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Rapid Development Of Efficacious COVID-19 Vaccine Is One Of The Few Success Stories From This Pandemic: Dr Poonam Khetrapal Singh

Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region in conversation with Jyotsna Sharma from BW Businessworld on the third wave of Covid-19 – the current condition and the outlook.

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JS: There’s been a lot of talk about the third wave of Covid-19 in India. Please give us your views on when it is likely to hit? And what will it look like in terms of virulence and impact etc.?   
PKS: It is hard to predict a surge or a wave. No country, and specially a big and diverse one like India, will ever witness uniform virus transmission scenario.  

Our experience from the pandemic globally has shown that the public health and social measures work and are critical to limiting transmission of COVID-19 and reducing deaths. These include personal protective measures such as physical distancing, avoiding crowded settings, hand hygiene, respiratory etiquette, mask wearing, disinfection and ventilation, and surveillance and other response measures.  

These measures should be tailored to the local settings and conditions, and continuously adjusted based on the situational assessment at the sub-national level, which include the intensity of virus transmission and the capacity of the health system to respond.  

With more doses of COVID-19 vaccines now available, all efforts must also continue to scale up vaccination coverage as vaccines help reduce severe disease and death. Earlier this week India registered its highest ever single day coverage of 8.8 million COVID-19 vaccine shots. The country has the capacity and commendably, continues to scale up vaccination coverage with COVID-19 vaccines. 

Though the highly transmissible Variants of Concerns have added to our challenges, we have evidence that the current tools strategies work against both the virus and its variants. Our efforts to control virus transmission will depend on the prevalence of infection and circulating variants; the types, use of, and adherence to control measures in place; and the speed with which vaccination occurs.  

Mobilizing communities would be critical for the uptake of vaccines as well as adherence to the public health and social measures. Hence, it is time for all of us to do it all to stop the virus spread. 

JS: There is belief that If a vast majority of people in India are vaccinated, we might be able to stem the spread in case the third wave strikes. In your opinion will this hold true?   
PKS: Rapid development of efficacious COVID-19 vaccine is one of the few success stories from this pandemic. Vaccines protect against severe disease and hospitalization, hence scaling up coverage to rapidly reach as many people as possible, is important.    

However, vaccines alone cannot stop virus transmission. Initial observational studies on vaccine roll out had suggested that the vaccines may lead to protection against infection and a reduction in transmission, when implemented along with public health and social measures.   

Also, for two-dose vaccines, protection provided by vaccines is only partial after the first dose, and time is needed before protection reaches its maximum level after the second dose.   

For a one-dose vaccine, people only have maximum protection against COVID-19 a few weeks after getting vaccinated.  People may still get infected, especially if they do not continue to take precautions. Besides, no vaccine is 100 percent effective, which means that while vaccines are especially effective in preventing severe disease, need for hospitalization and death - there can be rare cases of breakthrough infections.  

As we are not yet in a situation where a very large proportion of the population is immunized, public health and social measures are still needed to protect against the virus and prevent its further spread. Even after being fully vaccinated, people still need to continue to wear masks, regularly wash hands, watch their distance, avoid crowded and closed settings. 

In addition to vaccination and public health and social measures, what will help prevent /reduce impact of any future surge is our lessons from the previous surge, and how well we are able to apply those and scale up our preparations and response capacities. 

JS:  What are your views about the booster shot- would people need this to stay safe?   
PKS: WHO is calling for a moratorium on boosters until at least the end of September.  This is to allow for at least 10 percent of the population of each country - including those most at risk and health workers - to be vaccinated.  

At the same time, WHO is carefully monitoring the rapidly evolving body of evidence regarding the need for booster doses. This evidence is developing across different vaccine products. As yet, there is no consensus of opinion between experts as to the need for booster doses.  As necessary, WHO will adjust its guidance in a timely way based on the science. 

Administration of booster doses may be needed in the future for specific population groups and/or in precise contexts. However, more data is needed on optimal timing and dose of booster doses, which may differ between vaccine products. WHO is also monitoring the use of booster doses by countries, and those countries that have stated they are considering implementation of booster doses. Several studies are currently under way with results expected in the coming months on a portfolio of critical research questions.   

Whilst huge inequities in vaccine rollout continue across the world, the priority should be on ensuring that all countries use the currently limited vaccine supplies to provide high coverage of first and second doses, to priority populations such as health workers, older people and other at-risk groups, in alignment with the SAGE prioritization roadmap recommendations.  

Providing booster doses in highly vaccinated populations risks exacerbating inequities by driving up demand and consuming scarce vaccine supply- while priority populations in many countries have yet to even receive a primary series. 

JS:  Globally, the Delta variant is causing havoc – your views on how it can be contained.  
PKS: The Delta variant is highly transmissible. It appears to be twice as transmissible as the original COVID-19 virus strain.  WHO is trying to get a better understanding of why the Delta variant is more transmissible. There seem to be certain mutations in the Delta variant that could be allowing the virus to bind to human body cells more easily. 

In few countries where Delta virus has been reported, we are seeing increased hospitalization rates but not an increase in death rates.  

It is important we use a comprehensive approach to control virus transmission. A robust surveillance supported by rapid diagnostics, early clinical care and life- saving therapeutics, provided by well-trained health workers who are able to work in safe conditions.  

We need to do all we can to stop the virus spread.   The more we allow the virus to transmit, the higher will be the risk of getting highly transmissible virus variants which, when allowed to spread, would cause more infections, put greater strain on the already overwhelmed health systems, and cause  more deaths.  

JS: Please tell us about the progress of the COVAX scheme so far   
PKS: The COVAX -facility aims to ensure fair and equitable access to Covid-19  vaccines for everyone, everywhere. It is overseeing the single largest supply of vaccines in history. As of early August, COVAX has shipped more than 180 million doses to 138 participants, of whom 40 were able to launch their first COVID-19 vaccination campaign.  

WHO continues to appeal for and work towards vaccine equity as approximately 75 percent of all vaccine doses have been administered in just 10 countries.  17.6 percent of vaccines have been administered in LICs/LMICs which account for 51.2 percent of the world's population.  

If large sections of the population remain unvaccinated, the virus will get a chance to spread and mutate and infect more and more people and, in the process, prolong the pandemic. 

It is time for all countries to together work towards curtailing the pandemic, as the virus anywhere is a risk everywhere. No one is safe until everyone is safe. 

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Dr Poonam Khetrapal Singh WHO experts