Battle plan: Priority actions for the second wave and beyond | Bengaluru News – Times of India

India is reeling under the second wave of the Covid-19 pandemic. Three potential reasons for rapid surge in cases are related to the agent (virus), host response (immunity) and environment.
Apart from newer variants of concern imported from other countries, B.1.617 (known as double mutant) is the most widely prevalent in India. Initial evidence indicates it’s more infectious, if not more virulent.
Apart from this, B.1.618 is prevalent in West Bengal. The genomic epidemiology assessed by scientists at Nimhans suggests that multiple variants are present in Karnataka. In particular, a distinct clade within the B.1.36 lineage was associated with a local outbreak in Bengaluru. The evidence regarding virulence and immune escape properties of variants is under investigation concerning host factors, poor pace and inability to cover wider population coverage. Evidence suggests waning antibodies resulting in a minor proportion of people with reinfection. Environmental factors include continual presence of super-spreader events resulting in faster spread of the virus.
The higher circulation is also correlated with higher chances of developing newer variants of concern (VOC). The effective way to contain transmission involves active case detection by a higher and reliable testing strategy.
The ministry of health shared data that the risk of Covid-19 infections is almost negligible in vaccinated persons. Also, preliminary evidence suggests that Covaxin is effective against B.1.617 while awaiting peer-reviewed publications. Evidence available from other countries suggests that vaccines offer reasonable protection against newer VOC. Hence, wider and faster vaccine coverage is the most optimistic path ahead, as vaccines offer complete protection against deaths by eliciting a broad immune response involving a range of antibodies and cells.
However, there are several challenges. First, the supply chain shortage has to be managed by expanding it to domestic and international vaccine manufacturers. The US President’s offer to provide vaccines should be readily accepted. The country can turn this crisis into an opportunity to reclaim the status of the world’s vaccine powerhouse by inviting more firms with regulatory approvals to manufacture in India.
Second, the communication strategy has to improve. While the intent is clear in expanding vaccine coverage to younger age groups, a realistic date of a start based on supply chain distribution could have avoided confusion. Third, till shortage issues are resolved, over the next three weeks, the states should focus on better micro-planning and mobilisation efforts so that the pace can be increased when vaccines are available. Planning should focus on operational issues to reduce crowds at vaccination centres while no eligible person is left out.
Fourth, while the private sector is instrumental in ensuring that those who can afford it can get their shots, governments should plan extensively to ensure that people below the poverty line are prioritised. Finally, additional healthcare personnel should be employed by filling existing vacancies so that dedicated human resources are available to administer the vaccine and monitor the cold chain management and follow-up after vaccination.
There will be a third wave some time in the winter. Hence, ensuring vaccination coverage is important in preventing deaths and severity of disease in the next wave. From the current share of 8.97% vaccinated of the total population, it would be ideal to completely cover all the vulnerable and as many persons as possible in other age groups. Advance in research is important to cover children and pregnant women.
Governments over several decades haven’t been successful in building fit for purpose public health systems in India. The strongest component is its people. Governments should ensure that all vacancies are filled up permanently, so that vaccine coverage and Covid-19 response are balanced with other health services. The vaccination programme should ensure people’s involvement, utilising the experience of elections and universal immunisation programmes.
The authors are part of the Indian Institute of Public Health, PHFI, Bengaluru
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Sagar Biswas

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