Combating Covid-19: Get testing and vaccine strategies right
December 25, 2020 7:30 AM
It is important that our policymakers do not buy into a sense of overoptimism regarding the imminent arrival vaccines. It will be months before a vaccine can be administered in sufficient numbers throughout our country.
At a time like this, our reliance on wide, smart testing and tracing should increase even further
By Pradyut Bordoloi
Be it developed nations or developing ones, young countries or old, democracies or autocracies, Covid-19 has not spared any society. The pandemic has grimly tested the resilience and preparedness of health infrastructures across the world and revealed its many cracks. However, it is interesting that a few countries, like New Zealand and Vietnam, have still managed to outsmart the virus by mobilising resources and following a robust testing and tracing strategy.
India’s response to Covid-19 has been extremely dynamic, and the fluid conditions and contexts have required frequent revisions in strategy. It is unfortunate how key aspects like quality and equity in the overall testing strategy have been ignored, including in my home state of Assam. Since the state began using Rapid Antigen Detection Tests (RADT) to carry out tests in July, their share has been higher than the more reliable RT-PCR tests. The sensitivity of RADT has been pegged as low as 50%, and that has caused a decline in positivity rate due to the frequent false-negative results. Besides, the state has not followed up with confirmatory RT-PCR tests.
Moreover, RT-PCR tests at private labs in the state continue to be priced (at the time of writing) at Rs 2,200, making them unaffordable and severely limiting testing options for the public. This is in stark contrast to Odisha and Delhi, where the price of the test has been capped at Rs 400 and Rs 800, respectively. This throws some profound questions on the differential between the available and required testing capacity in the state.
In Assam, the first case of Covid-19 was detected on March 31, and since then, the state government has taken some outrageous decisions like, being the only state to import PPE kits from China, or the alleged siphoning of public funds under the garb of awarding emergency procurement contracts. In the initial few months, Assam had one of the lowest mortality rates in the country, and it was attributed to reasons ranging from higher immunity of the population to genetics and even the large forest cover. However, it has since emerged that the state government had misled everyone by setting up “Death Audit Boards”, which had the power to certify and label Covid-19 deaths, stating them to be ICMR-recommended—a claim that was denied by it later. This jugglery allowed the state government to fudge data and artificially depress the death count in Assam.
There are other aspects unique to the state which merit even greater attention from the state government. For example, millions of estate workers work in close proximity in over 800 tea gardens of Assam. Given the environment that they operate in, these workers suffer from pre-existing health conditions making them highly vulnerable. If the virus were to make its way into this population, the scale of morbidity and mortality would be massive, especially without accessible testing services. To comprehend the actual extent of the spread of the virus, frequent, large scale and smart testing drives must be carried out in all tea gardens of the state. Although cases are on the mend at present, the cost of complacency can be exorbitant, as is evident in the complete lockdowns re-imposed in Europe as well as the recent spike in deaths in the US.
At the same time, it is equally important that our policymakers do not buy into a sense of overoptimism regarding the imminent arrival of clinically proven and safe to administer vaccines. It is true that we now have multiple vaccine candidates claiming efficacies above 90% and some have been rolled out in other countries. But it will be months before a vaccine can be administered in sufficient numbers throughout our country. At a time like this, our reliance on wide, smart testing and tracing should increase even further.
As can be seen worldwide, countries are in a frenzy to make an advance purchase of the vaccine doses. India has to proceed strategically such that the limited vaccine resources are allocated in the most optimal manner possible. The Union health secretary has already stated that once a vaccine becomes available, it might not be administered to the entire population but to a critical mass to ensure that the transmission chain is broken. Thus, drawing up an order of priority is imperative to safeguard the interests of those most vulnerable to contracting the infection.
It would also be prudent for the government to consider reserving vaccine doses for those who have not been infected previously to extend protection where there is a greater need. The identification of persons who have developed antibodies against the virus would only be possible by rigorous testing of all those in the priority list. This is likely to foster a well-informed, data-driven vaccination strategy while minimising infections. For the populations who are unlikely to get inoculated in the first phase, testing and tracing will continue to be primary tools of detection and control of infection.
The author is INC MP (Lok Sabha). Views are personal