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India’s Covid Surge Is Cause For Concern

India’s Covid Surge Is Cause For Concern

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India has become the fastest vaccinating nation in the world; but the ratio of inoculation in respect of population is the real cause for concern

By Prasanta Paul

The latest unprecedented surge in daily number of Covid positive cases across India has not only been posing a grave concern, but also reviving frigid memories of countrywide lockdown last year. The arrival of new variants of corona virus and lackadaisical approach of people in observing minimum caution are being blamed for the second or latest wave of afflictions.

There are two contrasting aspects that has put India before the world gaze so far as the Covid 19 cases are concerned. First, with 30 lakh Covid-19 vaccine jabs a day, India has become the fastest vaccinating country in the world for a brief while, overtaking the US with an average daily rate of 30,96,861 jabs.

Despite a low population vis a vis India, US still exceeds India in terms of the total number of vaccine doses administered. US presently tops the world with a total of 16 crore vaccine doses followed by China 14 crore and India ranks third with 8 plus crore jabs.

But India’s rate of vaccination compared to its high population has become a reason for concern as the ratio of inoculation in respect of total population comes to 0.25 against 100 persons.

So far, 8,70,77,474 doses have been administered in India till 7th of April, 2021. India’s massive inoculation drive launched in early January this year, has been desperately trying to grapple with a huge surge in cases. Nearly 1.15 lakh new cases reported on Wednesday (7th April) alone and the figure is rising every day. Maharashtra, Karnataka and Kerala are among the states leading the latest spike.

At the end of 2020, there was a strong hope that high levels of vaccination would see humanity finally gain the upper hand over SARS-CoV-2, the virus that causes COVID-19. In an ideal scenario, the virus would then be contained at very low levels without further societal disruption or significant numbers of deaths.

But since then, new “variants of concern” have emerged and spread worldwide, putting current pandemic control efforts, including vaccination, at risk of being derailed.

Put simply, the game has changed, and a successful global rollout of current vaccines by itself is no longer a guarantee of victory.

No one is truly safe from COVID-19 until everyone is safe. We are in a race against time to get global transmission rates low enough to prevent the emergence and spread of new variants. The danger is that new variants will arise that can overcome the immunity conferred by vaccinations or prior infection.

What’s more, many countries lack the capacity to track emerging variants via genomic surveillance. This means the situation may be even more serious than it appears.

These new variants mean we cannot rely on the vaccines alone to provide protection but must maintain strong public health measures to reduce the risk from these variants. At the same time, we need to accelerate the vaccine program in all countries in an equitable way.

What are “variants of concern”?

Genetic mutations of viruses like SARS-CoV-2 emerge frequently, but some variants are labelled “variants of concern”, because they can re-infect people who have had a previous infection or vaccination, or are more transmissible or can lead to more severe disease.

There are currently at least three documented SARS-CoV-2 variants of concern:

  • B.1.351, first reported in South Africa in December 2020
  • B.1.1.7, first reported in the United Kingdom in December 2020
  • P.1, first identified in Japan among travellers from Brazil in January 2021

Similar mutations are arising in different countries (India included) simultaneously, meaning not even border controls and high vaccination rates can necessarily protect countries from home-grown variants, including variants of concern, where there is substantial community transmission.

If there are high transmission levels anywhere in the world, more variants of concern will inevitably arise and the more infectious variants will dominate. With international mobility, these variants will spread.

South Africa’s experience suggests that past infection with SARS-CoV-2 offers only partial protection against the B.1.351 variant, and it is about 50% more transmissible than pre-existing variants. The B.1.351 variant has already been detected in at least 48 countries as of March 2021.

The impact of the new variants on the effectiveness of vaccines is still not clear. Recent real-world evidence suggests that India’s Covi-shield and Co-vaccine have a better track record even though both the Pfizer and AstraZeneca vaccines offer significant protection against severe disease from the B.1.1.7 variant.

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But the B.1.351 variant seems to reduce the efficacy of the AstraZeneca vaccine against mild to moderate illness. We do not yet have clear evidence on whether it also reduces effectiveness against severe disease. For these reasons, reducing community transmission is vital.

Why we need maximum suppression
Each time the virus replicates, there is an opportunity for a mutation to occur. And as we are already seeing around the world, some of the resulting variants risk eroding the effectiveness of vaccines.

That’s why there has been an increasing demand for a global strategy of “maximum suppression”. Public health leaders should focus on efforts that maximally suppress viral infection rates, thus helping to prevent the emergence of mutations that can become new variants of concern.

Prompt vaccine rollouts alone will not be enough to achieve this; continued public health measures, such as face masks and physical distancing, will be vital too.

The second most important aspect is global equity in vaccine access. High-income countries should support multilateral mechanisms such as the COVAX facility, donate excess vaccines to low and middle-income countries, and support increased vaccine production.

However, to prevent the emergence of viral variants of concern, it may be necessary to prioritize countries or regions with the highest disease prevalence and transmission levels, where the risk of such variants emerging is the greatest. This must be followed by an acute stress on production of affordable yet, reliable vaccines.

Importantly, in the immediate aftermath of the QUAD meeting held virtually last month, the United States has resolved to finance increased capacity to support Indian drug maker Biological E Ltd’s effort to produce at least one billion doses of COVID-19 vaccines by the end of 2022. Japan is in discussions to provide concessional Yen loans to India to expand manufacturing for COVID-19 vaccines for export.

The QUAD group will also form a vaccine partnership aimed at accelerating the end of the coronavirus pandemic by expanding vaccine manufacturing and help Indo-Pacific countries with vaccination, according to a fact sheet from the group. The Quad countries comprise US, Australia, Japan and India.

COVID-19 variants of concern have changed the game. We need to recognize this and act fast if we as a global society, are to avoid future waves of infections, more lockdowns and restrictions, and avoidable illness and death.

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