India is a country of big numbers and numbers can cause concern or comfort depending on the subject under discussion. As a covid-19 vaccine producer, India is already on its way to emerge as a vaccine hub of the world. There is already vaccine diplomacy under way and India has reached out to other countries and is trying to contain China’s growing presence. On the other hand, in terms of India’s own vaccination drive, it has in 62 days administered 45 million doses. Again, a huge number in an absolute sense but seen in the context of India’s total requirement. just about 3 per cent of the population. Also, if the total vaccinations are seen in the context of vaccines India can produce, there seems some distance waiting to be covered. After all, just one company, the Pune-based Serum Institute of India, which on day-one got the emergence use authorization, is producing 60 million doses a month. So far, it alone has made over 100 million doses and supplied in nearly equal quantities both to the Indian government and for exports. So, in a sense, India has not used up even one month’s vaccine production of one company.
But then, it is not to suggest that we should stop exports or start saving up the vaccines. The real question, as one expert asks is: of what good is saving up vaccines if we cannot get them to people? We need to move a lot faster on this.
The India numbers become important at a time when there is a rising COVID-19 caseload in the country. It was this day, March 22nd, last year that prime minister Narendra Modi had called for a ‘Janta Curfew’ . As we get to publish this, India in the past 24 hours was witness to over 46,000 new cases, the biggest jump in cases seen in the past few months.
Beyond vaccine hesitancy
Keshav Desiraju, the former health secretary of India and a highly regarded health expert, sees the key challenges essentially still around the issue of vaccine hesitancy and the vaccine dispensing infrastructure in terms of staff preparedness, cold chains and all the rest needed to inoculate in large numbers.
Dr Gagandeep Kang, the globally known Indian medical scientist and professor at the Christian Medical College, Vellore, feels, communication is critical and is not sure if we are doing enough to explain to people that it is important that they be vaccinated. Also, “there is still very little clarity on how much vaccine is actually available in the country and how it is being used,” says Dr Kang.
Realtime sequencing crucial
On the way to deal with the current situation, Dr Kang says, it is really about getting back to basics: “how do you suppress a virus and keep it suppressed, you keep testing and tracing and keep at it. We need to get back to aggressive testing, contact tracing and isolating, we need to do much more on these,” she says. The private labs, she points out, test if someone orders for a test but it is the government that needs to do this for public health purposes. In addition, if we need to track the variants, it is important that the genome sequencing of the virus is done in real time and all the inputs needed for these (some imported kits) are all made available in adequate quantities.
At the moment, she sees only official remarks that there are no variants but then she cautions that the developments in the UK, South Africa and elsewhere showed variants were noticed about two months before they became a public health problem. “To have a clear picture on the variants we need real time tracking and there are concerns that we are not doing enough of that,” she feels. At the moment, the vaccines are the only defence available and according to Dr Kang the current vaccines are good enough and therefore just having people vaccinated is the best protection we can hope for.
Why there is still hope
How serious are the concerns about India headed yet again for a peak, like last year? What is comforting is that Dr Kang is still very hopeful and says, “If we take action even now and if this is not a variant, I don’t see us reaching the peak we reached last year. It is important to remember we are not in the same situation that we were in last year and a large proportion of our population has already been infected and we have some level of protection and we may see the large number of cases but we may not be the kind of hit in terms of severe disease and death at the same rate that we saw last year.” Apparently, the level of mortality will certainly be much lower.
Check the super spreaders
The quick response in many states has been the imposition of lockdowns but experts see time to approach the problem in a much more focused manner. “It is not the lockdown but vaccinating the super spreaders – the young and working population, which is also exposed the most, the 20 year old and above – that need to be inoculated,” says Dr Devi Shetty, the renowned cardiac surgeon and the founder of Narayana Health. He feels, it is important to get more vaccines suppliers into the fold as “we are too big a country to be dependent on one or two suppliers. Also, opening up the vaccination programme for the younger population is essential as they can be the real spreaders.”
He also feels instead of lockdown, the focus will have to be on testing, contact tracing and isolating and off course inoculation. After all, it is the injections that will alone protect all against the infection – the sooner the better.