 Hello and welcome to the news click today on COVID watch we have with us Satyajita to talk more about vaccinations and as and when it's just you know getting clearer by the day that how important vaccinations are in in this process of getting safe against COVID. We want to ask him you know where we are right now and what we really need to be doing about about getting these vaccinations and where we need to be going right now. So, Satyajita, firstly, I wanted to ask you about the study that has just been conducted in this in this town in Brazil called Serana, where they basically I think inoculated the pretty much all the adults and they had some very interesting results. Can you tell us about that what happened after this Chinese vaccination Corona back was used. You know, there's a great deal of fuss made about these studies and it's all driven to a significant extent, but more by politics I suspect rather than by science, because it's really not surprising that any of the standard vaccines that have been circulating whether they are of Chinese origin or Russian origin or of European or American or Indian origin will provide reasonable degrees of protection. The science behind it is relatively simple and straightforward. If you have high levels of antibodies that neutralize meaning that stop a virus from sticking to a cell, then you are going to cut down on the extent of infection and therefore the extent of transmission, but most importantly you're going to cut down on the severest form of COVID-19 illness which results in hospitalizations and deaths and unsurprisingly in the Serana study that's being talked about. This 80-90 plus percent protection I think population is about 40,000 plus adults and you get excellent protection against death, you get very, very good protections against hospitalization and you also see evidence for extremely robust protection against pretty much all symptomatic infection. The numbers tend to decrease and that's been the general pattern in pretty much every vaccine report whether it is, as I said, the American Moderna vaccine, the European Pfizer vaccine, the adenoviral AstraZeneca, Covishield, Johnson & Johnson, the Russian Gamalaya vaccines, the Chinese vaccines which are both adenoviral and killed virus vaccines. All of them in the early months after immunization are providing respectable degrees of protection particularly against hospitalization and death and this study confirms that. It's interesting just how much of fuss is being made about this and as I said it's in part driven by this entire notion that Chinese data and Chinese studies or Russian data and Russian studies are somehow less credible or believable and regardless of whatever that credibility or believability of evidence from any part of the world is, the science behind it is that these are all pretty much the same vaccine platforms, the same vaccine designs, the world over and it's unsurprising that they all provide about as much protection as each other. So putting nonetheless. Yes, I mean even this vaccine which supposedly has, I mean according to clinical trials, not a very high efficacy rate I think it was only about 50% which is just a threshold, which still has given quite a bit of protection. So I should clarify this and remind our viewers because we've discussed this, that 50% number that was quite widespread at one point as a criticism of the Chinese vaccine, leaving aside the fact that there are multiple Chinese vaccines. But even so, that number was actually against asymptomatic infections with SARS-CoV-2 or mildly symptomatic infections against SARS-CoV-2 in a design which is not very common. So we have discussed this at that point that that number was not surprising and that what all vaccines were showing really good protection against was severe illness, hospitalization, death and somewhat less percentage efficacy or effectiveness against milder disease, moderate illness or mild illness or some asymptomatic illness. And these numbers are pretty much in the same ballpark. It's notable that these numbers are in Brazil and therefore likely in all likelihood to be showing protection against the so-called P1, P2 virus lineage. I forget what the Greek letter now is because we are now supposed to be using Greek letters for this variant, but this has been a variant of concern. This is one of the small handful of variants of concern and it's comforting though unsurprising that there is very respectable protection. And coming to India where we are also where our government is also now at least trying to course correct where the earlier liberalization vaccination policy, which was a complete failure as we saw in now, we see that the central government is saying that okay, we are going to procure at least 75% of the vaccines and take care of the distribution still leaving 25% for private peers. But even beyond this, we see that the vaccination rates in India remain dismally low and the availability is still of course a matter of concern and for that, what we know is that it's the production which really needs to be ramped up. And even now that co-vaccine, we see that some public sector units have been given the permission to start producing but even that's happened just awfully. So how soon can we really expect for this process to be set up and for vaccination numbers to really actually see the kind of increase that we need to be seeing? So leaving aside for the moment the politics of the so-called course correction which the formal government announcement acknowledged no course correction whatsoever or did not acknowledge it as a course correction. And quite frankly, it falls in the category of Derai or Tannik Durustai, not entirely an appropriate course correction, a partial course correction if you will. But leaving all that aside, the fact as you point out remains that if there is no water in the well, redesigning a larger bucket is not going to fetch you more water, so how are we ramping up production? And the fact remains that our major vaccine supply, the largest quantity still remains Syrum Institute of India's AstraZeneca Covishirid vaccine. The Syrum Institute of India had said months, many months ago that it needed a financial injection in order to expand its Covishirid manufacturing facilities. That was done again in the Derai Tannik Durustai mold only a few weeks, a couple of months ago by the government of India and the Syrum Institute's estimate is that by sometime late next month they should be able to start supplying a somewhat larger volume. Of Covishirid doses. So my expectation is, given how these things go, that by August we should be seeing a respectable increase in the Covishirid supply. Let's keep in mind that we are holding back Covishirid supplies to the WHO International Covax Initiative through which a fair fraction of the global south needs to be vaccinated. Let's also keep in mind that case numbers across Africa are showing worrisome signs of rising. That's true in Southeast Asia as well. And therefore, there's always going to be pressure as Covishirid manufacturing goes up for resumption of supply to the Covax Initiative. But in all of this, my suspicion is that by August we will start seeing an increase in Covishirid supplies. The second is, as you point out, Covaxine and that's supposed to be manufactured by a whole range of both private and public sector enterprises within the country. But I really have not as yet seen in the public domain any actual estimate of when supplies from those sources will start. There has been some indication from Bharat Biotech that they themselves will start supplying somewhat higher amounts in another month or two. But given that their original supplies over these past six months, let's keep in mind have been 10% or less of the total vaccine rollout in the country. Again, that's going to be small, patchy, limited. And I don't expect any real non-Bharat Biotech Covaxine supply to start before September or so. The Sputnik supplies are at the moment even smaller than the Bharat Biotech supplies. And let's keep in mind that this partial rollback of the vaccination campaign strategy announced this week by the government of India persists in 25% of the vaccine commitment to the private market. Let's also keep in mind that at least about 60% of the private market sales over these past weeks have been to a handful of very large, very high-end hospital chains in metropolitan India. So, vaccine inequities continue and are going to be fed. I seriously doubt that we are going to see any of the government's just thumping claims about when they will vaccinate how much coming true fairly soon, although I wish they were right. But I do see that by August, we should start seeing some amount of increase. Let's also keep in mind that the highest per day vaccination that we've ever managed is 40-something-luck vaccinations in one day. And that was really a spike. It was not a maintained number. Current numbers are 20-lack optimistically speaking. In fact, quite frequently on many days, much below that. The argument therefore that we are going to achieve half the country by the end of the year, if you calculate it as 70% or 80% of the adult population of the country by the end of the year, that amounts to about half the population by the end of the year, will involve 120-130 crore doses to be done by the end of the year. And 20-lack, 25-lack going up to 30-35-lack a day is unlikely to do it. Hopefully, we will see more and more vaccines coming in, but how and when the approval and the supply process will kick in high gear still very much remains to be seen. And I mean, even at the global level, this urgency of resolving the issue of vaccine inequities is not being seen. I mean, you know, at the WTO where the intellectual property rights waiver is being negotiated, there's still not been a lot of headway despite, as you said, that COVID-19 is not being sent out to the co-vaccination issue anymore. And numbers across the global south are across Africa and Southeast Asia are rising. But even then, you know, even the small step of raising of waiving intellectual property rights, even that much is not been achieved. Well, there are two or three issues for us to keep in mind in these dire, straight situations and at this juncture about that issue. Number one, while the US administration has made some supportive noises, as you point out, that has not resulted in any actual forward movement about the kind of comprehensive waivers that were being discussed. But also keep in mind that even if, for example, suddenly tomorrow magically, these waivers are agreed upon at the WTO for companies to gear up and to start expanded manufacture companies across India, across Korea, across South Africa and Nigeria, across Malaysia, across some countries in South America and Central America, none of this is going to be an overnight matter, especially because for many of these technologies, it's not simply the formal on paper waivers that matter, but also the actual handing over of cell lines and starting seed material in actuality for vaccine manufacture. And as a consequence of that, the sad reality is that for many months, even under the most optimistic of circumstances, hugely expanded vaccine manufacture is unlikely to be the case. And therefore, for us globally, to be dreaming of meeting WHO goals or forget about meeting WHO goals, but even dreaming of a reduction in the inequity of vaccine distribution across the world is a fairly dim hope. It's on that background that self-righteous and holier-than-thou announcements at the G7 and related fora about how this or that G7 country should and will take the lead in equitable vaccine distribution across the world are deeply aggravating. And finally, Satyajit, I want to ask you about the question of booster shots, because do we have any data as such at the moment about how long the immunity lasts, because as we know it has been pointed out that if the immunity of the first section of population that has been immunized is over, then and we start then immunizing a second section of the population and you know in this sort of process can we really achieve herd immunity? How can we achieve herd immunity? So let's get three issues straight. Firstly, when we begin thinking about the intermediate term future, let's not even call it the long term future, but something beyond just getting everybody vaccinated for the first time. There are three issues involved. First, how long do the current vaccine generated immune responses persist at very good levels? That's simply a matter of collecting data information evidence from ongoing trials from ongoing rollouts that have started last December, but the trials remember have started last June. So the initial data from those are extremely promising. And those say that antibody levels, neutralizing presumably protective antibody levels persist quite well, at least for the mRNA vaccines for 10 months or so, for the AstraZeneca, for the COVID shield vaccine also seven, eight months. There are really very good maintained antibody levels. And if that's the case, then my guess is that suddenly it's very unlikely that booster doses will be required in less than a year of time. How much more than a year is still completely up in the air? Simply because we don't want, I mean, I can make guesses about it, but we don't want to be making guesses about that. We need for that policy to be driven by evidence and the evidence is there. It accumulates month by month by month. And I suspect that what we are going to see is each month we are going to see reasonably comforting data. That's my guess that says, oh, we can push it to a year and a few months and so on and so forth. So that's the first component. So either I suspect is reasonable to think about. But the second issue with respect to this question is to do with is protection over this period maintained only against yesterday's strain or against today's new variants and strains as well. And again, the information from that, both from this recent Chinese vaccine study in Brazil and Surano that you're referring to at the beginning of our conversation today, as well as the UK and HS data on on the so-called Delta variant protection by Kobe shield and so on and so forth. All of these are indicating that real life protection against the virus variants that have so far come up prominently. Protection in terms of hospitalization and death is quite reasonable and continues to be so, which is again in a very cautious and qualified fashion, reasonably good news. This does not mean that we are never going to see variants against which next generation vaccines will need to be generated. And that's really my third point in response to your question. And that third point is we still do not know what the currently emerging variants are because the world has not learned the lesson. And in this matter, I must underline that despite many other disagreements, the UK's program starting from late last year about extremely wide large scale virus sequencing in order to monitor variant emergence over real time has not yet been emulated by the bulk of the world. Certainly, India's in secog is nowhere even a fraction near that. And until we manage that kind of intensive, careful virus variant monitoring and surveillance, we're not going to be in a position to be tracking variants that may require next generation vaccines in order to nip them in the bud. And therefore, the real unanswered question is going to be, when we are ready for boosters, is that booster going to be the same vaccine that we took a year or so back? Or are we going to need a next generation vaccine as the booster? And on that, the jury still remains out. Thank you Satyaji. Thank you so much for joining us today. And that's all the time we have. Keep watching this clip.