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The pandemic deals a blow to Pakistan’s democracy

The pandemic deals a blow to Pakistan’s democracy

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By Madiha Afzal

As Pakistan continues to deal with COVID-19 — with more than 280,000 cases to date and over 6,000 dead — in the face of a struggling economy, the pandemic is dealing a blow to its fledgling democracy. While Pakistan has brought new coronavirus cases and deaths under control in the past month, the pandemic’s aftershocks have weakened the country’s current civilian government, further emboldened its military, and brought about a broader crackdown on dissent.

The military steps into the “gap”

I, along with other analysts as well as public health experts, criticized Pakistani Prime Minister Imran Khan’s initial response to the coronavirus for being weak and indecisive. He refused to implement a nationwide lockdown, letting Pakistan’s four provinces implement their own lockdowns. The provincial actions limited the initial spread of the virus. Khan focused instead on a gimmicky coronavirus youth “Tiger Force” that would help the government disseminate its message. His government first caved in to the religious right to keep mosques open during Ramadan and then allowed markets to reopen too quickly toward the end of Ramadan in May, resulting in a spike of cases across the country in June, stretching its hospitals and doctors to the limit. Khan’s messaging during this time was muddled.

The country’s powerful military, reportedly unhappy both with Khan’s response and that it drew criticism, had publicly backed a tougher lockdown at the same time that Khan opposed it in March. It then started taking a more visible role in the coronavirus response. When the virus seemed to be spiraling out of control in June, the National Command and Operation Center — the joint civilian-military body created to coordinate the national COVID response, in which high-ranking military officers play increasingly visible roles, enforced “smart” lockdowns in hundreds of COVID hotspots across the country. The military’s intelligence agencies led in surveillance and contact tracing efforts.

As the military’s involvement has grown, the pandemic has been brought under control in the country — at least for now, with Pakistan on the other side of its first wave (see graphs below). The communications aspect of the pandemic response is certainly being managed better. Critics contend that the government is under-testing, thus making the picture appear rosier than it is, but case positivity rates in Pakistan — the proportion of positive cases among those who are tested — have also declined, suggesting that the situation really is improving. Though the causes behind the declining cases and deaths aren’t completely clear — even Khan acknowledged he was surprised by the speed of the decline — nor is it clear how long the decline will last, it seems the government’s strategy of “smart” hotspot lockdowns across the country, combined with keeping restaurants and large indoor venues (e.g. marriage halls) closed, has worked. (Khan has argued that this validates his approach against a blanket lockdown.)

Graph showing COVID-19 cases in Pakistan.

Graph showing COVID-19 deaths in Pakistan.

Beyond former and current military men being highly visible on the COVID response — the executive director of Pakistan’s National Institute of Health is also a major general — Khan’s cabinet is increasingly populated by former military men. Retired Lieutenant General Asim Bajwa, a former head of the Inter Services Public Relations (the military’s public relations arm) and the current head of the China Pakistan Economic Corridor Authority, was appointed the prime minister’s new special assistant on information and broadcasting in April. There are other ways the military’s growing role in civilian affairs is visible: In June, it was Chief of Army Staff General Qamar Javed Bajwa, not Khan, who took a trip to Kabul and met with President Ashraf Ghani and chief negotiator Abdullah Abdullah on the Afghan peace process. General Qamar Bajwa is also U.S. Secretary of State Mike Pompeo’s main Pakistani interlocutor on the peace process.

The military’s increasing control seems to be a response to the initial performance by Khan and his government on COVID. As a retired general told the Financial Times: “The government left a big gap in its handling of the coronavirus. The army has tried to fill that gap, there was no choice.” There were also several other factors at play: Khan’s apparent decline in popularity with the public, an exposé of a sugar industry scam, fissures within Khan’s party’s ranks, and the fracturing of his weak coalition in parliament. Pakistan’s military used similar excuses in the past to destabilize democratically-elected governments behind the scenes. The cycle is repeating yet again.

A “minus-one” formula

In June, rumors began to float in Islamabad that Khan’s hold on power was precarious and he might not last much longer as prime minister. He took to the floor of the National Assembly to address the rumors in a long, rambling speech on his government’s performance. Khan even brought up the opposition’s call for a “minus-one” formula: the idea that he should step down to pacify opposition parties while his government finishes out its term. That is essentially how former Prime Minister Nawaz Sharif’s party survived its term in government — without Nawaz. In his speech, Khan insisted that he would finish his term.

Khan’s strident tactics in the past as an opposition politician haven’t helped him now that he’s in power, in terms of dealing with the current opposition. During a sit-in that lasted for weeks in 2014, Khan clamored for Nawaz Sharif’s ouster every night while standing on a shipping container, and some say he is reaping what he sowed. But part of the problem is also the structure of civilian-military relations in Pakistan: Pakistan’s powerful military relies on performance legitimacy for itself, but also for civilian governments, and quickly loses patience with them once their performance falters. The military does not wait for the civilians to be voted out but progressively asserts control, or pushes for their ouster, as it did in the 1990s, destabilizing Pakistan’s entire democratic enterprise. In this playbook, opposition parties often work as pawns for the military, willing to go beyond parliament — such as with “multi-party conferences” or back-room deals — to destabilize the incumbent government. In recent weeks, the current opposition parties, the Pakistan Muslim League-Nawaz (PML-N) and the Pakistan People’s Party (PPP), have fit right into those prescribed roles. The public, too, has become accustomed to this cycle, and begins to lose patience during a government’s term rather than waiting for elections.

When it comes to Pakistan, stories of the military’s growing control may seem to blur into each other. Is anything different this time? Khan was the military’s favored candidate in the 2018 election, and it paved the path to his election. He has gone out of his way to be accommodating to the military, including by extending the current army chief’s tenure. For a time after his election, it seemed that Khan’s closeness with the military might give him the space to implement the domestic policies that he wanted. It seems that period is over. Khan is now clearly constrained by a military whose role has grown progressively through Khan’s term in office and has expanded to the ambit of domestic policy during the pandemic. (Khan’s aides deny this, saying that Khan is still “calling the shots,” with the army’s support — a repetition of Khan’s mantra that they are “on the same page.”)

Wither provincial autonomy?

When Khan let the coronavirus response fall to provincial governments this spring, it briefly seemed as if the pandemic might actually help democratic consolidation in Pakistan. Instead, it has opened up a largely unconstructive and inconclusive debate on problems with provincial autonomy and the 18th constitutional amendment that granted it — with those critical of the law pushing back against the initial provincial control of the virus response. Some of the criticisms of the 18th amendment are warranted, but it is no secret that the military doesn’t like the law, which in taking power away from the federal level threatens the military’s power and finances. The provincial autonomy that defined Pakistan’s initial pandemic response is now firmly in the hands of the National Command and Operation Center.

Illiberalism reigns

The military’s increasing control has also translated to a crackdown on dissent and freedom of the press — a matter on which Khan’s government is studiously quiet. On July 21, a prominent journalist critical of the military and the government, Matiullah Jan, was abducted in Islamabad in broad daylight. He was released that night after an international outcry. In a statement, he said his abduction was the work of forces that are “against democracy.” And this is not to mention concerns about how intelligence agencies are using militant tracking technologies to trace coronavirus patients and their contacts, and the disturbing potential to use that tracing to crack down further on critical voices.

Pakistan’s provincial governments have also used this time to indulge in illiberal impulses, seemingly taking advantage of a permissive environment to do so. In Punjab, the legislative assembly passed a bill to “protect the foundations of Islam,” by giving the province’s director general of public relations the power to ban any books in the province — published locally or imported — that he or she sees as against the “national interest.” In a similar vein, the head of the Punjab textbook board began banning textbooks chosen by private schools for “anti-Pakistan” or “blasphemous” content — citing objections that the books include Mahatma Gandhi’s quotes or photos of pigs in math equations. Both developments are clearly regressive, a blow to freedoms in Pakistan.

Pakistan’s civilian-military games continue, and democracy loses out

Last week, the state minister for health in Pakistan, a political appointee, resigned, citing political pressure and opposition criticism. Amid the pandemic this summer, Pakistan’s usual civilian-military games continue, with an empowered military and opposition parties all too willing to play the game to help weaken the ruling party. Khan’s political space has now been constricted as much as previous prime ministers, with one difference: He is apparently more willing to cede space to the military for his political preservation. In Pakistan, as in some other countries, the longer-term loser of the pandemic is becoming clear, and it is its democracy.

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Glimpse Of Sanity: Dartmouth Returns Standardized Testing For Admission After Failed Experiment

Glimpse Of Sanity: Dartmouth Returns Standardized Testing For Admission After Failed Experiment

In response to the virus pandemic and nationwide…

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Glimpse Of Sanity: Dartmouth Returns Standardized Testing For Admission After Failed Experiment

In response to the virus pandemic and nationwide Black Lives Matter riots in the summer of 2020, some elite colleges and universities shredded testing requirements for admission. Several years later, the test-optional admission has yet to produce the promising results for racial and class-based equity that many woke academic institutions wished.

The failure of test-optional admission policies has forced Dartmouth College to reinstate standardized test scores for admission starting next year. This should never have been eliminated, as merit will always prevail. 

"Nearly four years later, having studied the role of testing in our admissions process as well as its value as a predictor of student success at Dartmouth, we are removing the extended pause and reactivating the standardized testing requirement for undergraduate admission, effective with the Class of 2029," Dartmouth wrote in a press release Monday morning. 

"For Dartmouth, the evidence supporting our reactivation of a required testing policy is clear. Our bottom line is simple: we believe a standardized testing requirement will improve—not detract from—our ability to bring the most promising and diverse students to our campus," the elite college said. 

Who would've thought eliminating standardized tests for admission because a fringe minority said they were instruments of racism and a biased system was ever a good idea? 

Also, it doesn't take a rocket scientist to figure this out. More from Dartmouth, who commissioned the research: 

They also found that test scores represent an especially valuable tool to identify high-achieving applicants from low and middle-income backgrounds; who are first-generation college-bound; as well as students from urban and rural backgrounds.

All the colleges and universities that quickly adopted test-optional admissions in 2020 experienced a surge in applications. Perhaps the push for test-optional was under the guise of woke equality but was nothing more than protecting the bottom line for these institutions. 

A glimpse of sanity returns to woke schools: Admit qualified kids. Next up is corporate America and all tiers of the US government. 

Tyler Durden Mon, 02/05/2024 - 17:20

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Four burning questions about the future of the $16.5B Novo-Catalent deal

To build or to buy? That’s a classic question for pharma boardrooms, and Novo Nordisk is going with both.
Beyond spending billions of dollars to expand…

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To build or to buy? That’s a classic question for pharma boardrooms, and Novo Nordisk is going with both.

Beyond spending billions of dollars to expand its own production capacity for its weight loss drugs, the Danish drugmaker said Monday it will pay $11 billion to acquire three manufacturing plants from Catalent. It’s part of a broader $16.5 billion deal with Novo Holdings, the investment arm of the pharma’s parent group, which agreed to acquire the contract manufacturer and take it private.

It’s a big deal for all parties, with potential ripple effects across the biotech ecosystem. Here’s a look at some of the most pressing questions to watch after Monday’s announcement.

Why did Novo do this?

Novo Holdings isn’t the most obvious buyer for Catalent, particularly after last year’s on-and-off M&A interest from the serial acquirer Danaher. But the deal could benefit both Novo Holdings and Novo Nordisk.

Novo Nordisk’s biggest challenge has been simply making enough of the weight loss drug Wegovy and diabetes therapy Ozempic. On last week’s earnings call, Novo Nordisk CEO Lars Fruergaard Jørgensen said the company isn’t constrained by capital in its efforts to boost manufacturing. Rather, the main challenge is the limited amount of capabilities out there, he said.

“Most pharmaceutical companies in the world would be shopping among the same manufacturers,” he said. “There’s not an unlimited amount of machinery and people to build it.”

While Novo was already one of Catalent’s major customers, the manufacturer has been hamstrung by its own balance sheet. With roughly $5 billion in debt on its books, it’s had to juggle paying down debt with sufficiently investing in its facilities. That’s been particularly challenging in keeping pace with soaring demand for GLP-1 drugs.

Novo, on the other hand, has the balance sheet to funnel as much money as needed into the plants in Italy, Belgium, and Indiana. It’s also struggled to make enough of its popular GLP-1 drugs to meet their soaring demand, with documented shortages of both Ozempic and Wegovy.

The impact won’t be immediate. The parties expect the deal to close near the end of 2024. Novo Nordisk said it expects the three new sites to “gradually increase Novo Nordisk’s filling capacity from 2026 and onwards.”

As for the rest of Catalent — nearly 50 other sites employing thousands of workers — Novo Holdings will take control. The group previously acquired Altasciences in 2021 and Ritedose in 2022, so the Catalent deal builds on a core investing interest in biopharma services, Novo Holdings CEO Kasim Kutay told Endpoints News.

Kasim Kutay

When asked about possible site closures or layoffs, Kutay said the team hasn’t thought about that.

“That’s not our track record. Our track record is to invest in quality businesses and help them grow,” he said. “There’s always stuff to do with any asset you own, but we haven’t bought this company to do some of the stuff you’re talking about.”

What does it mean for Catalent’s customers? 

Until the deal closes, Catalent will operate as a standalone business. After it closes, Novo Nordisk said it will honor its customer obligations at the three sites, a spokesperson said. But they didn’t answer a question about what happens when those contracts expire.

The wrinkle is the long-term future of the three plants that Novo Nordisk is paying for. Those sites don’t exclusively pump out Wegovy, but that could be the logical long-term aim for the Danish drugmaker.

The ideal scenario is that pricing and timelines remain the same for customers, said Nicole Paulk, CEO of the gene therapy startup Siren Biotechnology.

Nicole Paulk

“The name of the group that you’re going to send your check to is now going to be Novo Holdings instead of Catalent, but otherwise everything remains the same,” Paulk told Endpoints. “That’s the best-case scenario.”

In a worst case, Paulk said she feared the new owners could wind up closing sites or laying off Catalent groups. That could create some uncertainty for customers looking for a long-term manufacturing partner.

Are shareholders and regulators happy? 

The pandemic was a wild ride for Catalent’s stock, with shares surging from about $40 to $140 and then crashing back to earth. The $63.50 share price for the takeover is a happy ending depending on the investor.

On that point, the investing giant Elliott Investment Management is satisfied. Marc Steinberg, a partner at Elliott, called the agreement “an outstanding outcome” that “clearly maximizes value for Catalent stockholders” in a statement.

Elliott helped kick off a strategic review last August that culminated in the sale agreement. Compared to Catalent’s stock price before that review started, the deal pays a nearly 40% premium.

Alessandro Maselli

But this is hardly a victory lap for CEO Alessandro Maselli, who took over in July 2022 when Catalent’s stock price was north of $100. Novo’s takeover is a tacit acknowledgment that Maselli could never fully right the ship, as operational problems plagued the company throughout 2023 while it was limited by its debt.

Additional regulatory filings in the next few weeks could give insight into just how competitive the sale process was. William Blair analysts said they don’t expect a competing bidder “given the organic investments already being pursued at other leading CDMOs and the breadth and scale of Catalent’s operations.”

The Blair analysts also noted the companies likely “expect to spend some time educating relevant government agencies” about the deal, given the lengthy closing timeline. Given Novo Nordisk’s ascent — it’s now one of Europe’s most valuable companies — paired with the limited number of large contract manufacturers, antitrust regulators could be interested in taking a close look.

Are Catalent’s problems finally a thing of the past?

Catalent ran into a mix of financial and operational problems over the past year that played no small part in attracting the interest of an activist like Elliott.

Now with a deal in place, how quickly can Novo rectify those problems? Some of the challenges were driven by the demands of being a publicly traded company, like failing to meet investors’ revenue expectations or even filing earnings reports on time.

But Catalent also struggled with its business at times, with a range of manufacturing delays, inspection reports and occasionally writing down acquisitions that didn’t pan out. Novo’s deep pockets will go a long way to a turnaround, but only the future will tell if all these issues are fixed.

Kutay said his team is excited by the opportunity and was satisfied with the due diligence it did on the company.

“We believe we’re buying a strong company with a good management team and good prospects,” Kutay said. “If that wasn’t the case, I don’t think we’d be here.”

Amber Tong and Reynald Castañeda contributed reporting.

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Petrina Kamya, Ph.D., Head of AI Platforms at Insilico Medicine, presents at BIO CEO & Investor Conference

Petrina Kamya, PhD, Head of AI Platforms and President of Insilico Medicine Canada, will present at the BIO CEO & Investor Conference happening Feb….

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Petrina Kamya, PhD, Head of AI Platforms and President of Insilico Medicine Canada, will present at the BIO CEO & Investor Conference happening Feb. 26-27 at the New York Marriott Marquis in New York City. Dr. Kamya will speak as part of the panel “AI within Biopharma: Separating Value from Hype,” on Feb. 27, 1pm ET along with Michael Nally, CEO of Generate: Biomedicines and Liz Schwarzbach, PhD, CBO of BigHat Biosciences.

Credit: Insilico Medicine

Petrina Kamya, PhD, Head of AI Platforms and President of Insilico Medicine Canada, will present at the BIO CEO & Investor Conference happening Feb. 26-27 at the New York Marriott Marquis in New York City. Dr. Kamya will speak as part of the panel “AI within Biopharma: Separating Value from Hype,” on Feb. 27, 1pm ET along with Michael Nally, CEO of Generate: Biomedicines and Liz Schwarzbach, PhD, CBO of BigHat Biosciences.

The session will look at how the latest artificial intelligence (AI) tools – including generative AI and large language models – are currently being used to advance the discovery and design of new drugs, and which technologies are still in development. 

The BIO CEO & Investor Conference brings together over 1,000 attendees and more than 700 companies across industry and institutional investment to discuss the future investment landscape of biotechnology. Sessions focus on topics such as therapeutic advancements, market outlook, and policy priorities.

Insilico Medicine is a leading, clinical stage AI-driven drug discovery company that has raised over $400m in investments since it was founded in 2014. Dr. Kamya leads the development of the Company’s end-to-end generative AI platform, Pharma.AI from Insilico’s AI R&D Center in Montreal. Using modern machine learning techniques in the context of chemistry and biology, the platform has driven the discovery and design of 30+ new therapies, with five in clinical stages – for cancer, fibrosis, inflammatory bowel disease (IBD), and COVID-19. The Company’s lead drug, for the chronic, rare lung condition idiopathic pulmonary fibrosis, is the first AI-designed drug for an AI-discovered target to reach Phase II clinical trials with patients. Nine of the top 20 pharmaceutical companies have used Insilico’s AI platform to advance their programs, and the Company has a number of major strategic licensing deals around its AI-designed therapeutic assets, including with Sanofi, Exelixis and Menarini. 

 

About Insilico Medicine

Insilico Medicine, a global clinical stage biotechnology company powered by generative AI, is connecting biology, chemistry, and clinical trials analysis using next-generation AI systems. The company has developed AI platforms that utilize deep generative models, reinforcement learning, transformers, and other modern machine learning techniques for novel target discovery and the generation of novel molecular structures with desired properties. Insilico Medicine is developing breakthrough solutions to discover and develop innovative drugs for cancer, fibrosis, immunity, central nervous system diseases, infectious diseases, autoimmune diseases, and aging-related diseases. www.insilico.com 


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