BOOSTER SHOTS
India ended Monday with fewer than 100,000 new Covid-19 cases, the first time since April 5 that it registered cases below this benchmark. Low as this number may look — everything is relative — compared to the peaks of early May (yes, it was just a month ago), it is worth remembering that at its peak, India’s first wave did not see cases crossing 100,000. Back then, that seemed like a large number; right now, it seems like a low one. India also ended Monday with 46.6 million people vaccinated fully, and another 142.8 million vaccinated with one dose — a significant milestone because this means at least 20% of the population eligible for vaccines (those over the age of 18 years) now has some form of protection against Covid-19. The supply of vaccines is expected to increase from this month — it is not likely to reach the rather optimistic projections provided by the government, but vaccinating 4 million people a day (the likely number this month) is still a significant achievement — and a combination of non-pharmaceutical interventions, Covid-19-safe behaviour and partial restrictions on movement and activities, should help India ensure there isn’t a third wave of the pandemic.
The chaos and confusion over India’s vaccine drive, and recent scientific revelations point to the need for some changes in how India procures vaccines, and how and when it administers them. The Union government, on Monday, addressed some of these.
On procurement, Prime Minister Narendra Modi said in an address to the nation, the Union government will procure vaccines, and then allot them to the states. The move came after most states, including those that wanted to procure vaccines on their own, said they wanted the Union government to take over the task. India is one of the few countries allowing private hospitals to directly procure vaccine doses from manufacturers, and it has decided to continue to allow this, with the existing 25% ceiling on the number of doses that can be thus acquired.
But there are other changes that should be discussed. On administration, for instance, it makes no sense for the country to open up vaccination to those under the age of 18 years till it covers at least 75% of the addressable population over that age. That’s 705 million people, and once they are fully vaccinated, the vaccine drive can move on to those under the age of 18 years. If supplies are going to be a constraint, it is important to prioritise who gets the vaccine (and when) and sequence the drive. If supplies are not a constraint, then the government should open up vaccinations to all.
The drive also has to factor in new scientific revelations that both doses of two-dose vaccines are required to effectively combat variants of the coronavirus, including the so-called Delta variant first identified in India, and which, it is now clear, was behind the surge of cases during the second wave in the country. India would do well to ensure the gap between two doses of Covishield, the Indian version of the Astrazeneca/oxford vaccine, which is currently being administered to the majority of people in the country, does not exceed 12 weeks.
Equally important to factor in is new research that shows that vaccine-provided immunity fades faster than natural immunity acquired from an infection, pointing to the need for booster shots. Some of the vaccine companies, including Pfizer, have also said that boosters are required. More data on this will become available in the next few months when the first recipients of vaccines (in clinical trials) will complete a year after being vaccinated. It is becoming clear that the first generation of vaccines may be effective only for a year at the most.
This means India will have to plan for two, maybe three simultaneous vaccine drives in 2022: one, for those who need to be given booster shots (which is pretty much every one of the 940 million adults in the country, although not all of them need it); two, for those who were either not covered by the first drive, or chose not to be vaccinated, in 2021; and three, for those under the age of 18 (even in the most optimistic scenario, India is unlikely to fully vaccinate 705 million before October, which means that even if this phase is launched immediately after, it will continue into 2022).
The process will require a realistic assessment of capacities and supplies (not cheery projections), the placing of advance orders, and a phased vaccine administration plan.
It is important to factor in new research that shows that vaccine-provided immunity fades faster than natural immunity acquired from an infection, pointing to the need for booster shots. Some of the vaccine companies, including Pfizer, have also said that boosters are required.