 Hello and welcome to NewsClick today in COVID watch, we will be discussing with Professor Satyajit Rath about the Delta variant, how it is now spreading across the globe, what the global picture looks like. And also from there we want to go to the question of vaccines and how they are, you know, of course we know that they are important but as we see variants are arising and infections surge, then what importance of vaccines there is and then what the promise of the G7 countries in that situation. That situation is going to, you know, is it really going to help or not. So thank you Professor for joining us today. Can you first then tell us about the variant and you know what is the global picture currently looking like. Of course we see, I think by June 16, the almost 76,000 cases of the variant were sequenced in UK but of course you guys are very good secrets has very high sequencing, which is happening so can you tell us about the global picture, what it looks like. So on our updates through the last year, we have regularly discussed the origin and the consequences of viral variants. Now, as we keep pointing out, the virus makes copies of itself including its genetic code using a biochemical process that copies the genetic code one letter at a time. And as a consequence of that, there is always some error rate for this copy and because of that, every time the virus generates new progeny, there are potential variants in the sense that there are differences in the somewhere in the sequence of each individual copy. Most of the times this doesn't matter, those variations are minor. Quite a few times those variations actually make the virus useless because it loses something that it needs to propagate. But every once in a while, the variation, the change may provide on that particular sequence some characteristic that allows it to survive and propagate a little bit better. In a given set of circumstances, this is not for all time. There is no universally fit variation in Darwinian evolutionary ideas, which is really what we are talking about. So, to recapitulate a conversation we've had earlier, what we've had therefore is a lot of spread of virus and therefore a lot of potential variations. These are not, these are random variations. But for what we've been doing over the past year and a half is maintaining physical distancing across the world. As a result, unsurprisingly, the variants that have been emerging in different parts of the world, pretty much everywhere, there are different variants. There are South American variants, there are African variants, there are European variants, there are North American variants, there are Asian and Southeast Asian variants. I'm not going to be more geographically specific than that. But all of them have one property in common and that is they are transmissible even when we maintain distancing. And that in fact is how they became prominent even though we are distancing. So the most recent one in conversation for which we have a little bit of parochial interest is the Delta variant. Now, at one level the Delta variant is like the Alpha, the Beta, the Gamma and all of which are just variants from different parts of the world. What's common is the characteristic that they are more transmissible. What's also common seems to be the basis, the biochemical basis of this transmission, better transmissibility. And that is the spike protein seems to be changed by these variations so that it sticks much better to human cells. And therefore infection can be established much more efficiently. All of them have that. So unsurprisingly, many of them share variations. Even though they have emerged independently, many of them share variations. They share a functional characteristic, they share a structural characteristic as well. So the Alpha variant which was called B117 seemed in parts of Europe and North America to replace last year's strains quite rapidly. And the estimate was that it was 20%, 30%, 50% more efficient at transmission. The Beta and the Gamma variants had similar claims mean about them. These estimates of just how much more transmissible are really not very accurate because the methodology is quite crude and that's true for the Delta variant as well. But as a result, that's how we are making sense of the observed fact, which is that in the UK numbers, for example, after having gone down dramatically, seemed to be beginning to move up especially in specific major metropolitan areas and a lot of that is the Delta variant. The UK data are especially interesting because there is a great deal of virus sequencing in the UK. Unlike in India, which has still not managed anything near reasonably useful scales and levels of sequencing despite really quite strong efforts by the scientists involved. The logistic and administrative organization has simply not happened as yet, we live in hope. So do we have the Delta variant? Yes, we do. Are we beginning because of these scientists making major efforts? Are we beginning to see changes further in the Delta variant that are emerging? That's what's being talked about as the Delta Plus variant. We don't really know a great deal about the Delta Plus variant in terms of its functional properties. At this point, we don't have information and in a sad sense, we don't have information because of India's lagging with the scale and speed of virus sequencing. But are we likely to keep seeing these sorts of micro evolutionary changes in the virus population over time? Yes, of course. So long as the virus is growing in large parts of human communities, there is a lot of varied material available from which under specific circumstances, specific variants can get selected with particular properties, with particular characteristics. So that's really where we are with the Delta variant and the Delta Plus variant. We'll talk about vaccines, but I suspect that's a question you're going to ask. So yeah, that is the question then. In UK, if you're seeing a higher number of cases of the Delta variant, UK is a country which also has a higher number of vaccinations because it has a good vaccination rate. So in that scenario, we are going back to the emphasizing the importance of vaccines and how back to the argument that no one is safe until everyone is safe. So let's think about the science a little bit more. Remember that the Delta variant, like all its other cousins of this year, changes the spike protein so that it binds better to cells. Now, you'd think that if this is how it is selected, why shouldn't the vaccine work? Why shouldn't the vaccine made using last year strains work on this? And the reason for that is a little odd and awkward. The reason for that is that the bulk of the vaccines that we are making are made using the spike protein as the target. In fact, our vaccine making strategy is to generate an antibody response in the body that sort of puts a lid on just that part of the spike protein which binds to the cell. So now, if there are changes in that part which allow it to become better stickers completely act coincidentally, that might also change how efficiently antibodies against the earlier strain can bind to this. So in a sense, the loss of potency of vaccine mediated immunity to these variants is a byproduct of our focus on this protein rather than the virus having gotten selected to survive in vaccinated individuals. And I hope all of us will make that distinction, which is important for two reasons. One, because what it says is that the loss of potency of last year's strain based vaccines for this year's variants is not very high. It's not a lot of loss of potency. So is there some loss? Yes, but it's moderate loss. And what that means is that because we all seem to be making a lot of antibody, both with natural infection and with vaccination, some amount of loss of potency will still provide us with pretty good protection. That's what the current evidence is. So let me give you an actual real life example of what this moderate loss of potency is. If we take Covishield as the vaccine, these are data I am quoting from the UK, because again, there is intensive data collection, which India doesn't seem to be doing very well, sadly. But if we take Covishield, last year's strains were protected quite well against by one dose of Covishield. The second dose improved matters, sure. But one dose also did a pretty good job. For the Delta variant, one dose does a much worse job. The second dose, which increases antibody levels, now does a pretty good job because as I said, the increase in the amount of antibodies compensates for the loss, small loss of potency. And this is what I mean by a real life consequence of this. So do I think that all of these variants are losing, are a little bit vaccine resistant? Yes. Do I think that that means that these vaccines, current vaccines are useless against the variants? Not at all. They are pretty useful. And in order to appreciate that pretty useful, the second point that we need to keep in mind is that very low levels of antibodies still protect quite well against severe illness and death. Whereas protecting against infection and transmission seems to require even higher levels of antibodies. So a loss of potency is first going to affect transmission. It's going to allow transmission. But it's not going to start sending people to hospital and killing people. And in that sense also, we need to wrap our heads around the fact that these are going to be nuanced situations with multiple factors and dimensions to be considered when we think about public policy responses. The final point I'm going to make and I'm going to make that because you raised the point of global equity. And I would actually point out that we in India should think about domestic equity between rural and urban and well often poor India as well for vaccination equity purposes. But here's the point. As we begin to vaccinate people more and more, if we do this slowly, then because of the lack of equity, what we are going to have geographically is populations with a lot of, with very high vaccination percentage, living very close to populations that have very low vaccination percentage. And we can imagine that this is a rich population and this is a working class poor population. The virus will be circulating in this population. But it will be testing the variant variations will be tested against a vaccinated population. We are inviting by due to a lack of equity due to a lack of social conscience. We are inviting a relatively earlier emergence of genuinely vaccine resistant. So, at least that should spur us to action. But I suspect you're going to ask me about the futile action so I will stop. Right. I mean, as you say, we need until these differences will be there in our populations with in terms of protection, of course, you know, virus continues to spread and we give the chance to mutate. And then, in fact, even the relatively protected populations. So, in that case, then we go to the question of how much vaccinations we need to be doing the rates at which we need to be doing it at and, of course, then the lack of vaccinations that are still there. So recently we know that supposedly some for this, this step has been taken by g7 that they're saying now that you know we will donate. We recognize this and we will donate 1 billion doses. But, but this is only going to happen and buy what made or end of 2022. So, what, what is this number, what do you think is this sufficient can we really, you know, think that this could actually really mean something for us in terms of protecting protecting ourselves. So here's the point taking on going on from where we I was a minute ago. The point is that we need to vaccinate widely and equitably in order to do two things simultaneously, we need to increase the proportion of vaccinated people and in those communities, decrease the amount of circulating virus. And this needs to be done equitably and rapidly, equitably in a statistical sense, meaning uniformly across communities and rapidly rather than creating islands of haves and have nots in vaccine terms. Under those circumstances, we, the world doesn't seem to be getting anywhere near this perspective. Clearly, the rich countries have vaccinated themselves to the extent that their communities are willing to accept vaccination. They have an astonishing degree of anti science irrational vaccine rejection, not to speak of hesitancy or apathy. But a consequence is going to be that we are going to keep doing this in patches, rather than uniformly, and we are going to be doing this slowly. So it's on that background that we must think about the recent G7 publicity release, which said that they are going to provide a billion vaccine dose charity for the world's poor. There is no timetable on that release. So it's entirely unclear as you point out, there is only, oh, by some time towards the end of next year, we will have achieved this. So there is no sense of the practicalities and logistics, because keep in mind that for many vaccines, the occasional Johnson and Johnson vaccine exception being an exception. For most vaccines, there are two doses needed. So the logistics of organizing vaccination campaigns rapidly has been a nightmare, particularly in the South, especially when supplies run short. And we then need to worry about whether to do single dose provision for large number versus doing genuine two dose vaccination on the background of the variant issues that we just discussed. So in all of this, the G7 statement says nothing about which vaccines in what amounts over what time frames, leave alone any mention of what financial or non-financial crisis will be extracted from the results. And all of that is stuff that remains to be seen. The devil is truly in those details. So for the moment, it's a publicity statement. Of course, there was also still no discussion, no, I think absolutely no discussion on the question of patent waivers, which really is the right step at the moment, the first small step which needs to be taken as we have discussed earlier as well. Well, yeah, keep in mind that the patent waiver is only one small component. Actual, specific, proactive, non-exclusive technology transfer is going to be crucial if we are going to truly democratize, decentralize and accelerate COVID vaccine manufacture across the world. And if even the patent waivers are not going to happen, then the fight to achieve the struggle to achieve proactive technology transfer is likely to be even harder. So thanks, Satyaji, for joining us today. And we will speak to you next week. Until then, keep watching this clip.