 Hello and welcome to NewsClick. Today we are going to discuss some of the issues which has been causing some concern amongst both our population in India as well as outside. Satyajit is first the issue of spacing out the vaccine doses. Of course, it is really for COVID-19. From what it was originally supposed to be four to six weeks, then it became two months, six to eight weeks. Now it is now being talked about as three to four months. Now is it to make the number of vaccines roll more in the sense that the same stock you can vaccinate more people or is there some scientific basis to say that your immunity will actually improve if the spacing is longer? And what does it mean for people who have got two shots within the original six weeks as was talked about by the government? So the unsatisfactory answer is that it's a little bit of both. So let me explain that. But let me begin by stating some things that really need to be said, which is when you first either take a vaccine or you are infected, your immune response to the trigger goes up and then it settles down. But at that point, it has begun to make a certain level of antibodies. The active response then settles down. Antibodies are maintained. Now, if while the response is going on, you introduce another dose, you're not going to increase the magnitude of response very much. But if after the response settles down, you introduce another dose or you catch an infection, then you're going to get an even better response and your antibody levels will stabilize at an even higher level. This subsequent to the return of the immune response to baseline can go on far away. In other words, what I'm saying is so long as you don't take a second dose in anything less than three or four weeks, all subsequent doses will show you an improved response. And that subsequent dose can be after four weeks, six weeks, 10 weeks, 12 weeks, 16 weeks, up to six months, you will get a perfectly good second higher booster response. The immune system is flexible and accommodating in this matter. So this is not a matter of life and death that I have to take my second dose at exactly four weeks. No, at exactly six weeks. No, at exactly, oh, now it's 12 weeks. So my having taken it at eight weeks is an error. None of these fears should be held by anybody. And I am quite unhappy, both with the technical advisory committee, which has provided these guidelines to the government from time to time. And of course, with the government messaging that this has not been clarified. Because this is quite likely to raise anxieties and feed vaccine hesitancies. Because all of this then says, oh, if you take the vaccine at such and such a take, then it's not good. And all of this is utterly avoidable because the immune system is truly flexible in this matter, you'll get respectable responses. So that's the first thing I really want to say and underline. Having said that, let's look at the formal matter. The formal matter is since clinical trials were done with two doses with a four week or six week separation, that's what the protocol is that we should use. But for Covishield in the United Kingdom, because the layout was rapid and because there is careful monitoring with the National Health Service, which is the public health system. And because of that, there is now emerging evidence available about how much protection is gotten with one dose, how much with six week separation, how much with eight, 12, 16, etc., etc. Those numbers are interesting. They are not definitive. They are not definitive because that's not a planned trial. That's simply the system looking back on what inadvertently happened. So all confirmers are not dealt with. So these are not definitive claims to be made that if you take your second dose after six weeks or eight weeks, your protection is not as good as if you take it after 12 weeks. And yet, my second criticism of the committee and the government is that that's the air with which recommendation shifts are being made. All of that said, what the committee is trying to do is to provide some evidence based support to the reality that the major singular vaccine available in India, which is Covishield, is in short supply. So can one make practical adjustments to cover as many people with at least one dose as possible? And can one do so with at least a little bit of evidence based support? And on those matters, I am in agreement with what the committee has done, which is it has taken the Covishield data from the United Kingdom and it has said, it says that you can extend it up to 12 weeks, 16 weeks. It's fine. It's not a problem. And therefore, let's just give the second dose 12 weeks later. It's not a problem. Let's just take the vaccine dose six months after somebody who's got a natural infection of COVID. It's not a problem. For Cov- vaccine, we have no other source of evidence. So we are going to stay with four weeks. But I am in agreement with all of them, with those two serious and severe criticisms. You know, the eking out of the same lot of vaccines for a longer period, which what you're saying is underlines this decision is of course something we have to accept because we have a shortage. But does it mean that the people who have taken one dose are not as well protected in this period? Frankly, I don't think so. I'm saying it tentatively because I really don't think that the data, that the evidence is as strong and robust and incontrovertible as to let me make a definitive statement or let anybody make a definitive statement. I think after one dose of Cov- shield, there is very good protection for many months. I think after a second dose of Cov- shield and body levels go up. I think that therefore in some people, the second dose of Cov- shield may actually provide a little bit of better protection. I think that high levels of antibody against Cov- shield will mean that at least against some very new variant strains. Despite reduction in recognition, there will be enough recognition to provide some respectable level of protection. So there are a lot of quantitative ambiguities and unknowns about all this. So do I think that it's a life and death matter? No, I don't. I think that having one dose of vaccine is a good thing. I think having a second dose of vaccine is a better thing. I think having it at any time point between four weeks and 16 weeks is fine. I think that all of this should be properly explained as realistic tentative sober evidence and the realities of vaccine shortage when these decisions are being communicated. It's very difficult to accept that the government is basing itself on vaccine shortage because still they're denying there is a vaccine shortage in spite of the fact that you don't have vaccines available now for the 18 to 45 age group which is what was something which was quite widely known when the government said everybody can be vaccinated because you knew that there are not enough supplies and now you don't even have supplies for the second shot for a lot of the 45 upward age group and let alone vaccinating people who have not been vaccinated in that age group, you're not even able to give the second shot. So in that sense, you have really would have to confirm that you made a big mistake by talking about 18 to 45 when you don't have vaccines for even the 45 upward group. Yes, but maybe the government should try telling all the truth. A truth telling and building narratives and positivity seem to be the conflict at the moment because if truth is unpalatable then of course it becomes anti-national as you know and particularly in certain states there are threats of the NIA, NSA and various other draconian measures which will be used if and if you point out an oxygen shortage. Now coming back to the pandemic itself that's something that we need to also think about there are some noises being made that the numbers are going down somehow we are going to be over the hump. Now we've been talking in our discussions that predicting the future definitively in terms of a mathematical model has not worked. It doesn't work for two reasons which you have explained to us a number of times. A because it's a number of smaller epidemics which are happening in different parts of the country therefore a model which explains all of their future behavior is not possible. Second what we're seeing now and that's quite of concern is that while the cities which had gone up earlier their numbers seems to be coming down whether it's Maraftra, Delhi, Karnataka, Bangalore or even other cities what you see now are two things Eastern India seems to be going up from Tamil Nadu to Andhra Pradesh, Orissa, West Bengal and even Northeast. So you see seem to see new areas where it is numbers seem to be going up and plus now it isn't much of the rural areas and as we know the rural areas the testing rates are very low so the numbers that we are talking about are not captured as well as it would be even though that's even partial in the urban areas. So we should be looking towards a longer tail than what this so-called model seems to predict. So I've been saying this for a very long time I will reiterate this whole notion of a wave we should be setting aside we should look at local outbreaks we should we should decentralize our the perspective of our understanding as much as our pandemic management strategies and the reality is that we have districts large numbers of districts where case numbers are rising we have a few where case numbers are falling and because they are populist districts we can comfort ourselves that we did not go to five lakh cases per day but that's a very pretend victory if at all we are going to think about it in those terms. I would much rather urge that we need desperately decentralization of our detection systems of our surveillance systems but much more of our outreach healthcare systems because rural India is nowhere near as easily inclined to access emergency medical facilities as urban India is so we need outreach to identify people who might need oxygen we should keep in mind that pulse oximeters are the way in which people in urban India are discovering that they're running short of oxygen and need oxygen this may not even happen in rural India we desperately need critical care related community outreach which is an extremely unusual notion to bring into operation during a pandemic really we should have thought of this earlier but at least now we should be planning for it because as you point out once transmission has taken root in rural communities it's not going to disappear overnight either so this is going to be with us for a long time to come that said let me make a general point and that is because everybody looks at waves nobody none of us is paying as much attention to where the tail of the wave stabilizes and the united states is a very interesting example of where the tail of their wave seems to have stabilized and what has stabilized is that's a number of daily cases that's not really changing dramatically as a broad feature it's undergoing changes locally in the united states just as much as in India but as a result the perspective of pandemic management strategies is shifting towards treating it as something that you can live with as a level that you can live with that you can shift back into normal life and go to it which has its own consequences I think going forward in how we not just as American society globally as human communities begin to come to terms with the pandemic and what sort of unforeseen difficulties we might still land ourselves in. You talked about rural areas the health outreach that we should have made preparations for in terms of critical care as well as in terms of oxygen supplies as well as you rightly pointed out even oxymeter based monitoring now we are talking about it now just that we started to talk about how to increase our oxygen capacity production capacity distribution capacity only when we ran short and people started dying of a lack of oxygen it's while we have been living with this issue of a possibility of a second wave now we also are talking about a possibility of a third wave it's only now and this is 18 months past the pandemic that we are really talking about what we need to do so obviously whatever planning that we should have had has been missing and what we have had is what we have again discussed in our show about something which is stopped down seen as a law and order problem not as a public health problem and that's what is really now really causing us to see what are the huge gaps that we have something coming to the last point today is that you know suddenly we have a CDC statement that because a certain number of people have been vaccinated in spite of the fact of what you call in the united's a new normal where 40,000 50,000 infections but they are taken to be normal in fact there per 100,000 the number of cases that are the active cases that are there not very dissimilar for that India except the fact our health systems are collapsing while their health systems have been able to cope with it but taking off masks and this might feed into the anti-mask campaign which is already there do you think at this stage of the pandemic given the numbers that you yourself talked about this is something which is good and don't you think it might also have adverse implications for countries countries like India later so let me draw a parallel at the beginning of this conversation we talked about the government of India's advisory committee which attempted to provide evidence-based support for accommodating the realities of vaccine shortage and I think that what you're pointing to is a very analogous situation where the CDC is attempting to accommodate to the exigencies and realities by providing a little bit of evidence-based support for it what what do I mean by that number one vaccination rates across the united states vaccine uptake rates are falling there are so in other words people who are willing to take the vaccine have have gotten a vaccine those who haven't got a vaccine are quite often people who are not willing to take a vaccine which clearly creates two separate categories these categories in the united states are also politically separated this is not by any means a hard and fast situation it is it still remains true that there is socio-economic disparity in vaccine access in the united states still so it's not entirely a political divide but there is a very strong political divide number one number two as I said a little while earlier we all get used to looking at vigilance and the fact that as you point out there is a new normal of a certain plateau of daily levels seems to be bearable number one as you point out because the critical care system can deal with it and number two because you have the contrasting image of a peak to comfort you that you are much lower than that and as a result this seems sustainable and if it's sustainable then the combination of the fact that you have a certain substantial proportion of your population vaccinated and that you are not growing that number very dramatically and that your case numbers are not going down and therefore you are in a kind of stable situation makes you think okay let's take another step towards quote normalcy unquote or at least just pre-pandemic situation unquote and can we provide a little bit of some support and evidence-based guidance for that and that I think is what the CDC has done the difficulty with this of course is that once you do that exactly like our vaccine gap altering situation you allow all sorts of interpretations of that and given the fact that a great deal of life in the United States for example or in Europe is still indoors you know taking masks off in short groups may or may not be safe in all situations and the ambiguities might well lead to little outbreaks that will then have to be controlled and a smoldering situation and a smoldering situation at the level at which the disease seems to be in a community that is substantially vaccinated may well give rise to a situation that leads to vaccine-resistant variant emergence. Okay that's a serious threat that we might get in the future that what you we have discussed this earlier again that what we have seen because of the physical distancing masks etc we have seen the evolution of the viruses in the direction of more being more transmissible but once you have a large vaccinated population you might give rise to viruses which are then going to be to some extent vaccine resistant so to say and therefore you might get new kinds new variants which would also reduce the efficacy of the vaccines meaning that we'll need to vaccinate again right. I think that that possibility I emphasize that it's a possibility I'm not even claiming it to be a probability but the fact remains that this is why equity in vaccinations has been such a critical critical feature this is why taking a globally inclusive comparative approach we have discussed this repeatedly through the WHO solidarity vaccine trial proposal would have been so much more useful this is why building consensus for vaccinations across both political divides and across socioeconomic divides was such a crucial matter this is why building reliable supply chains of vaccines to scale was such a major issue and it is also why having such a diversity of vaccines could have been built into a strength of the global response by putting the virus evolution under different kinds of pressure so as to delay the emergence of hugely vaccine resistant escape variants might have been a possibility none of this have we distinguished ourselves with as a global community. Let's put it more bluntly Satyajit the rich countries and the rich tried to separate themselves from the rest thinking if they take care of themselves then the world can take care of itself later what you are talking about is this principle of vaccine appetite which is what it has been is the one which is now going to cause us a lot of grief possibly and in this India has not distinguished itself either because in fact a lot of the money that came into Serum Institute for scaling up vaccine manufacture now has been captured by the Indian state's inability to scale its own production up which it had other companies manufacturing concerns to do it which they did not use and as a consequence commitments that we have made to other countries have now failed and this is something which is also of deep concern for instance because those are the countries who are banking on the Covish ill vaccine supply from Serum Institute and that has not materialized we have talked about these issues again earlier because a lot of it is really re-singing old tunes that we are now doing but the point is the reality is now coming out far more starkly at this point than it was earlier Satyajit thank you for being with us sharing your insights on these and other issues we will continue to cover COVID-19 because this pandemic is going to be with us for quite some time it's not going away soon and we hope to see you soon in news click do visit our website as well