From a pandemic to an endemic, India’s vaccine drive enables a way out

Those managing India’s vaccine drive have always been a step or two behind the curve. But a reading of the infection and vaccination trajectories indicates that they need to start planning now for a future of endemic Covid-19.

A week from now, maybe a day or so sooner, maybe a day or so later, India will reach a magic number in terms of vaccinations: 470 million people would have received at least one shot of vaccines that prevent death and serious illness from Covid-19.

470 million people would have received at least one shot of vaccines that prevent death and serious illness from Covid-19 (REUTERS)

That number, 50% of all adults (those over the age of 18 years) in the country, is significant for several reasons. The most important one, I believe, is that it marks the first major marker or milestone in the transformation of the coronavirus disease pandemic into an endemic.

Not everyone agrees. After all, at the milestone, a maximum of 15% of India’s adult population is likely to have received both shots of the vaccine, and data shows that people need to be fully vaccinated to prevent serious illness and death when it comes to the Delta strain of the Sars-CoV-2 virus. There is no arguing with that research — even if countries currently seeing waves on account of the Delta variant were not ravaged by it, much like India was, in April and May.

But it would still be extremely short-sighted to not recognise the 470-million-with-at-least-one-shot number for what it is. It is a way out, the beginning of the end, and it comes not a moment too soon.

As I write this, the seven-day average of daily new Covid-19 cases in India has touched a 149-day low. There is enough reason to remain vigilant — the surge that Kerala witnessed, presumably caused by the Delta variant (we don’t know for sure because we haven’t sequenced enough genomes) can happen in some other parts of the country; and Maharashtra is already beginning to see an increase in infections caused by the Delta-plus variant. But there is also enough reason for everyone to start planning for what will likely be.

That simply involves understanding the meaning of the transformation of Covid-19 from a pandemic to an endemic. This has implications for national, state and local policymakers, administrators and public health workers. And it has implications for how we work, learn, travel, and play.

Mathematically, it simply means understanding that while there is going to be the constant presence of the virus that causes the coronavirus disease, this needs to be treated as a baseline (or usual prevalence of the virus). Seen that way, it immediately becomes clear that there has to be a shift in response in terms of both management and behaviour.

Is it too soon to start treating Covid-19 as an endemic disease? Perhaps, but it is definitely not too soon to start planning what its eventual, inevitable, and imminent transformation to an endemic means. There is still the question of people under the age of 18, but the immediate focus needs to be those in the 12-18 age group (there are 145 million people in this segment). As for younger children, there is nothing to suggest that they are any more vulnerable to serious illness and death than they were during the first wave of the disease (very low). There is also enough research to show that a high proportion of fully vaccinated adults helps reduce even asymptomatic infections among young people who are not vaccinated.

There is also the question of booster shots. But at this time, the only people who should even be considered for this in India are the most vulnerable (and there is enough medical science to identify them, starting with those who have had organ transplants).

Those managing India’s vaccine drive have always been a step or two behind the curve. But a reading of the infection and vaccination trajectories indicates that they need to start planning now for a future of endemic Covid-19.

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