Expert take: Dr Gagandeep Kang on booster shot, children’s vaccine & the state of the pandemic

India recorded 25,072 new COVID-19 cases in the 24 hours ending August 23rd morning. It is the lowest in over 150 days so far, and the recovery rate is increasing to over 97 per cent. This is good news though there are pockets of major concern such as Kerala and a few other regions from the North East. There are several hot spots in smaller pockets across the country with a higher share of vulnerable population where care and more targeted strategies will have to play a key role now.

Questions Galore

So, where are we on the pandemic, and what is the way ahead? As businesses get to reopen and people try to emerge from self-isolation, how important is it for you to get a booster shot? How real are the fears of a possible third wave? How protected are the children, the precious and most vulnerable section of the population?

As schools begin to reopen and parents are fearful of letting their unvaccinated children mingle, India still does not have a vaccine fully approved for children. The country only recently saw its first emergency-use approved COVID-19 vaccine for children from Zydus Cadila, but then it is a DNA vaccine. It is the first such vaccine in the world and, as with every new product, there are several questions being raised and concerns expressed – some arguably genuine on the long-term effects?

Financial Express Online reached out to Dr Gagandeep Kang, one of India’s most respected virologist and the professor at the Christian Medical College, Vellore. Here is what she has to say on some of these prickly questions:

On The Determinants Beyond Delta

On what is happening with the pandemic, Dr Kang who has looked closely at the pandemic since it began unfolding 18 months ago, says, “in the rest of the world, the Delta variant is causing the kind of spread of infections that we saw in April and May in India. However, within India, because delta is so transmissible, we are continuing to see a fair amount of delta variant.”

“As soon as you lift the restrictions, delta begins to appear in pockets that were previously protected,” says Dr Kang. Any solution and preparedness plan now is therefore linked to granular data. She apparently does not see a one-size-fits-all solution for those regions that have a high seroprevalence that is where a larger proportion of the population has already been exposed to the virus, the solution is different when compared to regions where the vulnerability is more. Unfortunately, there is not much clarity on this granular data. Also, in regions where there are more cases, micro-containment strategies may be needed and with better district-level grip on seroprevalence will help focus resources and containment strategies better. Also, if adequate care is not taken, many experts have been arguing that India given its size and numbers, there can always be another variant that could take us all by surprise therefore the focus has to be on vaccination, masking, and social distancing.

On What Data Matters Now

“For me the stage that we are in now, we really need data that is broken down” and much of it is now readily available and even if has been collected is apparently not being shared, says Dr Kang.

So, what is the kind of data we need now? “If the government does 1.5 million tests a day, how many are for asymptomatic individuals, how many are for contacts, how many are tested because somebody known to them is sick, how many tests are for people who are in hospital? We need that breakdown now to try and understand what is happening in the country in the context of 67 per cent seropositivity.” Previously, she says, “even without detailed data, because everybody was susceptible, we managed. Now, we are in a situation where there are many places that are 80 per cent seropositive. So, as long as the virus that is circulating there is an alpha or a delta variant, it does not really matter because there are only 20 per cent of people left to be infected in that area.”

It may therefore help if entities like the Indian Council of Medical Research (ICMR), which apparently have access to a wealth of data could share it. This could be data around testing, vaccination information, vaccination history of people who have had breakthrough infections.

Dr Rajib Dasgupta from the Centre of Social Medicine and Community Health at the Jawaharlal Nehru University (JNU), who has been studying this for a long time, says, in the aftermath of the second wave – April to June last – the ICMR had conducted the fourth round of a national sero-survey to see how many had been exposed to the virus and found a sero-prevalence of 67.6 per cent overall. But then, there is huge variation across regions and within regions.

There is a low 44.4 per cent in Kerala, which became more vulnerable than say 79 per cent in Madhya Pradesh. But then, again within Madhya Pradesh, there may be regions with lower sero-prevalence that may need more targeted approach to ramp up vaccination or to contain the spread of the virus.

On the Booster shot

With arguments doing the rounds, even among the physicians, about the length of time antibodies remain in the body after vaccination – six months or thereabouts – and that with time, the immunity tends to wane, there are some already wondering if there is need for booster shot, at least for the healthcare and frontline professionals handling COVID-19 cases. A booster shot is yet another jab after the two initial vaccination shots and it is taken to remind the body’s immune system about how it responded to an infection and thereby provide an added layer of protection.

Here, Dr Kang is in favour of a more nuanced approach instead of a universal solution because she sees a clear link to the findings on the antibodies and could vary from one person to another. But, currently, in the Indian context when a large set of population is still not vaccinated, feels it is not morally right to take a third dose when many have not had access to even one dose. “With two shots of the vaccine, there is reasonable level of protection against severe disease and death. So, there is no reason why someone who has had two doses of the vaccine should take a booster shot when the rest of the world has not been vaccinated.” To her, it boils down to a question of morality.

The six months that antibodies remain argument? “If you go out and test all adults for antibodies for polio virus, you will find that 40 to 50 per cent of them will not have measurable antibodies to polio. Do we think that they are protected against Polio? Yes, we do but they don’t have measurable antibodies. You don’t expect antibodies to remain at a high level forever. What you need to know is that did the people make an immune response? If they made an immune response and it fades with time then that is the natural course for every vaccine and every infection.”

Here, she points to a strategy where there could be sampling of people done for antibodies. If the antibody count is found to be negative then one could get a booster shot. We could come to this in future but then, she feels, “the time for it is not now.”

On the danger is a potential third wave, she says, “keep vaccinating and keep wearing masks and maintain social distancing for that alone will help.”

On the DNA vaccine

On the newly approved DNA vaccine from Zydus Cadila and how safe can it be for use in children, Dr Kang says: “In general, any vaccine that is safe and efficacious in adults will also be safe and efficacious in adolescents and that is the data from the DNA vaccine, which we have not yet seen, seems to indicate that they had a large number of children in the study and the vaccine seems to be working. Obviously, we would like to see a breakdown of the data and that has not yet been shared and we will have to wait for the company to release that data.”

On the questions being raised in some quarters and by some experts on the long-term effects of a DNA vaccine, Dr Kang says, “DNA vaccines are typically engineered to not be able to integrate with the chromosome of human cells but the way to rule is to do bio-distribution studies, which is to take samples from various locations and see if there is any evidence of integration of DNA vaccine into the genome. This can easily be done in animal studies. This will provide additional reassurance to people,” she says.