 Welcome to this click on our another edition of COVID-19 discussion that we have with Professor Satyajit Rath. Today, we're going to discuss the vaccine inequity issue that has been plaguing poorer countries, which the WHO director general has talked about as vaccine appetite. And we're also going to talk about other vaccines which are coming in now and how they're being looked at in terms of the market, in terms of the health systems. Satyajit, to discuss the first issue with you, we have discussed on our shows earlier as well that the vaccine inequity is a huge public health issue because if we still have large pockets of people who are not vaccinated, then we also have the potential for the pandemic to continue for a much longer period because you will get newer and newer strains of viruses arise and therefore the pandemic in different forms will continue. Do you see that as a major issue? And if you look at the vaccine inequity figures, what are the completely unequal vaccines in different continents countries have got? You will see countries in Africa, for instance, Congo has only 0.4% vaccines, even a single dose being given. While large parts of the poorer parts of the world, particularly in Africa, being one of the key ones, really see 8% to 6% at best. Isn't this a fertile ground for new strains to emerge and therefore the pandemic to continue? Yes, Prabir. Let's put some detail and nuance into this unhappy situation. In the first place, this is not simply a between country inequity. All of these are also within country inequities. To take India's example, there are the vaccination coverage between the quote best performing unquote and the quote worst performing unquote states is quite substantial. So what that amounts to is that poor marginalized, disenfranchised, suspicious of the state communities tend to have across the world, including in the global north, relatively poor vaccination coverage, which means that these are socioeconomic culturally coherent communities in which the virus can be exchanged. These are communities where people interact with each other on a daily basis and will exchange the virus. And as a consequence, these are communities for virus growth. There are two consequences to this. One, that is an immediate consequence that the world has begun to pretend doesn't exist without adequate evidence. And that is that everybody's thinking that Omicron is a mild illness. But Omicron is a mild illness amongst the vaccinated. The evidence that Omicron is a mild illness even amongst the unvaccinated is exceedingly poor fragmentary and it's not even clear that that is correct. And as a... The argument is while it might be true for the, maybe the 2020, sorry, let me rephrase that. It might be true for the Delta version of the virus, but if you compare the illness and the mortality rates, it's not very different from the 2020 early virus infection that we had. The figures seem to be relatively similar in terms of seriousness and the illness that we have, including death. That's what the evidence is beginning to indicate. Now, keep in mind that this means that strains such as Omicron are spreading amongst unvaccinated communities extremely rapidly. There are serious illnesses coming up in those communities. And because those communities are marginalized, disenfranchised and or simply suspicious of state apparatuses, their access to public health care is proportionately lower. We are seeing not just a vaccine inequity, but leading on from this vaccine inequity and illness and health inequity in the pandemic itself right away. That's one issue that we should not lose sight of as a matter of inequity. The second issue is what you have pointed out that if the virus keeps spreading in this fashion in the unvaccinated communities, then there is that much more of the virus population. There is that much more likelihood that variants with all sorts of characteristics might emerge. That's for the intermediate future. On both grounds, vaccine inequity is a major concern that we should be all deeply bothered by. It's also interesting that Omicron seems to have arisen from a variant, which is really at least early stages of the epidemic, maybe for six months from which it seems either to have laid low, maybe in an animal population or in a human population, which is relatively isolated the way you are talking about that groups which don't interact too much. And it seems to have come back into a much bigger pool, so to say, after it managed to break this barrier, either a human animal and back to animal to human barrier, or a group, small group, which was infecting each other, but really did not spread out among the general population. Absolutely. I'm much more inclined to think that it emerged in relatively, at least culturally isolated communities somewhere, we haven't as yet seen direct evidence of animal and back to human examples, even though we know that very large numbers of non-human animal species are in fact quite easily infectable by SARS-CoV-2. But regardless, the fact remains that this is a virus, a collection of viral strains, that's not going to go away in simple terms anytime soon. We need health vaccine equity across the world if we are to address it effectively globally. And as we have discussed earlier, that it can only become endemic when the public health system can handle the virus outbreaks and that is only possible if people are vaccinated in large numbers. So the public health system is not stressed. So this is the crux of the issue, why vaccination is so important. And of course, we have discussed earlier also the number of unvaccinated seem to be unusually large amongst the population which are reaching the intensive care sections of the hospital. So that's the indication that it is definitely differentially affecting the population and that we may postpone for a different discussion on what is called the antibody protection and the T cell protection which the infections or the vaccinations give us. So we'll postpone that discussion Satyajit for another day. Coming back to the other issue that we seem to find a concerted campaign particularly if we see the American media not say the global medias as much as the American media which seems to indicate that apart from the mRNA vaccines all other vaccines are particularly useless against Omicron. They don't produce enough antibodies to the Chinese tests and the results seem to show that they do. All kinds of arguments being stressed. In fact, some of the big arguments have also been that Sputnik also doesn't provide any residual protection against Omicron which would seem to indicate that even the AstraZeneca vaccines won't because they're really very similar kinds of vaccines. Now how much of it is scientific? How much is entirely based on the need to push your pharma companies vaccine nationalism if you will and particularly if mRNA vaccines which if we have to believe the American newspapers if that is to be true then what we would see is actually the world particularly the poorer sections of the world would be at huge risk. We don't have the cold chain for the kind of requirement that mRNA vaccines have and that's why we have not opted for the mRNA vaccines really for a public health program but really on the AstraZeneca Serum Institute version and of course, a co-vaccine. So this is an interesting issue, Prabir because it is beginning to look as though the science or more correctly the evidence is being somewhat selectively and conveniently read in the service of a competitive advertising capitalist profit making approach on the one hand and narrow vaccine nationalism at the political level on the other hand. And let me explain that. Keep in mind that when the vaccine trials are done for all vaccines, it doesn't matter if they are Chinese, Russian, American, European, Indian, whatever all vaccine trials have had a vaccine ability tested for protection against serious illness, hospitalization and death. The vaccine ability to protect against mild infections or asymptomatic infections has not been rigorously tested. In fact, it was not one of the criteria for success because it was not a criteria in the trial. Now, here is a peculiar sort of careful ambiguity. Omicron as a virus strain clearly infects vaccinated people quite efficiently as compared to last year's strains or 2020 strains, which really did not even infect people particularly efficiently. However, upon infection with Omicron, illness amongst the vaccinated as we just commented remains by enlarge mild, people don't land up in hospital at a very great frequency and so on and so forth unlike amongst unvaccinated people with Omicron. So in the formal sense, the vaccines, all vaccines appear to be providing respectable protection against serious illness by Omicron strain. But because they are providing far less protection against mild or asymptomatic infection by the Omicron strain it now becomes possible to begin to do a certain amount of carefully ambiguous hair splitting. What do we mean by don't protect? Oh, the mRNA vaccines generate a lot of antibody, a lot of antibody, even if it is against 2020 strains does provide some reasonable protection against mild disease and infection whereas some other vaccines don't. But that wasn't the original point. This is what the WHO, its director general with COVID task forces and groups have repeatedly pointed out that therefore, all vaccines work well, whether 90%, 80%, 75%, these are relatively small differences that shouldn't affect the decisions to use vaccines in public health policies. However, if you are competing for sales then of course, every small and or simply perceived difference is grist for your advertising bill. When that is coupled to what I'm calling vaccine nationalism and vaccine nationalism has a mercantile capitalist component as well as a straightforward xenophobic component then you will see what you are in fact seeing which is name calling between the manufacturer between vaccine originators and manufacturers in the global north versus elsewhere. Quite interesting because again, both the Chinese and the Russians based on their respective tests have said these claims are not viable. In fact, the Sputnik manufacturer originators have said they are providing better protection and all of this is open to really questioning because as you said, the original trials never indicated whether there was a protection at all against even asymptomatic or mild infections. In fact, the criteria very carefully spelt out serious infections and that was always the target for what the vaccines were designed. So interesting that how that is now being twisted into something else based on antibody titers which is what you see. And as we know, antibody titers and how they prevent the correlation between prevention of infection and antibody of course, theoretically is there. But again, testing to test to really bear out whether this level of antibodies will stop infections completely or not still an open question. Very much. But all that said, let me point out something that is of relevance to India. And that is the nature and quality of evidence about co-vaccine. Co-vaccine is an inactivated virus, whole virus particle vaccine. And it was created in the ICMR laboratories. It is manufactured and distributed by an indigenous manufacturer and so on and so forth. What by now should have been gathered is real-life evidence about what the differences are, if any, between say, co-visualed generated immune responses versus co-vaccine generated immune responses on the one hand. And even more than that, whether in the current Omicron based outbreaks whether co-visualed vaccinated people and co-vaccine vaccinated people have any differences in how frequently they land up in hospital in critical care. That would have been an important scientific question for which straightforward evidence should have been gathered. That we have not gathered it, does not speak well of our commitment to evidence-based, transparent decision-making. There are lots of other issues on that count, how well we are using our data for our public health policies. Big question mark, how much we are actually covering the sections which are really find access to vaccines difficult, as you have said, backward areas, villages, rural communities, among the rural communities, also those who are marginalized in social ways. All those questions are there. But again, that data, if it is available, is under lock and key. Those researchers do not really have access to that and that researchers have pointed that out time and again that can we get better access for public health purposes to this data? And we also have the other issue that though a number of vaccine makers have got clearances to start to manufacture. They have been given clearances to actually produce vaccines and distribute it. I think it's happened on that count, you have pointed it out earlier as well. So what is stopping them from doing? So these are some of the questions we will discuss later, not today because we're running out of time, but Satyajit, we want to come back to the issues that we have discussed partially in the passing, so to say with more detailed discussions on the same. Thank you very much for being with us, explaining to us what the issues are and what could be the way going forward. This is all the time we have for NewsClick today. Do keep watching NewsClick and visit our website.