New Delhi: While most Indian states have precluded the possibility of opening up schools due to the spectre of the third wave, Dr Monica Gandhi, professor of medicine at University of California in San Francisco, said that children can return to physical classes with adequate safety protocols even without immunisation against Covid-19.
An infectious diseases expert, Dr Gandhi said that protocols like masking, social distancing and ventilation can allow schools to reopen as prolonged closure has affected children adversely.
“Children have largely been spared the effects of Covid-19, also a vaccine for children is still being tested. On the other hand, prolonged school closure is affecting children severely. UNICEF has just brought out a report. Children are suffering from mental health problems, eating disorders, learning problems etc.,” she told ThePrint in an exclusive interview.
“With safety, children, including in India, can be back in school even before vaccinations. Masking, social distancing and ventilation are the key. India has plenty of doors and windows so children can get to school even prior to vaccinations,” she added.
Schools in India shut in March 2020 and all classes have been conducted virtually since then. The central government did allow the phased reopening of schools in October last year but they shut again, in late March this year due to rising cases and eventually the aggressive second wave.
According to Gandhi, it is also important to vaccinate children as and when one is approved, particularly in the Indian context where they stay in multigenerational households.
At present, Covid vaccines have been approved in India only for adults though several companies are testing their vaccines on younger people. Bharat Biotech has started a Covaxin trial in children and Zydus Cadila is also conducting trials among younger people.
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Big pharma, rich countries to blame for vaccine shortage
A firm believer in the power of vaccines to end the pandemic, Dr Gandhi expressed concerns about the pace of vaccination across the world, including in India.
“Given that India has been exporting vaccines without Indian people having been taken care of first, was a true tragedy. India is complex, there are 1.37 billion people. I think it was sad that India did not vaccinate fast (enough),” she said.
The professor also blamed big pharma and rich countries for the current vaccine shortages in the country.
“I also blame the world,” she said, citing the patent waiver that was sought by India and South Africa from the World Trade Organization to mass produce Covid vaccines. The waiver was eventually turned down.
“Very soon after President Biden took over, pharma companies wrote to him against this as it would hurt their profits. Biden decided to waive (the patents) but unfortunately the European Union did not. India actually did something very very proactive to avoid this situation and it is the world’s fault that they did not work hard enough to get vaccines to them when we could have anticipated what happened in 2021,” said Dr Gandhi.
Gandhi, who has been working on HIV for years now and therefore has experience with a pandemic, also highlighted her own experience of dealing with big pharma for years as an HIV doctor and their reluctance on patent waivers.
It caused thousands of people to die of HIV in India and South Africa, she said, when medicines were available in the high-income countries.
“I blame pharma, I blame WTO and I blame rich countries,” she added.
She also noted that India may not actually end up having a third wave primarily because of the residual immunity from the massive second wave.
“I do not see a third wave coming in India because of this terrible second wave…that led to a lot of natural immunity and also vaccinations are coming up. The third wave can be avoided.”
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Vaccines work against mutants
Dr Gandhi also laid to rest fears about vaccines not working against mutant variants.
The multipronged human immune system, the professor said, can be better equipped to fight variants if it has been exposed to a vaccine. And this is why India’s slow pace of vaccinations is worrisome.
Gandhi noted that there are two arms of the immune system — T-cells and B-cells, and vaccines elicit both kinds of responses.
This is also why merely doing an antibody test to decide if the vaccine worked, is not the right way to assess whether the vaccine has generated an immune response, she added.
“It is hard for any mutant to avoid T-cell immunity. There are 10 mutations in Delta or 11 in Delta Plus (and even they) cannot evade T-cells. But you can evade B-cell antibodies. We are finding reduced antibody responses against Delta variants for example. So we can get through the Delta variant with two doses but we cannot get through with one dose of a two-dose vaccine,” said Gandhi.
She further noted: “That wasn’t true of Alpha (variant first identified in the UK); we could get away with one dose. Antibodies prevent transmission and help prevent mild disease. We will see more breakthroughs, even mild breakthroughs if we don’t stop the ongoing transmission.”
According to Gandhi, immunocompromised and elderly people may need a booster shot soon but for others, vaccine-induced immunity is expected to last a long time.
But masks, she said, are a must even for fully vaccinated individuals when there are high levels of infection in the community.
“Immunocompetent people, I do not think will need a booster soon. In the future, may be in five years (or) in 10 years. I do not know the duration yet but not likely on a yearly basis … the first clinical trial participants are still being monitored and we are not seeing breakthrough infections in those patients,” said the infectious diseases expert. Breakthrough infections are cases of vaccinated people contracting the disease.
Gandhi further noted that for now, it seems like even with all the mutants, people with a history of the infection are as well protected as those with vaccines but that does not preclude them from taking the shots.
Mutations are mistakes that a virus makes when it is rapidly replicating itself and natural selection is the preferential replication of virus particles with those mistakes that are most conducive to its survival in a given situation. Selection pressure, therefore, is overexposure of the virus to circumstances that challenge it and lead to its evolution to a version that can contend with adversities.
Gandhi does not subscribe to the theory that selection pressure due to vaccines targeting the spike protein is making the virus more infectious.
“Studies have shown that vaccines limit the virus from mutating. The reason it’s replicating and changing so fast is because we don’t have enough vaccines. I don’t think vaccines are providing selection pressure for the virus to mutate, like it happens with antibiotics. It is a very different phenomenon in immunology,” said Dr Gandhi.
While refusing to pick a preferred vaccine, Gandhi specified that she is a votary of the claim that Covaxin may have a better chance against mutants, as it is a whole inactivated virion.
“The good thing is it is really the whole inactivated virion. It gets T-cell and B-cell responses against multiple parts of the virus. That (it works against mutants because mutations happen only in a small part of the virus) is a sound argument. However, even mRNA vaccines are acting against variants,” she said.
“Give whatever vaccine you have. Covaxin is a great vaccine, all others are great too. Anything we can do to give anyone a vaccine will reduce transmission,” Dr Gandhi added.
(Edited by Rachel John)
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