Health challenge in New Year
The year-end usually provides an opportunity to reflect on the happenings during the preceding twelve months and is also an occasion to look forward to the next twelve. The ongoing Covid-19 pandemic, however, has turned this exercise into a difficult one. The outgoing year began with the fear of a new variant — Alpha. Just a handful of its cases were detected through genome sequencing in December 2020. As the year progressed, it saw the emergence of the Delta variant which led to the deadly second wave of the pandemic in India, peaking at over 2.7 million infections on May 3.
About 1.4 billion have been administered vaccine doses in India alone, but some harsh realities remain.
Delta resulted in millions of cases in several countries as it became the dominant variant globally. Towards the end of 2021, we are reeling under the spectre of Omicron. The variant is driving the pandemic in South Africa and is spreading fast elsewhere. New variants, genome sequencing, travel advisories, partial lockdowns and economic disruption, all sound familiar and seem to have become cyclical events. The challenge in 2022 will be to find ways to break this cycle and halt the pandemic.
Though the sequence of events unfolding now seems a déjà vu of what happened a year ago, there are significant differences. The biggest differentiator is that the world has a formidable weapon in the form of a slew of vaccines and hope of possible therapeutic tools as well. On December 8, 2020, Margaret Keenan of the UK became the first person in the world to get a Covid-19 vaccine. Since then, nine billion doses of different Covid-19 vaccines have been administered globally. Of them, about 1.4 billion have been administered in India alone. The Covid-19 vaccination has become the largest immunisation programme in medical history. The big picture looks impressive, but it masks some harsh realities of the iniquitous world. The rich have cornered the greatest number of vaccines, with people receiving the third dose as a booster as well. On the other hand, vaccination coverage in poor countries remains abysmal. This is what the World Health Organisation (WHO) chief Dr Tedros Ghebreyesus had feared as ‘catastrophic moral failure’. In India, the share of people who have received at least one dose of the Covid-19 vaccine as of December 26 is 60 per cent, while the share of people who are fully vaccinated is 41.8 per cent. Vaccination data for different socio-economic strata is not in the public domain.
Despite its shortcomings, vaccination remains the most potent weapon against the threat of new and emerging variants of SARS-CoV-2. Therefore, the focus will continue on increasing the number of fully vaccinated people and on rapidly rolling out booster or ‘precautionary’ doses among people already vaccinated. Though Omicron is gaining notoriety for its capability to infect those fully vaccinated, vaccination is supposed to protect against severe disease. The picture will become clearer as more data on Omicron is collated and studies are done, but vaccination will continue to be the mainstay of our fight against new variants and Covid-19 disease. The extension of vaccination coverage in India to teenagers and booster dose for frontline workers and elders with co-morbidities is critical. At the same time, it is vital to reach the unvaccinated urgently, as they remain most susceptible to Covid-19. It has been observed in countries with high vaccination coverage that even a small number of unvaccinated can start new waves, what experts are calling as ‘pandemic of the unvaccinated.’
Another important way to prevent Omicron from going the Delta way is to follow Covid-appropriate behaviour. At the beginning of 2021 when the Alpha variant had been detected and when the Delta variant was taking shape somewhere in India, the country lowered its guard on the behavioural front. There was euphemism over the likely availability of Indian vaccines, and the political leadership declared a premature victory over the virus. The Election Commission announced Assembly poll in Kerala, Assam, West Bengal, Tamil Nadu and Puducherry. It opted for an elaborate, multi-phase schedule which meant a continuous election campaign. Large rallies were held with no regard for safe distancing and masking. The polling took place in several rounds between March 27 and April 29, with counting on May 2. Within days, the Delta variant hit the country in full force.
At the beginning of 2022, we are in a similar situation again. A new variant has made its way into India, and elections to five states — Uttar Pradesh, Punjab, Uttarakhand, Goa and Manipur — are on the cards. Seemingly high vaccination rates have led to complacent behaviour, as demonstrated during the recent festival and holiday seasons. Political parties are all geared up for elections, large events and public rallies, even before the announcement of the election schedule in Uttar Pradesh and Uttarakhand. The Election Commission has consulted the Health Ministry on the pandemic situation. Hopefully, it will hold wider consultations with independent health experts and epidemiologists as well before taking a call on the poll schedule. The assembly elections should be held in such a way that they do not contribute in any way to a future wave of Omicron or any new variant which may be lurking to surface.
Science has progressed rapidly since the onset of the pandemic, giving us new insights into the virus and its behaviour, and new tools such as testing kits and vaccines. We still need India-specific studies on various counts. In addition, pandemic management has a lot to do with disciplines beyond medical research. We need social science and epidemiological research to address challenges such as vaccine hesitancy, behavioural change, mental health etc. Indian medical agencies have amassed a mountain of data in the past two years, analysis of which can help find possible solutions. For this, the data will have to be shared with researchers outside the government system. The government has so far been secretive with this data, despite repeated calls to open up. Hopefully, this will change in 2022 as we enter the third year of the pandemic.
