 Hello and welcome to NewsClick. Today we are going to do a round up of COVID-19 again with Professor Satyajit Rat, who has been with us for quite some time now, watching the epidemic or the pandemic. Satyajit, when we look at what's happening, Omicron seems to have taken off in a number of countries. We discussed this last week, but things are still looking bad, particularly for Western Europe, as of now, certain countries in Africa as well. And of course, the United States, which again seems to show very high figures. A lot of other countries are not showing an Omicron wave as yet, India being one of them. We don't see a particularly serious wave in any part of the country as of now. So what do you see in terms of the speed at which it has gone up? And is there a possibility, as South Africa seems to have shown, that the numbers may start coming down also rapidly as it happened in South Africa? So, yes, as you point out, the South African experience is instructive in two different ways. One, in that the numbers have begun to come down in South Africa. However, this has not happened in the United Kingdom. So while the South African experience is somewhat reassuring, it's by no means something that is definitely to be expected with Omicron as yet. Secondly, the South African experience that has been replicated outside South Africa of the Omicron-driven surge in case numbers is that a lot of the cases seem to be relatively mild illness. Hospitalization, intensive care needs and deaths clearly seem to be less frequent in this particular spike, not simply in South Africa, but also in the United Kingdom and elsewhere where we are seeing numbers from. Both of those are promising one somewhat more preliminary than the other. The Indian situation, I think, has to be looked at from two different points of view. Firstly, the straightforward issue is that cases of COVID-19 where the virus is being detected in rapid antigen or RTPCR tests are not rising dramatically despite about the same numbers of tests being done. This means that there isn't a general major rise in detected cases yet, which is what you meant when you said that there doesn't seem to be an Indian surge yet. But as far as Omicron is concerned, in the first place, all positive tests are not Omicron. Omicron can only be detected by either a tailor-made test for Omicron or, as is currently being done pretty much everywhere from a complete sequencing of the viral genome in that sample. And India's percentage of test samples that are being sequenced for Omicron detection are extraordinarily low. What is it? Well, it's actually, as far as I know, it's less than 1%. And we're really talking about comparing that with test percentages in the double digits for countries of Western Europe, certainly the UK is doing 15%. Or even the United States is doing high single digit percent sequencing. And even South Africa had fairly high genome sequencing? Yes, at about 3%, 4%. Certainly higher than India. If you want to put it in journalistic terms, it's 3% to 400% more than India. So the difficulty is we are only looking at a small subgroup of Omicron cases. Keep in mind that the sequencing is not necessarily only a random subsample of all tests. We are specifically sending likely traveler or traveling traveler related to positive samples for sequencing. But even there, what we really need to know is how many of, for example, yesterday's positive samples were sequenced. And of the ones that were sequenced, how many were Omicron? And we need that information from day to day to day to get some sense of whether Omicron is beginning to gain a larger and larger footprint in the community. Now, at my age, I'm not expected to be particularly silico savvy. And I really have failed to get access to data in this form. Whatever data is available, it's not at least transparent to us. And that's been one of the problems that we have had with the way the government releases the data. And this is therefore not very surprising. Coming to the second issue, India seems to have got more vaccines to its armory with two emergency use clearances being given. One is the COVAX, which is the NOVAX vaccine being manufactured by Sedum Institute. And the second is the Baylor Institute's vaccine being manufactured by Biologic E. And that's the COVAX vaccine. Both seems to be capable of being produced in large quantities, capable of, doesn't mean, therefore, you will produce in large quantities, as we've seen with the Zynder Scandilla case as yet. But it seems that you maybe, maybe in the better place position to manufacture them in large quantities. Can you tell us a little bit about these two vaccines? So, let's all remember that India now has approved for emergency usage, not one, not two, not three, not four, not five, but six vaccines for COVID-19. Of these six vaccines, two were approved almost a year back, COVI Shield and PROVAX. One was approved about six months back, that's puttnically. One was approved three months or so back, that's the Zynder Scandilla ZycovD. And two were approved in the past 24 hours. And those are, as you point out, COVAX and COVAX. Now, in scientific terms, or more correctly in biotech terms, COVI Shield is an adenovirus-based vaccine. So, we've discussed this before on this forum, that in order for designing vaccines, you either give the immune system the pre-made target manufactured in bioreactors and formulated and injected, or you inject the genetic code and let the body make the target and respond to it. The three categories of vaccines that use the genetic code are the mRNA vaccines, Moderna and Pfizer as they are called, which are RNA vaccines, the DNA vaccine, which is the Zynder Scandilla ZycovD and the adenoviral vaccines, which are COVI Shield and Sputnik B. So, these are the genetic code vaccines. On the other hand, there are the make the target outside an injected category of vaccine platforms. And in that, there are two kinds. One is just make the whole virus inactivate it and inject it. And that's the ICMR-Biotech Covaxy. Alternately, take the virus protein that you really want an immune response against, manufacture it in fermenters, fold it appropriately, formulate it and inject it. This is how the hepatitis vaccine works. This is how a whole range of childhood vaccines work. This is how the papillomavirus, the so-called anti-cancer vaccine works. It's a tried and tested technology of making so-called recombinant proteins, formulating them and injecting them. Both Kofovax and Korbevax are recombinant protein vaccines. And as recombinant protein vaccines, they are both easy to make and difficult to be sure. They are easy to make because they can be made in fermenters, because they can be made in bacterial culture systems or yeast culture systems which traditional pharma manufacturing is quite familiar with. They are finicky to make because after the bacteria or the yeast have made these proteins, the proteins need to be purified and folded right so that they have the shape that is there in the original virus before they are formulated and injected. And in fact, Novavaxis was over the past year where they have their vaccines have been, their vaccine has been delayed again and again and again, at least in part, are driven by protein folding difficulties because refolding of proteins is a little tricky. But it seems as though we've finally arrived at the point where these vaccines are also available in the armament daily. Now, there is one hopeful point to note about this and a cautionary point to note about this. Let me start with the hopeful point. The more differences we have in vaccine platforms, the greater is going to be the diversity of immune responses, particularly when we are talking about additional supplementary vaccine doses. I am very reluctant to call them either booster doses or precautionary doses, all of which sound as though there is a robust evidence-based protocol structure underlying it. They're really just plans for additional doses. But crossovers of additional doses are clearly proving to be reasonably full at least in small fragmentary studies. Having many different vaccines approved and available for these cross-platform additional dosing is, I think, a useful tool in the anti-COVID policy portfolio. The cautionary point is, I will remind everybody of where we started. A year ago, we had Covishield and Covaxin. Six months ago, we had Sputnik V approved. Three months ago, we had Zykov be approved. And yet, yesterday's vaccinations are overwhelmingly still Covishield, 80-something percent. The remaining is Covaxin for some 10-15 percent. No Sputnik V, no Zykov V of any really significant numbers as yet, months after emergency approval. Why this is the case seems to be a mystery that our investigative journalists do not seem to have addressed. And I'm wondering on this background, what the fate of Covivax and Corvivax is going to be? Yeah, a little bit of glimmer is that actually, CINEM Institute seems to be claiming that it is going to start large-scale manufacture. They also seem to be looking for export markets outside. So maybe, maybe for market reasons, we'll see a little more pickup of this. But you're right that Sputnik, we seem to have had five or six companies willing to make Sputnik V. What has happened to that? We have no idea. Zyda Skadilla is a big company. What's happened to that? We don't know. What is also disturbing is that we have no press information being made available by these companies or what the problems are. And therefore, neither the government nor the company seem to be sharing any information on that count. So it still seems to be at the moment dependent on the two old vaccines that we had. And your argument that you were saying that mixing of the vaccines will help and if we are going to provide additional vaccines, it gives you different kinds of humidity. Therefore, maybe it helps to control the public health aspect of what the current pandemic is. So last question. We also have given emergency use approval for Malnoopiravir. This is the MUX, the antiviral drug which is on the market. There have been some cautionary voices also raised about the Malnoopiravir that it tends, it could have problems if you're immune compromised, if you have other problems and so on. But again, it has got approval in the United States. The federal authorities have cleared it. So have the Indian authorities. Any specific comment on the Malnoopiravir that it could prove to provide new variants and therefore could be also causing problems for us? So we've discussed this before on this forum about whether inadequate use of all Malnoopiravir might give rise to new variants while it's arguable actual laboratory evidence with these categories of drugs have not really shown dramatic emergence of variants to be the case. What will actually happen in real life, of course, remains to be seen. However, I will point out something of more pressing immediacy to do with Malnoopiravir. And that is, as we just noted, a vaccine we licensed for usage six months ago is not particularly visible. A vaccine we licensed three months ago is not particularly visible. Malnoopiravir is an oral antiviral drug. Keep in mind that Malnoopiravir works as well as far as anybody can tell with initial evidence against the Omicron strain as it does against the Delta strain as it does against the original strains. Unlike, apparently, the vaccine generated immunity. So clearly, if we want to bring transmission and speed of transmission of variants like Omicron under control, we should be identifying people infected very, very rapidly with extraordinarily widely available, easy to access testing. And for everybody who tests positive with just 24, 48 hours of symptoms, perhaps very mild symptoms, we should be providing Malnoopiravir because it will control virus growth in that person, cut down the period for which transmission from them can happen. And of course, Malnoopiravir brings down the likelihood of serious illness by something like 80%. In order to do this, we need very high volumes of Malnoopiravir to become accessible, extremely affordably the length and breadth of the country. Emergency approval is simply wishful thinking at this point. How is the rest of this pipeline going to be achieved is going to be the really crucial question in the days and weeks to come. And the supply chain to reach the people so that quick taking of Malnoopiravir can be done by the patients or given by the doctors so that you actually stop the viral replication. If we do it too late, it doesn't have an effect. So therefore, early delivery of the drug is of utmost importance. And unfortunately, as of now, we don't see either any preparation of large scale manufacture, which needs to be really pump primed as they say, they call them say, pump priming has to be done if you want to boost the supply chain. We don't really see any example of that either for the vaccines or for such drugs. Of course, we have a second one in the pipeline again, antiviral, which is Pfizer's combination antiviral drug. That also seems to be quite effective. And again, the same issue is there, except maybe maybe Pfizer has better lineup of manufacturing over here. We don't know. We as just as we don't know what Mark is doing or not doing. So with these questions, we still have to really address the fundamental issue that unless the government takes a proactive stand, proactive measures to see that these vaccines and for new molecules as they can be called are made available in large quantities, we are not going to get a handle on the current pandemic, whether it is here or elsewhere. And as we know, the global conditions in terms of the vaccines are really awful. We have discussed this time and again, vaccine appetite is very much what we see. We're talking of third, fourth doses in certain countries. And we seem to have even less than 20%, 10% in certain other countries. This is vaccine appetite in Spain. And if it continues, then we'll see the emergence of more and more variants. Thank you very much, Satyith for being with us, explaining to us the intricacies of what is happening both with us and with the virus. This is all the time we have for NewsClick today. Do keep watching NewsClick and do visit our website.