After I got my first dose of Covishield, I called Reena, a friend for over 45 years. Reena retired from service some years ago and now lives by herself. I asked Reena whether she has taken a vaccine. “No. I haven’t and I won’t,” she said. “But why?” I asked. Reena said that she knew of persons who received a vaccine and still came down with Covid-19. Also, Reena said that she has no one to look after her if she suffered from the side effects of the vaccine. Therefore, she wouldn’t take a vaccine and she refused to listen to my arguments to convince her. Reena is not the only one who is refusing to take a vaccine.
Vaccine hesitancy is now considered as a major impediment to the control of the pandemic. The vaccines against the SARS-CoV-2 coronavirus train our immune systems how to recognize the virus and fight back before it can cause Covid-19. That’s how the vaccines protect us. However, during this process of preparing our body to protect itself, the vaccines sometimes cause reactions lasting for a few days, such as fever or flu-like symptoms. This is normal, even if annoying. We also need to recognise that in order for our bodies to build immunity to protect ourselves against the coronavirus infection, several weeks must elapse after we have vaccinated.
During this period we are vulnerable to being infected. Further, no vaccine provides 100 per cent protection. Therefore, even after vaccination some persons fall ill with Covid-19. This is also normal. Therefore to Reena and others who buy her argument, I appeal that these normal consequences of vaccination must not deter you from being fully vaccinated. A virus cannot replicate, that is produce more copies of itself, unless it enters the cell of another organism. The SARS-CoV-2 coronavirus needs to enter cells of a human body to replicate. The more it is able to replicate, the greater is the chance that it will be able to infect another person.
A vaccine disables, to a large but variable extent, the ability of a virus to enter the body of a recipient. The protection afforded by a vaccine therefore not only protects the recipient, but also protects others from infection. A sure way of lowering the spread of a virus is to shrink the pool of persons to infect. A vaccine does this effectively. A friend, who had recovered from Covid-19 last year, called to ask whether he should take a vaccine. He felt that since many are struggling to get a vaccine, perhaps he should save a complete dose of the vaccine for others. I explained to him that the natural infection indeed confers some protection against infection by the same virus, but the immune response to natural infection is known to vary among infected individuals.
The variability is both in respect of the strength of response and how long it lasts. The vaccines against the coronavirus produce more robust and more stable immunity than the natural infection. Therefore, even if a person has suffered from Covid-19, (s)he must still take a vaccine. And, must take the complete dose of the vaccine to enjoy the most stable protection. As a matter of fact, a person who receives a vaccine after recovering from natural infection produces a much sturdier immune response than one who only receives vaccination.
However, a small number of vaccinated persons still contract infection. These are called “breakthrough infections,” implying that the infection has broken through the wall of protection provided by the vaccine. The causes of breakthrough infections remain unclear; scientists are engaged in identifying the causes. Presently many millions are infected with the coronavirus. In the face of this huge load of infection, a vaccine against the coronavirus may not protect us as reliably as it should. In other words, many vaccine recipients may get infected and transmit.
But the available vaccines are known to protect us from severe Covid-19 and death, if we are infected. As more and more of us get ourselves vaccinated, the number of infected persons will reduce in the population. The vaccine will then more strongly protect us from acquiring the infection. We are also hearing about many variants of the coronavirus – “double mutant,” U.K. variant, South African variant, Indian variant, etc. Variants arise as a consequence of the natural evolutionary process. Questions have been raised about the ability of the currently available vaccines to protect us from these variant coronaviruses. Opinions differ.
During this pandemic, it is hardly possible to conduct scientifically-designed studies to answer such questions. Adhoc answers to these questions are being obtained by observing individuals who are reinfected after vaccination. The differing opinions cannot justify our hesitation to take the currently available vaccines. Some level of protection will be provided by the current vaccines against the variant, even if the level of protection is insufficient. And, at this time any level of protection is better than no protection at all. Therefore, there is no room for second thoughts on getting fully vaccinated.
Even if a small fraction of our people refuses and remains unvaccinated, this pandemic will be hard to control. I hope that Reena is listening. Reena and other vaccine-hesitant persons have also raised the issue of blood clots after vaccination. It is true a very small number of persons suffer one or more adverse outcomes of vaccination. Sometimes the adverse outcomes cannot even be traced back to the vaccination. In any case, agencies such as the World Health Organisation sit up and call for a temporary halt to using the putatively dangerous vaccine while they evaluate evidence. This had happened for Covishield. The evidence exonerated the vaccine which has been put back into use. We have to be careful, but respect scientific evidence.
While I am emphasizing that no one should be hesitant to get fully vaccinated, there are millions who are wanting to get a vaccine and are unable. My neighbours had lined up at 4 AM to get a vaccine dose, only to return home around mid-day without being able to get a jab because of inadequate availability. The sudden rise in demand in vaccine doses is proportional to the huge surge in infections. The volume of this surge may not have been anticipated. Warning bells were, however, sounded from many corners but remained unheeded.
Election rallies, Kumbh Mela, large wedding gatherings and, in spite of a notification from the Election Commission to exercise restraint, even election victory jubilations were held. Participants of these large congregations who came from far and wide to participate got infected and carried the infections home. Politicians were more interested in getting their votes than in the lives. The aggressive, but sensible, vaccination strategy that was announced at the beginning of the year was welcomed by everyone. High-risk groups in the population, such as frontline and healthcare workers, elderly citizens, etc. were identified and 300 million of them were to be rapidly vaccinated. But the strategy was not followed.
We became complacent as the number of new infections fell. On March 7, when less than 1 per cent of our population was vaccinated, our Union Health Minister, Dr. Harsh Vardhan, announced that “we are in the endgame” of the pandemic in India. We relaxed on providing vaccinations. Today, only about 3 per cent of our population is vaccinated. We hear wails from people wanting to be vaccinated, but doses are unavailable. How sad! How unprepared we have been! This coronavirus spreads rapidly. Some of the variants that are arising are spreading even faster.
We are concerned about the B.1.617 variant that was first found in India in December 2020. The rapidity of spread of this variant, coupled with its ability to replicate more efficiently and cause more lung lesions prompted the World Health Organisation to declare B.1.617 as a “variant of concern.” This variant lineage has now evolved into three sub-lineages, of which one – B.1.617.2 – is causing greater concern. It is a super-rapid spreader. It is spreading rapidly in West Bengal. It has also traveled to many other parts of the world, notably the U.K., and has infected many in those regions.
In addition to vaccines, what must we do to control the pandemic in our country? We must identify variants soon after they arise. This can only be done by sequencing the genome of the virus and analyzing the sequence data rapidly. Not enough sequencing is being done. And the data are not being shared publicly, even though public funds are being used to generate these data. We must not only identify new variants soon after these arise, but also rapidly assess their local spread. Such evidence can be used to clamp local lockdowns to prevent the spread of the variant to a wider area. Local public health measures can also be enhanced.
This will require the State, scientists and publichealth officials to work in tandem. This is not being done. Country-wide lockdown is again being recommended by many, which will adversely impact the economy and inflict tremendous pain on our poor citizens. About 900 scientists, including myself, had appealed to the Prime Minister on April 30 to make relevant data accessible to all scientists, safeguarding confidentiality of data donors, and to scale up collection of relevant data pertaining to infected and vaccinated persons.
The intent was to analyze these data variously and to provide scientific feedback to public health policymakers. The Principal Scientific Advisor to the Prime Minister issued a statement on May 4 – the tenor of which appeared positive – and provided directions on how to ultimately access data collected with public funds. Some of us have followed his directions. We are still waiting for a useful response. Time is of the essence. Intent to help generate dynamic evidence-based strategies must not remain intentions for long. We must not remain mute spectators to the horrors of death and suffering.
(The writer is a National Science Chair, Government of India)