Geneva-based Dr Soumya Swaminathan, Chief Scientist of the World Health Organization (WHO), spoke to India Today Group Editorial Director Raj Chengappa about how to deal with the second wave and what we can learn from other countries. Excerpts:
Q. By when do you think the second wave will peak in India and begin its descent to more manageable levels?
A. I don’t want to give a date or a number because it depends on the interventions that are put in place. If there is a national lockdown for a couple of weeks, then that would probably help to bend the curve downwards. Right now, it is going up and up. Unlike last year, the virus is not confined to a few states and seems be everywhere. So, we may see a prolonged peak unless strict measures are put in place everywhere.
Q. How did other countries deal with the second wave and what can we learn from their experiences?
A. The UK, for instance, had very clear waves—it would go up and, when a lockdown was implemented, go down. In January, though, they put in place strict measures, prolonging the lockdown till enough people were vaccinated. Now, as the lockdown in the UK eases, it is quite likely that they won’t see another huge wave. In the US, a large country, the first wave never really went all the way down. It stayed somewhere in the middle. Then the country saw a second wave. The number of cases peaked and now it has sort of settled down at about 50,000 cases a day, which is not low at all. But again, because significant numbers in the US are now getting vaccinated, their hospitalisation and death rates are falling and the cases may gradually go down. In Brazil, the pattern is very different. It peaks and then comes down slightly, but then peaks again in other places.
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Q. So, is India going the Brazil way?
A. I am worried about that; about it continuing for a long time like in Brazil. Delhi and Maharashtra may improve, but we may see peaks in Uttar Pradesh, Bihar, West Bengal and the southern states that are only now imposing lockdowns. So, you could have a situation where the curve keeps going up and down and up again, never really coming under control. This is why we need a nationally-coordinated strategy like we saw during the first wave, with clear criteria as to when lockdowns need to be put in place, when they need to be lifted and to what extent. And the information needs to be available to the public so that people can understand why.
Q. Why did we fail to detect the second wave early?
A. One of the tracking parameters is mobility, which has been made possible globally because of mobile phone movement. Mobility was down in India till November, but then returned to pre-Covid levels unchecked. Another reason was that sentinel surveillance, which reports a surge in severe acute respiratory infections and influenza weeks before the wave happens, may have been inadequate. Then, of course, mask wearing and other Covid-appropriate behaviour was completely abandoned. Social mixing increased incredibly, as did mass gatherings. Certainly, by February and early March, those signals should have been there. You don’t jump from one to 20 overnight. You intervene when you see the slope rising, before you reach the point where people end up in hospitals.
Q. What about monitoring newer variants or mutants of Covid-19?
A. That can’t inform you of a surge. But it is important to track variants as they behave differently from each other. So, you not only need the sequencing data but also the accompanying clinical and epidemiological data to know if the variant is behaving differently. The UK did that mapping beautifully with the variant that was found there and classified. It soon became the dominant variant across the world. The Indian variant has also been one of global concern. The most worrying thing is that there could always be variants that will be able to overcome the antibody response induced by vaccinations or previous infections and become variants of concern.
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Q. So how will newer variants, including the Indian one, impact the efficacy of the vaccines developed against the original Wuhan virus?
A. The thing is, even if you have mutations in one, two or more places in the spike protein of the virus, you still have a broad immune response against all the other targets. The body’s T cell immunity seems to be the one that is actually more robust. It is broader and longer lasting, as shown by some recent research when studying similar coronaviruses. So that is probably one of the reasons why many of the vaccines, including Covishield and Covaxin, are working even in places where different variants are circulating.
Q. What do you think of the Indian government’s modified vaccine policy to include those above the age of 18?
A. The WHO had put out a very clear prioritisation framework which India had adopted—starting with the high-risk category, which included healthcare and frontline workers and the elderly who are at higher risk of death or are likely to have severe illnesses, and then gradually opening it up to lower age groups. Now that it has opened it up to 18 years and above, India has to be careful that the high-risk groups still get priority. The country also needs to ensure equitable distribution of the vaccine across rural and urban areas and among the rich and the poor. Till India ramps up production, it needs to make sure that vaccines are available to the right groups, to those who really need to be protected right now.
Q. US President Joe Biden, and some European countries, have talked of a waiver of patents for Covid vaccines so that production can be enhanced worldwide. Will that help?
A. I would just say that vaccines, unlike drugs, cannot be made with just a patent waiver. It is just the first step. It has to be followed up by technology transfer, especially if you talk of new technology, like the mRNA vaccines, which are not easy to manufacture. So, while symbolically the move to waive patents is excellent, it should be accompanied by other things, which is what we are trying to push for now.