WIth an increase in Covid 19 cases across many states in the country, renowned epidemiologist and India’s leading public policy, vaccines and health systems expert Dr Chandrakant Lahariya in an exclusive interview with Chetana Belagere speaks on how important it is for the government to now strategise on target vaccinating all adult population. Dr Lahariya also speaks on why it is important to wait before we think of vaccinating India’s children even if the vaccines are licensed by September.
The findings of the recent sero survey point out that nearly 67% of the Indian population has developed antibodies against SARS-COV2. At the same time there is a lot of buzz on underreporting of cases. What is your take on this?
The serosurvey data analysed by me has shown that for every single Covid 19 case reported in India, there were 30 cases that remained undetected or missed. The under-counting factor for India was 30 which means for every case reported 30 cases were missed. It may not be deliberate underreporting but many asymptomatic cases are there they would have missed too. A district or state specific survey will provide a more accurate picture and the government should urgently plan such a survey.
Keeping this survey analysis in mind, do you think the third wave will be severe?
The severity of the wave will depend on the seroprevalence and also on the vaccination percentage in that area. Purpose of vaccination is to reduce the severity of hospitalisation of the disease.if we can vaccinate the large number of India’s population that will definitely reduce the severity of the wave. So having antibodies will reduce the number of but getting the population vaccinated will reduce severity. So if you want to reduce the severity in the third wave India needs to scale up vaccination.
Severity will also depend on which variant will emerge and the transmissibility of that variant. In my opinion, states or districts with high prevalence during the delta led second wave may see a less severe third wave but those with low seropositivity will definitely see high number of infections. But severity can still be prevented with upping the vaccinations in those areas.
Survey also showed that the rate of natural infections was nearly very similar in all age groups, including children. Does it mean we can safely reopen schools?
We know now that the children aged between 6-17 years were infected at a very severe rate as the adult population. This is good assurance that they have been protected without severe disease or hospitalisation. Few other serosurveys like the one done in Delhi by AIIMS and Ahmedabad showed 70% and 81% of children had developed antibodies, This gives a fairly good assurance that we can be prepared to open schools.
What precautions should we take before opening schools?
Schools should follow guidelines and make necessary modifications to improve ventilation in classrooms. Teachers and staff should be vaccinated. Attendance should be less than 100%. Have alternate day clases. Plan well. It should be noted that in 170 countries schools have opened. Children without being vaccinated are going to schools and there is enough evidence to show that opening of schools does not result in increased transmission of infection in children. And that’s why India should consider opening up schools.
Most parents are concerned about vaccinating their children. What’s your take?
We need to remember the purpose of vaccination. It is to prevent severe illness and death. This is high in adults and lower in children so the purpose of vaccinating children cannot be reducing mortality and deaths is far low in children as that is already low. So the benefit of vaccinating children is far lower than benefitting vaccinating in adults. Since vaccines are low at supply , priority should be of vaccinating adults.
The other risk is children may bring back infection home. But we need to know that the currently available vaccination for children has a limited role in reducing transmission. Their role in preventing transmission is not proven. So even if we want to vaccinate the children with the currently licensed vaccine once their clinical trials are completed in children they will not play much of a role in reducing transmission so that purpose is also not served.
So in my opinion what should be done is we should wait for the right kind of vaccines. The age group of 12-17 is 45 crores in India and if they have to be given two doses it is 90 crores of vaccine. Even to administer 90 crore shots it will take 6-8 months and possibly even longer. In my opinion it is not realistic to expect that children can be vaccinated this year. Earliest possible for those who are eligible will be late 2022.
At the rate in which the states are vaccinating it's people, do you think India will be able to achieve the expected target?
We were told that India would have a high number of shots available by December 2021. But now it is clear that in July we got 13.5 crore shots and in August we have had additional 15 crore. This is far less than the original projection to achieve 216 crore which was announced in May and 135 crores that was announced a month later. So we are definitely not on the track to vaccinate all adult population by dec 2021.
But what is realistic is to utilise the available vaccines to target vaccinating high risk population. Realistic target would be 70 percent of adult population recieve one shot and 50percent receive both shots.
What can the government do to achieve that target?
First focus on covering the 60 plus population who are at high risk. Then cover the 45 plus population once we have covered a fairly good amount of 60 plus. Then focus on 18-45 those who are at high risk like pregnant women etc. They should have a targeted approach.
In high risk population Realistic goal should be 90 percent coverage and the rest should be 2022 early or mid. Rather than looking at absolute numbers, targeted focused high coverage.
States which have low seroprevalence and any other hill stations should be the target. Similarly, with low seroprevalence we may not have universal high coverage.
Do you see a need for any change in the existing vaccination policies?
States should strategise once they receive vaccine doses. Instead of distributing it generally they should target their doses. Also, private sector administration has been less than 1/3rd in many states so it would be better to rethink on vaccine allocation policy. Government should keep a plan ready for August to December. States should know how many vaccines will come, utilised and which populations will be considered. Serosurveillance at district levels to know where vaccination should be ramped up has to be done.