In search of a second generation silver bullet

In October's full moon, known as the Hunter's Moon India’s  celebration of inoculation of one billion Covid-19 vaccine doses was cast across as a major Broadway  release. To achieve this, vaccines in the Andamans and Nicobar were transported by boat and drones carried a payload of 900 doses (4.5 kg) to fly at least 43 miles to far-flung villages in north-east India's mountainous regions. 

India's premium hospitals such as AIIMS were decorated with petals and hundred historical monuments were illuminated in tricolour to celebrate the occasion. India's largest tricolour with dimensions 225 by 150 feet was unfurled in the snowcapped mountainous terrain Leh. 

However the reality check revealed only 291 million of the eligible population were fully vaccinated leaving 707 million  waiting for their next dose, the Covishield gap between doses catapulted the partially vaccinated to 82 days.  Nevertheless, it was a milestone achieved in 278 days, with 3.6 million doses administered per day. 

The 452,000 deaths counted till one billion milestone, which certainly could have been alarmingly more if the vaccination had not happened. Intriguingly, one “billion vaccination” jingoism eclipsed the reports of the massive undercounting of the deaths vindicated by hundreds of washed off bodies in the Ganges.  The analysis of granular data shows wide disparities across regions, gender and social groups. If India’s most vaccinated district, Mahe in Puducherry is recording 100 per cent coverage the least-vaccinated district, Kurung Kumey in Arunachal Pradesh, has covered only 11 per cent.

Now, as India rests on its laurels of one billionth dose, epidemiologists and public health experts are sounding a death knell warning:  Vaccinations are losing steam, festivals, marriage gatherings, prayer sites  now host humongous crowds , people largely unmasked without social distancing .  

According to Bloomberg, if some 8.34 billion doses have been administered across 184 countries, till today, with roughly 37.3 million doses a day (108 shots for every 100 people worldwide), India shares well over 1.3 billion doses (35.7 per cent fully vaccinated). Countries and regions with the highest incomes are getting vaccinated more than 10 times faster than those with the lowest. 

With 9.1 billion vaccines already manufactured and 12 billion expected by the year’s end the gap between the vaccines haves of Europe and the vaccine have-nots of Africa is stark (under 2 per cent people in Africa are  fully vaccinated). Further, only 3 per cent of people in low-income countries are fully vaccinated, while the figure exceeds 60 per cent in both high-income countries and upper-middle-income countries.

As the prevailing vaccine stranglehold monopolised by the G20 countries with 89 per cent of vaccine hoarding and 71 per cent of future deliveries scheduled for them the Social Darwinism seems to be at its ugliest best.

At the current pace of 10.9 million people getting their first shots daily, the goal of stopping the pandemic remains elusive. The situation continues to remain fluid, even for most vaccinated countries such as Israel where the virus audaciously has staged a comeback.  

The continuously mutating virus, the arrival of a highly transmissible Omicron variant, the anti-vaxxers and the sly cloak-and-dagger conspiracy theorists have thrown a spanner in vaccination works. 

It is noteworthy that between May and November 2020 four variants of concern were detected including Delta. Then Omicron has arrived after a gap of a year arming itself with 50 formidable mutations.  (Delta which caused havoc in India’s second wave had only 25 mutations). In addition to these 50 mutations 32 are on the spike protein which the vaccines identify and use to produce antibodies. (Delta had only 10). Moreover the part of the spike protein that is used to enter the cell has 10 mutations versus two in Delta. This would result in increased transmission and possible partial immune escape and reinfections. Thus due to increase breakthrough infections almost all vaccine manufacturers have pledged to go back to the drawing board to reinvent themselves.

Moderna chief Bancel dismisses the full-proof claim of Covid-19 vaccines against the Omicron variant adding that the current crop of vaccines would need to be modified. Thus embarrassing many vaccine manufacturers, who claimed to easily tweak their mRNA vaccine to adapt to any new variant.  However, current vaccines would possibly still prevent severe infections and reduce hospitalization. Hence at present equitable global vaccination is the only way forward.

Continuous monitoring and research is the way out of the current crisis. No matter how different each country may be, in terms of geographical location or wealth, all need to unite and invest in a common stock called “equitable distribution of vaccines.” 

 Dr Malka Chainani is a gold medalist and recipient of the Pfizer award for academic excellence, she has published various research papers at national and international level she is a consultant in South Mumbai and medical advisor to corporates

Dr Sarat Das is currently working with multiple foreign universities and co-owns Kilax Ltd, a London-based think-tank and has founded the public health care campaign Fight Corona with local chapters dotting across the world