Friday, June 11, 2021
Original post can be found on the Duke Global Health Innovation Center's Launch and Scale Speedometer website.
|High-income country confirmed dose total:||6 billion|
|Upper-middle-income country total:||2.2 billion|
|Lower-middle-income country total:||1.4 billion|
|Low-income country total:||271 million|
|COVAX total:||2.4 billion|
|Total worldwide confirmed purchases of Covid-19 vaccines:||12.2 billion doses|
How can India address a potential third wave of SARS-CoV-2 infections?
Author: Nikki Prattipati
Starting mid-March 2021, India has become the epicenter of COVID-19 as a second wave of infections devastated the country. India reported 50 percent of global cases and 30 percent of global COVID-19 deaths, and an alarming rate of over 400,000 daily new cases at the height of the wave in early May 2021. While official projections estimate 29 million total infections and 360,000 deaths, low testing rates and the lack of available data lead some to place the actual COVID-19 tallies at five to ten times the official numbers.
The new, more contagious B.1617 Delta variant is partially to blame for the intensity of the second wave. However, the premature lifting of initial population-level prevention measures, the paucity in medical supplies including hospital beds and oxygen, and a high proportion of unvaccinated population contributed to the wildfire-like spread of the virus, inflicting untold human suffering across the country.
With the number of cases declining, the second wave is waning, but many experts predict that a third wave is inevitable. India cannot squander this opportunity to prepare itself; the country must take proper precautionary measures to minimize the impacts of a third wave.
- India needs to continue urging proper population level prevention measures, including mask wearing and physical distancing.
A study completed during the height of the second wave of COVID-19 revealed only half the population wearing a mask and only fifteen percent of the population wearing a mask properly. With the majority of its population still unvaccinated, India needs to increase proper mask wearing among its constituents.
Moreover, after a strict nationwide lockdown in early 2020 curbed infection transmissions, India prematurely congratulated itself on controlling the pandemic and recklessly allowed large gatherings, such as cricket games attended by more than 130,000 unmasked fans, hosted large election rallies, and permitted gatherings for religious festivals, allowing the virus to spread. In the absence of a national lockdown to address the second wave of infections, many Indian states implemented strict regional lockdowns in May. Unfortunately, these draconian lockdowns disproportionately hurt the poorest and most vulnerable, and cannot be implemented for an extended period of time. However, the country should continue enforcing restrictions against large gatherings until higher proportions of the population are vaccinated.
- India needs to enhance its COVID-19 surveillance system, and its collection and use of granular data to better inform their policy response.
India’s low infection testing rates, far below the global average, make it difficult to precisely establish the situation and respond with targeted actions to prevent the spread of COVID-19 in the country. In rural India, for example, where two-thirds of Indians live, the lack of widespread testing makes it impossible to understand the COVID-19 burden in the area. Increasing COVID-19 testing and contact tracing across the country will provide India with more accurate data to control the spread of the virus.
In addition, the government is withholding official granular data on COVID-19 to those outside the government and to many within the government. Good data is at the heart of good policy planning, and allowing public health experts and epidemiologists access to the data will allow them to use their expertise in making recommendations for best allocating scarce resources in combatting this pandemic.
- India needs to increase the speed of COVID-19 vaccine rollout, especially to their most vulnerable populations.
After first prioritizing healthcare workers and those over age 65, then those over age 45, the country has opened eligibility to all those over the age of 18. As of early June, only 12.6 percent of India’s population has been administered at least one shot of COVID-19 vaccine, but the country reported slowed vaccine rollout in the midst of the second wave.
Prime Minister Modi’s announcement that vaccines will be free for all adults over the age of 18 should greatly improve the cost barrier in accessing vaccinations, but India can take further steps to improve its vaccine rollout. With huge shortages in vaccines, India needs to prioritize groups not only based on age, but also with other comorbidities and those at risk for acquiring and spreading the virus—those who are unable to properly social distance, practice good preventative hygiene measures, or access information on COVID-19 should be specifically targeted with the limited available doses.
- India needs to address some of the shortages highlighted in the second wave.
As the second wave overwhelmed the Indian healthcare system, patients resorted to social media to find medical care and some even tried to make oxygen at home. India has ordered additional oxygen concentrators, but the country is still woefully under oxygen sufficiency levels. In addition, a major problem in India is the distribution of supplies from the central level to individual hospitals, and these additional oxygen concentrators and other medical supplies need to be efficiently distributed to individual facilities to be useful.
- India needs to provide centralized, credible information to increase transparency and improve trust in their COVID-19 response.
In the midst of severe medical shortages and absence of a central, trusted authority on COVID-19 information, misinformation on miracle cures such as lemon juice or cow urine led individuals to reject proper prevention measures for one of these spurious hopes. Credible and transparent information on the proper COVID-19 prevention measures is essential to ensure that everyone is taking the appropriate measures to protect themselves and their families.
After its first lockdown curbed COVID-19 cases in India, the country failed to take continued pandemic prevention measures leading to the second wave of infections across the country. But there are key steps that India can take now to prevent the same devastation in the next wave.
Significant updates, news, and trends we saw last week:
- US President Biden announces a 500 million-dose Pfizer vaccine donation at $1.5 billion to lower income countries through COVAX, the coalition working to provide equitable access to COVID-19 vaccines globally, with delivery starting in August 2021.
- UK Prime Minister Johnson announces a donation of 100 million surplus vaccine doses, 30 million by the end of 2021. About 20 million of the doses will be donated bilaterally and the rest through COVAX.
- Preliminary research finds evidence for a stronger immune response when mix-and-matching doses for two dose COVID-19 vaccine regiments, leading Canada’s public health agency to permit the mixing of COVID-19 vaccines.
- US FDA rejects emergency authorization of Bharat Biotech’s Covaxin vaccine, but will welcome an application for full authorization when complete results from the Phase 3 trail are available.
- China approves emergency use of Sinovac for children over the age of 3.
- US is investing $500 million in establishing a new Center for Epidemic Forecasting and Outbreak Analytics at the US Centers for Disease Control and Prevention, which will help lead a new global pandemic early warning network.
- Mastercard Foundation will provide $1.3 billion to Africa CDC over the next three years to support the acquisition and delivery of COVID-19 vaccines.
For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.