Taming the second COVID-19 wave

Gyan Pathak
Vaccine net expansion in India’s arsenal in fighting the COVID-19 battle is certainly a wise decision of the Modi Government, though taken only after a great loss of lives and livelihoods, and tremendous pressure from the people, experts, and the opposition. However, it may not prove to be a magic wand, especially at a time when taming of the second COVID-19 wave has just got tougher than ever before, with unprecedented spike in infection, positivity, and mortality rates. The decision, therefore, needs to be followed by better strategy, faster than the spread of the infection.
In the midst of reported acute shortage of vaccines for the inoculation drive of India, the emergency use approval given to the Russian made vaccine Sputnik V has come as a great psychological relief for citizens of the country. It would be the third vaccine in India’s arsenal of vaccines after the Indian made Covishield and Covaxin. By taking such a decision and clearing the way for other foreign made vaccines waiting to enter in India, especially those already approved by the World Health Organization (WHO), the Government of India has kindled a great hope among the people regarding the availability of more vaccines’ doses.
However, the decision is only the first step towards assuring the availability of vaccines for 1.39 billion population of the country. We have already seen how SII and Bharat Biotech, the manufacturers of Covishield and Covaxin respectively, are not able to supply the required number of doses, and therefore, given the demand for corona vaccines all over the world, there is no guarantee that India can make up the shortage of the same from imports at affordable price. Even if required number of doses will be available for import, carrying the vaccines from the country of origin to the final destination of the consumer end would require additional logistics that would need to be created.
Russian made Sputnik V would be produced in India at Dr Reddy’s Lab’s manufacturing units. It is possible that other foreign manufactures of corona vaccines may opt for some arrangement with Indian companies to manufacture them locally. Even in such cases, actual production, may take time. India could place order for large number of doses but cannot take delivery of the same without creating logistics to handle them. It is therefore clear that the availability of vaccines at desired number to cover all the citizens of the country is not possible for months to come.
The logistics that India has already created have especially been designed to the two Indian vaccines Covishield and Covaxin. Other vaccines may need other types of logistics. For example, we can take the recently approved Sputnik V, which has two different versions, and both has different requirement for their storage in terms of maintaining temperature. Due to electricity and other problems, such as transportation, refrigeration, and manpower problems we are not able to make the present vaccines available beyond the cities. Creating logistics for more vaccines with divergent requirements is not going to be as easy as it may appear theoretically.
Even if we presume that the Government agencies and their officials would be working as fast as they could, availability of vaccine would be much less than the present requirement. It means Government would still need prioritization of the vaccines for some months to come. The present strategy of prioritization has inherently been laden with numerous shortcomings due to which we have landed into the present worsening condition of the second COVID-19 wave. If the Government continues with the present mindset of the prioritization, winning the corona battle in near future would remain a day dream.
The two basic concepts along which the present prioritization work are – preventing death of patients, and avoiding overwhelming of the health facilities. For the first, criteria of age and morbidity have been adopted, and for the second health facilities were strengthened. Vaccines are given to the people who needed it, not who wanted it. Prima facie it looked faultless to many. We never used vaccines to reign in spread of the infection, so it continued to be spread, and more patients ultimately overwhelmed the meagre health facilities that we had created. Shortage of beds, oxygen, and ICUs clipped the effectiveness of the healthcare system, and therefore recovery rate of patients fell substantially pushing up the caseload. The objective of preventing death of patients by making categories on age and morbidity could also not be achieved as a result. Thus the basic concept of the present strategy need change in the present scenario.
One must understand – if we cannot reign in the spread, overwhelming of health infrastructure and death of patients cannot be prevented. We thus need vaccines for all in and around the containment zones, while those areas may wait for vaccines where there is no threat of infection. ‘To those who need’ is the best strategy, but in the name of equitable distribution of vaccines even to those living in areas without immediate risk of infection is not justifiable.
India needs more and more testing, tracking, and treating its people. To show the level of infection low, we cannot afford lowering our testing efforts, as we have done earlier. Testings were highest in September 2019 and therefore we had found highest number of patients. Testings were lowest in February 2021 and we had found lowest number of infection. It created an illusion of winning the corona battle. Even our PM Modi, under such illusion, stated that we had won the battle. We should not repeat this mistake, especially at a time when there are hundreds of variants of concerns along with several foreign strains and double mutants, which are dreaded for evading immunity after recovery from COVID-19 and also after being vaccinated. Strengthening and widening our health facilities is also of immediate concern.
The last, but not the least, is the enforcement of the covid-appropriate behaviour. It is necessary because the advisories are violated both by common people and the persons ruling the country. Large assembly of people during election rallies, religious congregation, and packed market places are examples which have multiplied the number of infected people overwhelming the health infrastructure. From small political leader to our Prime Minister became instrumental in the past in violation of all guidelines regarding covid-appropriate behaviour. Lockdowns in various names, such as ‘corona curfew’ or ‘stringent measures’ etc, without other appropriate and modified strategies for the present circumstances, would only aggravate the miseries of the people. (IPA)

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