Need a more sound vaccine strategy

Need to open up boosters for all senior citizens, persons with co-morbidities, immune afflictions

Although there has been much discussion on boosters to lower the chances of serious morbidity, and help prevent evolution of variants, in India, we are just getting started.
Although there has been much discussion on boosters to lower the chances of serious morbidity, and help prevent evolution of variants, in India, we are just getting started.

Given the rapid pace at which Covid-19 cases are increasing, in the third wave of the pandemic in India, a more sound strategy on vaccination would have been more comforting. From 27,553 new Covid-19 cases on January 1, India recorded 1.79 lakh new cases on Monday. Although there has been much discussion on boosters to lower the chances of serious morbidity, and help prevent evolution of variants, in India, we are just getting started.

Vaccination for 15-17 year olds has kicked off and “precaution” inoculation—boosters in plain-speak—for healthcare workers, frontline workers and senior citizens with co-morbidities is a good step forward. However, it is curious that the government hasn’t opened up booster vaccination for all persons with co-morbidities, immunocompromised individuals, and all senior citizens (though a doctor’s certificate/prescription establishing co-morbidity hasn’t been made mandatory).

Also, an ICMR-RMRC study from September last year posited that the antibody levels started to decline in recipients of Covaxin after two months of a shot while this happened for Covishield after three months. A study published in The Lancet held that a third dose of Covishield given at least 6 months after a second dose, boosted antibody levels six fold and maintained T cell response. So, the 39-week gap between the second and the booster doses also needs to be explained better.

Against this backdrop, the Election Commission (EC) has done well to stop election rallies in poll-bound states till after January 15. At the same time, one wonders why it is not possible to have single-phase elections. Instead, the elections for the Uttar Pradesh assembly will be conducted over seven phases and that in Manipur over two phases. With different models, including one by IIT Kanpur, having predicted a peaking of the third wave by early February, the long polls could mean a longer third wave.

It is true that the West Bengal assembly elections last year were conducted even as the second wave raged, without resulting in a big spike after in that state. But, a variant with higher infectivity than the one responsible for the second wave could throw a curveball, and the EC needed to have been cognizant of that. As Swaminathan Anklesaria Aiyar wrote in The Times of India, with electronic voting machines, the threat of booth capturing—which necessitated phased-polling so as to allow for paramilitary forces to secure one area after the other—has largely been taken care of. In this age of social and digital media also helping to maintain scrutiny over electoral processes, the EC should know that single-/two-day polling isn’t entirely unthinkable.

We also need a clear picture on the number of Omicron cases; the variant is believed to be highly infective but official data shows only 4,033 cases. To be sure, not all positive samples can be sequenced—no country has adequate infrastructure to do this. But, the question to ask is if India is sequencing enough. Even if 10% of the positive samples since the detection of Omicron in India have been sequenced, such low numbers of Omicron reported would suggest Delta, which was responsible for the devastating second wave, remains the dominant variant; this means the surge could once again overwhelm India’s healthcare.

And if it is not Delta—the rapid surge seen so far would indeed suggest a more infectious variant—the effort should be towards tracking so that geographies within the country that are in the throes of a surge have a window to beef up healthcare infrastructure and personnel. While some researchers suggest Omicron may have a much milder pathology—compared to Alpha and Delta— the possibility of higher infectivity resulting in an overwhelming number of hospitalisations, at the population level, can’t be ignored.

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