Home [:en]Daily Updates[:] India Covaxin: Some Bhopal slum residents thought they had been being vaccinated...

[:en]India Covaxin: Some Bhopal slum residents thought they had been being vaccinated in opposition to Covid-19 however had been a part of medical trials[:]

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Locals who recalled listening to it again in December stated they scrambled to take up the supply — 750 rupees was about twice what they’d normally earn for a day’s onerous labor. And lots of had struggled to work in any respect through the pandemic.

“They informed us it’s the corona vaccine and we must always get it in order that we do not fall sick,” stated Yashoda Bai Yadav, a housewife from Bhopal who participated within the trial alongside her husband.

The Covaxin Part 3 examine, sponsored by the vaccine’s builders, Indian biotech firm Bharat Biotech and the Indian Council of Medical Analysis (ICMR), includes nearly 26,000 individuals at 26 places, together with greater than 1,700 in Bhopal, the positioning of one of the world’s worst industrial disasters.

The Shankar Nagar slum — the place lots of the members dwell — is simply 3.7km (2.3 miles) from the deserted Union Carbide manufacturing unit which was on the middle of the 1984 catastrophe that uncovered greater than half one million individuals to a poisonous fuel cloud. Practically 4,000 individuals died within the fast aftermath, and the catastrophe was blamed for at the very least 10,000 subsequent deaths, and greater than 100,000 everlasting accidents.

A long time later, many residents nonetheless undergo associated well being points, elevating questions from native non-governmental organizations about residents’ suitability to participate in a examine that vaccine developer Bharat Biotech has referred to as the most important Part 3 vaccine trial ever performed in India.

Part 3 trials are historically the ultimate step of human trials earlier than a vaccine is permitted to roll out en masse. Nevertheless, Covaxin was authorized by the Medicine Controller Common of India for restricted emergency use in January, earlier than preliminary outcomes from the trial had been launched. Its Part 3 trial is not anticipated to be accomplished till subsequent 12 months. The federal government has procured 5.5 million doses of Covaxin and 11 million doses of Covishield — the native title for the Oxford-AstraZeneca vaccine — for the primary part of what it’s calling the most important immunization drive on this planet.

At the very least two bioethics consultants, one public well being skilled and 4 native non-governmental organizations, have raised moral questions in regards to the trial website in Bhopal, run by Folks’s Hospital, which is related to the Folks’s School of Medical Sciences and Analysis Centre. As well as, these issues had been additionally raised in a joint assertion launched on January 14 by greater than 40 organizations and 180 people, together with public well being activists and bioethicists.

Greater than a dozen Bhopal trial members informed CNN they didn’t know they had been participating in a medical trial. One other 4 knew they had been a part of a trial, however say they didn’t perceive what that meant.

Bharat Biotech, ICMR and Folks’s Hospital have all denied wrongdoing. They are saying that the trial complied with examine protocol, tips and regulatory provisions, and that they’re targeted on producing top quality knowledge and wouldn’t do something that compromises affected person security. They are saying that members gave knowledgeable consent and denied that the cash supplied acted as an incentive. India’s drug regulator, the nation’s well being ministry, and the moral committee overseeing the trial in Bhopal haven’t commented on the allegations.

The push for Covaxin is tied up in nationwide rhetoric, as India — already the worldwide chief in vaccine manufacturing — goals to finish an formidable rollout at dwelling, and have interaction in vaccine diplomacy by exporting Indian-made photographs. On January 16, Indian Prime Minister Narendra Modi stated: “The world’s confidence in India’s scientists and our vaccine experience goes to be additional strengthened after the Made in India corona vaccines.”

However Jesani, Dr. Anant Bhan, a Bhopal-based bioethics skilled, and Amulya Nidhi, a public well being skilled and the co-convener of the Folks’s Well being Motion India, all say that the alleged recruitment course of, if confirmed true, could be a violation of Indian protocols governing how vaccine trials must be performed.

That might undermine the standard of the trial knowledge, and doubtlessly world belief in India’s prized coronavirus vaccine.

‘We thought it was the vaccine’

Shankar Nagar slum in Bhopal is made up of tiny, colourful homes with roofs created from tin sheets and discarded tarps.

Sometimes, many locals work as day laborers, waving down vans on the primary highway every morning to go to building websites the place they spend hours lifting stones and bricks. For the reason that pandemic, there hasn’t been sufficient work to go round, forcing many to depend on government-provided rations. Some girls wander the slum, carrying sticks to promote as firewood. Others have turned to alcohol or chewing tobacco to go the time.

So when the white van that locals recalled arrived in Bhopal slum areas close to Folks’s Hospital providing the vaccine, 18 individuals noticed it as a fast method to earn cash, they informed CNN.

“My life will go anyway sometime,” Hira Bai, a mom of three, stated sardonically. “I went due to the greed of 750 rupees, anyway we’re used to dying … my life has no worth.”

Locals say they believed the van was from Folks’s Hospital, a non-public institute lower than 3 kilometers (1.9 miles) away from Shankar Nagar which might typically ship vans to the world to conduct checkups as a part of the hospital’s group outreach program. Some stated they instantly piled into the automobile, which seated greater than a dozen passengers.

“The van got here and everybody round me was going so I additionally went,” stated Kesri Chillaar, 59, a laborer who lives together with his spouse and three youngsters in close by Gareeb Nagar slum.

“We thought it was the vaccine, so we went,” stated Yadav, the housewife, who lives in Oriya Basti, one other slum near Shankar Nagar. “We did not comprehend it was a trial.”

Chotu Das Beragi, a 27-year-old laborer, stated he heard the loudspeaker announce that if he did not take the vaccine now, he could must pay cash for it later. “I assumed, ‘There isn’t any work anyway as of late’ … so I assumed, ‘Let me get the vaccine, I’ll get 750 rupees as properly,'” he stated. “I assumed, ‘This will likely be a great way to get the day’s earnings.'”

As soon as on the hospital, a big white constructing with columns and reflective blue home windows, 12 members informed CNN they had been requested to signal varieties, though two individuals solely signed the varieties once they acquired their second shot. One other one gave audio-visual consent and one other was requested for a thumb print as a substitute of a signature. Nevertheless, of these 14 members, eight stated that they had been unable to learn — the state of Madhya Pradesh, the place Bhopal is positioned, has one of many lowest literacy charges in India at round 70%, based on the nation’s most up-to-date Census in 2011. Solely members over 60 stated they had been supplied audio-visual consent varieties. The 4 who might learn stated they weren’t given the chance or time to undergo the 10-page kind written in Hindi. The shape, which CNN has obtained, consists of jargon corresponding to “immuno response,” “placebo” and “immunogenicity” — phrases that might be complicated to anybody with out medical coaching.

Though six individuals CNN spoke to stated they had been conscious they had been in a trial, 4 stated they didn’t perceive what a trial concerned, or ideas corresponding to a placebo. “I didn’t perceive what it was a trial of,” stated Beragi, the day laborer. Solely two of the 21 members CNN spoke to knew they had been in a trial and had full understanding of what that entailed.

At the very least eight Bhopal slum residents informed CNN they weren’t requested about underlying well being situations, regardless that “uncontrolled” comorbidities is listed as a purpose for excluding members within the trial’s personal protocol. Rajesh Panti, 45, a survivor of the Bhopal fuel tragedy, stated when he acquired the primary dose, he was not requested whether or not he was taking any drugs. Chillaar stated he takes treatment for diabetes each morning, however was not requested on the hospital whether or not he had any underlying well being points. Sarita Jathav, 26, stated she is pregnant, however was solely informed that pregnant girls could not take the vaccine when she went to take her second dose, which she didn’t obtain.

All 21 of the members CNN spoke to stated they got varieties to file any adversarial results of the shot. Nevertheless, none had written something on it, regardless of eight of the 21 members describing unintended effects, together with aches, vomiting, abdomen points, pains, and feeling weak. It’s unclear whether or not the individuals who described unintended effects acquired the vaccine or the placebo. They stated they did not know why recording their signs was vital. At the very least 13 of the 21 members informed CNN they had been illiterate, that means they had been unable to make use of the shape anyway.

, [:en]India Covaxin: Some Bhopal slum residents thought they had been being vaccinated in opposition to Covid-19 however had been a part of medical trials[:], Laban Juan
, [:en]India Covaxin: Some Bhopal slum residents thought they had been being vaccinated in opposition to Covid-19 however had been a part of medical trials[:], Laban Juan
, [:en]India Covaxin: Some Bhopal slum residents thought they had been being vaccinated in opposition to Covid-19 however had been a part of medical trials[:], Laban Juan

Radha Bai (high), Jetender Veria (left) and Man Singh Parihar (proper) pictured in Shankar Nagar, a slum in Bhopal, India, on February 7, 2021. All say they didn’t understand they had been members in Part 3 Covaxin trials. (Credit score: Ajay Bedi/CNN)

Anil Kumar Dixit, the dean of Folks’s School of Medical Sciences and Analysis Centre in Bhopal, stated he was not conscious of any van and didn’t ship one to the slums. He stated it was clarified to members that they had been a part of a trial, and that solely 50% would obtain the vaccine whereas the opposite half could be given a placebo. He stated the hospital did pay members 750 rupees, per the ICMR and Bharat Biotech’s directions, but it surely was to cowl them for any misplaced wages — not as an incentive to participate within the trial.

Below ICMR’s 2017 Moral Tips, topics could also be paid for his or her inconvenience and reimbursed for bills incurred, though to not such an extent that it induces them to participate.

Dixit stated his hospital didn’t ask members in the event that they had been Bhopal fuel victims, though directors did look at them for underlying well being situations and rejected them if they’d a power well being drawback. Bhan, the Bhopal-based bioethics skilled, stated he was stunned the hospital hadn’t thought of that some members may be victims of the Bhopal fuel tragedy.

Round 10% of all Bhopal members reported minor adversarial results, whereas round 1 to 2% had been handled in hospital, based on Dixit. He stated his hospital was solely registering adversarial occasions that required remedy, and that many of the minor occasions had been resolved over the telephone.

Dixit stated that for many who could not learn, the shape was defined in both Hindi or English, relying on what they most well-liked, earlier than they signed.

Workers from Folks’s Hospital which is administering the trial informed members they might inspect them by way of telephone, based on Dixit and the members, however two members CNN spoke to stated they hadn’t acquired a name, and two stated they did not know if they’d. One other participant stated they’d acquired calls within the first week, however not within the second week when their adversarial results began.

Two others stated they’d acquired calls however that their telephone belonged to a member of the family, making communication tougher.

4 individuals CNN spoke to stated they wanted to go to a hospital for remedy, and of these two stated they had been requested to pay for remedy for what they thought of adversarial results, together with neck pains and vomiting, regardless of the 10-page doc that they signed stating that they might be lined, one thing that can also be required by India’s Good Scientific Observe tips.

Chillaar, for example, stated that when hospital directors referred to as to verify on him following the shot, he informed them that he was having neck issues. They informed him to come back in for remedy, however when he did, he stated he was informed to pay greater than 3,000 rupees ($41). Dixit, dean of Folks’s School of Medical Sciences and Analysis Centre, stated there have been solely “one or two instances” the place miscommunication led to members being charged.

Chillaar says he bought the primary shot on December 10 and the second on January 7 — Covaxin requires two photographs administered 4 weeks aside. When he spoke to CNN on January 28, he stated that he was nonetheless not in a position to work. “I’m the first earner and it has come to the purpose the place we’re going hungry,” he stated. “I’m not even in a position to go earn and I’ve spent 3,000 to 4,000 rupees on remedy.” CNN has no proof that the shot triggered his well being points and it’s unclear whether or not he acquired the placebo or vaccine because the trial is blinded.

What the foundations say

A whole bunch of people that dwell within the Shankar Nagar slum nonetheless dwell with well being results from the Bhopal fuel tragedy, based on Rachna Dhingra, the chief of Bhopal Group for Data and Motion (BGIA), which works with communities impacted by groundwater contamination from the leak.

In late December, Dhingra says she started listening to experiences of individuals residing within the slum being given the coronavirus vaccine. That set off alarm bells: she knew India hadn’t but formally rolled out a coronavirus vaccine.

Dhingra started investigating and located that a lot of these individuals had really been a part of a medical vaccine trial — and plenty of stated they didn’t understand it.

Dhingra and BGIA spoke to 233 members, and estimate that 800 residents from greater than 5 slum communities impacted by the 1984 tragedy in Bhopal had been a part of the Part 3 medical trial. Nasreen, a area employee from BGIA who makes use of just one title, stated that in lots of instances total households of 5 – 6 individuals had taken half within the trial.

Dhingra says in the entire instances there have been points round how consent had been obtained.

“It unfold like wildfire as a result of individuals thought they weren’t solely getting vaccinated, but additionally that they had been getting cash,” Dhingra stated. “They might by no means do this sort of announcement in middle-class neighborhoods as a result of everybody would know that this isn’t attainable.”

, [:en]India Covaxin: Some Bhopal slum residents thought they had been being vaccinated in opposition to Covid-19 however had been a part of medical trials[:], Laban Juan

India’s New Medicine and Scientific Trials Guidelines 2019 require “freely given, knowledgeable, written consent” from every examine topic, together with that they perceive the dangers and tasks concerned in receiving an unapproved drug. Data should be offered verbally and in a affected person info sheet in “language that’s nontechnical and comprehensible by the examine topic.”

Within the case of Covaxin, the vaccine had solely been examined on roughly 755 individuals throughout each Part 1 and a pair of trials earlier than it was administered in Part 3 medical trials — and people Part 1 outcomes, which had been launched within the Lancet in January, weren’t out when lots of the members acquired their first dose. That examine discovered that the vaccine can produce antibodies to coronavirus and no severe adversarial occasions associated to the vaccine had been reported.

ICMR’s head scientist of the division of epidemiology and communicable ailments, Dr. Samiran Panda, stated the seriousness of the pandemic justified utilizing the accelerated approval course of with out chopping any corners when it got here to security.

Dhingra additionally says round 25% of the members the NGO spoke to reported experiencing adversarial results — greater than twice the quantity that Dixit stated had suffered minor adversarial results. In trials the world over, it is not uncommon for members to report some adversarial results throughout a trial.

, [:en]India Covaxin: Some Bhopal slum residents thought they had been being vaccinated in opposition to Covid-19 however had been a part of medical trials[:], Laban Juan

One Bhopal trial participant who died 9 days after receiving the injection has drawn widespread media consideration in India, prompting shops to publish tales elevating questions over the trial.

CNN has no proof that 45-year-old Deepak Marawi’s loss of life was linked to the vaccine trial, however due to the dearth of transparency round his loss of life — the autopsy nonetheless hasn’t been made public — his widow, Vaijayanti Marawi, and others following the trial say the case raises concern and requires additional examination. Bharat Biotech couldn’t verify if Marawi acquired the vaccine or placebo because the examine is blinded, however they stated his loss of life “had been completely investigated” and located to not be related to the trial. The corporate says Marawi died from cardiorespiratory failure because of suspected poisoning.

Dixit stated employees had adopted up with Marawi for seven days, as he stated they do with all members, to ask about any issues. Marawi had stated no day by day, Dixit stated.

, [:en]India Covaxin: Some Bhopal slum residents thought they had been being vaccinated in opposition to Covid-19 however had been a part of medical trials[:], Laban Juan
, [:en]India Covaxin: Some Bhopal slum residents thought they had been being vaccinated in opposition to Covid-19 however had been a part of medical trials[:], Laban Juan

Vaijayanti Marawi and two of her sons in Bhopal, India, on February 7, 2021. Marawi’s husband Deepak Marawi died in December after collaborating within the Part 3 medical trials.

Arun Shrivastav, the top of the pharmacology division on the Gandhi Medical School in Bhopal, which headed the investigation into Marawi’s loss of life, stated that his committee’s investigation discovered that the trial protocols had been adequately adopted. When requested usually in regards to the alleged use of vans in recruitment, he stated that if a van loudspeaker was used to promote the vaccine for 750 rupees, then it will be “unethical, completely flawed.”

“If there may be something like this occurring then it can’t be counted within the trial and the trial could be barred,” he stated.

‘Violation of excellent medical practices’

Bioethics and public well being consultants Bhan, Jesani and Nidhi all stated Bhopal residents ought to have been thought of weak, and further care ought to have been taken to make sure they knew what they had been agreeing to.

The usual for getting consent is even greater for weak communities — together with people who find themselves impoverished or illiterate. In accordance with India’s 2019 New Medicine and Scientific Trials guidelines, if a trial participant is unable to learn or write, an neutral witness must be current all through the whole knowledgeable consent course of to assist signal the consent kind. An audio-video recording of the knowledgeable consent course of is required in instances utilizing “weak topics,” which incorporates “impoverished individuals” and sufferers with incurable ailments.

“You’re coping with people who find themselves extremely weak, who will not be even totally educated, do you count on them to come back and say, ‘These are my rights’?” stated Jesani, the editor of the Indian Journal of Medical Ethics. “It’s a must to inform them about their rights.”

As for the supply of 750 rupees, Bhan, the Bhopal-based bioethics skilled, stated it was not essentially an moral violation for cash to be supplied — the difficulty is whether or not it was used as an incentive.

However statements made by members counsel that regardless that the quantity supplied was comparatively low, it was sufficient to inspire some trial members in Bhopal. Madhya Pradesh, the place Bhopal is positioned, has a number of the lowest wages for informal employees in India, based on a 2018 India Wage Report by the Worldwide Labour Group. “I assumed it was some patriotic factor and, I will not lie, we had been getting cash additionally,” stated Bhopal resident Panti.

If the allegations about deceptive members, failing to get knowledgeable consent and failing to comply with up on adversarial occasions are true, the issue goes past ethics — it displays on the standard of the trial knowledge, based on consultants.

Bhan stated that if adversarial occasions had been missed, that meant essential knowledge factors had been omitted of the Part 3 trials.

“If that’s what has occurred, it is clearly a violation of excellent medical practices. It is also a violation of tips round how moral conduct of analysis ought to occur,” he stated, talking in regards to the allegations.

The present tips for medical exams in India are comparatively new. After Delhi liberalized its medical trial coverage in 2005, worldwide firms rushed to check their medication in India, the place it was cheaper and simpler to seek out members. A number of the exams had been reportedly carried out in Bhopal, on residents who allegedly weren’t conscious they had been concerned in trials. The 2019 New Medicine and Scientific Trials Guidelines are a results of varied orders from the Supreme Court docket following a case filed in 2012 by non-profit Swasthya Adhikar Manch, which Nidhi can also be a co-convener of.

Bhan, Jesani and Nidhi consider the brand new Bhopal allegations, if true, counsel that extra work must be achieved to enhance oversight over medical trials.

Jesani says, if the allegations are based, it means the info from Bhopal must be excluded because the trial on that website would not have been achieved in a scientific means.

What may be achieved

On January 10, Dhingra and three different Bhopal-based NGOs wrote a letter to Indian Prime Minister Narendra Modi and Well being Minister Harsh Vardhan, asking them to cease the Bhopal trial. They wrote that the involvement of the Indian Council of Medical Analysis in a trial with “obvious and grave violations” of the rules ICMR laid down was “alarming and deeply troubling” and stated the scenario should be addressed to keep away from the general public dropping religion in vaccines.

  • A timeline of Covaxin

  • Bharat Biotech receives Medicine Controller Common of India approval to conduct Part 3 medical trials with 26,000 members for Covaxin.

  • Covaxin’s Part 3 medical trials begins.

  • Bharat Biotech pronounces it has recruited 13,000 members — round half its goal.

  • Central authorities’s topic skilled committee, which recommends vaccines for emergency approval, says that Bharat Biotech ought to attempt to expedite recruitment for Part 3 Covaxin trials as “efficacy is but to be demonstrated.”

  • The topic skilled committee recommends India’s drug regulator approve Covaxin for restricted emergency use, citing “up to date knowledge … within the wake of the incidence of recent mutated corona virus an infection.”

  • India’s drug regulator offers restricted emergency use authorization to Covaxin and Covishield, the title given to the Oxford-AstraZeneca developed vaccine in India.

  • Bharat Biotech pronounces that it has completed recruitment and all 26,000 members have acquired their first dose.

  • 4 Bhopal-based NGOs write to India’s prime minister and well being minister, warning them of alleged moral violations within the Bhopal Part 3 Covaxin trials.

  • India begins the primary part of its vaccination drive — rolling out Covaxin and Covishield to 10 million healthcare employees.

Supply: CNN reporting

They copied the letter to the Medicine Controller Common of India, which has the ability to research alleged breaches.

Greater than a month later, the teams say they’ve acquired no response.

Regardless of a number of requests for remark, Bharat Biotech has not responded to CNN’s emailed questions. In a public assertion in January, the corporate stated participation was voluntary and each participant gave totally knowledgeable consent, even those that weren’t in a position to learn or write. All members had been paid 750 rupees, but it surely was not an inducement, the corporate stated, relatively a fee to cowl transport and bills, including that they’re following practices set by the Indian Good Scientific Observe tips. Members are solely enrolled after a cautious evaluation of their “varied well being parameters,” the corporate stated.

“The event of Covaxin is a matter of nice delight to us, not simply at Bharat Biotech but additionally for India, and certainly the remainder of the world,” the corporate stated. “We’d not do something that might compromise both the scientific rigor of what we do or the lives of sufferers.”

“Our fixed focus through the growth of the vaccine and the medical trials has been on guaranteeing affected person security and guaranteeing that the examine is finished to the necessities of all of the related and relevant guidelines and tips, and that the info generated is of the best high quality and legitimate.”

Three different trial websites informed CNN they’d collected knowledge on all minor adversarial occasions, together with complications or fever.

4 trial websites informed CNN they’d problem reaching the goal of 1,000 trial members. Against this, the Folks’s Hospital website in Bhopal managed to register instances shortly. “Different facilities weren’t in a position to obtain the goal so then (Bharat Biotech) requested us to do extra numbers,” Dixit stated.

ICMR’s head scientist of the division of epidemiology and communicable ailments, Panda, stated excluding the Bhopal fuel victims from the examine would have been discriminatory, denying them an “alternative.”

“You’re coping with people who find themselves extremely weak, who will not be even totally educated, do you count on them to come back and say, ‘These are my rights’?” Amar Jesani

Panda stated the ICMR spoke to the principal investigator operating the Bhopal trial following the moral violation allegations within the media, however had been assured by the investigator and his medical staff that they’d adopted protocol. They didn’t independently converse to any of the members within the trial, though they saved the Medicine Controller knowledgeable of their Bhopal communications, Panda stated.

In accordance with Panda, there have been no allegations of wrongdoing at another website. CNN has contacted 12 different websites however has discovered no proof that the alleged points that occurred in Bhopal came about at different websites.

In accordance with Dr. Mohammad Shameem, the principal investigator of a Part 3 Covaxin trial website in Uttar Pradesh, Bhopal’s alleged recruitment technique of providing vaccines for 750 rupees utilizing a van with a loudspeaker would have wanted sign-off from the native moral committee. It isn’t clear if the Folks’s Hospital’s institutional ethics committee knew {that a} van was allegedly getting used for promotional functions. CNN has tried to contact the committee for remark.

Push to roll out

The controversy over the Covaxin trials is going down as India rolls out its formidable plan to immunize 300 million of its 1.3 billion inhabitants by August.

However some healthcare employees in India, who had been first in line to obtain a shot, have expressed reticence to take the vaccine till there may be extra knowledge on Covaxin.

Consultants fear the moral questions over Bhopal might undermine belief within the vaccine when it is rolled out extra broadly — each in India and overseas.

Bharat Biotech has signed an settlement to produce Brazil with the vaccine, and is making use of to conduct trials in Bangladesh, Reuters reported. Bharat Biotech additionally signed an settlement with biopharmaceutical firm Ocugen to develop its vaccine for the US market.

, [:en]India Covaxin: Some Bhopal slum residents thought they had been being vaccinated in opposition to Covid-19 however had been a part of medical trials[:], Laban Juan

India has historically been receptive to vaccines, and there is not a powerful anti-vaccination motion within the nation, however Jesani, from the Indian Journal of Medical Ethics, says that would change if the federal government does not act to revive confidence in Covaxin. Bhan, the bioethics skilled, stated an audit of the Bhopal trial would construct confidence within the course of.

If these preliminary questions linger and manifest as normal anti-vaccination sentiment, that could possibly be an issue for the general public’s willingness not solely to get the Covaxin vaccine, but additionally different coronavirus vaccines as India continues to report greater than 10,000 instances every day.

Jesani stated that’s the reason it’s so essential that authorities examine claims that some Bhopal members did not know they had been a part of a trial.

“We do not need individuals to lose religion. We do not need individuals to lose belief within the vaccination,” he stated. “In the event that they lose belief within the Covid vaccine, they may lose belief in different vaccines.”

Esha Mitra reported from New Delhi and Bhopal, India. Julia Hollingsworth reported and wrote from Hong Kong.
Further reporting: Anup Dutta
Pictures and video: Ajay Bedi
Graphics: Natalie Leung
Editors: Hilary Whiteman and Jenni Marsh





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