New Delhi: For India, vaccinating essential workers — such as healthcare staff who are most exposed to the novel coronavirus — before everyone else will be the best strategy to follow in order to tackle the coronavirus pandemic, said Devi Sridhar, a public health expert and professor at the University of Edinburgh.
Speaking to ThePrint’s Editor-in-Chief Shekhar Gupta in the latest episode of Off The Cuff Tuesday, Sridhar explained that vaccine strategies differ depending on how one wants to deal with the virus.
“If the vaccine is aimed at reducing deaths, then the younger people will have to learn to live with the virus. If, on the other hand, the strategy is to break the chain of transmission, the vaccine should be given to super spreaders such as healthcare workers, social workers, who are exposed a lot to the virus,” she said.
“For measles, for example, we vaccinate the 80 per cent of the healthy people to protect the 20 per cent who can’t take the vaccine. For flu, we vaccinate the most vulnerable to prevent deaths,” she added.
Sridhar said that for a disease like Ebola, “we vaccinate to eliminate the virus completely. So a vaccine can be used for different ways and for different strategies”.
“What struck me looking at India is that about half the deaths have been people under the age of 60. Which means even if you vaccinate everyone over the age of 65, you wouldn’t prevent many of the deaths,” she added.
Sridhar suggested that in India, the best vaccine strategy would be to use it as a “strategy of suppression”. This would mean going after those who seem to be most likely to be exposed to the virus — the essential workers — who are out every day, she said.
Adopting the flu strategy — that is vaccinating the elderly — is very hard with this virus as the SARS-CoV-2 is also fatal for people under the age of 50, according to Sridhar.
Why India fared better
Sridhar said India’s proactiveness helped the country fare better in tackling the pandemic than high-income countries.
“I think India tried to respond much earlier than European countries and understood the severity,” she said, adding the effort in testing and tracing cases was huge.
“I think what probably was quite a difficult decision was the lockdowns and the economic harm done through lockdowns. We saw the images of migrant workers walking for hours, days, because there was no work for them anymore,” she said.
The lesson from India is that lockdowns are really the last resort. If people have the choice between feeding their family or getting Covid, they are probably going to choose the latter, Sridhar said.
She said governments must make sure that people never have to make such decisions again.
Commenting on why Covid fatality rates in India are much lower, Sridhar said it is because the country has a younger and healthier population, overall.
“People also got treatment much earlier. In Western countries, people were asked to stay home until they were really ill. That led to people getting to the hospital at quite a late stage, or even dying at home,” she added.
Herd immunity is ‘immoral’
Sridhar severely criticised the strategy of achieving herd immunity, calling such ideas “immoral” and “unscientific”.
“We have never used herd immunity as a strategy to any infectious disease. In the past, we’ve never said — whether it’s cholera, plague, malaria, or TB — that just let people get it,” Sridhar said.
She added that while the idea may look great as a computer simulation or in theory, such a risk with people’s lives and economies has never been taken before.
“People seem to think either we take Corona deaths, or we have our normal life,” Sridhar said.
“Uncontrolled transmission is actually the worst thing for your economy because people get scared — their behavior changes.”
Sridhar pointed out how at the peak of the pandemic in Europe, health services were overwhelmed, forcing countries into lockdowns and restrictions. This is because the SARS-CoV-2 virus leads to high rates of hospitalisation.
“So in a way, this herd immunity strategy is going to lead to a lot of deaths, economic pain, as well as health services being overrun,” she said.
Sridhar pointed out that even Sweden, which was an early advocate of letting the virus run its course, has now changed its strategy.
“If you look at their approach now, the town of Uppsala has gone into kind of a light lockdown,” she said.
The people in the town were asked to avoid public transport, meet people, and advised to work from home.
The idea, Sridhar said, is to see if people can be trusted to follow the guidelines, without using legislations to force restrictions on them. Whether this strategy will work or not is yet to be seen.
“We’ve tried that in the UK and we find it the opposite. If you tell people that bars are closing on Monday, on Sunday, there’s a huge party in the street and everyone says it’s our last night to party — let’s celebrate,” she said.
“I don’t think Sweden is just letting the virus run (anymore). They’ve taken a lot of deaths especially among the elderly. And I think they’re trying to avoid repeating that,” Sridhar said.
West lacks humility, needs to learn from countries like India
Sridhar said East Asian countries like South Korea, Hong Kong, Taiwan, Australia, New Zealand have won, both in terms of public health and their economies.
“Taiwan is seeing an increase in GDP — it’s astonishing,” Sridhar said, adding that it was only possible because the country dealt with their public health problem first, before trying to deal with their economic problem.
“They figured out how to get international travel going by forming travel bubbles,” she said.
“I personally lean to the East Asian model because it is a path that avoids a lot of death, economic damage, and keeps your society running.”
All of these countries’ governments used data science and have been advanced in their planning.
“Japan never did a lockdown. They have given good advice around face masks and avoiding crowded places,” Sridhar said.
She added that lack of humility among high-income countries has led them to be so badly affected by the disease.
“Britain or America are so used to telling the world what to do, because we are seen as the leaders, especially in pandemic preparedness, the UK and US are always ranked the highest.”
But Sridhar wondered if these countries would have been better-off if experts from other countries like India, Senegal or Malaysia had come in to point out the failings in their systems.
She also pointed out that African countries responded really well to the virus because of their previous experience with the Ebola pandemic.
“They took their post-Ebola recovery structures and made them Covid-response structures. And because they had all the infrastructure in place for how they responded to other infectious diseases, they just layered Covid on top,” Sridhar said.
Africa learned its lessons, but these lessons never reached rich countries like the US, she said. The US responded much worse because the leadership in charge did not acknowledge the seriousness of the problem of Covid.
Even within India, you have different states, who are managing remarkably well, she added. But in the UK, they are making excuses, Sridhar said.
For example, they are saying Vietnam did better because they have lots of bats or Hong Kong did better because SARS circulated through their whole population already.
Sridhar, however, believed that it was actually the policies of these countries that helped.
“They really were on their front foot. Africa CDC (Centres for Disease Control and Prevention) was briefing health ministers in January, warning that the virus will strain their health system. They immediately implemented their travel bans.”
It is because of their experience with Ebola, they knew it’s no joke, Sridhar said.
Vaccine ‘not the fairy tale ending’ to the pandemic
Sridhar said while it is essential to suppress the spread of the disease, vaccines are not the “the fairytale ending” to this pandemic. Rather it is an additional tool in the fight against Covid-19, she said.
“A vaccine will help us get to the normal alongside testing and alongside better treatments, but it’s only a part of your strategy,” Sridhar said.
“I think we need to be realistic with people of what a vaccine can and cannot do,” she added. “We’re not going to have enough doses to vaccinate everyone on the planet. So it’s not going to be like we can just vaccinate everyone and we go back to normal life.
“I’m not in a rush to quickly get a vaccine and take it myself, I’d want to see the full study results and make sure phase 3 is completed fully.”
Sridhar added that vaccines must get full scientific approval through proper channels. She also said the first vaccine may not even be the most effective one and the one that takes a bit longer may be more effective.