Gujarat illustrates the Modi government’s science denialism during the coronavirus pandemic

In the four months since the novel coronavirus pandemic hit India, the Narendra Modi led-government’s response has indisputably been marked by bad science, from pseudo-scientific remedies such as homeopathy to semi-scientific Ayurveda treatments, all backed by the Ministry of Ayurveda, Yoga, Unani, Siddha and Homeopathy, or AYUSH. In many states, governments are offering homeopathic treatments—globally unproven to be effective—as immunity boosters or prophylactics, to help prevent the contraction of a disease. With the death toll surging rapidly in the last few weeks, the Modi administration has continued to stick by measures that contradict the World Health Organization’s recommended responses to the pandemic as well as the accepted scientific wisdom of the twenty-first century.

The distaste for scientific evidence has been a consistent feature of the Modi government since it came to power in May 2014. One of its first decisions was to elevate the department of Indian medicine and homeopathy to the status of a ministry—AYUSH. In June that year, Dr Harsh Vardhan, the newly appointed health minister, visited the National AIDS Control Organization’s office in Central Delhi. Speaking on the government’s measures to combat HIV and AIDS, Vardhan advised NACO officials to focus on promoting “abstinence” instead of the successful measure of condom distribution—NACO had found that 86 percent of AIDS cases in India were a result of unprotected sex. The newly elected government’s emphasis on AYUSH was accompanied by cuts to other major health programmes, including those for HIV & AIDS, and tuberculosis intervention, and the National Health Mission, the government’s scheme for delivering health under-served areas.

Nowhere is this government’s approach better illustrated than in Gujarat—Modi’s home state, which he led with an iron fist for 13 years, and which he continues to lead by proxy. With the state’s cases among the highest in the country, the government’s public-health policy decisions of the past six years are chickens coming home to roost. The government in Gujarat has steadfastly backed the use of pseudo- and un-scientific methods to tackle the pandemic, even as its testing rates have plateaued despite a rise in coronavirus cases. It has turned its quarantine centres into a site for “experiments”  for pseudo-scientific remedies, where the government did not appear to have adhered to any research protocols prescribed under Indian law. 

Gujarat has emerged as one of the worst hotspots for the virus in India. The state reported its first COVID-19 case on 19 March. At the time of publishing, the state had reported 27,260 confirmed cases—the third highest in the country after Maharashtra and Delhi. With 1,663 deaths, Gujarat has the highest mortality rate among all states, of 6.1 percent—far ahead of the national average of 3.32 per cent. As of 22 June, according to the Gujarat government website, Ahmedabad alone had recorded 1,332 deaths. The total number of cases in the city is not listed on the government website, but according to news reports, as of 7 June, it had recorded over twenty-thousand cases. 

Going against scientific wisdom, which calls for extensive contact tracing and testing, the Gujarat government has instead distributed homeopathy pills and Ayurvedic mixtures in hotpots. In Vasana, a residential area in Baroda, the state government prescribed homeopathic medicine for certain neighbourhoods where cases had been discovered. On 11 May, “my building was sealed, after a neighbour tested positive,” a 21-year-old resident of an apartment complex in the area, who asked not to be named, told me. “The residents have a WhatsApp group, in which we were informed that no one is allowed outside anymore. I was freaking out,” she said. 

Two days after the neighbour tested positive, “people from the government” visited the neighbourhood to conduct a survey, the 21-year-old said. They asked questions that have come to capture the horror of the unfolding pandemic: how many family members in each family, what ages, whether anyone was ill, and if so, what their symptoms were, and so on. After the brief exchange, the men went away, only to come back with two small bottles marked with the address of a homeopathic hospital in Baroda. “They came back came a few hours back provided this ‘medicine.’ The bottles were supplied from Baroda Homeopathic Hospital,” she said.

The government officials told her that the medicine was homeopathic and was meant to be taken as prophylactic treatment. The 21-year-old said, “I’ve convinced my parents to not have the pills. I asked my friends in the neighbourhood, and they’d also received the same bottles.” Her neighbour, a 19-year-old who also asked not to be named, confirmed this. “We got that as well,” the 19-year-old said. “They told us the medicine was an immunity booster, and instructed us to have it before lunch, and before having raw onions and garlic.”

 A public-health activist based in Baroda confirmed what the Vasana residents told me. “In hotspots, the state government distributed homeopathic medicine, and recommended a three-day course,” the activist said. “It’s a small bottle … They recommend it to be had twice a day. Exactly what kind of medicine is being given, we do not know.” He added,  “They keep discussing the success of homeopathic medicine during press briefings, repeatedly stating that it was tested on COVID positive patients, and showed that patients who relied on homeopathic medicines got better faster. It boosted their immunity.”

The 21-year-old told me that, since 11 May, government officials had visited the neighbourhood several times to inquire if any of the residents had developed any symptoms but had not conducted any COVID-19 tests. “In one of the later visits, they gave my mom an Ayurvedic mixture, once again saying it is an immunity booster,” she said. 

In a press briefing on 22 April, Jayanta Ravi, the health secretary of Gujarat, had said that the state government gave out 1,05,41,000 doses of “kadha,” or decoction, describing it as a “concoction of various ayurvedic treatments.” Ravi said the government had further distributed 1.72 lakh doses of sanshamani vati, an ayurvedic treatment that purportedly treats fevers, and 76.72 lakh doses of Arsenicum Album 30. As early as 29 January, a day before India reported its first COVID-19 case, the AYUSH ministry had recommended a course of Arsenicum Album 30—used in homeopathy to treat influenza-like illness—to prevent the contraction of the novel coronavirus,. Even as cases mounted, all government employees, including health workers, police, administrative staff, and others on the front line in Gujarat were given these medicines.

“When there is a pandemic for which there is no specific remedy available, people turn to faith, they go to temples, try home remedies,” Dr Amar Jesani, a medical ethicist and a physician based in Mumbai, said. “These are all coping mechanisms, which is understandable. However, when a government, formally and systematically propagates certain remedies, giving it the credibility of being scientific, it is dangerous.” 

The basic premise of homeopathy, which originated in Germany, is a Latin phrase similia similibus curantur—like cures like. In other words, homeopathic belief states that small doses of a substance that brings on symptoms can also cure the symptoms. Homeopathy is banned in many nations for its unproven benefits. In 2017, the United Kingdom’s National Health Service issued guidelines instructing doctors not to hand out prescriptions for homeopathic treatments, stating that it found “no clear or robust evidence to support the use of homeopathy.” The NHS website notes that, according to a 2010 report by the scientific committee of the House of Commons in the UK parliament, “Homeopathic remedies perform no better than placebos (dummy treatments).” In 2019, the French government announced it will stop reimbursing patients for homeopathic treatment from 2021, after a major national study concluded that the alternative remedy had no proven benefit.

Ignoring the global wisdom on homeopathy, the Gujarat government substituted it instead with an “experiment” of its own design. Ravi said in the 22 April press briefing that the state had conducted an “experiment with those in quarantine centres.” In April, “we took a decision formally, at the government level,” Ravi said, to give Ayurvedic and Homeopathic remedies to the 6,210 people in 179 quarantine centres in Gujarat at the time. She said that Ayurvedic medicines were given to 3,585 people in the centre who consented to receive the treatment, and as many as 2,625 people chose to take homoeopathic medicines.

 Ravi claimed that this “very exciting” experiment had worked—according to her, only 11 of the people who agreed to the treatment subsequently tested positive. With these cases, too, she offered a caveat. These 11 people had only received the treatment for three days, instead of the seven days that it was to be taken for. “This again goes to show that the experiment of providing homeopathy and Ayurvedic treatment as prophylactic or immunity-boosters to those in quarantine, has worked quite well,” Ravi concluded, adding that the Gujarat government shared the data during a video conference of health professionals and the AYUSH secretary, Vaidya Rajesh Kotacha, as a “national best practice.”

“This is bad medical science,” an epidemiologist working with the Indian Council of Medical Research, or ICMR, told me, on the condition of anonymity. He explained that the “experiment” Ravi described was not a randomised trial—a method in which trial subjects are divided into two groups at random. In such a trial, which is the gold standard for testing the efficacy of a treatment, only one group is given the experimental drug or therapy. The second group gets a placebo, or no intervention at all. Researchers then compare the two groups to see if the treatment has worked. This was not done in the “experiment” in Gujarat, where one group was given Ayurvedic medicines and another received homeopathic pills.

But the Gujarat government jumped to the conclusion that homeopathy is an immunity booster, without establishing causality. “People who were in quarantine facilities were assumed to have some exposure to COVID-19. From the information available in public domain, it seems like there was no randomisation—patients selected themselves to receive either Ayurvedic care of Homeopathic care,” Jesani, the medical ethicist, who is also an expert in clinical-trial designs, said. “We don’t know if the clinical trial design had an approval from the ethics committee, if informed consent was documented, and if the patients were given scientific information about the risks and benefits from the ayurvedic and homeopathic products”—all requirements under Indian drug laws.

Jesani continued, “As per Indian law, they also have to show what compensation will be given to those who are injured during the trial. If they did find data that shows these therapies to work as immunity boosters, or prophylactic, the information should be shared so larger studies can be conducted to generate a higher level of evidence.” Jesani said that in India, people widely believe that no traditional remedies can have any harm. This is “not correct, as we know from that Ayurvedic practitioner who died from drinking a concoction,” he said. He was referring to a Chennai-based pharmacist who died after consuming such a preparation, in early May.

“When groups are not comparable and there is no control arm we cannot say whether the treatment provided any benefit, if any. The standard scrutiny of peer review was not applied,” the epidemiologist said. “The two groups are not even comparable. One arm is getting homeopathy, another is getting Ayurveda.” Echoing Jesani on the absence of clarity on whether the correct protocols were followed, the epidemiologist said, “There are certain norms to make sure patients are not harmed when experiments are done. We don’t know if this trial was registered, written consent taken, and ethics clearance obtained. The trial was not registered and this experiment is not scientifically valid due to the core methods used.”

Ravi, when contacted, said she was “not obligated to respond.” Queries sent to her email in May had not been answered even at the time of publication. The report will be updated if and when a response is received.

Under the AYUSH ministry’s direction, the use of homeopathy has become prevalent in several states in India. On 18 May, as Mumbai, the most populous city in one of the most populous nations in the world, had reported 35,058 cases and 1,248 deaths. That day, Praveen Chedda, a BJP municipal corporator from Ghatkopar area of the city distributed 200 bottles of homeopathic pills in his area. The same week, Riddhi Khursange, Borivali’s corporator—also a BJP member—distributed 10,000 bottles of Arsenicum Album 30, along with a prescription that the pills had to be taken, “once on an empty stomach for three days, to be repeated every month till the SARS CoV-2 continues to lurk.” Similar news reports have emerged from  Telangana, Uttarakhand, Tamil Nadu, Maharashtra, Odisha, Karnataka, and Punjab, where the AYUSH ministry has actively been distributing prophylactic medicines that have no proven scientific basis. 

The WHO has maintained a silence on India’s continued use of pseudo- and un-scientific remedies. Questions sent to the WHO office in Geneva as well as their South East Asia regional office went unanswered.

“Meeting healthcare demands through traditional medicine is generally an important and worthwhile goal. In times of novel, acute diseases, advancing any unproven remedy is not acceptable,” the epidemiologist said. At best, he added, it can be argued that homeopathic remedies are not actively harmful, because they contain no active molecules. People often ask, the epidemiologist said, “At least there’s no harm? But false hopes and distractions dilute important messaging. It is also a setback to the goal of cultivating a scientific temper, a constitutional duty based on the idea that such thinking in the broadest sense empower us as capable citizens.” In other words, during a pandemic, advertising pseudo- and semi-scientific therapies as an alternative to necessary medical treatment is actively harmful, as it can delay regular medical treatment, during which time the deadly lethal infection will continue to spread in the community.

The cumulative effect of the Modi government’s continued attack on science is being brought to bear on Indian citizens, as the pandemic unfolds. As of June, India is the epicentre of the pandemic in Asia. Without science as its guide, the government is likely to ensure that the novel coronavirus has a long and protracted stay in the nation.