Variant found in India may be of concern: Vijay Raghavan on the Covid crisis
The Johnson & Johnson vaccine is the present front-runner as the next foreign vaccine to possibly be available in India, according to the country’s principal scientific adviser K Vijay Raghavan. In an interview with Rhythma Kaul, he also said that the so-called double mutant variant that has arisen locally may now be a variant of concern. Edited excerpts:
Now that the path is opened for more vaccines to come in, do you think we should open up Covid-19 vaccination for all adults?
The dilemmas are the following: there are people who are older, who are more vulnerable if they get the disease, and people who are younger, who are vaccinated and can go into the workforce, mingle, and not bring back disease to their homes. Ideally, you’d like to vaccinate both groups, but there’s obviously a supply and demand challenge. As manufacturing increases exponentially, and we have the pipeline to vaccinate, there will be more and more flexible vaccination happening. Now with the emergency-use authorisation flexibility, which has just come in, globally authorised vaccines can become available here; we are going to see potential for many vaccines to come in. In practice, given global suppliers’ commitment, we are going to see the Johnson and Johnson vaccine, and the Novavax when it gets approval elsewhere, coming in to India. As that scales up, all these solutions will be at hand. J&J will certainly, likely, be a good candidate for entry into India soon because they have been authorised elsewhere. There have been points raised about J&J in a manner similar to another vaccine about potential clotting, but so far it looks very rare, and there’s no reason to not use the vaccine. Let’s see what the global regulators say in a day or two. Then it shouldn’t be a problem.
What about Moderna and Pfizer vaccines?
It is a bit of a hypothetical situation there, because their supply commitments are rather strong as it is, the manufacturing commitments already are in place, and they are rather stretched. So, should that situation change very rapidly then certainly they are also eligible to come in, should they apply.
How long do you see this second wave lasting? What are the projections?
Projections, of course, are difficult, but they are very useful, both best case and worst case, because they tell you how you should be prepared. The reasonable ground for pandemics of this sort is to look at the shape of the curve in terms of what’s happening; the rate of change, and not just the absolute level. And the rate of change now all over the country is, of course, a matter of concern. Therefore, right now, I would not focus on when the peak would come down but what one should do to prevent the peak from going further up. As for when we will reach the peak, we will know when they (the trends) start coming down. There are some positive trends which will start showing up in a week or two because that’s the typical gap between [containment] measures and their effect. The teams of central government have gone to 50 locations; more teams will go, and we will start seeing those impacts in a couple of weeks from now. How fast or how slow that downward trend will be remains to be seen. Intense efforts started a couple of weeks ago, so we should start seeing the beginnings of change very soon, and as those efforts continue you’ll start seeing the impact further and further.
What, according to you, has led to the sudden surge that we are seeing now?
We know that many factors have contributed; it’s not one single factor. As the peaks descended early this year, there was perhaps the feeling that we were over the worst, and we could relax. Fatigue also set in, particularly in young people; humans are social animals, after all; and it is difficult to curtail our interactions constantly. So, in theory, if you all stayed far away from each other, then nothing would happen. It’s tough to do that both in terms of livelihood and social behaviour. The other factor related to this is the way disease spread takes place. There are pockets where there is high infection, and there are other pockets that are less infected, so it is a network effect. And the result of that is there are many areas which were not open to infection earlier, which, because of changes in behaviour and so on, have now become open. Finally, there is, of course, the important contribution of variants that can have greater speed of infection, and also other consequences.
What role are mutants playing in driving the current surge?
It is good to understand how one characterises changes in the virus. A virus goes from place to place as it infects people; and mutations in the virus are, by and large, just indicative of where it has been. There are, however, other mutations that expand in a population for two kinds of reasons: one is something called the founder effect -- that those mutations just happen to be there in a population early on, and therefore, when the spread occurs, these are also seen at a greater level. Now there are other mutations which have a physiological effect, an advantage, over other viruses. When all these mutations accumulate in a virus then these are called variants of interest, first, and then variants of concern. We know globally that there are some mutations that are variants of concern (some of them are seen even in India) – some are famously called the UK variant, or the South African variant or the Brazil variant. These have either come here, or could have independently arisen over here. There is another variant which has been found in India, and now it’s reasonable to say that the variant is of concern because it’s been found in a significant number of people and has physiological effects. Our scientists have isolated these strains in our national labs of ICMR, CSIR and DBT, and they are studying them. They will know for sure, in our context, soon what are their biological impacts.
Will the vaccines that are currently in use in India work against these variants of concern?
It’s important to see how this conclusion is reached. There are multiple kinds of tests. People have already been vaccinated, and they are on the field -- you can ask whether these variants infect them despite being vaccinated, and do they show symptoms of disease, and if so, what are the levels of symptoms they show. Even if anyone is vaccinated no matter what the strain, vaccines don’t protect against the infection; they protect against progression of illness. Therefore, what people are finding now for the variants of concern, which are being studied, the vaccines at hand sometimes reduce protection to mild and moderate disease but they still afford protection to severe disease. These are the kinds of concerns that will come up, and we need to see how they work out in our population, but right now it looks very reassuring that the vaccines are protective; they don’t cause big escape, and those who still get disease, despite being vaccinated, are likely protected against severity. Speedy vaccination reduces the prevalence of viruses in the population, and therefore, reduces the impact of current variants and potential of new variants.
Are we going to ramp up our genome sequencing efforts?
We should look at the percentage from the time when we started ramping up genome sequencing; there’s no point in looking at it as a percentage of all the cases so far. The genome sequencing capacity is ramping up; it hasn’t yet reached 5%, but it’s ramping up quite well. Importantly, it has to be combined with epidemiology on one side and laboratory tests on the other. That linkage is also a work in progress, and is going pretty well, and we will have a dynamic analysis at hand soon. Right now the good news is that the variants have been isolated in the national laboratories of ICMR, CSIR and DBT; they are being studied now and results should come in a matter of week or 10 days. As new data are studied in different patients, and in different contexts, we will keep getting that information. It’s a dynamic situation.
What additional measures are being taken this time around as Covid-19 situation clearly is worse than before?
We actually have now multiple elements in our kit to deal with the virus which we didn’t have during the first wave. We are better ramped up on personal protection equipment (PPEs), oxygen, hospital facilities, ventilators and so on. So, even though those are being stretched now, the response time, and dealing with any crisis in any locality will be better. The second change is the potential of the impact of people’s behaviour; we know a lot now which we didn’t earlier. We know now how the virus is transmitted -- through droplets, through aerosols -- and it gets transmitted in closed rooms, for example. So, there are measures like masks and distancing that we know will be very effective. Therefore, depending on whether one is inside or outside, in crowded spaces or open spaces, we really need to take calibrated measures that are feasible and can reduce transmission. In terms of treatment, hospital practices have improved a lot, and we know treatments like dexamethasone and steroids have an impact in lowering the disease intensity. And very amazingly, within a year’s time, we have vaccines at hand. We have two vaccines in India, and the permission now to deploy more, so the vaccination is getting scaled up. All the positive aspects need to be balanced with how we deal with situations such as variants of concern of Sars-CoV-2 in circulation.