‘India Must Vaccinate Vulnerable Sections On Priority’

Prof Jimmy Whitworth, a  member of the Scientific Advisory Committee for WHO’s R&D Blueprint for Action to Prevent Epidemics, has been at the helm of several global initiatives on public health research in low- and middle-income countries. An academic staff member at the Liverpool School of Tropical Medicine and the London School of Hygiene & Tropical Medicine, he has rich experience in devising strategy and policy on population health. In an emailed interview, Prof Whitworth spoke with LokMarg about the pandemic situation in India, what to expect in the foreseeable future and how India can tackle the situation.

India has witnessed a deadly second wave of the COVID pandemic that has left in its wake millions of people dying and many more battling with the infection. Although there has been a decline in cases, are there still risks of another wave?

The deadly second wave of COVID-19 in India is now thankfully receding. From a peak of 400,000 new cases a day in early May, there are now around 100,000 new cases per day. However, unless there are concerted efforts to control the epidemic, there are likely to be large waves in the future. These reported numbers of cases are likely to be severe underestimates of the true burden due to a backlog in reporting test results, poor access to testing and many people not being tested because of fear or stigma.

Do you think the Indian government’s decision or recommendation to increase the interval between the first and second doses will have an impact on its efficacy? Or is it, as many believe, an attempt to solve the demand and supply gap for vaccines?

The gap between first and second doses is of minor importance right now, getting vaccines in Indian arms as quickly as possible is the priority. Early on in the pandemic India provided vaccines and medicines for other countries. But now there is a shortage of vaccine supplies in India that is expected to last until July 2021.

The important actions now are to give priority to vaccinations for vulnerable populations, support state level estimates of demand, ensure a coordinated strategy between states and make sure there is an effective supply chain. This means national and state level negotiations are needed to procure vaccines urgently.  There also needs to be a negotiation of patent waivers and clearances for production of a broad set of vaccines with incentives and support for local manufacturers.

One of the variants of the virus in India is believed to be a mutation that is resistant to antidotes. How effective are the vaccines available now? Is there reason to believe that they are not effective against new variants of the COVID virus?

The current vaccines appear to be effective at preventing infection and disease of all of the new variants described so far, although there is some drop-off in effectiveness in protection against some of the strains. The vaccines are still valuable and one of the most important tools that we have to combat this terrible epidemic. Everyone should be encouraged to come forward for vaccination.

How do you think India can best handle the situation there in the context of lack of healthcare infrastructure and the sheer size of the population?

Despite the vast population and fragmented health system, India can control this epidemic. This needs political leadership, with good quality data for decision making. Transparency, public communication and engagement to ensure collective responsibility and action will be important. We need to enhance the ability of health services to respond by expanding the pool of trained, well-protected staff, establish dedicated well-equipped and safe COVID-19 facilities, use primary care for home care, and ensure sufficient medical supplies and oxygen. As well as the need for mass vaccination mentioned above, we need to scale up SARS-CoV-2 testing and expand decentralised contact tracing and isolation. International and domestic travel need to be reduced and made safe through testing and quarantine. Effective bans of gatherings of more than 12 people, closing venues and indoor public spaces and ensuring physical distancing, hand hygiene and mask-wearing will be important to prevent transmission of infection.

What does the future scenario look like? Would most of the world’s population have to live with the reality that the virus and its mutants will continue to be a threat in varying degrees for the foreseeable future?

The measures mentioned above will be sufficient to bring the epidemic under control, however it is likely that this virus will remain in the human population and cause outbreaks for years to come. We will need to adapt to become faster and more effective at controlling these waves of infection. This may need the development of new vaccines to combat variants that occur in the future.