There is light at the end of the tunnel: Top experts
Doctors discuss the inconceivable complexity of the disease, rapid breakthrough on the Covid-19 vaccine, and the road ahead for India
The world may be in the “last big wave” of the coronavirus disease (Covid-19) pandemic and the fight to halt the infectious disease from stalking the globe could begin to wind up sometime next year, top health experts said on Thursday at the 18th Hindustan Times Leadership Summit.
The pandemic will start slowing once vaccines are rolled out, said Dean of the Brown University School of Public Health, Dr Ashish K Jha. “I am hopeful that we are in the last big wave of this pandemic. While things are very bad in the US and very bad in many parts of Europe, India is in a bit better shape than it was a couple of months ago… What will happen is as the vaccine starts rolling out it will start making a difference. It will start slowing the spread of the virus. It will start building up population immunity.”
“In a country like America, where my guess is 15 to 20% of the people have already been infected, once another 10 or 20% of the people are vaccinated you start getting some of the benefits of population immunity. It’s not herd immunity at that level, but it is helpful. So, I am hoping that we are not going to see any more major outbreaks, but you will see lots of places with minor, small, and medium sized outbreaks happening probably all through 2021, if not beyond,” he added.
Two firms, Pfizer and Moderna, have released preliminary findings that show their vaccine candidates are about 95% effective in preventing Covid-19.
With the latest developments in the quest for a successful vaccine against the disease, the world must remain cautious and follow Covidappropriate behaviour, said Director of the All India Institute of Medical Sciences (AIIMS), Dr Randeep Guleria, while speaking on the topic of vaccine development and lessons from the pandemic. “Covid-appropriate behaviour is more important now than ever before because there is light at the end of the tunnel. So you can’t say you don’t know when this will get over. We know that it will now start getting over sometime next year.”
“Somehow, because of what I would call ‘Covid fatigue’, we are seeing a lot of people not following the general precautions that we keep advising. Many of the young individuals who go out, get the infection, carry it to their homes where the elderly get the infection. This can also contribute to higher morbidity and mortality. It would be very sad for someone to lose an individual now when the vaccine is just around the corner,” he said. “If we hold on for just a few more months, then we can save a large number of lives.”
Dr Guleria, who is also a part of the national committee on vaccination, said he hoped at least 30% to 40% Indians will get the vaccine by the end of next year, with several vaccines in advanced stages of trials. “I hope at least 30-40% (Indians are vaccinated). But I would not hazard a guess. I am sure all the health care workers and the frontline workers will be vaccinated but then we also need to look at the high-risk group. It will depend on how many vaccines come into the market within the first quarter in terms of regulatory approvals,” he said.
With successful vaccines around the corner, evidence of immunity lasting about nine months has reassured experts. Dr Jha said: “The evidence so far has been largely reassuring. We know across the world 50 to 60 million people have known to be infected; there have been reinfections, but those are very uncommon. I did not expect a 100% immunity forever; that is unrealistic. What you should expect that most people will be immune for at least some period of time, ideally a year or longer. Everyone who has recovered seems to have some degree of immunity and what we are finding that it is durable for eight or nine months.”
With the vaccine, there may be a need for a booster shot. “That okay. It’s not great. But it’s okay,” he said.
The two speakers, who are at the forefront of the fight against the pandemic, said they were pleasantly surprised by a vaccine being developed within 10 months of a novel infection emerging, especially with two of the candidates announcing their efficacy to be around 95%. “I have been very pleasantly surprised. Two or three weeks ago, I would have said I would be happy with a vaccine that was maybe 60% effective, I dare not hope for 70%. And, yet we have two vaccines – one from Moderna and one from Pfizer – that have both shown to be 95% effective against this virus. That is in the range of what we have seen with the Polio vaccine, it’s almost as good as the Measles vaccine,” said Dr Jha, adding that there were still challenges in getting billions of people around the world vaccinated.
Dr Guleria said: “No one expected such a high vaccine efficacy and especially in the older age group. For all other vaccines, this is encouraging news because all of them are focussing on the same spike protein. The challenge is the next step; once you have the vaccine then how to take it to every individual, the cold chain, procurement. There will be many vaccines to choose from; which group will benefit most from which vaccine and how long does the immunity last.”
NO SHORT-CUTS
No short-cuts were taken to get vaccines within such a short period of time; it was the head-start with the research on Sars-CoV-1 virus that caused the 2002 Severe Acute Respiratory Syndrome (SARS) outbreak that helped. “How did we pull off a vaccine development in just 10 months? Did we take shortcuts? Typically, with vaccine development, there is a sequential process – you do animal studies, then you go into small human trials. Then you raise money for the next phase. You do careful planning to say should we move forward with this or not. All of it is to really minimise financial losses and to make sure that you are prioritising things correctly. In this pandemic, we have done things in parallel,” said Dr Jha.
“When we started human trials, we also did animal trials at the same time. We would usually do one before the other. All the steps that go into a vaccine trial have been done; they have been done much more quickly. We have been willing to suffer financial losses. Part of the reason we got the vaccine in 10 months is we had spent years developing a vaccine for the original SARS virus and so we had quite a head start in terms of understanding the spike protein,” he said.
He added that as this pandemic begins to come to a close, the world must prepare for future pandemics, where such a head start is not there and think about a system that can generate a vaccine quickly.
For people who have seen pandemics and respiratory illnesses, there were warning signs that there would be another pandemic, said Dr Guleria. He said that the country needs to invest much more to be ready for another one in the future.
“When we started off, there was a lot of panic that we will not have enough PPE and ventilators. We now have the capacity to export PPE. We said we have very few labs that have the capacity to diagnose Covid-19 using RT-PCR, now we have 2,000 labs scattered all over the country and we are doing over 1.5 million tests a day. There has been a lot of learning. But there has to be more investment in the public sector, there has to be more involvement of health care professionals in preparing for surveillance, scaling up of infrastructure so that whenever we have the next pandemic, we learn from this and take it forward rather than making the same mistakes,” he said.
I hope at least 30-40% (Indians are vaccinated)... I am sure all the health care workers and the frontline workers will be vaccinated but then we also need to look at the high-risk group.
DR RANDEEP GULERIA, AIIMS Director