Understanding the Ebb and Flow of COVID-19: An Interview with Prof. Vir Chauhan
The ferociousness with which the second wave of Corona virus has ravaged through India is on everyone’s minds.
To better understand India’s capacity to deal with the virus, why we shouldn’t be hesitant of the vaccine and what we should expect in the future, we interviewed Inlaks Trustee, Professor Virander Chauhan.
What should be the top three priorities for India in the next 6 months as we experience the second wave of the COVID-19 pandemic?
The top priority right now is to deal with the second wave. All over the world and in India, it has proven to be more ferocious than the first. Therefore immediately, we need to do whatever we can to reduce the infection rate. If the infection rates aren’t curbed, then the virus has more chances to multiply resulting in a rise of mutant strains. If the infection rates remain high, it will become a cyclic process: the more the virus multiplies, the higher the chances that the virus will mutate. Wherever there is an intense wave or huge amount of infection, localised lockdowns are necessary to lower the infection rates.
The second most important priority, which has been reiterated 1000 times over, is to wear masks and practice social distancing. Given the high infection rates, I would recommend that masks be worn inside homes as well and people isolate as much as they can. While life must go on and leaving home for various tasks is unavoidable, people should be prudent and responsible. Double masking in public and maintaining social distancing, even after one has been vaccinated, is essential in the near future. To clarify, mutants are really the same virus which have evolved into a fitter, more infectious version of itself. Hence one has to be extra cautious.
The third most important priority would be very clear public messaging. From the start the messaging seems to have been inconsistent. Sometimes too much information is relayed and most times the information circulated is incorrect. The dissemination of information should be scientifically driven and not by belief or faith as it has been in the past. Messaging should be from the medical and scientific community and information must be evidence based.
It is imperative that we curb the spread of the virus, as it will reduce stress on an already crumbling health system in India. As a society it is imperative for us to protect our currently overburdened health systems.
Should we expect 3rd wave of the virus?
A third wave is inevitable where ever there has been huge amounts of infection as we have seen around the world. We hoped it would become a background virus by now, but that hasn't happened, as the virus has been able to select much bold fitter versions of itself. The scientific community is learning about this virus on a daily basis.
As the viral wave ebbs, the questions on everyone’s mind is, should we open up, work, educational institutions, businesses, public transport etc.? The answer is yes and life must go on. However, it is essential to remember that the virus hasn’t gone away, it’s still lurking. If we decide to attend mass gatherings such as melas, weddings, political rallies, needless to say there will be a third wave. The only way for us to open up the economy and soften impact of the third wave is to vaccinate large portions of the population.
However, coming back to your question, taking a cue from countries such as France, Germany and Spain, who are currently experiencing their third wave as we speak. To reiterate, the answer is yes, third waves are inevitable, but hopefully less vicious.
What is your advice for people who are hesitant to take the vaccine?
Let’s looks at why people are hesitant. The confusion about vaccines arises from WhatsApp and other types of social media and news channels. News about the possibilities of contracting a blood clot from AstraZeneca or that Johnson & Johnson has had to stop trials have set doubts in people’s minds. However, we are learning as we go on and the vaccines being administered are absolutely safe. The vaccines have a few temporary side effects such as slight or high fever or muscle fatigue. Different people respond differently. These vaccines would not have been out had they not proven to be safe. In fact, more than one billion shots have been administered. If they were unsafe, people would have aware of it by now. I, personally would go as far as to say that it is a social and moral responsibility for everyone to not only protect themselves, but also protect their neighbour.
The other questions in people’s mind is can you get infected and transmit the virus even after two doses of the vaccine? The answer is yes. However, the chances of infection and transmission are not as high, should you be vaccinated. For the vaccinated population, there is a 95-99% chance that they will not have a severe attack and therefore will not need hospitalization. These vaccines were not developed to stop reinfection but to protect against severe disease and death. There's enough data from world over to back up this claim.
To eradicate vaccine hesitancy the messaging to citizens must come from the top. The medical, scientific and political communities should advocate vaccination. While we are uncertain about the vaccine’s effect on future strains and mutations, we are certain it will be effective against the current virus.
What is your opinion on India's capacity to vaccinate the majority of the population starting May 1st?
Now that's a very interesting question. I had predicted, sometime last August or September, that India has a large capacity to produce and distribute the Covid-19 vaccine. No other country is currently in this position.
You might then question why has India taken so long to produce a vaccine, since the world has started vaccinating sometime in December- January and we began in March. I think that we were probably not fully ready considering our regulatory frameworks are slow. By end of May, India will have the capacity of producing 60 – 70 million doses.
Vaccine production is a lengthy and delicate process. To put it simply , a vaccine is not just a piece of a whole virus, it has 20-30 chemicals and stabilisers that are used. These ingredients have to be extremely pure, carefully produced and quality controlled.
Going back to the question about our capacity, it currently is much lower than what we need. By mid-June India will have Sputnik imports and our capacity will go up to 100 million doses a month. With careful distribution and no wastage, we could inoculate about 9-10% of the population. Optimistically, by July our supply chains should become robust. I’m guessing that by August or September we should have enough vaccines, if Biological E starts making the Johnsons & Johnsons’ vaccine, Reddy’s start making the Sputnik vaccine and the Serum Institute of India and Bharat Biotech increase their production by about 30-40 million.
I think we can come to the last question now…
Before we get to it, there is one thing you haven't asked, which is on everybody's mind. Now that we’ve seen the high prevalence and infectivity of the mutants, will some of these mutants have the ability to escape the vaccine induced immunity or the natural immunity that one develops from being exposed to the virus?
Viruses have the inherent ability to mutate. When their infection rates are high they tend to multiply faster. The first mutant was discovered in England at the same time similar mutants were also noticed in Brazil and South Africa. Wherever there are infected people, mutants can be found. Unfortunately, the current mutants are very infective so they bind to our receptor faster and therefore can spread much faster.
What we do know is that as of now the immune responses produced by antibodies or by natural infection still protect us from severe disease. I want to hammer this point that even after being vaccinated, people are still able to contract and spread the virus. The vaccines never claimed that one can't get infected. However, if infected, it will be mild, moderate or asymptomatic and you will be protected from death. If you are vaccinated the chances of the virus multiplying fast is remote, as the chance of infection is much less and the probability of spreading it to others will be considerably reduced.
We may have new mutants in the future and one can't predict if these will mutants will escape our immune responses. Therefore we should be on the guard and therefore quickly vaccinate.
What steps will we need to take to safeguard ourselves from the virus going forward?
From the history of viruses, we know that they disappear, go into the background. In fact we have various types of Corona viruses that infect people every year, like red eyes, colds and coughs etc. Scientifically, there is no reason why this virus should not peter out. The havoc we are experiencing now seems to be another peak, not only India, but in other parts of the world as well. There is no question in the scientists’ minds, that it will finally become an epidemic situation and will not remain a pandemic.
Currently we have the first generation vaccines, but newer vaccines will be discovered and produced which will protect against mutants. Hopefully, after two years we should see a massive decline, the pandemic won’t go on forever. If we look at New Zealand and Barcelona that recently held large outdoor concerts, these gatherings resulted in little to no cases of infection.
If we can vaccinate 30-50% of population, the virus will have significantly less to hosts replicate in. All viruses in the past have been controlled like this. Unfortunately we don't have a cure yet, but hopefully we will have one soon.
This interview was conducted on 28th April, 2021.
Professor Chauhan is the ex Director, International Centre for Genetic Engineering and Biotechnology (ICGEB) and is an Emeritus Scientist with the ICGEB, Govt. of India.
His area of interest lies in the research of infectious disease research, especially malaria.
