With escalating number of Omicron cases in India and WHO’s latest reports on reducing efficacy of vaccines against the variant, many now look up to the booster shots as a ray of hope, but is it an efficient solution to the possible predicament? To discuss this, Medically Speaking invited a panel of top notch health experts that included: Dr Dhiren Gupta, Pediatrician, Sir Gangaram Hospital; Dr Rakesh Garg, Additional Professor, IRCH, AIIMS; Dr Suman Lal, Senior Gynaecologist and Cancer Consultant, Max Hospital; Dr Rajesh Chawla, Senior Consultant, Pulmonology and Critical Care, Indraprastha Hospital.
What do we know about the efficacy of Covishield vaccine?
Dr Rajesh Chawla: If one has taken a vaccine, it doesn’t mean one can’t get an infection; it means that the vaccinated person will be 100% prevented by death or will not get any severe disease, and even if he gets one, there is a chance he will not die due to it. Omicron is a very mild pathogen. Almost no one suffers from severe disease or dies as a result of this. It is important to get the first two shots of the vaccine. We still need to reach 51% of the population with both doses.
Do you think there is any need of booster doses as of now or its better that we hold ourselves till the whole population of India gets doubly vaccinated?
Dr Dhiren Gupta: Some of the studies on Covishield have found that efficacy has been reduced over 6 months. People who were vaccinated six months ago have deteriorated immunity. Western countries are already providing assistance; why shouldn’t India? We should give boosters as I consider that Covishield is inferior to other vaccines from the west. The thing is, we can probably compare the west to India because we have the delta variant. We are going to get more RNA mutated viruses in the next 6 months, and it is high time we all get booster doses.
There are many children getting hospitalised in South Africa. Do you think we should start vaccinating children at the earliest?
Dr Suman Lal: Basically, when it comes to pregnant women, we previously had the issue that they were not coming for vaccination, but now they are, and there is no problem with that because the first two doses are critical for them. Secondly, among the workers who were vaccinated in January and February, there were females who were planning pregnancy and they are the candidates for whom we should provide boosters because during vaccination, we gave them a 4 week gap, so the immunity is considerably lower in them.
Would you rather agree with Dr Chawla that there’s large proportion of rural people who haven’t been vaccinated yet?
Dr Rakesh Garg: It has two aspects to it. When we see 100% population coverage for vaccines, as we have discussed in previous panels, this is referred to as “herd immunity.” When we talk about this herd immunity, we have to provide a coverage of 100% vaccination to people with both doses, so this should be the primary target as of now and then, as it is rightly said that antibody wanes off with time, then it will be time for booster doses in the high-risk population. So there has to be a strategy because covering such a large population for a booster dose and not giving some even the first dose will not be a good idea.
Don’t you think that it would be pertinent proposition that why the government isn’t acting on it sooner than later? Don’t you think we should start hearing on what the government’s policy is on booster shots?
Dr Rajesh Chawla: It is a well-known fact that at least the antibodies go down, but we still do not know what happens to the T-cell immunity. The other thing is that people who are very at-risk, like healthcare workers or patients with comorbidities, who had their vaccines scheduled more than 6 months or 9 months ago can be given a booster dose if there is enough availability of the vaccines.
The horrible mutation as South African researchers define could be because a large number of people were not vaccinated. There could possibly be more mutations carrying more danger and this is why perhaps we should hold this discussion around boosters?
Dr Rakesh Garg: We need to look at the scientific factors. The vaccine is not getting updated. People whose antibodies are waning off should be given the boosters. Secondly, we should have modified vaccines available in 90 days or 100 days. Thirdly, people who are most prone should be given boosters. The government should have a strategy to cover the high-risk population.
As far as modified vaccine is concerned, what do we know about the ability of this variant to evade the immunity provided by vaccines?
Dr Suman Lal: When we talk about any virus and its variants, if we are vaccinated for one virus, protection to some extent will be provided for other strains also. Thus, if we have not had other forms of vaccines till now, we can still protect our population. If we just delay, we will again face a crisis just like previous times. Therefore, we can use current vaccines as boosters for high-risk populations. At the same time, I agree with Dr. Gupta that we should think about variant vaccines as well.
What would you like to say if vaccines should get double jabbed for those who haven’t or the fact that we have brought down our masks to the pre-delta level has made the situation even more dangerous?
Dr Rakesh Garg: None of the vaccines in the world provide 100% immunity against infection. We cannot say that this omicron will be the last variant of COVID. Some other variants might mutate and emerge. Thus, we have to take care of the COVID’s appropriate behaviour.
Till what extent will you keep upgrading vaccines? What really is the way ahead?
Dr Rajesh Chawla: This is not a new thing for a virus to mutate. Influenza vaccine is given each year because each time the virus mutates, the vaccine is upgraded. Hence, every year depending upon the hemisphere they release the vaccine. Similarly, for Covid-19 this is going to happen. Probably with the time we will have more data to know what happens to immunity in these. Then probably you may have to take vaccines every year and eventually it will be part of the influenza vaccine or the normal vaccine.
How prepared are our hospitals this time?
Dr Rakesh Garg: It appears to me that after the second wave which was managed to a large extent, we have taken a lesson and the infrastructure, teaching and training including the pediatric has been very well done. I am sure that in case if something happens, we will combat it very properly.
Dr Gupta what will be your message to the people?
Dr Dhiren Gupta: First of all, any system is not able to take care of such huge population, recently when the dengue was spreading every system failed. when any minister catches virus they run to private hospital. Even if we take USA and UK into consideration, they will crumble. Secondly, everybody is fed up of covid now. Therefore, recently Nature has published a beautiful article, they found how old Covid evolved over the years. This virus also may lose its potency and may become like cold-cough virus.
