Issue 34: Pushed to the Brink, India’s Situation is Now Improving

Jun 10, 2021

By Gagandeep Kang, FRS

Christian Medical College

When the first wave of COVID-19 hit India last year, the country braced for the worst. But it wasn’t until the second wave of the virus this spring that the country felt the pandemic’s full force. According to the New York Times, India now has more than 29 million officially reported COVID-19 cases. More than 350,000 deaths are attributed to the virus, though some suggest the true toll may be substantially worse.

Now the country seems to me on a much better trajectory. New cases have decreased by 53% from the average two weeks ago and deaths are down by 35%. Vaccines, most of which are being manufactured in the country, are slowly making their way to the population.

To understand the rise and fall of COVID-19 in India, HVP Editor Kristen Jill Abboud recently spoke with Dr. Gagandeep Kang, a Professor in the Department of Gastrointestinal Science at the Christian Medical College in Vellore, India. Dr. Kang is an infectious disease researcher with decades of experience and is the first woman working in India to be inducted as a Fellow of the Royal Society of London. We spoke about how more transmissible viral variants fueled India’s COVID crisis and the need to distribute vaccines rapidly.

An edited version of the conversation appears below.

It seemed that India had dodged a bullet with the first wave of COVID. What caused the second wave to be so much more catastrophic?

The second wave was so much bigger than the first because of multiple factors. One is that during the second wave we had imported the variant now known as Alpha (B.1.1.7), and that had begun to spread in many parts of the country. Then, on top of that, in western India, we have the variant that is now known as Delta (B.1.617.2). For the first couple of months there was hardly any sequencing going on—I think we had a total of about 4,000 sequences all of last year—and a decision was made to ramp up sequencing, but it didn’t really get going until March. When we started to see this exponential growth of the virus towards the end of February/March, we thought it had to be due to variants. There’s no other way that we could explain this. We had a lot of seropositivity in cities, and it was in these same cities that we were seeing cases climb again. Obviously, people’s behaviors had changed. They were no longer taking the precautions they should’ve been, but, even with that, the regional seropositivity shouldn’t have taken off like that unless it was due to the virus becoming more transmissible. We now know that was the case, but at the time we were told there was no new variant and that the variants weren’t the problem.

Then, in March, when it was clear that cases had begun to climb, we had elections. Our elections consist of rallies that can sometimes attract hundreds of thousands of people, with no distancing whatsoever. We also had religious events with millions of people attending in very close proximity. And the thing about the religious events is that people travelled thousands of kilometers to attend them and then went back to their communities all over the country. When testing was done it was clear that a very high proportion, between 40%-80%, of people returning from these events were infected, so it was like seeding the virus all over the country, even in places it hadn’t been before.

What is known about the Delta variant now?

We know now that the Delta variant is linked to increased transmission—I’ve heard everything from it being 40% to 60% more transmissible than the B.1.1.7 or Alpha variant. This is backed up by the data from India. This time around, if the virus got into your household, entire families were infected despite taking precautions. That wasn’t the case in the first wave.

A report from the U.K. also shows how the Pfizer/BioNTech and AstraZeneca vaccines are performing against the B.1.1.7 and B.1.617.2 variants. It doesn’t cover severe disease and death, but in terms of symptomatic infection, there is a reduction in efficacy against these two variants with the AstraZeneca vaccine. The Pfizer vaccine does better. What we still don’t know is how likely this particular variant (B.1.617.2) is to cause more severe disease.

Do you foresee the Delta variant causing surges in COVID cases in other countries with low vaccination rates, particularly in Africa?

It is a significant concern. This variant is already in 60 countries, and the U.K., which has really good surveillance and is identifying these strains very quickly, is seeing an uptick in cases and in hospitalizations in age groups that have not received the vaccine yet. This is a very transmissible virus. We should be worrying about Africa.

How is vaccine rollout progressing in India?

We’ve gotten to just under 15% of the population vaccinated with a single dose and under 4% vaccinated with two doses. That is actually well over 200 million vaccine doses distributed, but, in a country with such a large population, our number needs to be in the billion plus doses distributed to have any significant impact and there just isn’t enough supply at the moment.

And are these primarily the vaccines manufactured in India?

Yes. We’ve had a few hundred thousand of the Gamaleya Sputnik V vaccine come in, but other than that, the only two vaccines being used at the moment are the AstraZeneca equivalent vaccine from Serum Institute and the inactivated vaccine from Bharat Biotech. About 90% is AstraZeneca vaccine and about 10% is the inactivated.

Are there any Indian companies that are manufacturing mRNA vaccines?

There is a company that is looking at making an mRNA vaccine in India. This company, Gennova, had a tech transfer from the company HDT Biotech in Seattle and their mRNA COVID vaccine candidate is in Phase I studies already. They are now establishing a manufacturing pathway. This is a company that has not made vaccines before, but they do make biologicals. Hopefully they will be up and running soon, but with the way the world is going, we probably need more than one mRNA vaccine manufacturer in the country and many more in the region.

Are things improving dramatically now in terms of new cases?

Yes. We had this really sharp spike, and now we are having a really sharp decline. We reached a maximum of 400,000 cases per day and we are just over 100,000 cases a day now. It’s been a pretty dramatic fall in the last two and a half weeks or so.

What worries you most now?

Getting vaccines out before the variants. We need vaccines around the world. There are many places that could have second and third waves if we don’t protect people enough. We need to stay ahead of the variants, and we can’t do that without vaccines.

Interview by Kristen Jill Abboud

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