India lacks robust public health system, need-based medical research: Virologist

Anyone who has not had two vaccine doses plus booster is not immunised against Covid, says Dr Jacob T John
Last Updated : 12 April 2023, 15:07 IST

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While Covid hospitalisations and deaths are rising in India, Navya P K talks to eminent virologist Dr Jacob T John about whether the current scenario is worrying and how vulnerable groups can be protected.

Is the current increase in Covid numbers cause for concern?

The daily Covid numbers are still hovering around 6,000. On a daily basis, India is adding 65,000 to 70,000 newborns to the population. They are unvaccinated and uninfected, which means all of them will get infected since the XBB.1.16 sub-variant of Omicron is highly infectious. Only around 10% of them will get sick though, and only this population will get tested. That would come to 6,500 per day, so the current numbers are not worrying. XBB.1.16 appeared in India only in December 2022, and the virus takes time to infect everybody. So we also have an accumulation of susceptible population (children born over the last few months) who were not infected until April. In addition to 6,500, there will be more people from this accumulated population who get infected daily. Hence, the daily numbers may increase further.

If it plateaus and begins to come down, that’s a natural fluctuation within the endemic prevalence. Covid has been endemic in India since February 2022, and fluctuations are expected. But if it goes steadily above 6,500, I’ll sit up and think about it.

Cases of deaths are higher among the elderly though

Those getting sicker may be the elderly and those with comorbidities, but it’s the younger children who are promoting infections among them too. We are letting the virus spread.

What is the solution?

Countries like the UK have announced a children’s vaccination programme. But that has to be systematic, and India doesn’t have a system for this. Also, you have to use a vaccine that’s guaranteed to be safe. In Europe, one in 50 women below 65 years developed bleeding and clotting problems due to AstraZeneca (Covishield), and Europe stopped using it in women a long time ago. In India, we don’t know how many people have died due to vaccine-related complications. Covaxin has not caused any serious side effects, but there’s no discussion about this. Why can’t Covaxin be given to children?

Will the population need booster doses for Covid frequently, like in the case of flu?
If you want to prevent flu, immunity against it has to be kept up with annual flu shots. With Omicron that’s not necessary, some immunity in the past is protecting lives, and high immunity will prevent hospitalisation. Anyone who has not had two vaccine doses plus booster is not immunised against Covid. Anybody above 60 years, or has diabetes, hypertension, chronic lung or heart disease, had organ transplant, must have a second booster. Reinfection must be expected later, but it won’t lead to any drastic outcome.

Are more variants of Covid likely to emerge?
After the variants of concern (VoCs) Alpha, Beta, Gamma and Delta, Omicron emerged. In an upcoming research paper, we predict that Omicron will be the last Covid VoC. This virus does not require any more variants. Within Omicron, new sub-lineages may emerge, but all of these cause upper respiratory tract infections only, and not complications like hypoxia and pneumonia.

Given the lack of clarity about Covid, is a better system for testing and data needed in India?
Scientific medicine, that’s accepted globally, is a three-legged system - healthcare which is about getting treatment, public health which strictly monitors the distribution and determinants of diseases, and third, medical research. India has no public health, or systematic, need-based medical research. Without these, we won’t get the right data or answer questions such as Covid mortality rate or the number of people who escaped XBB.1.16 infection. Countries like Sweden and the UK already have a good public health system, so they can rely on their Covid data. Every healthcare provider there is legally required to report certain things to public health. Here we just believe that God will take care of the situation.

Published 10 April 2023, 17:28 IST

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