Science Vs Coronavirus, Again

NEW YEAR MUSINGS PANDEMIC

Science Vs Coronavirus, Again

New vaccine technologies will be developed, and India will be key player in battle against variants

K Srinath Reddy

27.12.2021

Even in the new year, will there be fear? Or will the pandemic descend the slope, as we fervently hope? Will vaccines win the game, even if variants don’t stay the same? Or will we still need to seek safety behind a mask, as taming the wily virus is no easy task?

I have been posed these questions, which are on everyone’s mind. I will start with the disclaimer that uncertain elements of virus behaviour and inconsistent elements of human response dim the images on my crystal ball. However, science provides a light to navigate through the thickets of available facts and posit a plausible path that the pandemic may take during 2022.

Omicron arrived on the world stage in November, replacing the prospect of joyful jingle bells in December with blaring alarm bells. Early studies show that it is milder in virulence but far more infectious than its dreadful cousin Delta which devastated India in the first half of 2021 and is still on a world tour in the western hemisphere.

While individuals may be at a lower risk of severe disease with Omicron, the total number of severely ill persons will still be high if very large numbers get infected by the new variant which is reported to have high capability for escape from prior immunity. Even a small fraction of a large mass of infected persons will yield numbers that will stress our health and social systems.

Recent news from South Africa, that their outbreak of Omicron has been short-lived with case counts coming down, is reassuring. While this decline needs to be sustained, for us to be certain that Omicron is a breezy batsman that does not last long at the crease, the prospects for 2022 do not appear as gloomy as they appeared in mid-December.

As India is just beginning to experience the Omicron effect, we will get to know to what extent the ‘hybrid immunity’ conferred by the Delta wave and the still-advancing vaccination programme offer protection against Omicron-induced illness if not infection.

For India, the first quarter of 2022 will be challenging, with elections and festivities that will draw crowds despite virus warnings. Will people at least wear masks, for protection as they abandon physical distancing? If the initial case counts do not rise steeply, Covid-appropriate behaviour may not find enthusiastic adherents, resulting in a sharp rise in cases later. We will get the reality check by February.

New vaccines will enter our supply chain after completing trials and securing regulatory approvals, as viral variants stimulate innovation. The task of completing double dose vaccination for all eligible adults will be a priority.

January 2022 will see a third dose protection commencing for sections of the population who are at high risk of exposure (frontline health workers) or high risk of severe illness (elderly individuals with co-morbidities). Vaccination will also commence for children in the 15-18 year age group from January 3. India will scale up vaccine development and manufacture for domestic and global use.

Globally, search for new vaccines will continue. Despite being high performers in clinical trials, the mRNA and virus vector vaccines are now demanding additional ‘booster’ doses to provide protection against variants which emerged after the trials. Their current versions are being tweaked to counter recent variants, but will they hold ground against other variants that may emerge later?

Adverse effects of these vaccines, infrequent though they may be, are a matter of concern as boosters are advocated. Inflammation of the heart muscle (myocarditis) and blood clotting disorders (thrombotic thrombocytopenia) are complications of concern. Sub-unit protein vaccines and inactivated virus vaccines may become the preferred options for boosters next year.

Concern that spike protein specific vaccines are becoming less effective against variants with spike mutations will lead to development of multi-antigen vaccines. Besides the inactivated whole virus vaccines, laboratory developed vaccines with an ensemble of several viral antigens are in the trial pathway, with the nucleocapsid protein being a prominent target. India’s growing scientific prowess will play a larger role in vaccine development.

Recently, the Walter Reed Army Institute of Research in the US successfully completed the Phase 1 clinical trial of a pan-corona vaccine which targets all Covid and SARS variants, including Omicron and SARS-1. This soccer ball shaped Spike Ferritin Nanoparticle Covid-19 vaccine has 24 faces, which allows spikes of multiple coronavirus variants to be attached. If it completes the multi-phase clinical trial journey successfully, it may become one of the preferred vaccines.

New antiviral drugs will also be developed and trialled, besides those that have received WHO approval in 2021. Therapeutic approaches to effectively treat symptomatic Covid will improve, for home and hospital care. Telemedicine will see amplified potential and extended use. Investment in health system strengthening will see increased infrastructure and improved surveillance systems, with the challenge of limited health workforce beginning to get addressed. With uncertainty about new variants persisting, mask mandates will continue for several months, even as other restrictions ease.

The virus will continue to mutate. If we widely adopt Covid-appropriate behaviours and vaccinate equitably across the world, we can exert evolutionary pressure on the virus to mutate to an even milder form. The virus will follow the logical path of evolutionary biology if we travel on the road of rational public health policy. We may then not need a Covid-related prediction for 2023.

The writer, a cardiologist and epidemiologist, is President, Public Health Foundation of India (PHFI). Views are personal

This is the first in a multipart series of commentaries on how 2022 may shape up for India and Indians