Dr. Rajiv K Gupta, Dr. Richa Mahajan
The current scenario of COVID-19 pandemic in the world reveals that Europe is becoming the epicentre of this highly infectious disease. The continent is reporting about 62% of the total new cases of infection showing a rise on weekly basis.
Fear of disruption have led to decline in stock markets and looming threat of new lockdown have sparked protest marches across various European nations especially Vienna, Brussels, Rotterdam and Rome. The resurgence in Europe has been attributed to many reasons. The first and foremost cause is Delta variant of the virus which has ability for greater transmission than its original variant. Vaccine hesitancy along with waning immunity is another challenge which the European nations are faced with. All this is leading Europe to a scenario similar to pre-vaccine era where lockdowns were inevitable. As per WHO projections, a grim scenario has been predicted with anticipated 7 lakh deaths in European nations due to COVID-19 by March 2022 unless urgent actions to combat the pandemic are initiated.
Another matter of emphasis is the new COVID-19 variant B.1.1.529, first reported from South Africa on November 24 which has been designated as “variant of concern” by WHO and has been named ‘Omicron’. Omicron, as per reports, has upto 32 mutations and thus there is need for vaccine equity as soon as possible to protect the most vulnerable everywhere. Preliminary evidence suggests an increased risk of reinfection with this variant. Besides South Africa, this variant has also been reported from Botswana, Belgium, Hong Kong and Israel. Consequently, all countries face compelling necessity to perform field investigations and laboratory assessments to improve understanding of potential impacts of variants of concern on COVID-19 epidemiology, severity, effectiveness of public health and social measures, diagnostic methods, immune response, antibody neutralization or other relevant characteristics. In addition, countries should enhance surveillance and sequencing efforts to better understand variants, submit complete genome sequences and associated metadata to publicly available database.
Crucial lessons for India
India is currently in a similar situation as a year ago. The outbreak has receded, cities are opening up, big festival months of October and November are behind us and the country is gearing up for a major round of Assembly elections in the next year. Our partially vaccinated country is reopening and trying to return to its pre-pandemic ways, leading us to expect a major surge of COVID-19 cases. In addition, the seasonality of the SARS -CoV-2 virus can be a major cause for the upsurge of cases during winter. The number of deaths from COVID-19 in this potential surge would depend mainly on the level of vaccinations by then and the new variants circulating as we enter winter. Regional Director WHO Europe, Hans Kluge has said that Europe and Central Asia face a challenging winter ahead. He has also advocated “Vaccine Plus” approach consisting of vaccination, social distancing, use of face masks, hand washing and ventilating indoor spaces. Because of waning vaccine immunity, people who were vaccinated between December 2020 and February 2021 will probably need a vaccine booster before winter. A greater concern for India is that only 38% of the population has been fully vaccinated though nearly 80% of all eligible adults have received the first dose. About 220 million unutilized doses speak of the challenges about vaccine uptake. Since full protection is achieved only with two doses, State governments need to pull out all the stops to increase the percentage of the fully vaccinated population. Outreach programmes have a greater role in increasing immunisation coverage as we know from our experience of delivering polio vaccine.
India has reached a stage where a corrective action needs to be taken at the earliest so that our nation avoids the trajectory towards which Europe is heading. Booster dose of the vaccine for the vulnerable population and reduction of the current gap of 12 weeks between 2 doses of Covishield vaccine can be groundbreaking steps in preventing the third wave of COVID-19 in India. As per standardised practice followed around the world, the best time for booster jabs is six months to one year after the second dose. The issue of administering booster dose of the vaccine even seems to be on agenda for the next meeting of the National Technical Advisory Group on Immunisation in India (NTAGI). Inclusive approach to mass vaccination for all adults is to reach Herd Immunity Threshold in an attempt to bring this pandemic on its knees and at worst, allow it to crawl as endemic COVID- with low and steady numbers.
Dr. Rajiv K Gupta, Dr. Richa Mahajan