On guard, to keep waves at bay: No rush to stockpile Covid vaccines

Just as life without masks and social distancing was increasingly becoming a new normal, Covid-19 has made a comeback. Even if the impact is not severe, doctors, health experts and hospital administrations have stepped up their act on the next steps. 

The numbers explain why the situation is not alarming, but the sudden surge in patients infected with the Sars-CoV-2 virus is worrisome. India is adding 250-350 fresh Covid-19 cases daily. Compare this with the numbers in early May 2021, when infections were at their peak. India was reporting an average of around 400,000 daily cases and close to 5000 deaths, four summers ago. 

The virus may have lost its ‘bite’, but is still highly transmissible, as experts point out. 

Public health expert Anish T S, professor and nodal officer, Kerala One Health Centre for Nipah Research and Resilience, fears that climate change, and growing antimicrobial resistance may emerge as precipitating factors for the next pandemic. “More or less 60 per cent of epidemiologists agree that the next pandemic would not be Covid-19, but could be caused by a different virus, as Covid-19 is becoming endemic in the population,” he says. 

Medical professionals agree. Dr Rahul Pandit, chair, critical care, Sir HN Reliance Foundation Hospital, Mumbai, who has been at the forefront of Mumbai’s fight against Covid-19, says it’s highly unlikely that we will have another Covid-19 type pandemic that spreads across the globe, affecting thousands and thousands of people. 

“What is more likely is that we will continue to see small outbreaks across the globe—localised infectious diseases in specific areas. If you look at the 20-year history before Covid-19 hit us, we had a number of such outbreaks. We started with SARS. In 2009, there was H1N1. Then, there was Ebola in some African countries. We also saw avian flu spread to many nations, and in between, there was the Middle Eastern Respiratory Syndrome (MERS) as well,” he points out. 

However, Pandit cautions that it may not take another 100 years for the next pandemic to occur. 

So is it okay to down the guards against Covid-19 as cases surge now?   

Herd immunity 

Doctors believe the population has some amount of herd immunity against the virus. Anish calls it hybrid immunity — a mix of vaccine induced immunity (based on Wuhan strain) and immunity from being infected with subsequent variants. 

Dr Deepesh G Aggarwal, consultant physician and head of department in critical care medicine, Saifee Hospital in Mumbai, cites multiple serosurveys to explain things. Some of them are reporting neutralising antibody prevalence in the range of 70–80 per cent across diverse wards (and regions, in context of India), says Aggarwal. This suggests that a large portion of the population has acquired immunity either through vaccination, natural infection, or, most often, a combination of the two (so-called “hybrid immunity”).” 

Aggarwal adds that although antibody levels may wane over time, recurrent exposures to mild infections have helped maintain protection against severe disease. This herd immunity is a key factor in reducing the probability of a large-scale outbreak, even if case numbers may rise intermittently during seasonal fluctuations. 

The current surge in India is driven by new Omicron sub-variants such as JN.1, NB.1.8.1, LF.7, XFC and XFG which are known to have shown increased transmissibility. The country now has more than 7000 active cases (with Kerala reporting the maximum number). An estimated 97 people have died since January. 

The World Health Organisation (WHO) has classified these as variants under monitoring (VUM) as against the variants of concern (VOC). The NB.1.8.1 has been behind a recent surge in cases in China, Singapore and Thailand, and has been detected in some parts of Europe and Canada also. 

Against this backdrop, the question on top of the mind revolves around the need for vaccine. With these little surges from time-to-time, do we need to take an annual Covid-19 shot? 

 

The vaccine question 

The CoWIN website shows not a single vaccination center is active at the moment. Incidentally, the site lists nine Covid-19 vaccines approved in the country. 

A top executive of a corporate hospital chain says that vaccine stocks they had have expired. “We lost quite a bit of money on that. After vaccinations became paid, hardly a few have opted barring some cancer patients or highly morbid individuals,” he says, adding that even if vaccine makers start production they were not planning to stockpile any further. 

Anish explains the reasons behind the dilemma — “Covid-19 is unlike the influenza which has relatively stable strains (northern hemisphere and southern hemisphere have different times of possible spikes). This virus is mutating very fast and vaccine companies have to run with the virus,” he says. This does not make economic sense for corporates. 

Key players who vaccinated most of the Indian population like Serum Institute of India and Bharat Biotech are not making the Covid-19 jabs anymore. In fact AstraZeneca has announced the global withdrawal of its Covid-19 vaccine, Vaxzevria. The company attributed the decision to an abundance of more recent vaccines that target new variants of the coronavirus. This move comes in the wake of recent admissions by AstraZeneca, acknowledging in their legal documents that their vaccine can cause rare side effects like blood clots and low platelet levels. 

The owner of a mid-sized vaccine company says there is no point in making and stockpiling the jabs. “All the vaccines are based on the Wuhan strain and the bulk of the population has been vaccinated with that. A booster shot would not stop infection or transmission,” he says. Companies which were working on developing potential vaccine candidates against disease X (unknown disease which can cause the next pandemic) have also gone slow, he claims. “We don’t know which family the virus will belong to. We have to make 20-30 or even more potential candidates, and funding is not easy....,” he adds. 

Doctors too don’t see the need for boosters. “I think medically and scientifically, it would not make any sense for me to make a recommendation for or against it currently,” Pandit says. 

According to Anish, not-for-profit organisations or public entities could make a stockpile for the vulnerable. 

According to market research firm Pharmarack data, five-year CAGR for the overall vaccine market in India is negative 2 per cent. Sales of influenza vaccines have remained static at around ₹200-240 crore in the last few years, indicating no spike in demand from adults. Similarly, pneumonia vaccine sales have slipped from ₹363 crore in 2021 to ₹154 crore now. Sheetal Sapale, vice president, commercial, Pharmarack, however, says that since the pandemic, many have become used to walking into hospitals for their shots and retail sales data does not capture that. 

“Adult vaccine uptake in India remains suboptimal. There is a strong need for public education campaigns and policies to implement vaccinations in vulnerable adults,” points out Dr Charudatt Vaity, director-critical care, Fortis Hospital at Mulund in Mumbai. 

Despite everything, the need for surveillance does not end. 

“We can use community-based methods. It's important to identify clusters quickly for the public health response to begin,” Anish says. 

The central government, on its part, has not taken the situation lightly — reviewing the situation periodically, conducting mock drills at health facilities and also asking states to ensure availability of oxygen, isolation beds, ventilators, essential medicines.

For the moment, preparing for timely detection and stepping up medical infrastructure in the hinterland should be a priority, regardless of the severity of the infection.