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Premature to conclude that India has been spared a Third Wave: Epidemiologist Prabhat Jha

It is important to track deaths and hospitalizations, despite being lag indicators.

August 26, 2021 / 11:37 AM IST

Prabhat Jha is Founding Director of the Centre for Global Health Research at St. Michael’s Hospital in Toronto, Canada. As an endowed Professor in Global Health and Epidemiology at the Dalla Lana School of Public Health, he is regarded as one of the most influential epidemiologists in the world. He talked to Moneycontrol. Excerpts:

Has India been spared the Third Wave, or would it be premature to jump to that conclusion?

Premature. Peak deaths in September to peak deaths in May took eight months. We don't know enough about how the Delta variant will behave in India, given the high levels of background infection. The past bellwethers like Mumbai are now different- for example, Kerala. So, let’s see what the states show.

We are past the third week of August, and a Third Wave should have been here, as predicted by many.

Modellers can predict anything- except the future.

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COVID-19 Vaccine

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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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Or could it be that authorities are hiding or underreporting figures?

Testing goes down in non-pandemic weeks, so it is important to track deaths and hospitalizations, despite being lag indicators. The testing percentage positive is also useful.

Conventional wisdom would have us believe that it may be difficult to conceal figures in India. Do you agree with that assessment?

Not necessarily. Death classification away from COVID has been a strategy for some state governments.

Vaccination is still pretty low, and it is doubtful even if 20 percent of the population has been covered thus far. Under the circumstances, chances of other variants of COVID floating around cannot be ruled out.

We need more genotyping data to know if it is, as suspected, the Delta that drove the last wave. Two doses are needed to counter Delta, and without high levels of coverage and uncertain evidence, if past infected (67 percent according to ICMR) have protection, it’s hard to know. I would say that national antibodies and follow up studies are needed urgently in India.
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first published: Aug 26, 2021 09:51 am
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