By Kiran Mazumdar-Shaw
The second Covid-19 wave has hit India, and hit it hard. Record jumps in coronavirus infections on a daily basis have pushed health infrastructure to the brink in several states. While patients are scrambling to secure hospital beds, hospitals are running out of oxygen supplies and critical anti-Covid-19 drugs along with medical staff reportedly stretched to the breaking point.
While the ferocity of the second wave seems to have caught everyone unawares, it holds some very important lessons for us.
Vaccinate, Vaccinate, Vaccinate: It is abundantly clear by now that vaccination is key to managing this pandemic, achieving herd immunity, and protecting a population from a repeat outbreak. Thanks to a very successful and efficient mass vaccination drive, Israel has now been able to ease some Covid-19 restrictions.
The Indian government has done the right thing by allowing all citizens above the age of 18 years to get Covid-19 vaccination from May 1 onwards. It now has to ensure that there is enough manufacturing capacity to produce these vaccines. We cannot have a situation where vaccination centres are forced to suspend operations and beneficiaries turned away.
GoI’s sanction of a ₹4,500-crore credit line to Serum Institute of India (SII) and Bharat Biotech is a step in the right direction.
Opening up the private market for vaccination, and providing more leeway to states and private companies in deciding immunisation strategy can ensure enough Indians are inoculated and the larger objective of herd immunity is achieved. Better realisations in the private market will also spur vaccine players to raise local production.
Pandemic Preparedness Planning: India heralded 2021 on a strong positive note – the virus was on the wane, economic indicators were looking up, businesses were optimistic. We never ever thought a second wave would hit us so hard within a few months. Complacency led to unanticipated shortages of medicines, medical supplies and hospital beds. All the planning that went into successfully tackling the first Covid-19 wave were forgotten, and we are back to square one.
The second wave has underlined the urgent need to focus on pandemic preparedness planning. State governments and central agencies need to invest in stockpiling minimal inventory of essential medicines and medical supplies at critical centres to provide industry-adequate buffer time to cater to demand surges. Surveillance systems need to be installed to identify and track outbreaks and contain spread within hotspots. Quarantine protocols need to be calibrated to the transmission and spread of the virus.
Informed policy development must be at the centre of our national strategies for pandemic management.
Deploy Latest Scientific Tools to Tackle Mutants: India will need to ramp up genetic sequencing of positive Covid-19 test samples to catch new variants quickly as the virus mutates. This important data will enable the government to rework its virus strategies based on the new strains.
Immune-escape from the two vaccines being deployed across our country is a serious challenge, as can be seen from the high incidence of re-infections. Mutations in India have resulted in a double variant that appears to be far more virulent than the original strain. Variants in other parts of the world are also leading to new waves of infection, which all point to immune-escape from the current portfolio of vaccines, be they mRNA-derived, adenoviral vector-based or DNA sub-unit vaccines.
There are varying levels of protective cross-reactivity among the vaccines, and only time will tell whether a mix-and-match vaccination strategy is more optimal than using certain classes of vaccines. The fact that India will have access to a heterogeneous portfolio of vaccines augurs well for us to pursue various experimental models in our long-term battle against Covid-19.
The Indian Council of Medical Research (ICMR) and other research institutes have a challenging, yet exciting, task ahead to generate a data lake of various immunogenic parameters of vaccines. We will need high-end analytics to convert this diverse data into meaningful vaccine deployment protocols. For example, based on the various strains of the virus circulating in India, GoI will have to fine-tune its vaccination strategy. High-efficacy vaccines like Pfizer’s mRNA can be used in areas where there is a high emergence of immune-escape variants.
We also need better data on the sero-positivity rates in the country. For instance, if we can identify populations who have already developed Covid-19 antibodies, they need not be vaccinated on priority. It would be better to deploy these vaccines on populations that have low sero-positivity. Hence, antibody surveillance and antibody assessment before vaccinating populations may be an approach worth considering.
Improve Data Governance: There is an urgent need for better and closer partnership between the government and civil society organizations in responding to people’s needs during this pandemic. India needs to create a Covid-19 response command center, with support from the private sector, to identify, share and utilize real-time data on inventory of medicines, oxygen cylinders, hospital beds, etc.
The creation of a central or state level data warehouse through a coordinated public-private partnership (PPP) model can help the public access standardized data, and find much-needed medical resources, thus preventing needless suffering and deaths.
The article first appeared in The Economic Times on 21st April 2021.
One thought on “Lessons from the second wave of coronavirus pandemic”
https://theindependentpanel.org/wp-content/uploads/2021/05/Summary_COVID-19-Make-it-the-Last-Pandemic_final.pdf – the independent pandemic panel has some larger lessons. Some of the points raised here align with the recommendations of the panel. We can extend the capabilities of our mobile COVID-19 testing labs to include sequencing, sero-positivity determination and vaccination thereby making them a tool in the overall COVID-19 management solution and as a preparedness measure for future pandemics.