Focus on double-dose Covid-19 vaccinations. Boosters can wait

India administered over 588 million Covid-19 vaccine doses by August 23. This translates into over 34% of the estimated 940 million eligible adult population having received at least one dose, while another 14% have been fully vaccinated. Over 60% of the 60-plus age group have now received at least one shot of the vaccine. This is no small achievement.

The novel coronavirus has recently undergone mutations, the prominent among these being Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1) and Delta (B.1.617.2). Genome submissions on GISAID show an overwhelming dominance of the Delta variant, which caused India’s devastating second wave, and has been behind the majority of the clinical cases of breakthrough infection (Sars-cov-2 infection despite vaccination).

Fortunately, the available vaccines have provided sustained protection against all variants, including Delta. According to a recent Indian Council of Medical Research (ICMR) study, only a small number (9.8%) of such infections required hospitalisation and the fatality rate in them was also very low (0.4%).

A look at the global seven-day new Covid-19 cases and deaths presents an interesting picture. Countries with the most aggressive vaccination drive and recording full vaccination of over 50% of their population (two doses) are now presenting a near-zero case fatality rate even though the number of infections has shown a rise. This includes the United States (51% fully vaccinated), the United Kingdom (61%), Spain (67%), Germany (58%), France (55%), among others.

On the contrary, countries with poor vaccination records are reporting a consistently increased number of infections as well as deaths. These include Indonesia (11% vaccinated), Thailand (8.2%), Iran (4.9%), Bangladesh (3.6%), and Tunisia (12.5%). The share of people vaccinated against Covid-19 in the rest of the world, including Africa, is dismally low, raising concerns on the equitable and fair distribution of available vaccines.

Even though the virus is not going away soon, many experts believe that the worst of the pandemic may be behind us. With increasing vaccinations, particularly of the vulnerable groups, Covid-19 will be a different disease in the not-too-distant future, with a vast majority of infections remaining asymptomatic or causing mild illness not requiring hospitalisation.

India’s daily vaccination drive is expected to increase further, with two-to-three more indigenous vaccines expected in September. In addition, the fourth sero-survey data suggesting a high rate of Covid-19-specific antibody occurrence in over 68% of the population is encouraging news. But people must continue to strictly maintain Covid19-appropriate behaviour for at least six more months, if not longer.

There is evidence to indicate that vaccinated people maintain enough long-lasting immunity, going up to a year or even longer. But there is a debate on a possible booster dose to increase the magnitude of protection. Countries such as the US, Israel and the United Arab Emirates have decided to offer a booster dose to cover the immunocompromised group, those undergoing organ transplantation, health care workers and the 70-plus group.

On the other hand, the US Food and Drug Administration and the Centers for Disease Control and Prevention have said that Americans who have been fully vaccinated do not need a booster shot at this time. Similarly, the European Medicines Agency and the World Health Organization (WHO) have both stated that it is too early to determine whether more than two shots are needed. Instead, WHO has issued an advisory to nations with excess vaccines to spare the same for countries with a low vaccination record.

India must singularly focus on vaccinating all of its 18-plus adult population by the end of the year and even include children above 12 years as early as possible. Booster doses can wait until the science demonstrates that they are needed. And then too, it will be important to categorise those who may need it the most.