BENGALURU: With the increase in Covid-19 cases across many states in the country, renowned epidemiologist and India’s leading expert on public policy, vaccines and health systems, Dr Chandrakant Lahariya, discusses how important it is for the government to now strategise on targeted vaccination of the adult population. He also talks on why it is important to wait before thinking of vaccinating children even if the vaccines are approved by September.
The findings of the recent serosurvey point out that nearly 67% of the Indian population has developed antibodies. At the same time, there is a lot of buzz on under-reporting of cases. What is your take on this?
The serosurvey data that I have analysed has shown that for every single Covid-19 case reported in India, there were 30 other cases that remained undetected. The under-reporting factor was 30, which means for every case reported, 30 cases were missed. It may not be deliberate under-reporting, but many asymptomatic cases may not have been counted. A district- or state-specific survey will provide a more accurate picture and the government should urgently plan such a survey.
Keeping this analysis in mind, do you think the third wave will be severe?
The severity of the wave will depend on the seroprevalence and also on the vaccination percentage in an area. The purpose of vaccination is to reduce the severity of hospitalisation. If we can vaccinate a large number of the population, it will definitely reduce the severity of the wave. So, if you want to reduce the severity in the third wave, the country needs to scale up on vaccination. Severity will also depend on which variant will emerge and its transmissability. In my opinion, states or districts with high prevalence during the Delta-led second wave may see a less severe third wave, but those with low seropositivity will see a high number of infections. But severity can still be prevented with upping vaccinations in those areas.
Most parents are concerned about vaccinating their children...
We need to remember the purpose of vaccination. It is to prevent severe illness and death. This is high in adults and lower in children. So the purpose of vaccinating children cannot be reducing mortality, as that is already low. So, the benefit of vaccinating children is far lower than vaccinating in adults. Since vaccine supply is low, priority should be to inoculate adults. The other risk is children may bring the infection back home. But we need to know that the currently available vaccines for children have a limited role in reducing transmission. Their role in preventing transmission is not proven.
So, even if we want to vaccinate children with the currently approved vaccine once their clinical trials are completed, they will not play much of a role in reducing transmission and the purpose is also not served.We should wait for the right kind of vaccines. The 12-17 age group is about 45 crore in India and if they have to be given two doses, it is 90 crore doses of vaccine. Even to administer 90 crore shots, it will take 6-8 months or possibly even longer. It may not be realistic to expect that children can be vaccinated this year. The earliest possible time for those who are eligible will be late 2022.
At the rate at which states are vaccinating its people, do you think India will be able to achieve the expected target?
We were told that India will have a high number of shots available by December 2021. But, now it is clear that in July, we got 13.5 crore shots and in August we will have an additional 15 crore. This is far less than the original projection to achieve 216 crore doses which was announced in May and 135 crore that was announced a month later. So, we are definitely not on track to vaccinate the entire adult population by December. But what is realistic is to utilise the available vaccines to target the high-risk population. A realistic target would be 70% of the adult population receive one shot and 50% receive both.
What can the government do to achieve that target?
First focus on covering the 60-plus population who are at high risk. Then cover the 45-plus population once we have covered a fairly good number of the 60-plus. Then focus on 18-45 those who are at high risk like pregnant women etc. There should be a targeted approach. In the high-risk population, a realistic goal should be 90 per cent coverage and the rest should be vaccinated by early or mid-2022. Rather than looking at absolute numbers, focused high coverage should be a priority. States with seroprevalence and other hill stations should be the target. Districts with low seroprevalence may not need universal coverage.
Do you see the need for any change in the existing vaccination policy?
States should strategise once they receive vaccine doses. Instead of distributing it generally, they should target the doses. Also, vaccine administration by the private sector has been less than 1/3rd in many states, so it would be better to rethink the vaccine allocation policy. The government should have a plan ready for August to December. States should know how much vaccines will come, how much is utilised and which population groups will be considered. Serosurveillance at the district levels has to be done to know where vaccination should be ramped up.