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Interview I For booster COVID-19 shots, people should rely only on expert advice: Dr Gagandeep Kang

People at high risk will continue to be at some level of risk, even if they are vaccinated or previously infected. Vaccination and prior infection reduce the risk but do not completely remove the chances of getting infected again, says one of India’s leading microbiologists and virologists.

June 24, 2022 / 11:16 AM IST

Dr Gagandeep Kang is currently associated with the Christian Medical College, Vellore, in the gastrointestinal department. Kang holds the distinction of being the first Indian woman scientist to be elected as the fellow of the Royal Society, the United Kingdom’s prestigious national academy of sciences.

She is known for her research works related to viral infections in children and the testing of rotavirus vaccines. She has previously worked as an executive director of the Centre’s Translational Health Sciences and Technology Institute. At present, she is also a member of the National Technical Advisory Group on Immunisation, the top advisory body on immunisation under the Union health ministry.

In this chat with Moneycontrol, she shares her perspective on the current uptick in Coronavirus cases, why some people keep falling very sick, despite vaccination or prior infection and whether India is preparing for COVID-like pandemic in the future. Here are the edited excerpts:

Q: What do you think about the current surge in COVID-19 cases in parts of India? Most say it’s not a wave yet and is happening at a very low level. What is your view?

A: I think we need to define what a wave is. If it is an increase in the number of cases, they will continue to rise and fall at some level, as new sub-variants emerge, as immunity wanes and/or as people behave differently.


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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A real new wave, with consequences similar to what we have seen before, will only happen when a new variant not just infect people previously vaccinated or infected (as current sub-variants do), but also cause severe disease to them.

Therefore, I agree that this is not a wave yet. That may, however, change.

Q: Though the rate of hospitalisation and death due to COVID-19 are far lesser than the last waves, there is definitely an uptick in these numbers too. Does that mean that certain people will keep dying or keep falling severely ill because of Coronavirus for a long time to come, irrespective of their vaccination or prior infection status?

A: With any virus, however mild the disease among the general population, there is a chance that an infection may push a vulnerable person over into severe disease or mortality.

People at high risk-- the elderly, those with other illnesses -- will continue to be at some level of risk, even if they are vaccinated or previously infected. Vaccination and prior infection reduce the risk but do not completely remove the chances of getting infected again, even among the healthy.

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Sadly, the most vulnerable are also the ones who the vaccination protects less.

Q: When even people who have been previously infected or have taken booster shots are contracting COVID-19, what does it say about the efficacy of the booster doses?

A: That is a situation to be expected with Omicron, its sub-variants and the further variants that will emerge. For a new variant to propagate itself into the general population, it should infect the previously infected or vaccinated people.

Boosters may slightly decrease infection or help shedding (virus getting released from an infected host). But their role is to strengthen, to some extent, the protection against severe diseases. They are probably doing that.

People who are getting infected are symptomatic, but it is likely that if they were not previously vaccinated or infected, a much greater proportion would have developed much more severe symptoms, as happened during the waves of the original virus and Delta variant.

Q: What are your views on the mixing of COVID-19 vaccines? Do you think it should be allowed in India? What should people consider when deciding their booster doses?

A: Absolutely, we should consider it. Globally, only the mRNA vaccines have no mixing. We do not have them. People should rely on expert advice, which is based on evidence, and not speculate on what is likely to work best for them.

That places a responsibility on us, as medical and public health scientists, to be generating the data. The government and policymakers have to facilitate such studies.

Q: It has been nearly two-and-a half years since the pandemic began but it is far from over and keeps coming back. What do you think we should expect, moving ahead?

A: We will have to learn to live with one more variable virus. This will require the calibration of our responses. I hope this means that we will maintain the right amount of syndromic surveillance, expand sequencing capacity and strengthen primary and secondary care and accompanying data systems so that people have the access to health services that are needed.

Strengthening clinical research, technology development and regulatory systems are, of course, critical to underpin our ability to make better tools for this virus and those that are to come.

Also read I Explained | Poliovirus detected in sewage water in Kolkata: how worried should we be?

Q: There appears to be a big threat from zoonotic diseases (those which are transmitted naturally from vertebrate animals to humans or from humans to vertebrate animals) due to climate change in the coming times. What can India do and do you think enough is being done to tackle the pandemics that may unfold in future? 

A: Addressing climate change is important for reasons that go well beyond the potential for pandemics. We need a globally coordinated surveillance and response system to be built in the inter-pandemic period that allows data sharing. For India to operate with confidence, building strong epidemiology, laboratory and infectious disease modelling capacity is essential.

Sumi Sukanya Dutta
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