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All pandemics settle with less frequent oscillations: Dr Gagandeep Kang

India has done better than many other countries with different age structures, infection histories and vaccination coverage in containing the third COVID-19 wave, says Dr Gagandeep Kang, senior virologist and professor, CMC–Vellore.

January 28, 2022 / 12:38 PM IST

Dr Gagandeep Kang is one of India’s foremost virologists and member of the COVID-19 Working Group under the National Technical Advisory Group on Immunisation. She holds the distinction of being the first Indian woman to become a Fellow of the Royal Society. In a conversation about the course of the COVID-19 pandemic in India, she said that while the worst of the Omicron-fuelled surge may be behind, existing vaccines against the coronavirus need to be refined to offer better protection. Dr Kang believes that despite the surge in infections during the third wave, India has done relatively well thanks to the high vaccination coverage and previous history of infections.

Here are some excerpts from her interaction with Moneycontrol:

Given that the third COVID-19 wave in India, fuelled by the Omicron variant, seems to be plateauing, can we say that the worst is behind us?

For this wave, the descent has started and we hope that the tapering will be rapid. There is a lag of severe disease behind acute cases, but it is unlikely to be beyond the capacity of the health system.

The number of hospitalisations as well as deaths due to COVID-19 infections this time round have been far lower than in the Delta wave. Is this because of the nature of the variant or vaccination/hybrid immunity? What can we say conclusively?

COVID-19 Vaccine

Frequently Asked Questions

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How does a vaccine work?

A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

How many types of vaccines are there?

There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

What does it take to develop a vaccine of this kind?

Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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Conclusively, we can say that prior exposure and vaccination helped in reducing severe disease. We have done better than many other countries with different age structures, infection histories and vaccination coverage. Is the omicron variant less severe than Delta? Based on the limited data on disease severity in unvaccinated, uninfected individuals, it appears a little less severe; but it is likely that the bulk of the reduction in severity is because of infection or vaccination.

The way this ongoing wave has played out in India, do you think there was an element of surprise as compared to the recent waves in several European countries and the US?

Not really, we expected a situation more similar to South Africa than Europe or the US and it has played out that way, thankfully.

Some countries are reporting that the BA 2 sub-lineage of Omicron, which is even more transmissible than BA 1, is causing a fresh rise in COVID-19 cases. What do we know about this strain and what implications could it have on the pandemic trajectory locally?

We know that it grew rapidly as a proportion of cases in Denmark, India and the UK, and is still growing. At the moment we do not have any evidence of either increased transmissibility or increased severity, but the question of whether it is increasing because of better immune escape needs to be investigated urgently.

Also Read: Coronavirus Update | India marks 12% decline in daily cases

The consequences of a more rapid spread are that greater numbers of people will be infected or reinfected, which is always a concern for the clinically vulnerable. Also, we need to remember that a variant with increased immune escape could give rise to future, more concerning variants as well, so tracking is essential.

It is now obvious that new variants of the COVID-19 virus are emerging every few months and triggering fresh waves of infections. Do viruses have an indefinite capacity to keep mutating? How long do you think this pandemic will continue?

RNA viruses can mutate forever. We have the common cold coronavirus, which still mutates, but the question is how often will the mutations have clinical consequences? That is unpredictable.

Also Read: Tamil Nadu lifts curbs, allows schools, colleges to reopen on February 1, withdraws Sunday lockdown

There is still room for greater transmissibility and greater immune escape, and greater severity, but whether we will see a virus with all three attributes is unknown. All pandemics settle with less frequent oscillations. We are in the middle of a cholera pandemic — does the world know?

What are your views on COVID-19 vaccine booster doses in a country like India? What data and parameters should be taken into consideration before booster doses are offered to people?

This needs a really long answer, but briefly, the vaccines we have now are great but are the first phase of vaccines. We need to either make new vaccines or have vaccination strategies that give more durable protection to the most vulnerable populations. I don't think we have reached the limit of the protection that vaccines can give us yet.

Sumi Sukanya
first published: Jan 28, 2022 12:38 pm