Covid being endemic is as mystical and mythical as herd immunity: N K Arora

'Vaccine equity not possible if we include imported mRNA vaccines in our programme', said Arora

With low infection and hospitalisation rates, India is ‘in a good space’. But N K ARORA, head, Covid-19 working group, National Technical Advisory Group on Immunisation, tells Sohini Das that a new and targeted communication strategy is in the works to increase vaccination coverage. There are no plans to bring in imported messenger RNA (mRNA) vaccines for kids yet. Edited excerpts:

What is the role of vaccination coverage in terms of mutant variants of Sars-CoV-2 that are emerging?

What is driving the mutations in the Sars-CoV-2 virus is difficult to ascertain from a global perspective. There is one school of thought that mutations are from countries with low vaccination coverage. That is flawed. Even in highly immunised populations, new mutations have surfaced. The same virus behaves differently in different geographies. In the US, the impact of the Omicron wave has been more pronounced than what India had experienced.

The context, the virus, and the immunisation rates are important decisive factors. Right now, our hospitalisation rates are low. But surveillance is paramount. We have also started sewage surveillance to pick up on strains of the Sars-CoV-2 virus. The testing rate has gone down. There is also reluctance to test when one has symptoms.

This is the time to consolidate our surveillance activities. We have to remain vigilant during social gatherings and maintain Covid-appropriate behaviour. We have been thinking about health so far; now we have to think about our economy.

We have to be extremely vigilant and careful for the next six to eight months.

What is the next stage in India’s Covid vaccination strategy?

We have again resumed ‘Har Ghar Dastak’ from Wednesday. There is a clear indication that we need to catch up with both the precautionary as well as the primary doses in all age groups.

Vaccination is a key tool. We know it works, we know it practically eliminates the risk of severe disease/death. We will now see a change in social mobilisation and communication strategy for immunisation in the days/weeks to come.

There is an ongoing effort to restore the confidence of parents and tell them that the vaccines are safe for their children. On the one hand, one section is asking for vaccines, on the other, another section is still apprehensive. Our communication strategy will now be more targeted towards parents. There is no shortage of vaccines. A bouquet of vaccines is available. The target is to immunise everyone above 12 years.

Will Covid vaccination become part of our routine immunisation programme?

We will see if we need to make Covid immunisation a part of our national routine immunisation programme. We have learnt how to immunise adults. We can put adults under the national immunisation programme. We can take a life-cycle approach — right from the embryonic stage to the end days. There are some vaccines which when given to expectant mothers protect the foetus. There is work on developing a pan-coronavirus vaccine. Even for influenza, there are efforts to find a pan-influenza vaccine.

Are there any plans to use imported mRNA vaccines for children?

mRNA vaccines have several adverse events being reported. Several events on myocarditis (inflammation of the heart muscle) have been reported worldwide. Moreover, if we bring in a global mRNA vaccine, is that an equitable option? The vaccine should be for all kids. With a global mRNA vaccine, it’s not possible to give it to every child in the hinterland (for logistical challenges around temperature). Public health distribution system is difficult with imported mRNA vaccines. Vaccine equity is not possible if we include imported mRNA vaccines in our programme.

Our indigenous mRNA vaccine has got delayed unfortunately. The studies are ready. Let’s see whenever that becomes available, we will consider that.

At present, we have Corbevax, Covovax, and Covaxin. All three are safe vaccines. Corbevax and Covovax are some of the best vaccines available anywhere globally. Indians are getting top-grade vaccines.

Will we continue to offer boosters as top-ups?

We are giving third shots after nine months. Hardly 5-6 per cent of the population have taken their precautionary shots. We do not have an infrastructure issue. People have become more complacent. Nothing is set in stone. We have tried to be evidence-based throughout the pandemic. The data is reviewed almost on a daily basis.

What is the future surveillance strategy?

We are trying to make Covid and other disease surveillance permanent because this is not the end of it. There is a consistent effort to continue this for the long haul. At the moment, it is an annual extension, but the plan is to make this a part of our public health structure. Not just Covid surveillance, but for all viruses and bacteria. Tomorrow if a drug-resistant bacteria surfaces, we should have a mechanism in place to track it. This network of laboratories that has been created now for Covid surveillance will continue to function. Indian SARS-CoV-2 Genomics Consortium will stay.

Any decision on mixing vaccines?

Studies are on to assess the impact of mixing vaccines. As good evidence keeps coming, we will continue to take a call. No idea is closed off.

Are we in an endemic stage of Covid infections?

We are rapidly progressing towards normalcy. There is no less crowding in public places, but our cases of severe disease are low. That is why things have started to look up. Life initially in the third and fourth quarter of 2021 was hobbling. It is now gradually getting back to normal. We are saying remain vigilant, and remember to mask up and wash hands. Endemicity is as mystical and mythical as herd immunity. If the virus changes its face, how can we achieve endemicity and herd immunity?