Vaccine reach & efficacy queer Covid-19 outlook, govt must ready people for sustained non-pharmacological measures
The WHO had warned that younger people, who are more likely to be holding jobs and participating in other income generating activities, are likely pushing transmission.
Given how the government has said that it expects 20-25 crore Indians to be vaccinated for Covid-19 by July 2021, it is highly likely that meaningful vaccination coverage in India won’t be possible till at least 2022. And, as long as the bulk of the population doesn’t have access to pharmacological intervention, the government will have to continue efforts to make non-pharmacological measures, such as wearing of masks in public spaces, including indoor facilities, hygiene practices and distancing, mainstream.
Distancing requirements will mean that there has to be a long-term view taken on activity that needs gathering of people. Planning and protocols for work-from-home, online classes, crowd restrictions, etc, will need to be threshed out, keeping in mind that they will be necessary for much longer than previously imagined.
As this newspaper has argued before, the Centre and the states should treat Covid-19 as an opportunity to not just sustain but widen the reach and scope of the digital leap in delivery of education that the pandemic has catalysed; to that end, the government’s decision to free up universities for online programmes is a step forward. But, to ensure that digital access doesn’t become a barrier, the government will need to tie-up with industry for making devices and internet available to students from the economically vulnerable classes for free or highly subsidised prices.
Apart from ensuring access to masks, sanitiser/soap, etc, there will be a need to enforce distancing—avoidable gatherings, such as for festivals, in places of worship, celebrations, etc, will have to be strictly restricted in the interim.
The WHO has recommended 50% effectiveness as the threshold for vaccine candidates against Covid-19, and many jurisdictions, including India and the US, have adopted this standard. However, several experts have voiced concern that this may not be adequate—even if low-efficacy vaccines are not to be dismissed completely since they could have certain desirable outcomes in terms of disease severity in recipients.
Indeed, as per data-based projections by Public Health Computational and Operational Research (PHICOR) at the CUNY’s School of Public Health (discussed in a National Geographic article), even with 100% of the population covered, a vaccine with 50% efficacy won’t deliver the immunity-spread that the US would require to successfully stall SARS CoV-2. As per PHICOR’s projections, to ensure immunity in over 70% of the population—which is estimated to be the threshold to stall the virus based on its basic reproduction number—the vaccine needs to have an efficacy of more than 75%. Besides the Achilles heel of efficacy, governments will have to contend with the dilemma of who should be prioritised for receiving the vaccine. The consensus seems to favour frontline workers, including healthcare personnel, and the high-risk (of severity/mortality) groups for disease such as the elderly, those with co-morbidities, etc.
But some experts argue it should be the ones who are likely to effect the most transmission, such as those who have to venture out of their homes and meet many people—from across the sections of society—for work and other reasons. The WHO had warned that younger people, who are more likely to be holding jobs and participating in other income generating activities, are likely pushing transmission.
An epidemiological study by Ramanan Laxminarayan and others, based on data from Andhra Pradesh and Tamil Nadu, shows that children spread the virus just as efficiently as adults; given wearing of masks, distancing and hygiene are difficult to enforce in this cohort, their role in spread needs to be better understood for designing the right vaccine strategy. Till these factors are addressed, governments across the world will have to ready their populations for a ‘vaccination plus continued non-pharmacological measures’ reality.