Vaccine deals in the works with candidates, producers

DR HARSH VARDHAN, Union health minister

U nion health and family welfare minister Dr Harsh Vardhan spoke to Sanchita Sharma about when Covid cases will peak in India, whether Delhi and Mumbai have already crossed their peaks, a possible second wave of infections, the low fatality rate in the country, and India’s vaccine procurement plan, among other Covid-related issues. Edited excerpts:

Have Covid-19 cases already peaked in metro cities such as Delhi and Mumbai?

The current level of outbreak is showing a decline in new infections in both Delhi and Mumbai. This is also corroborated by the fact that hospital admissions of Covid-19 cases have come down. Moreover, the number of tests being offered continues to be high in these cities. Based on these evidences, it appears that the spread of Covid-19 has slowed down in these two cities. A big part of the credit goes to people practising precautions.

Is a second wave expected?

A second wave has not yet been observed with its prior intensity globally. This is a sevenmonth-old infection. We still have many gaps in understanding the natural history of the outbreak. So far, a few countries that were reported to have “controlled” the infection have reported smaller second waves in comparison to the first outbreak. It is still not clear whether the second wave of infection is smaller due to implementation of effective public health implementation and/or a proportion of people continuing to follow precautions.

When are infections projected to peak across India, following which there will be a fall in new cases?

It is difficult to predict. India is a large country, and the outbreak is heterogeneous in different states in terms of their vulnerability, the maturity of outbreak, and the number of confirmed cases. The outbreak is likely to peak at different points in different cities and states.

Also, different states are continuing to implement different measures for containment, and the proportion of people following preventive precautions differs in different places. All this makes it difficult to say when the outbreak will peak, and when a drop in new cases will occur.

With multiple peaks, what is the strategy going forward?

“Test, Track, Treat” will remain our strategy to move forward.

When is India going to cross one million tests a day?

India has rapidly upgraded its Covid-19 testing capacity and is very near to crossing the mark of one million tests a day. In last past 24 hours, 918,470 tests have been done. When we promised to take testing to 1 lakh a day by 31st May, we achieved the goal on the 10th of May. Just a few weeks ago, I promised to reach the one million mark in 12 weeks, but within three weeks, you can see the progress. We are working ahead of targets.

The case fatality ratio (CFR) is under 2% and falling every day. What are we doing right on that front?

CFR depends on the number of tests conducted, test positivity rate, improved management strategies, and the improved health systems responses. On charting the seven-day moving average of CFR, it is observed that there was an inflection point on 23rd June, when the crude CFR was noted to be 3.27%. Beyond this point, there has been a steady, almost linear trend of reduction in the CFR. The current CFR (on August 20) is 1.9%.

The effective containment, aggressive testing with contact tracing and standardized clinical management protocols based on a holistic standard-ofcare approach continues to result in a progressively reducing CFR and keep it well below the global average.

Three India-made vaccines have entered advanced stage trials. If successful, by when will a vaccine be ready for use?

Vaccine trials against Covid-19 are being fast-tracked globally. It is expected that the trials of India-made vaccines would be completed by the end of this year.

We will know the efficacy of vaccines by then. The Oxford vaccine produced by Serum Institute of India is already being produced parallelly, so that the time required to market it will be reduced to a larger extent.

The other two vaccines may require at least a month more to produce it and introduce in the market in a phased manner. It is expected that if the vaccine trial results are good, we could be ready to use the vaccine by the first quarter of 2021.

Human trials of Covaxin, which has been developed and manufactured in Hyderabad by Bharat Biotech, started about two week back and it may be available by end of the year.

Serum Institute of India said it is ready to begin human trials in India this month and is hoping to have the AstraZeneca vaccine available by the yearend.

ZyCoV-D from Zydus Cadila has started clinical trials with the first human dosing and is likely to complete clinical trials in few months.

Several countries have preordered millions of doses of Covid-19 vaccines. What are India’s procurement plans?

The details of the procurement plan are being developed by the ministry of health and family welfare, but it is important to note that India has the world’s largest vaccine manufacturing industrial base that provides two-thirds of childhood vaccines used across the world.

The Indian Council of Medical Research (ICMR) is collaborating with Bharat Biotech and has entered into an MoU that clearly states that priority will be accorded to provide vaccines, if successful, to the Government of India at an affordable and subsidised rate.

A similar agreement is in the advanced stages of negotiation with the Serum Institute of India for three Covid-19 vaccine trials to be supported by ICMR. Serum institute and ICMR are to undertake the trials of Oxford vaccine and two others – one produced by Novamox-Serum and another by Serum Institute by itself.

Once the results of Phase I and II will be available, the detailed contours of plan to roll out will be finalised.

Who will be vaccinated first?

Health care workers, front-line workers and vulnerable subgroups such as persons over the age 65 years and those with chronic morbidities will be prioritised.

Then, depending on the number of available doses, a special drive to provide vaccines to all will be developed and implemented.