Thursday, July 23, 2020

Randomised Control Trials and the Alleviation of Poverty in India

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Sattva Vasavada

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Randomised Control Trials and the Alleviation of Poverty in India

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Global Views 360

Publication Date

July 23, 2020

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Poverty in India — A Representative Image

Poverty in India — A Representative Image | Source: Atul Kumar via Unsplash

Abhijit Banerjee and Esther Duflo won the 2019 Nobel Prize in Economics for their “experimental approach in alleviating global poverty”. Their experimental approach encompassed a variety of novel methods to understand and analyse interventions and Randomised Control Trials (RCTs). Their research has been used by policy makers to make informed policy decisions to best help the marginalised.

What are RCTs?

To understand the effect of a policy, intervention, or medicine, decision makers try to measure the efficacy of the treatment. Do deworming pills given to children improve test scores? Does providing chlorinated water improve the health and economic outcomes of villages? These are some causal (read causal, i.e. caused by, not casual) questions researchers are interested in. The best way to analyse causal effects is to randomise the selection of people in the treatment and the control group (for example: children who are given deworming pills versus children who are not given the pills). This random selection of the two groups removes many statistical biases that might affect the results.

RCTs in India:

Many of the RCTs performed by Banerjee and Duflo were in India. They involved short- and long-term impact assessments of various interventions, policies, models, and treatments. We look at a few RCTs implemented in India:

Teacher absenteeism rates:

Troubled by the low attendance rates (or high absence rates) of public-school teachers in India, Duflo assessed the impact of financial incentives on the absence rates of teachers in Rajasthan. The study monitored teacher attendance by cameras, which was tied to a financial incentive if the attendance was high. From a baseline absence rate of 44%, teacher absenteeism in the treatment group fell by 21%, relative to the control group. High teacher attendance caused child test scores to improve too.

COVID-19 and health-seeking behaviour:

In the context of COVID-19, Banerjee tested the effect of sending messages via SMS that promoted health preserving behaviour. The results were very positive. By sending a short, 2.5-minute clip to 25 million randomly selected individuals in West Bengal, the intervention i) found a two-fold increase in symptom reporting to village health workers, ii) increased hand washing rates by 7%, and iii) increased mask-wearing by 2%. While mask-wearing rates increased only marginally, the spillover effects (wearing a mask stops the virus from infecting more people) were moderately high and positive.

Asset Transfers and the Notion of Poverty:

An RCT by Banerjee in West Bengal involving a productive asset transfer accompanied with training found large and persistent effects on monthly consumption and other variables. The treatment group reported 25% higher consumption levels relative to the control group, who did not receive the asset transfer and training. Implications of such RCTs are huge. The notion that the poor are lazy and unwilling to perform strenuous labour is falsified by this RCT. Often, what the poor lack are opportunities that are hard to come by, given their financial status. A small nudge, like the asset transfer, can cause large and positive effects on their well-being.  

Salt fortification to reduce anaemia:

RCTs also help rule out less cost-effective interventions. Duflo and Banerjee evaluated an RCT which distributed fortified salt in 400 villages of Bihar, to reduce the prevalence of anaemia. However, this intervention found no statistically significant impact on health outcomes like anaemia, hemoglobin, etc.  Thus, while RCTs help introduce novel methods of impacting the lives of the poor, they also help in ruling out in-effective measures. A policy maker might try other alternatives to reduce the prevalence of anaemia.

Are RCTs the gold standard?

Maybe. Extrapolating results from a regional RCT to national policies could present problems. Contextuality matters. A study that indicates positive gains for one region might present different, and rather adverse effects for another region. Nation wide effects might not be as prominent as regional results of a single RCT. The good part is that Banerjee and Duflo have a solution. Just perform more RCTs!

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February 4, 2021 5:14 PM

Asian countries & the race for COVID-19 Vaccine

Our relationship with the new strain of coronavirus is almost 8 months strong now. Countries like the US, Russia, UK, China, India, and many more have already set their brainy scientists in the task of developing a vaccine, turning it into a race which desperately needs a winner, since no one wants this deadly relationship to endure. Several attempts have proved to be successful, especially in countries like Russia, USA, India, and China.

China was the first to start scouring for a vaccine the day WHO declared that the new strain of SARS-CoV, originating in Wuhan-China, has resulted in a pandemic. It is a fierce competitor, especially to the US, as almost 8 of the 24 promising vaccines approved for clinical trials are from China. It used the technology of ‘inactivated vaccine’ which basically means killing the actual virus and using that to create a vaccine. This method is quite useful in treating measles and influenza, thus, increasing the chances of success in the case of COVID-19 as well.

“It’s a tried and true strategy”, Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said  about the inactivated vaccine. One potential vaccine from China-based Sinopharm is already in the phase 3 of trials whereas Sinovac will enter the third phase this month. Moreover, China has permitted Sinovac and Sinopharm to dilute phase 1 and 2 of vaccine trials on humans to hasten the process.

The head of the Chinese Center for Disease Control and Prevention, Gao Fu, had also been injected with a potential vaccine on July 28, 2020. “I’m going to reveal something undercover: I am injected with one of the vaccines'' Gao Fu said in a webinar hosted by Alibaba Health, an arm of the Chinese e-commerce giant, and Cell Press, an American publisher of scientific journals. However, he did not reveal any more details about how and when exactly he administered himself with the vaccine and ‘hopes’ that the vaccine works.

Vladimir Putin, President of Russia | Source: Wikimedia

Elsewhere in Russia, on August 11, 2020, President Vladimir Putin proudly announced that Russia was the first country to grant regulatory approval to their vaccine after carrying out human trials for less than 2 months by the Gamalei Institute in Moscow. Regulatory approval permits vaccination of the masses. Although it has not undergone phase 3 of trials, Russia expects to initiate mass production of the vaccine by the end of this year. Kirill Dmitriev, head of Russia's sovereign wealth fund states that the vaccine will be called ‘Sputnik V’, named after Sputnik 1, the first satellite launched by Soveit Union which was a euphoric moment for Russia. More recently, China and Russia have joined hands in proceeding with the clinical trials of their vaccines.

These two instances seem to bring a new hope for the future, yet raise alarms and invite scepticism from the experts in the field of public health. One major concern is that without prolonged trials, vaccines should not be authorized for public use. Anthony Fauci, an infectious disease expert based in the US said “I do hope the Chinese and the Russians are actually testing the vaccines before they are administering the vaccine to anyone. Because claims of having a vaccine ready to distribute before you do testing is problematic at the very least”. Hence, some people are still in doubt regarding the safety of the product. Putin, however, rubbished such concerns and said "I know that it works quite effectively, forms strong immunity, and I repeat, it has passed all the needed checks".

An Indian biotechnological company, Bharat Biotech developed ‘Covaxin’ in collaboration with Indian Council for Medical Research (ICMR), using the mechanism of inactivated vaccine. It was successful in getting approval for human trials which were scheduled to begin in July, 2020. Initial reports stated that it would be ready for mass use by August 15, 2020, which also marked the 73rd Independence Day of India. However, Bharat biotech was clear in letting the public know that phase 1 of the trials are still on-going. ICMR cleared the confusion by stating that it would prepare the results of the phase 1 trials by August 15, 2020, not the actual vaccine for use. Phase 2 of the trials are awaited in September, 2020.

So far, the results of phase 1 trials have been positive as no serious side-effects are observed in the vaccine candidates. “The vaccine has been safe. No adverse effect has been reported. Even the point of injection pain, which is normal in vaccines, has been very mild” said Dr Kushwaha of Prakhar Hospital.

Meanwhile, the South Korean government stated on August 21, 2020, that it will secure adequate vaccine supply to its citizens by cooperating with international bodies and promoting local drug development. Three South Korean companies have started the process of making a vaccine and all are in the clinical trial phase. Bill Gates asserts that the South Korean pharmaceutical company, SK Bioscience, will have around 200 million vaccine doses ready by June 2021.

Japan is jointly collaborating with the UK, France and other European countries to establish a $20 billion fund to buy coronavirus vaccines, with Japan pledging a contribution of $800 million. It’s vaccine program aims to focus on giving primary attention to its medical workers and the elderly people of the country when the first doses of the vaccine are made. The state-funded vaccination program is believed to be officially adopted by Japan in September this year with negotiations with the UK and US based drug makers already in place.

With the race to bring COVID-19 vaccine seemingly coming to a close and it will hopefully be ready by the end of 2020 or early 2021. Till then, the entire world is watching this race with bated breath.

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