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Health workers wearing personal protective equipment attend to COVID-19 patients inside a banquet hall temporarily converted into a COVID-19 care center in New Delhi on April 28.

For a century, the Indian Council of Medical Research was a little known government body quietly studying illnesses in New Delhi. But during the pandemic, it’s taken on a role akin to Anthony Fauci’s National Institute of Allergy and Infectious Diseases in the U.S. – a powerful position that’s made it a controversial face of India’s struggles with COVID-19.

As the ICMR has acted as a key medical adviser to Prime Minister Narendra Modi and his health ministry, it’s increasingly drawn criticism from the nation’s doctors and independent scientists, who have questioned its drug recommendations and the group’s lack of transparency on data related to variants identified in India that are now spreading globally.

India struggled to curb the world’s fastest coronavirus surge this summer, and public health experts are warning that the country is ill prepared to face a possible third wave of infections. Some of the ICMR’s decisions during the pandemic reflect the broad chaos that’s dogged India’s overwhelmed government apparatus, and have ended up benefiting the pharmaceutical industry rather than patients, critics say.

In April last year, physician SP Kalantri – who helps run a 1,000 bed hospital in the village of Sevagram – wrote to the international scientific journal, The Lancet, strongly criticizing the ICMR for signing off on the health ministry’s decision to recommend the malaria drug hydroxychloroquine as a COVID-19 therapy. The medicine remained on India’s virus guidelines for almost a year after the drug, once embraced by Donald Trump, was discarded as a treatment for COVID-19 in the U.S.

Kalantri’s hospital in Sevagram, a village once home to Mahatma Gandhi, refused to prescribe that and other unproven treatments. Desperate patients, however, simply sought them out elsewhere, he said.

“Countrywide, the doctors started writing these prescriptions, which artificially inflated the cost for COVID management,” said Kalantri, director professor of medicine at Sevagram’s Mahatma Gandhi Institute of Medical Sciences. “Big Pharma was laughing all the way to the bank and ultimately the one who suffered was the poor patient – it’s where the science failed in India.”

Numerous therapies initially looked promising and the ICMR’s guidelines are constantly evolving as trial evidence emerges, said Aparna Mukherjee, a New Delhi-based senior scientist at the ICMR. “It’s very easy to criticize when something is put forward,” she said in an interview. “When you know there is some possibility that this drug might work, then just because it is in shortage you cannot say don’t use it.” Like other Indian government health agencies, the ICMR has been “stretched thin” during the pandemic, Mukherjee said. Spokespeople for the ICMR and the Ministry of Health and Family Welfare didn’t respond to requests for comment.

Yet criticisms of the ICMR don’t stop there. Over the past year, the government and the ICMR have also been accused of withholding data about COVID-19 and its variants that left physicians in the country flying blind, and of promoting a homegrown vaccine before it had passed key clinical trials. Public health experts say that it isn’t clear how the ICMR decides which COVID-19 drugs to back, and have complained that the agency hasn’t fully disclosed how much funding it provided for the local shot.

Such moves have made the ICMR emblematic of India’s struggles with COVID-19, exemplifying problems in the country’s social and political fabric that existed for decades and lingered under Modi – from a lack of transparency to the underfunded health-care system.

India’s government needed “better evidence making and policy advice from the ICMR,” said Shahid Jameel, a virologist who resigned in May as chair of the advisory panel of a state COVID-19 genome-sequencing panel after criticizing India’s response to the pandemic. The ICMR has also drawn criticism on social media from scientists and health care advocates for its decision making and recommendations, at times attracting attention overseas.

“The Indian Council of Medical Research has been singled out by experts for straying from scientific evidence, appearing at worst politically motivated and at best overly optimistic,” an editorial in the Lancet said in September 2020, discussing the dangers of the “false optimism” that India’s government was projecting even as virus cases continued to rise.

The pandemic has killed more than 400,000 people in India, numbers that experts say are vastly undercounted. As infections surged this summer, hospitals ran short of life-saving oxygen and some patients died in the streets. This month, India’s federal health minister, Harsh Vardhan, resigned amid a broad cabinet reshuffle by Modi, whose popularity has taken a hit over the government’s handling of the pandemic. But the ICMR hasn’t changed.

Headquartered in New Delhi, opposite India’s parliament, the ICMR was set up in 1911 by British colonial rulers and was traditionally focused on research. COVID-19 thrust the organization into the uncharted waters of actually managing an outsized viral outbreak.

In past epidemics, India’s National Centre for Disease Control – which has several infectious disease experts on its board – has played a bigger role. Yet the ICMR has become the more public face of India’s response to COVID-19, a development some scientists questioned. Sujeet Kumar Singh, the director general of the NCDC, didn’t respond to an interview request.

ICMR’s Mukherjee acknowledged that the ICMR’s remit had widened during the pandemic and said that was due to the “need of the hour.” It’s taken on added responsibilities such as testing and procurement of diagnostic equipment, she said.

Funded through the health ministry, the organization has a budget of 23.5 billion rupees ($316 million) this year and backs hundreds of scientist fellowships. ICMR-linked researchers published more than 800 papers in Indian and international journals, according to its last annual report.

Since 2018, it’s been headed by Balram Bhargava, a cardiolologist. The ICMR has several experts focused on diseases like malaria that have traditionally been India’s biggest public health concerns, but few virologists work for the agency. Bhargava didn’t respond to multiple requests for an interview.

With its states easing lockdowns despite only about 6% of the population being fully vaccinated, India is at risk of new waves of infection. But experts question whether India’s health network will be better prepared when the next resurgence comes.

“There is a distinct uneasiness in the scientific community on the government’s handling of the pandemic” and the “opaqueness of the process of consultations, consensus building, data sharing, and decision making,” said Lalit Kant, who headed the ICMR’s epidemiology and communicable diseases division for 13 years until 2011. “If we want the third wave to be managed appropriately then we need evidence-based insights.”

In April, almost 300 Indian scientists and medical researchers appealed to Modi to allow them access to data that could help study, predict and curb the spread of the coronavirus. While the ICMR has data on all Indians who’ve been tested for COVID-19 so far, it restricts access, they say.

“The ICMR database is inaccessible to anyone outside of the government and perhaps also to many within the government,” the scientists wrote. “While new pandemics can have unpredictable features, our inability to adequately manage the spread of infections has, to a large extent, resulted from epidemiological data not being systematically collected and released in a timely manner to the scientific community.”

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