Are We Ready For A Third Wave?

–Kakali Das |

The active cases of Kerala had jumped to 12,000 in the last 10 days, its overall death toll had doubled in the past two months. The wonderful photographs of people vacationing in Manali and the other hill stations, while thronging, roaming around with no masks, or precautions of any kind have baffled me. Also, the people in the cities are no less. We have doctors emphasizing time and again regarding the urgencies of wearing masks, staying indoors, but to us, “intelligent, intellectual beings” these advises, protocols, all sounds and feels like ‘déjà vu.’

With the appointment of a new health minister of the country, we have the government that has tweaked and turned and pitted the vaccine policy over and over again. In order to be fully prepared for a third wave, India needs to vaccinate at least 60% of its population of 1.3 billion people, apparently meaning about 8.6 million doses per day. On the contrary, the country has been managing with 3.5 to 3.9 million doses a day, resulting in a massive amount of shortage every day. For an instance, this works like a required run rate in a cricket match, if we fall short each day, the required run rate keeps on rising, making it even more difficult for us to catch up to. On the one hand, the states, Tamil Nadu, Delhi, Rajasthan, Maharashtra have all complained about the shortage of vaccine doses, and the fact they are running out of it, because of receiving insufficient doses from the central government. On the other hand, in the midst of the cabinet reshuffle, the central government said that the States and the Union Territories would be informed well in advance about the quantity of the doses each state would receive, for them to plan their covid-19 vaccinations based on their availability of vaccine.” But is the third wave planning to appear before us based on the unavailability?

As far as my awareness and knowledge is concerned, the third wave depends on three factors – the first being the individual behaviour – how we behave during the unlock period, whether we put on our masks or not (not on our chins or ears, but nose and mouth), maintain distance, crowd markets etc. Secondly, our rate of vaccination, which, unfortunately is falling short as well. If we see the amount of vaccination that have been done, and the people eligible to receive the vaccine, the overall India figure stands only about 30%. And, in fact, 30% of those who are eligible to receive a vaccine have received one dose, and not the two. Thirdly, a third wave would depend upon whether a more infectious variant emerges and spreads.

“As far as the emergence of a more infectious variant is concerned, it is something that we have little control over. We can have some control in vaccination and individual behaviour, so if we reduce transmission, we reduce possibility of new variants emerging. But we need to understand that the new variant must be much more infectious than Delta which we have gone through. We do not have enough data on the Delta plus variant to make any sort of conclusion on whether or not it’s more dangerous or more transmissible,” Dr. Shahid Jameel, Virologist, Director, Trivedi School of Biosciences said.

“With time passing on and not enough cases of Delta plus variant jumping off the charts, it’s getting clearer by degrees that conclusively it’s off the list. When the Delta variant emerged in between January and March, it became exceedingly prominent, and from March until May it just went off the charts. Besides, with merely 600 identified cases of Delta plus variant worldwide, and around 52 cases in India until today, it doesn’t appear to be transmitting that efficiently for whatever reasons”, Dr. Jameen further said.

We are well aware that COVAX, the global vaccination programme, co-led by CEPI, GAVI, and WHO, alongside key delivery partner UNICEF is working for global equitable access to Covid-19 vaccines. Its aim is to accelerate the development and manufacture of Covid-19 vaccines, and to guarantee fair and equitable access for every country in the world. The countries, Pakistan and Bangladesh have received the doses of ‘Moderna’ through Covax, but India hasn’t yet. As far as the news says, the reason behind it is because India hasn’t completed some of the legal processes, liabilities, and that’s holding up the process.

“If what the news says is true, then it’s just tragic; this issue could have been dealt with in August last year, when Dr. Vinod Kumar Paul was in charge of procuring vaccines. This isn’t a new issue for us, it’s been on the table for a year now. The deal, simply, is that Covax will provide us with vaccines, and insurance cover for those who are injured by the vaccines. Now, what more it is that we want to negotiate with really befuddles me,” Murali Neelakantan, Principal Lawyer at Amicus & Former Executive Director, Glenmark Pharmaceuticals said.                                                                              Here are the vaccines for Covid-19, and an insurance company standing behind any injury to pay compensation to, so what are we quibbling over now?  

We have had several changes to the vaccine policy by now, but there has been very little equipment on the ground in terms of the supply of vaccine. I find it offensive to our intelligence that the central government is of the opinion that informing the state governments about what the quantity of the supply will be, in advance, to plan their vaccine drives accordingly, will do any good in this state of emergency. Sigh! These aren’t tickets to any Metallica concert, where 50 tickets are distributed for 50 people to show up. This is about getting as many people vaccinated as possible. It appears that there’s still a fundamental misunderstanding on how the dynamics should be, and which has been in existence for a while now. The central government seems to suggest to the people that the states aren’t vaccinating enough, and that comes across as the messaging all the time. There’s an update, each day, saying that the states and union territories have 1.6 billion vaccine doses available with them, resulting in the circulation of messages indicating that the states have been lying around, and are being lazy in vaccination. Whereas, the reality is if you try to book a slot on cowin.gov.in, there’s a strongest possibility you won’t find one. In one in thousand attempts, there’s a slim chance one would get hold of a slot. There are no vaccines on the ground, even the paid ones aren’t available.

“If we backtrack and analyse why we are in this situation now, the story is very simple – as of the end of June, India had only ordered 80 crore vaccine doses, when the rest of the world ordered three times the size their population. We don’t have vaccines because we never ordered them. It’s not like you order food from Zomato, Swiggy which arrives in 40 minutes, the manufacturing and distribution of vaccines take time, and for the massive scale or quantities of vaccine doses India requires, the process calls for ample time. We just are still refusing to order what we need,” Murali Neelakantan further said.

As far as the gap in between the two doses of Covishield is concerned, three of the 14 ‘core members’ of the National Technical Advisory Group on Immunisation (NTAGI) said that they didn’t recommend such a wide gap of 16 weeks in between the two doses of the AstraZeneca Covid-19 vaccine; however, they had backed increasing the dosing interval to 8 – 12 weeks – the gap advised by the World Health Organisation.

On being asked if this wide interval would put us at risk of any kind, since it’s perhaps based on reports not from the penal members of the advisory committee, the virologist said that even one dose of Covid-19 vaccine provided a shield of at least 70% from severe diseases and hospitalisation, based on the real world data on vaccine induced protection, from Israel, Canada, and the two sets of data from India, CMC Vellore and Tamil Nadu Police Department.

“It’s the reality that there is a shortage in the availability of enough vaccines in the country. So, I think this decision to extend is from a combination of factors – one being that a single dose provides one with 70% protection, and second is that the supply isn’t enough. That’s the reality of the situation now,” he further said.

In fact, even if the vaccines such as Moderna and Pfizer through the Covax programme be supplied to India, it won’t make much of a difference in a country which is the second largest populated in the world. Given the reports on the amount of vaccine doses Pakistan and Bangladesh have received by now, Covax would supply not more than 3.4 million doses of the foreign vaccines to India in one consignment, which equals to one day’s vaccination in the country today. So, placing orders to our domestic vaccine companies that can supply us with adequate doses as per our requirements is the real solution now.