Omicron wave: India should give booster shots to 18-60 year olds; it’s the need of the hour

One thing that impedes India’s booster drive is the country’s policy of not allowing mixing of vaccines. (Representational image)

From January 10, the Indian government decided to give booster doses. It wasn’t for all–only for senior citizens and for frontline workers.

Read also: Coronavirus Omicron Live Updates

I argue that we need to widen the net, that booster dose for 18-60 year olds–the population that powers our economy–is the need of the hour. 

Here’s why.

It is true that Omicron is less severe than Delta. Study after study says this. But, the new variant is highly infectious. Study after study also says this. Add this fast-spreading virus variant into India’s vast population and congested cities, and you will have understaffed hospitals overburdened in no time.

We also have elections coming. 

The biggest worry, however, is the possibility of large-scale infections among medical professionals. They will be dealing with the mandate to give the third dose and rising number of cases, when they may also have to deal with a personal health crisis and fewer colleagues to share their workload.

The strain will begin to show soon.

Read also: UN report warns of deadly Delta-like waves in near term

Should India mix-and-match?

One thing that impedes India’s booster drive is the country’s policy of only allowing booster/precautionary doses that are the same as their earlier doses. Unlike other nations, India hasn’t approved the mixing of vaccines. This approach has “very modest” advantages in most situations.

For one, the production of Covaxin and Covishield are still limited in comparison to the country’s requirement. On December 14, the Centre informed the Rajya Sabha that Covishield's current monthly vaccine manufacturing capacity was around 250-275 million doses and Covaxin's was around 50-60 million doses. The government has said that enough vaccines are being manufactured in India to vaccinate the adult population, with both companies – Serum Institute of India (SII) and Bharat Biotech – operating at 90 percent of their current capacity.

Covaxin booster capable of neutralising Omicron: Bharat Biotech

However, assuming current production objectives and other factors stay unchanged, it will take around three to four months to obtain 810 million doses and cover the declared target groups as well as the remaining adult population. The timeframe is likely to be prolonged since the Health Ministry's recommendations state that Covaxin must be given to those aged 15 to 18, and that a cautionary dosage must be given nine months following the second dose. Covaxin is only around 15% of the vaccine production in India, the rest of the 85% is Covishield.  

Okay, but aren’t there safety concerns in mixing vaccines?

Not really.

A global consensus has led public health organisations of other countries, such as the US Centers for Disease Control and Prevention (CDC) and NHS UK, others to approve the mixing of vaccines or the mix-and-match approach for their booster drive. They have done so based on the two quantitative criteria–of reactogenicity and immunogenicity–being the same or better. Reactogenicity is a vaccine’s tendency to cause adverse reactions and immunogenicity is a vaccine’s ability to cause an immune response in the recipient. 

These organisations have realised that cross reactivity (any reaction from mixing vaccines) does not appear to represent a significant risk based on these two factors. 

Therefore, India may safely follow this course and reach the booster/precautionary doses to a larger population.

Allow more vaccines in

Globally, there is an understanding that immunity begins to wane after six months of the initial two doses. Countries are advocating the delivery of the booster dose after this period; in fact, the UK has approved delivery of the dose after three months. Meanwhile, India is still considering a nine-month gap.

Since there are current shortages of vaccines and a large proportion of our population needs vaccines, we should examine Phase 3 safety and immunogenicity statistics from other nations and permit other nations to export their vaccines to India.

While granting this permission, we could give priority to vaccine candidates that have received emergency use authorisation (EUA) from a stringent regulatory authority, for example, Sinopharm’s Inactivated SARS-CoV-2 vaccine (Vero cell), as per WHO’s list of SRAs . There are now 22 vaccines in Phase 3 investigations throughout the world (Table 1), with 14 of them receiving EUA in one or more countries.

With these two changes in policy, India could meet the ‘booster challenge’ more effectively. They can help the country ‘boost’ its working and spending population back into action.