With the Covid-19 vaccination programme set to begin in India, there is a growing sense of relief among people. Is this the end of the epidemic? Can people go back to life as it was pre-Covid-19? Public Health Foundation of India president K Srinath Reddy tells DH’s Kalyan Ray, that it’s not yet time to lower the guard against coronavirus.
With two vaccines around, is it time for people to relax as the pandemic is clearly on the decline and the vaccination campaign may start within weeks?
It has been announced by the Prime Minister that the Covid-19 vaccination programme will commence on January 16. This is welcome news. However, this is no time for complacency or carelessness. We have managed to control the pandemic overall, but even now some states are seeing some spikes. Elsewhere in the world, the pandemic is still raging. Mutant variations of the virus are emerging, with greater infectivity. One of them, the B.1.1.7 variant with 17 Spike protein variations, has already entered India and is spreading in the country. The North Indian winter is still to end. Some festivals are ahead in different parts of the country. Slippages at this time, such as abandoning personal safeguards or allowing crowded events to develop into ‘super spreader’ events, will undo the gains made so far.
Is a second surge still possible?
A second surge is still possible, even if it is confined to some locations in the country. We must do everything to prevent it. We should not take it for granted that a surge will not happen again. We must be on guard till mid-summer and reassess the situation then. We also need to monitor the state of the global pandemic and take care not to let the surge in other countries spill into India.
The Kumbh Mela, India’s biggest congregation of people, is slated to start in about 10 days and will continue for the next four months. Is that a cause for concern?
I am concerned over any crowded event. Though the Kumbh Mela is an outdoor event, with lower risk than at an indoor gathering, it is nevertheless a very large gathering that carries risk of transmission. There will be many locations where people stay, dine or have daily ablutions. This is where there will be a great opportunity for viral transmission. Even the crowded buses and trains that carry people to the mela from different locations in the country can increase transmission. I believe public health caution warrants that the event must be carefully regulated to prevent large or static crowds at any point in time. Masks and hand hygiene must be used for protection, even if crowding cannot be fully avoided. Symptom-based surveillance must be carried out at the venues, for quarantining and testing persons suspected to have Covid-19-related symptoms.
India has never done an adult mass vaccination. What are the challenges?
The challenges are at three levels: procurement of vaccines to keep the supply chain in good flow; availability of a large number of trained and certified vaccinators to administer two-dose vaccines to a huge adult population; and acceptance of the vaccines by most of the population. Each of these has to be tackled. We begin with two vaccines and then more may get approved by mid-summer. We can train a large number of vaccinators, as this requires short-term practical training prior to induction, followed by participation in supervised team functions. We need to overcome vaccine hesitancy by effective communication through both mass media and community networks.
Would people need to take the Covid-19 vaccine every year?
We do not know as yet how long the pandemic will be active or how long the vaccine-induced immunity lasts. It is being claimed by some manufacturers that immunity may last up to two years. Even if it lasts a year, virus transmission may cease with mass vaccination during that period. It is unlikely that further mass vaccination programmes will be needed every year. It will neither be feasible nor affordable. Once the pandemic is under control, surveillance systems will tell us when vulnerable groups will need revaccination.
There is a gap of 28 days between two doses. Do you think people will adhere to such a schedule?
If people are clearly explained the need and benefits, they will. They must understand that for any of the currently available vaccines, protection is gained only when both doses are received. Otherwise, it will be like a farmer taking the trouble to sow a crop but not bothering to harvest it. Every person receiving the first dose will need an appointment slip and timely reminder messages. Rescheduling should be permitted in case of difficulties in keeping the appointment. Soft skills are needed for polite and persuasive communication throughout.
A sense of vaccine hesitancy seems to be growing. How do you think that can be countered?
Hesitancy is the result of inadequate information given to people and doubts that are not clarified. Clear and repeated communication is the key to address both challenges. Both mass and local communication channels must be utilised to explain the benefits and remove misconceptions. Once the programme rolls out smoothly, confidence will grow. The positive experience of others who have received the vaccine shots will boost confidence in others. Rumours must be quickly countered and credible persons must quickly clarify any reports of adverse events.
Do you think that teachers need to be counted among the frontline staff and vaccinated for reopening of schools?
Resumption of school education is a high human development priority. For that reason, we need to consider teachers, other school staff and also school bus drivers as essential staff for early immunisation. It is also likely that some of the older teachers will have co-morbidities. Irrespective of that, all school staff must be regarded as essential workers for the purpose of immunisation.