Be Careful, India

Be Careful, India

US and Western Europe are a cautionary tale of Covid dangers despite brisk vaccination

25.11.2021

The Covid surge in Western Europe and the US, including in some countries where around 70% of the population is fully vaccinated, sends a message to India – be very careful. India cannot be swayed by comforting assumptions. It must focus on upping disease surveillance and expediting vaccination. Just 30% of Indians are fully vaccinated; and decisions on child immunisation as well as booster shots for 2.5 crore senior citizens and healthcare workers who received second doses over six months ago are still awaited. Reopening educational institutions have triggered a few Covid clusters, evidence that the virus is transmitting even when unable to wreak much damage.

The national serosurvey in July had revealed Covid antibodies in 67% of the population even when single-dose coverage was just 28%. Subsequent serosurveys in Delhi, Kerala and Haryana had revealed over 90%, 80% and 70% seropositivity respectively in the general population. But as the Kerala seven-day Covid trajectory of over 5,000 daily cases, despite 95% single-dose adult vaccination, indicates, only speedy universal full vaccination can mitigate infection risks. High seroprevalence is a comforting prospect but in a situation where immunity is waning, India’s propensity for rapid infection transmission – evident during the Delta second wave in April-June – poses a nightmarish scenario to be avoided at all costs.

Scientific studies to glean actionable intelligence are needed. Regular serosurveys could signal the duration of seroprevalence by vaccine type besides societal-level protection. Hospitalisation data can reveal concrete evidence of waning immunity based on vaccination status, age, sex and location. NTAGI, the apex technical advisory group having the mandate to recommend the booster dose, should requisition all-out support from research bodies under ICMR to pursue studies that further our understanding of vaccines. Mix-and-match trials of vaccines to establish safety and immunogenicity are also necessary: Those wishing to switch out of Covishield or Covaxin must get that option with booster doses.

Concurrently, NEGVAC, the expert group on Covid vaccine administration, must debate the merits of rolling out booster doses in the private sector for those receiving medical advice to take the third dose, while governments steadfastly focus on the community medicine aspect of accelerating first and second doses. From 61% three months ago, the UK’s fully vaccinated population has inched up to just 68% now. With over 20 crore doses lying unused and nearly 10 crore people overdue for their second doses, the vaccination effort is entering a complicated stage in India too. Scientific rigour and state capacity are on test.