit and vegetables.

The member of this family which most often causes infection in humans is called Rhizopus oryzae. In India though, another family member called Apophysomyces, found in tropical and subtropical climates, is also common.

Fungus growing in a petri dish.
Mucormycosis is a disease caused by the Mucorales fungal family.
Shutterstock

In the lab, these fungi grow rapidly and have a black/brown fuzzy appearance.

The family members causing human disease grow well at body temperature and in an acidic environment (seen when tissue is dead or dying or with uncontrolled diabetes).

How do you get mucormycosis?

Mucorales are considered opportunistic fungi, meaning they usually infect people with an impaired immune system, or with damaged tissue. Use of drugs which suppress the immune system such as corticosteroids can lead to impaired immune function, as can a range of other immunocompromising conditions, like cancer or transplants. Damaged tissue can occur after trauma or surgery.

There are three ways humans can contract mucormycosis — by inhaling spores, by swallowing spores in food or medicines, or when spores contaminate wounds.

Inhalation is most common. We actually breathe in the spores of many fungi every day. But our immune system and healthy lungs generally prevent them from causing an infection.

When the lungs are damaged and the immune system is suppressed, such as is the case in patients with severe COVID, these spores can grow in our airways or sinuses and invade our bodies’ tissue.

Mucormycosis can manifest in the lungs, but the nose and sinuses are the most common site of mucormycosis infection. From there it can spread to the eyes, potentially causing blindness, or the brain, causing headache or seizures.

It can also affect the skin. Life-threatening wound infections have been seen after injuries sustained during natural disasters or on battle fields where wounds have been contaminated by soil and water.




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In the environment

We haven’t seen mucormycosis infections associated with COVID in Australia, and there have been very few in other countries. So why is the situation in India so different?

Before the pandemic, mucormycosis was already far more common in India than in any other country. It affects an estimated 14 per 100,000 people in India compared to 0.06 per 100,000 in Australia, for example.

Globally, outbreaks of mucormycosis have occurred due to contaminated products such as hospital linens, medications and packaged foods. But the widespread nature of the reports of mucormycosis in India suggests it’s not coming from a single contaminated source.

Mucorales can be found in soil, rotting food, bird and animal excretions, water and air around construction sites, and moist environments.

Although never compared, it may be that in Australia we have a lower environmental burden of Mucorales than in India.

Mucormycosis and diabetes

When diabetes is poorly controlled, blood sugar is high and the tissues relatively acidic — a good environment for Mucorales fungi to grow.

This was identified as a risk for mucormycosis in India (where diabetes is increasingly prevalent and often uncontrolled) and worldwide well before the COVID pandemic.

Of all mucormycosis cases published in scientific journals globally between 2000-2017, diabetes was seen in 40% of cases.

A recent summary of COVID-19-associated mucormycosis showed 94% of patients had diabetes, and it was poorly controlled in 67% of cases.

A man measures his blood sugar.
Diabetes is a risk factor for mucormycosis.
Shutterstock

A perfect storm

People with diabetes and obesity tend to develop more severe COVID infections. This means they’re more likely to receive corticosteroids, which are frequently used to treat COVID-19. But the corticosteroids — along with their diabetes — increase the risk of mucormycosis.

Meanwhile, COVID itself can damage airway tissue and blood vessels, which could also increase susceptibility to fungal infection.

So damage to tissue and blood vessels from COVID infection, treatment with corticosteroids, high background rates of diabetes in the population most severely affected by COVID, and, importantly, more widespread exposure to the fungus in the environment are all likely to be playing a part in the situation we’re seeing with mucormycosis in India.




Read more:
India is facing a terrible crisis. How can Australia respond ethically?


Treatment challenges

In Australia, as in many other Western countries, we’ve seen increased cases of another fungal infection, Aspergillosis, in patients who had severe COVID infections, needed intensive care management and received corticosteroids. This fungus is found in the environment but belongs to a different family.

As Aspergillosis is the most common opportunistic fungus globally, we have tests to rapidly diagnose this infection. But this is not the case with mucormycosis.

For the many patients affected with mucormyosis, the outcome is poor. About half of patients affected will die and many will sustain permanent damage.

Diagnosis and intervention as early as possible is important. This includes control of blood sugar, urgent removal of dead tissue, and antifungal drug treatment.

But unfortunately many infections will be diagnosed late and access to treatment limited. This was the case in India prior to COVID and the current demands on the health system will only make things worse.

Controlling these fungal infections will require increased awareness, better tests to diagnose them early, a focus on controlling diabetes and using corticosteroids wisely, access to timely surgery and antifungal treatment, and more research into prevention.The Conversation

Monica Slavin, Head, Department Infectious Diseases, Peter MacCallum Cancer Centre, Peter MacCallum Cancer Centre and Karin Thursky, Professor, The Peter Doherty Institute for Infection and Immunity

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Charging Indians for COVID vaccines is bad, letting vaccine producers charge what they like is unconscionable


R. Ramakumar, Tata Institute of Social SciencesCountries around the world are racing against time to vaccinate their populations against the coronavirus.

But India has thus far been a poor performer, with only 9.6% of its population receiving a vaccine so far (compared to 51.8% in the UK, 45% in the US, 32.1% in Germany and 14.9% in Brazil).

While there are a few issues plaguing the vaccine roll out, the most egregious is the fact most Indians, many of whom live in poverty, are being made to pay for their shots. And the government is allowing vaccine producers to charge whatever they like.




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Not enough jabs

To cover its entire adult (over 18 years) population, India needs 1.9 billion doses of vaccines. If these vaccines were to be administered over the next 12 months, India would need 161 million doses each month, or 5.4 million doses each day.

At present, India produces only about 2.5 million doses per day, which may rise at best to three million doses per day over the next few months. At the present rate, India would be able to cover only 30% of its population by early 2022.

Only by 2023 would it be able to administer the shot to everyone above 18, which would be late, given the pace and spread of the pandemic.

How did it come to this?

There are three major reasons for this issue.

First, while many countries permitted a diverse basket of vaccines for domestic use, India limited its emergency approvals to just two — Covishield and Covaxin.

Covishield is the Indian name for the Oxford-AstraZeneca vaccine, produced by the Serum Institute of India. Covaxin, on the other hand, was developed jointly by India’s public sector and a private company named Bharat Biotech.

The reason appears to be a belief – based on zero evidence – that the two “Made in India” vaccines would be sufficient to meet India’s domestic needs and international commitments.




Read more:
India’s staggering COVID crisis could have been avoided. But the government dropped its guard too soon


For example, India could have granted emergency approval to the Russian vaccine Sputnik V, and the US-based Pfizer vaccine, in February 2021. Sputnik V was refused approval in February on the grounds that it had not supplied data on immunogenicity (immune response).

However, the same standards did not appear to have been applied to the other two vaccines – Covishield was given approval in January, even though its immunogenicity data were not yet available. Trial data from the UK, South Africa and Brazil published in The Lancet was considered adequate at the time.

Similarly, Pfizer was compelled to withdraw its application for emergency approval because the drug regulator insisted conducting a local bridging study would be necessary. However, Covaxin was given approval in January even when its Phase 3 data on efficacy were not available.

Second, the vaccine business is risky, given the amount of money that has to go into research, development, and testing, and many won’t end up being effective. Early public investments reduce risk exposure for vaccine companies and help raise their production capacities. Countries such as the United States, the United Kingdom and Germany made large at-risk investments in vaccine companies for research and capacity expansion. India failed to do so.

Third, India failed to place advance purchase orders for adequate quantities of vaccines. The first purchase order wasn’t placed until January this year. By this time, capacities of vaccine producers were already locked into other supply commitments elsewhere.

As a result, vaccination centres are being closed, and people are being turned away. In most cities, the mobile application – CoWin – used to book appointments for vaccination, isn’t allowing people to register. And even if people manage to register, appointments are not available for many months.

There is enormous public anger against the government of India for this, as well as for the serious flaws in its public health system which have been exposed by the sharp rise of infections in the second wave. This includes a lack of oxygen in hospitals and even a lack of space for funerals in crematoriums.




Read more:
Why variants are most likely to blame for India’s COVID surge


Vaccine price deregulation

In April the government of India undertook a curious policy shift in its vaccine policy. It deregulated vaccine prices. Vaccine producers could “self-set” the price for their vaccines. Consequently, the two vaccine producers steeply raised the prices of vaccines by two to six times in just a week.

For the same vaccine, the government of India, state governments and private hospitals have different price tags. And the only people in India who receive the vaccine for free are healthcare and frontline workers, and those aged over 45.

The vaccine prices are now so unaffordable that informal workers are forced to spend about half of the household’s monthly salary on vaccinating all the adult members of their households. While it may only be about 800 Rupees for both doses (A$14), when a person at the poverty line may only earn around 50 Rupees (A$0.87) a day on average, this is a large portion of their monthly income. Depending on the definition, one-quarter to one-third of the Indian population is below the poverty line.

The vaccine producers lobbied hard to “free” vaccine prices. One producer said in a television interview he was hoping for “super profits”, and another said he wished the “maximum price” for his vaccine.

The government’s decision to deregulate the vaccine prices allowed “super profits” for private companies, even as an economic and humanitarian crisis was building and unemployment was rising.




Read more:
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Predatory capitalism during human tragedy

Many commentators welcomed the new vaccine policy in the hopes increased prices would incentivise producers to increase supply. But they fail to see that vaccines are global public goods. They impart not just private benefits, but also social benefits, and so every barrier to vaccination must be minimised.

This is why most other nations, including Australia, the US, UK, Germany, France and China, are providing vaccines free of cost to all. India is an unfortunate exception to this global trend, and vaccines are now unaffordable to many.

Poor and faulty planning by the government of India has led to an acute shortage of vaccines. In the midst of the vaccine shortage, the government has effectively withdrawn from the social responsibilities of a welfare state. It has also opened the flood gates for a vulgar form of predatory capitalism to take the stage amid a raging human tragedy.The Conversation

R. Ramakumar, Professor of Economics, Tata Institute of Social Sciences

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How can the world help India — and where does that help need to go?


Channi Anand/Ap/AAP

Dileep Mavalankar, Public Health Foundation of IndiaIndia is in the grip of an unprecedented second wave of COVID-19.

Official data suggests new cases have crossed 400,000 per day, and the daily death count is around 4,200. But the actual numbers may be significantly higher.

We know the hospital system is stretched beyond its limits and there are dire shortages in the country’s expanded vaccine drive.

Clearly, India is in need of help from beyond its borders. What can other countries do?

Help already pledged

In this moment of crisis, the international community has already stepped in to provide some help.




Read more:
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Several countries including the United States, United Kingdom, United Arab Emirates, Russia, Germany, and France have already sent aid such as oxygen and related equipment, ventilators, medicines and ICU equipment. The US has also said it will provide vaccine help, and critical drugs.

Australia has announced it will send ventilators, surgical masks and other personal protective equipment.

How should this help be used?

This aid is all critical. But given the size of India’s population — almost 1.4 billion — more will be needed and even this will not be enough.

Given this, we need to make best use of the incoming aid. India needs to conduct a quick national and state-level needs assessment exercise. Where is help most needed? And where can it be most useful?

Indians in Prayagraj line up for a COVID vaccine.
India’s vaccine program has begun but has been hit by shortages.
Rajesh Kumar Singh/AP/AAP

This should include an assessment of capacities for care and utilisation by each major city and rural area. For instance, there’s a need to evaluate diagnostic and testing capacities and their distribution across the country. An important measure missing at this point is high capacity testing systems which can help increase testing.

The review would also help answer: what are the strengths of the private and NGO sectors and how can they be harnessed? Where exactly are the most vulnerable, and how best can we reach them? Such a review would also help in ensuring that sophisticated machines such as ventilators are not sent to places where they cannot be operated or maintained.

At the same time, there’s a need to look for available internal funds and services that can strengthen India’s efforts.

The importance of vaccines

Given the emerging shortage of vaccines, they will, of course, be the most helpful gift in the long run. Many countries have booked more than they need. Such excess vaccine doses can be offered to India, as it will need millions of doses of imported vaccine to cover its population rapidly.

Besides the very visible gaps in emergency and critical care — such as oxygen and ventilators — technical expertise in epidemiology, biostatistics, data sciences and modelling as well as diagnostic technology would be very useful.




Read more:
COVID crisis in India: why its public health strategy failed


We need help in conducting expert analysis of the situation, prediction modelling by each state and city, and assistance on how to improve systems to record and analyse the huge amount of data that is streaming in.

Sharing knowledge and collaboration in areas such as understanding mutations via gene sequencing, identification of variants of concern, and studying their virulence and transmissibility will also help.

Such efforts are intangible and would fall in the realm of “knowledge aid”, and hence, governments may not be keen to prioritise this. But foreign support could also come in the form of specific funds and grants.

Help must come with no strings attached

In this process, the countries offering the support should not put any conditions or delay the process. Immediate assistance is needed as the peak of the current wave seems to be only a few weeks away.

This support should reach where the most vulnerable get COVID services: public hospitals, healthcare centres run by non-government organisations, and community COVID care centers. The technical help in epidemiology and data sciences should be given to state health departments and major research centres located in cities.

Most importantly, foreign support should strengthen the health system and not be a burden on it.

Only if we are in it together, can we all hope to defeat the virus.The Conversation

Dileep Mavalankar, Vice President western region, Public Health Foundation of India

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Indians are forced to change rituals for their dead as COVID-19 rages through cities and villages


Mass cremations in the city of Bengaluru, India, due to the large number of COVID-19 deaths.
Abhishek Chinnappa/Getty Images)

Natasha Mikles, Texas State UniversityIn the past several weeks, the world has looked on in horror as the coronavirus rages across India. With hospitals running out of beds, oxygen and medicines, the official daily death toll has averaged around 3,000. Many claim that number could be an undercount; crematoriums and cemeteries have run out of space.

The majority of India’s population are Hindu, who favor cremation as a way of disposing of the body. But the Muslim population, which is close to 15%, favors burying its dead.

A worker digging a cemetery in Guwahati,  India.
Workers digging as they prepare to bury the body of a person who died of COVID-19 in Guwahati, Assam.
David Talukdar/NurPhoto via Getty Images

Generally, tradition holds that the body is to be cremated or buried as quickly as possible – within 24 hours for Hindus, Jains and Muslims, and within three days for Sikhs. This need for rapid disposal has also contributed to the current crisis.

Hundreds of families want their loved ones’ bodies cared for as quickly as possible, but there is a shortage of people who can do the funerals and last rites. This has led to a situation where people are paying bribes in order to get space or a furnace for cremation. There are also reports of physical fights, and intimidation.

As a scholar interested in the ways Asian societies tell stories about the afterlife and prepare the deceased for it, I argue that the coronavirus crisis represents an unprecedented cultural cataclysm that has forced the Indian culture to challenge the way it handles its dead.

Cremation grounds and colonial rule

Many Americans think of cremation happening within an enclosed, mechanized structure, but most Indian crematoriums, known as “shmashana” in Hindi, are open-air spaces with dozens of brick-and-mortar platforms upon which a body can be burned on a pyre made of wood.

Hindus and Sikhs will dispose of the remaining ashes in a river. Many shmashana are therefore built near the banks of a river to allow for easy access, but many well-off families often travel to a sacred city along the banks of the river Ganges, such as Hardiwar or Benares, for the final rituals. Jains – who have traditionally given significant consideration to humanity’s impact on the environmental world – bury the ashes as a means to return the body to the Earth and ensure they do not contribute to polluting rivers.

The workers who run shmashana often belong to the Dom ethnicity and have been doing this work for generations; they are lower caste and subsequently perceived as polluted for their intimate work with dead bodies.

The act of cremation has not always been without controversy. In the 19th century, British colonial officials viewed the Indian practice of cremation as barbaric and unhygienic. But they were unable to ban it given its pervasiveness.

However, Indians living in the United Kingdom, South Africa and Trinidad often had to fight for the right to cremate the dead in accordance with religious rituals because of the mistaken and often racist belief that cremation was primitive, alien and evironmentally polluting.

Rituals and a long history

The earliest writings on Indian funerary rituals can be found in the Rig Veda – a Hindu religious scripture orally composed thousands of years ago, potentially as early as 2000 B.C. In the Rig Veda, a hymn, traditionally recited by a priest or an adult male, urges Agni, the Vedic god of fire, to “carry this man to the world of those who have done good deeds.”

From the perspective of Hindu, Jain, and Sikh rituals, the act of cremation is seen as a sacrifice, a final breaking of the ties between the body and the spirit so it may be free to reincarnate. The body is traditionally bathed, anointed, and carefully wrapped in white cloth at home, then carried ceremonially, in a procession, by the local community to the cremation grounds.

While Hindus and Sikhs often decorate the body with flowers, Jains avoid natural flowers for concern of inadvertently destroying the lives of insects that may be hidden within its petals. In all of these faiths, a priest or male member of the family recites prayers. It is traditionally the eldest son of the deceased who lights the funerary pyre; women do not go to the cremation ground.

Relatives gather around the body of a man who died of COVID-19 in India, to perform religious rituals.
Family members perform rituals at a crematorium for a person who died of the coronavirus in India.
Sajjad Hussain/AFP via Getty Images

After the ceremony, mourners return home to bathe themselves and remove what they regard as the inauspicious energy that surrounds the cremation grounds. Communities host a variety of postmortem rituals, including scriptural recitations and symbolic meals, and in some Hindu communities the sons or male members of household will shave their head as a sign of their bereavement. During this mourning period, lasting from 10 to 13 days, the family performs scriptural recitations and prayers in honor of their deceased loved one.

The changing times of COVID-19

The wave of death from the COVID-19 pandemic has forced transformations to these long-established religious rituals. Makeshift crematoriums are being constructed in the parking lots of hospitals and in city parks.

Young women may be the only ones available to light the funerary pyre, which was previously not permissible. Families in quarantine are forced to use WhatsApp and other video software to visually identify the body and recite digital funerary rites.

Media reports have pointed out how in some cases, crematorium workers have been asked to read prayers traditionally reserved for Brahmin priests or people from a higher caste. Muslim burial grounds have begun to run out of space and are tearing up parking lots to bury more bodies.

The work of the dead

While other important rituals such as marriage and baptism may take on a new appearance in response to cultural changes, social media conversations or economic opportunities, funerary rituals change slowly.

Historian Thomas Laqueur has written on what he calls “the work of the dead” – the ways in which the bodies of the deceased participate in the social worlds and political realities of the living.

In India’s coronavirus pandemic, the dead are announcing the health crisis that the country believed it had conquered. As recently as April 18, 2021, India’s Prime Minister Narendra Modi was holding crowded political rallies, and his government allowed the massive Hindu pilgrimage festival of Kumbh Mela to proceed a year early in response to the auspicious forecasts of astrologers. Authorities began to act only when the deaths became impossible to ignore. But even then, the Indian government appeared more concerned about removing social media posts that were critical of its functioning.

India is one of the world’s largest vaccine-producing nations, and yet it was unable to make or even purchase the needed vaccines to protect its population.

The dead have important stories to tell about neglect, mismanagement or even our global interdependence – if we care to listen.

[Explore the intersection of faith, politics, arts and culture. Sign up for This Week in Religion.]The Conversation

Natasha Mikles, Lecturer in Philosophy, Texas State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

COVID has made one thing very clear — we do not know enough about Australians overseas


Bianca De MarchI/AAP

George Tan, Charles Darwin University; Andrew Taylor, Charles Darwin University, and Kelly McDougall, University of South AustraliaThe COVID-19 crisis has thrust a largely unseen part of Australia’s population firmly into the national spotlight.

These are the Australians who live and work abroad — our diaspora.

For more than a year, we have been hearing harrowing stories of Australians unable to get home. Most recently, there is the distress of those in India, currently banned from even trying to return.

But despite increasing awareness of this group, there is still much we don’t know about our diaspora. The bottom line is, we don’t have precise or up-to-date information about Australians overseas.

This lack of knowledge and understanding highlights the need for a national diaspora policy that truly reflects contemporary, multicultural Australia.

What do we know about Australians overseas?

Australia’s diaspora is estimated to include around one million people, but this would be significantly higher if former residents, such as international students, were included.

Australian family returning to Canberra in November 2020.
COVID-19 has seen more than 400,000 Australians return home, but more than 30,000 are still registered as wanting to come back.
Mick Tsikas/AAP

Large-scale studies in 2003 and 2006 told us Australians overseas tend to be highly educated and highly valued by employers. Many also retain links with family and friends in Australia. They continue to identify as Australian and intend to eventually come back.

In 2004, without putting a number on them, the Lowy Institute identified five sub-groups of expats.

  1. The who’s who — people at the pinnacle of their careers in significant international positions
  2. Gold collar workers — highly-skilled, well-paid Australians developing their careers on the international stage
  3. Other professionals — including nurses or teachers
  4. Return migrants — first or second generation Australians, going to their family’s original country for family or professional reasons
  5. Rite of passage travellers — young Australians living or working overseas.

Organisations such as Advance (which is supported by federal government funding) work to connect Australians overseas with each other and Australia. The focus here is on high-profile or very successful expats and how we can leverage their skills and networks to Australia’s advantage.

Traditionally, the majority of departures from Australia have been to Europe, the United States and New Zealand. This has lead to a narrative that doesn’t necessarily reflect the make-up of Australia’s population living overseas and Australia’s multicultural story.

We know from immigration and short-term travel data (those away for less than a year) that Asia, and in particular countries such as India, China, Indonesia, Thailand and Japan, are increasingly important for Australians.




Read more:
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Long-term departure data present a similar picture. Our analysis of Australian Bureau of Statistics data shows India saw a 54% increase as a destination for Australian residents between 2007-08 and 2016-17.

So, the idea that Australia’s diaspora is largely made up of young Aussies backpacking in Europe, or hyper-successful entrepreneurs in Silicon Valley is an outdated one. There is every indication today’s diaspora is complex, and largely made up of everyday Australians doing everyday things.

Yet, we don’t have comprehensive or up-to-date data on where Australians are overseas, what they are doing and whether they are planning to come back.

Why don’t we have a clearer picture?

At a broader level, Australia’s national focus has been on our immigrants, for whom detailed data are recorded and available from the Department of Home Affairs and Bureau of Statistics.

Emigrants have long been an understudied element of Australia’s migration story.

Qantas plane leaving Perth from London in 2018.
Australia does not have a dedicated policy to keep track of and make use of its citizens living overseas.
Tony McDonough/AAP

One of the reasons for our limited and outdated information on our diaspora is the voluntary nature of registration with the Department of Foreign Affairs’ SmartTraveller program.

In 2017, Australia also stopped collecting information on intended destination and reasons for travel on outgoing passenger cards. This was to improve the “traveller experience” and streamline the border clearance process.

Meanwhile, despite recommendations from Senate committees in 2005 and 2013, Australia has not set up a dedicated diaspora policy and monitoring unit within government.

Why do we need a diaspora policy?

At a basic level, a diaspora policy would provide a formal commitment to strengthen links and maintain connections with Australians abroad.

Aside from taking advantage of the knowledge and skills of Australians overseas (which can influence bilateral trade, business and investment opportunities), a diaspora policy should also foster engagement by attending to the welfare of Australians overseas.

COVID-19 has shown us how important it is to understand where Australians are and their circumstances in a time of crisis.

This lack of information makes it difficult to plan and help people quickly. A holistic, consistent and ongoing dataset would tell governments where the pressure points are in times of crisis — where are most of our citizens? How old are they? How vulnerable might they be?

How can we do it better?

A commitment to deeper engagement with our diaspora is fundamental. In addition to a diaspora policy, a relatively easy way to get a better grip on Australians overseas would be to improve how Australians interact with SmartTraveller, so it becomes second nature for travellers to register and update their movements when overseas.




Read more:
The crisis in India is a terrifying example of why we need a better way to get Australians home


Another alternative is to use census data from destination countries. This requires greater synchronisation among national censuses as suggested by the United Nations. However, this also means we are relying on other countries’ data collection, not our own.

We could also look at regular large scale “census-like” surveys of Australians living overseas.

Getting a better grip on Australians overseas will have huge benefits in terms of planning, our economy and national identity. Bringing our diaspora back into our national population and migration story will help us understand its true character, nature and value.

Importantly, it will also move beyond the narrative of Australians overseas as either a “burden” or an “asset”.The Conversation

George Tan, Research Fellow, Charles Darwin University; Andrew Taylor, Associate professor, Charles Darwin University, and Kelly McDougall, Research fellow, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

India is facing a terrible crisis. How can Australia respond ethically?


Paul Komesaroff, Monash University; Ian Kerridge, University of Sydney, and Wendy Lipworth, University of SydneyIndia’s COVID-19 crisis has revived a longstanding debate about whether foreign governments should come to the aid of countries facing major economic or humanitarian challenges and, if so, what kind of help they should provide.

There’s a common assumption foreign aid produces undoubted benefits. But there’s actually limited evidence that it does. Increasing data suggests it may perpetuate existing inequities and inefficiencies, enable corruption, and generate adverse cultural and economic effects.

There are serious questions about the underlying causes of India’s crisis. There’s evidence the Modi government repeatedly ignored warnings from public health experts and refused to plan for the predicted increases in need. Instead, it pursued a public discourse of misinformation, promoted fake cures, withheld health data, intimidated journalists, and encouraged super-spreading events.

Government officials also continue to deny the existence of shortages of vaccines and other medicines. These facts suggest there are underlying structural obstacles, which aid contributions would be unlikely to reverse.




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But the moral arguments about the obligations humans have to each other are well established. So is the principle that we should come to someone’s aid if they’re in need. We are also bound by mutually beneficial values such as equity, justice, solidarity and altruism. Consequentialist philosophers, who argue the only things that matter are outcomes (rather than principles, obligations or intentions), claim foreign aid generally provides more benefit than harm overall.

Unfortunately, the fact we have a moral obligation to rescue someone from harm provides little or no guidance about what kind of help or assistance is thereby required.

We should enter into discussions, led by the Indian people, about what kinds of support are likely to make a difference.

As imperfect as the outcome may be, Australia might genuinely be able to help in areas such as assisting the development of expertise and infrastructure, and advocating for the relaxation of vaccine patent restrictions.

Here’s how Australia can help

Last week, Australia committed to sending an initial support package of ventilators, oxygen, and personal protective equipment to India.

If we choose to act further, we should do so in a generous and compassionate manner, but also with prudence and circumspection. We should be realistic about the limited options available to us. Aid cannot be given with conditions attached — for example, that it be directed preferentially to those in greatest need.

What’s more, it cannot be contingent on the enforcement of a value system that’s contrary to those presently in authority. Foreign donors have no straightforward right to insist on the abolition of corrupt or counterproductive policies and practices in the countries they’re supporting.

However, there are options available to us that can ensure we actually make a difference — and some of these may appear to undermine our own interests.

Top health officials have suggested wealthy countries, which have contracted to purchase many more vaccine doses than they need, should urgently donate excess vaccines to middle- and lower-income countries such as India. Some people may argue that, because of our present lesser need, Australia could donate its entire stock of available vaccines. However, this wouldn’t likely be of much benefit given the logistical, political and structural impediments described above.

Instead, we should draw on our experience over the past year in developing effective processes for responding to the pandemic. We should offer to provide India with expertise about quarantine measures, hygiene, masks, and vaccine education campaigns. Our experts and policymakers could respectfully advise on appropriate economic and social policies.

What’s more, we could call for the relaxation of patent and other intellectual property restrictions. These have, since the late 1980s, imposed severe limits on the ability of poorer countries to produce vaccines and pharmaceuticals developed in the United States and Europe. Although India is the world’s largest vaccine producer, the current demand obviously exceeds supply.

What vaccines are available are much less likely to find their way to poorer sections of India’s population than wealthier ones. This is partly because of insufficient government support, but is also exacerbated by the refusal of rich countries (including Australia) to allow the relaxation of the strict patent laws that prevent state-of-the-art vaccines being manufactured cheaply and efficiently in developing countries.




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There’s already a well-tested mechanism for suspending patent restrictions in an emergency, known as the “Doha Declaration”. This was negotiated in 2001 in response to the urgent need for increased access to newly developed HIV medications. This instrument is ready to use and could be implemented rapidly. Australia should announce its unqualified support for the immediate application of the Doha Declaration to COVID vaccine production.

But that’s not all

India’s huge pharmaceutical industry has previously provided vaccines and medicines to developing countries — many of them in Africa — largely funded by the World Health Organization. The Indian crisis has left these countries vulnerable, through no fault of their own.

Rather than merely responding to the crisis in India, largely self-inflicted by its own government, we should also turn our attention to the increasingly urgent needs of those countries that now face their own major emergencies as a consequence.

Regardless of what anyone does, many people will still die. All that’s open to us is to act ethically in accordance with our own values, informed by knowledge about the complexity of the multiple forces at work.The Conversation

Paul Komesaroff, Professor of Medicine, Monash University; Ian Kerridge, Professor of Bioethics & Medicine, Sydney Health Ethics, Haematologist/BMT Physician, Royal North Shore Hospital and Director, Praxis Australia, University of Sydney, and Wendy Lipworth, Senior Research Fellow, Bioethics, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Official medical advice warned of health risks Australians stranded in India face


Michelle Grattan, University of CanberraThe official medical advice to the Morrison government recommending “pausing” Australian arrivals from India also contained a blunt warning that those stranded risk serious illness and even death.

Chief Medical Officer Paul Kelly’s advice said: “It is important in any measures we implement that we balance the burden on our quarantine and health systems and the protection of our community with the need to help Australians to get home, including those currently residing in high risk countries”.

Kelly said COVID-19 continued to be “a severe and immediate threat” to health in Australia and India was a high risk country, with a sharp increase recently in the number and proportion of overseas-acquired cases coming from there.

“Each new case identified in quarantine increases the risk of leakage into the Australian community through transmission to quarantine workers or other quarantined returnees and subsequently into the Australian community more broadly,” Kelly wrote in his Friday advice to Health Minister Greg Hunt.

“This quarantine ‘leakage’ presents a significant risk to the Australian community.”

The advice was in relation to the government’s determination under the Biosecurity Act – announced in the early hours of Saturday – which makes it an offence for anyone to enter Australia if they have been in India in the preceding two weeks.

This was to close any loopholes enabling people to arrive via third countries after the government suspended flights from India until at least May 15.

Kelly said in his advice, running to more than three pages, that Australia’s quarantine and health resources to prevent and control COVID from international arrivals were limited.

“Due to the high proportion of positive cases arising from arrivals from India, I consider a pause until 15 May 2021 on arrivals from India to be an effective and proportionate measure to maintain the integrity of Australia’s quarantine system,” he said.

But Kelly was careful to put on record a clear warning about the dangers faced by Australians who could not get home.

“I wish to note the potential consequences for Australian citizens and permanent residents as a result of this pause on flights and entry into Australia.

“These include the risk of serious illness without access to health care, the potential for Australians to be stranded in a transit country, and in a worst-case scenario, deaths.”

However he said “these serious implications can be mitigated through having the restriction only temporarily in place, i.e a pause, and by ensuring there are categories of exemptions.”

Under the law, action taken must be no more restrictive or intrusive than necessary and in place only so long as needed.

The determination will expire on May 15 unless extended.

The exemptions include crews of aircraft and vessels and associated workers, Australian officials, defence personnel and diplomats and family members, foreign diplomats accredited to Australia and family members, and members of an Australian Medical Assistance Team (AUSMAT).

There are more than 9,000 Australian citizens and residents registered in India of whom 650 are considered vulnerable.

The advice pointed out this would be “the first time that such a determination has been used to prevent Australian citizens and permanent residents entering Australia”.

On Monday Kelly was anxious to say he had nothing to do with the penalties that exist for breaching the determination, which include large fines and up to five years prison and have received much negative publicity. His letter did note the penalties the act carries.

Scott Morrison told 2GB the arrangement was aimed at ensuring Australia did not get a third wave of COVID and its quarantine system could remain strong.

He downplayed the sanctions, saying they would be used appropriately and responsibly.

Morrison said people who had been in third countries for 14 days could return home to Australia. “But if they haven’t, then they have to wait those 14 days.”

Asked on the ABC whether the government should vaccinate Australians stranded in India, Kelly said: “It’s certainly worth looking at. I would say, though, that we know that many of the Australians that are in India at the moment, they’re very scattered. So it’s a huge country; being able to get to them would be a challenge”.

Queensland Nationals senator Matt Canavan has condemned the government’s stand, tweeting:The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.