Health workers prepare for the dry run of COVID-19 vaccine at a community centre, in Gurugram, on 7 January 2021 | PTI Photo
Health workers prepare for the dry run of COVID-19 vaccine at a community centre, in Gurugram, on 7 January 2021 (representational image) | PTI Photo
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As we start 2021, the Covid-19 epidemic in India has progressed to a point where a near majority of the population has developed immunity to the virus. Though too many have died, India’s Covid death rate is, fortunately, lower than many other countries. With the vaccine roll-out imminent, there are reasons for optimism after a challenging year.

The primary question at hand for Indian Covid response policy planners is how best to use the vaccine — roll-out for which in India begins from 16 January and will target three crore health staff  — to minimise the harm from the disease until the end of the epidemic. Given the size of the population and the rate of production of the vaccine, it may take a considerable amount of time to vaccinate the entire population. So it will be necessary to choose who receives priority.

Despite the deployment of the vaccine, many countries – including the US and UK – continue to impose lockdowns as the primary means of controlling the virus’s spread. The results have not been good, with both cases and deaths rising despite the shuttered businesses, schools, and places of worship. Indian policy planners should take full advantage of these bad examples and continue to avoid lockdowns that have devastated the lives and livelihoods of millions of poor people throughout the country.

We know from the mortality statistics that the Covid infection poses the greatest risk to older populations. Worldwide, the infection survival rate for people under 70 is 99.95 per cent, while the analogous number for those aged 70 and over is 95 per cent. So, the only ethical choice requires offering the vaccine to people aged 70 and older first, as well as to the frontline health workers who care for Covid patients.

The problem is that, with 88 million elderly citizens in India, there will not be enough doses in the immediate future to vaccinate them all for months to come. We argue that inoculating only people who have not been previously infected provides an efficient way to target the vaccine at those who will benefit from it most.


Also read: Russia’s Sputnik V vaccine has no peer-reviewed data yet. Question is — would you take it


Immunity after recovery from Covid

The scientific evidence is overwhelming that natural immunity attained after recovery from Covid infection is effective and long lasting. The immune system responds to infection by various mechanisms, including the production of specific antibodies, T-cells, and B-cells to protect nearly every recovered Covid patient from reinfection. After almost a year of pandemic, globally, only 34 cases and two deaths have been definitively identified as reinfections at the time of writing, out of the 90 million Covid cases and likely hundreds of millions of infections worldwide.

Vaccines cause the immune system of those inoculated to mimic the immune response that natural infection induces. While the immunity conferred by the Covid vaccines documented in the clinical trials is excellent, it is not as effective as the immunity conferred by natural infection.

Furthermore, those who have already developed immunity to Covid through natural infection are extremely unlikely to develop additional immunity from vaccination. For instance, in the Pfizer randomised trial, the vaccine was tested in previously infected patients to check for its safety in that group. But those same patients were excluded from the analysis of efficacy, presumably because the scientists understood that the vaccine would confer no additional benefit to them.

Every vaccine has some side effects, and though the approved Covid vaccines are safe, they are no exception. Most of the side effects are mild – soreness at the injection site, aches and pains from the immunological reaction – but very rarely, severe adverse events do occur. For recovered Covid patients, then, the vaccines provide no benefit and some harm. It is thus unethical to vaccinate them.


Also read: How India’s regulatory pitfalls helped Covishield and Covaxin get rapid approval


India is reaching very high level of natural immunity

These considerations are not merely of theoretical interest because an enormous proportion of the Indian population has already been infected and recovered. While the officially reported figure of Covid cases in India is around 1.4 crore, mathematical models imply that more than 50 per cent of the Indian population may have developed natural immunity to the virus.

This fact is corroborated by serological tests for Covid antibodies carried out commercially on a large scale by Thyrocare. The founder of Thyrocare, Dr A. Velumani, says that “nature… already has immunised, freely, silently 70% Indians”.

Though this may sound like bad news, since it implies that nearly a billion Indians have already been infected, the silver lining is that the vast majority have recovered from infection and have lasting immunity to reinfection. They will likely be better protected from Covid over a longer period of time than those who achieve immunity via vaccination since it is not clear how long the vaccination-induced immunity lasts.

Checking for previous infection is simple. Before vaccination, patients should be asked if they have been previously infected, and if the answer is no, an inexpensive test for antibodies should be administered. Only if that test is negative should the vaccine be administered. This procedure will not capture all previous infections since antibodies fade after a few months, and many infected people were never identified as cases. Still, this procedure will nevertheless spare a large number of people from unnecessary vaccination.

Thus, reserving vaccine doses for people who have not been previously infected could solve the problem of excess demand for the vaccine by the vulnerable in the early months of the vaccine roll out when not enough doses will be available for all.


Also read: Vaccine maker IIL, other companies in touch with Moderna to bring its Covid vaccine to India


Prioritise the vulnerable for vaccination

In a disease with high asymptomatic cases and low morbidity or infection fatality rate, the first goal of vaccination is to reach herd immunity and not 100 per cent eradication through universal vaccination — that would be simply impossible. The only human virus that has been entirely eradicated from the face of the earth is smallpox, and that effort took decades despite the availability of an excellent vaccine. Chasing this impossible goal would impose great harm to India.

By contrast, a swift, focused protection strategy of vaccine administration, which prioritises the most vulnerable who have not been previously been infected, would reduce death rates from Covid infection to nearly zero and is a far better strategy.

Once the vulnerable are protected, even while the vaccine is administered to the less vulnerable younger populations, the Disaster Management Act’s lockdown restrictions should be lifted fully and forever. The economic, physical, and emotional harms from the lockdown far exceed the mortality and morbidity risks from Covid infection for less vulnerable people. Since either vaccine-induced or natural immunity would already protect the vulnerable, there would be no ethical reason for the remaining lockdown restrictions to be in place.

Sanjiv Agarwal is the founder of the Good Governance India Foundation, Mumbai. Jay Bhattacharya is Professor of Medicine at Stanford University. Views are personal.

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VIEW COMMENTS

58 COMMENTS

  1. NATIONALIST PROPAGANDA… this didnt age well did it? Perhaps you may learn something from experience. or maybe you cant learn anything at all…

  2. Indian Ayurveda and Indian medicinal system is way contrarian to western concepts

    Our concepts are strengthening internal immunity and facilitate repairing within ourselves…

    Propping up the body mechanism with external inputs, will eventually disable our own mechanisms at our own peril

  3. People opposing the contents of this article should see real downward trend of the disease in India in spite of gross violations of ‘Covid19 appropriate preventive measures’ at all levels including festival related, religious and political gatherings in India for the past few months.

    As per the epidemiological triad, in any communicable disease fertility of the ‘soil’ (human) is more important than the ‘seed’ (pathogen) in causing devastating effect in a given population. For both unknown and few known reasons the the corona is kind to us when compared most of the developed nations.

    I fully agree with you.

    • Well this comment didn’t age well now did it. That’s what happens when you believe articles written by pseudo intellectuals rather than listening to professionals.

  4. The kind of references you give -its unfortunate. Dr. A. Velumani’s Thyrocare has been banned in many areas due to false reports. Check your facts before you mislead people.

    • The number of daily new corona infected and deaths due to it has drastically reduced during last 30 days quite opposite to opinion of Indian medical experts community whose assessment was that cases in India will tremendously increase with cold winter season.. However Our respected prime minister is crazy of his publicity and tries to take credit out of nothing . The doctor community is also of opinion that those who developed immunity in natural course in last 10 months need not to be inoculated .compelling all the so called FRONT LINE KARM VEER to get vaccinated under threat is neither necessary nor ethical .Secondly it will be sheer wastage of vaccine and labour being put in for the job . However expressing opinion which may not please blind BJPwalas invite risk of being termed as ANtI NATIONAL may be put behind jail bars.

  5. Even I read article where author is against the lockdown and saying if there will more lockdown then its a foolish decision. There is some case of late 1980 same pandemic as covid but they chose to reopen, they haven’t imposed any lockdown and result were good as compared to covid scenario.
    So we should urge government to reopen schools and colleges.

  6. The people who think this article is irresponsible are advised to check the credentials of the authors before leaving their ill informed comments

  7. I have lost all of my respect for print
    What a shame .
    Why is print speak like an anti vaxxer
    All of the things say in the article is not right

  8. Please arrange a big research to prove your hypothesis that majority indian have natural immunity and shut down your your journal and open a laboratory.
    Then only you will be able to understand what type of immunity you have when u write such a irresponsible article …

  9. What are the credentials of the authors? Are they experts in virology? Or experts in vaccines?
    All the statements are written as they are facts whereas they are not. Click bait article headline,

  10. HOPELESS article! If vaccine is not needed, why it was developed at all?
    How vaccine is harmful if it is attenuated or killed?
    Why whole population takes polio vaccine??

  11. No Muslim and Christian should take vaccine. Made with pigs blood. Created by evil Modi, Modi bad man, no take vaccine. Only vaccine should be left for evil Hindus.

  12. Many things are incorrect in this article.

    The goal of lockdowns is to prevent the spread of infection while gearing up to face the spread that has already occured. Preventing infections reduces death and long term illness that is produced by Covid. Please remember that sick people cannot work well. Thus prevention of infection is crucial to a healthy workforce and economy.

    Sweden initially did not go for lockdowns and was hit with a double whammy – the people and the economy both suffered. Countries that managed the first wave well and brought numbers down with lockdowns suffered relatively lower losses.

    Vaccines have only just become available. One of the reasons that there is widespread infection despite lockdowns in some countries, is that people are not following the rules. Thus, we cannot say that vaccines have failed in preventing infection. It is actually thought processes like the ones in this article, that have caused more infection to spread.

    This article claims that immunity after Covid is long lasting, but the basis for that claim is an article which says that the immunity lasts for 8 months. Is 8 months long lasting?

    What is the evidence that Indians have better immunity?
    The best option is to vaccinate, with an effective and widespread programme, so that society is protected.

  13. Really nice article or I can say that the only article that throw some light on this topic in these dark times.

  14. Polio vaccine was well researched and effective. The current Covid vaccines did not have that much time to be properly developed due to the nature of the pandemic and these vaccines are all only emergency approved.

    We will have to wait and see how people react to the vaccine first and then later on see if the vaccine is effective in the population. The authorities and scientists are learning more on the go. No one is totally sure.

  15. Unsubstantiated personal views of the writers have the potential for larger harm than good of the population. Vaccines in general are extremely useful tool for minimizing morbidity and mortality since ages…….as the State Immunization Officer for nearly a decade I have witnessed collapse ( demise) of polio and near containment dangerous measles diseases in young children so this write up negates the very concept of immunization

  16. The pandemic is almost over in India because of masks and social distancing. The virus is not able to find new people to infect due to this. However if we remove our masks, the virus will find it’s way to spread gain. So vaccinating will be of benefit if we have to quickly recover our economic and social life.

    I am interested in the real data behind Thyrocare claims that majority of Indians have already produced SARS COV-2 antibodies.

  17. Extremely irresponsible article! You have no idea of the negative impact this can cause to the vaccination drive! Someone should report this. Freedom of speech and freedom of press can not be a tool to misguide the mass at such a critical point. This article has no scientific data backing it! No sane doctor will ever back this theory!

  18. Its highly disturbing to see seemingly educated well placed Indians react in such a manner to an article. The tone and the language is shocking. Saying “shame on you” or “i doubt your degree” just shows the amount of venom people are filled with. All the nastiness that can’t be released in a direct confrontation finds an outlet here.
    The article may seem inaccurate but there’s no doubt that it is well-meaning. It is also mentioned at the end that the views expressed are the authors’ personal views. The authors are respectable citizens of the country and dont deserve this kind of treatment. If one doesn’t agree, he can ignore the article. I am sure people who read these posts are also intelligent enough to decide what they want to believe as true and what they want to reject. So asking the editor to regulate and filter such posts is unreasonable.

  19. Can’t believe thePrint decided to go ahead with this. The article is factually incorrect, wildly speculative and editorially immoral.

  20. This irresponsible headline and the content within is playing a spoilsport in educating people regarding the importance of vaccination. I am already receiving whatsapp forwards, citing this headline and asking not to get inoculated.
    I expected better editorial filtering and standards by Shekhar Gupta.
    Please change the headline and write a follow-up clarification artical asap.

  21. This is post is highly irresponsible. To say the US & UK are witnessing high incidence of disease and stricter lockdown although they have ‘deployed’ the vaccines is totally misleading. The percentage of people actually vaccinated is miniscule. The impact was never expected before a good 50% are vaccinated.

    Let’s be careful about expert sounding ipinion pieces which start with a wrong premise.

  22. Aise articles na likho. Already it’s going to be difficult to convince people to take vaccine. Such articles will only make it further difficult. People with little analytical brains already know this. And they are the ones taking precaution too to not acquire the virus. The rest who are not cautious are the ones who need the vaccine

    • This article has a very narrow view about the risks involved getting the virus. From what I know here in Israel, people who were infected and ” recovered” some have side effects. The best for the planet we live in is to get vaccinated so that we would get heard immunity.
      Here in Israel (9 million people) about 2 million people hot the first vaccine’s shot, and desperately are waiting for the 2nd shot. We implement the green passport; if you got a vaccine, you could be free to enter s theatre, hotel…
      So our freedom depends now on whether we have it or not. I think the world is stepping toward this direction.

  23. This is an utter non sense article. Mr Jay, I really doubt your degree. Shame on you to spread such confusion in public. If this is so, you should not have given polio vaccine to your kid. When it comes to your family, you follow utmost safety, but for others all this idiotic philosophies. Shame on you

  24. What nonsense are you talking? Do you even have scientific proof to back up what you are saying?
    Don’t you know that studies have proven that antibodies last between 2 weeks to months after you recover from Covidh? Who are you to make these claims? Let a scientist talk – someone who knows what they are saying.

    • Antibodies produced by B celks alone are not enough. T cell memory is also required to kill viruses hiding in cells .

  25. It appears the article is based on assumptions! I am really searching for test to measure Immunity level in a healthy individual it will immensely help in taking necessary doses of Immunity Boosters?

    • There is no scientific definition of what is good or bad immunity. All you can get is immune cell counts from testing. Doctors in India cannot interpret your immunity level by just looking at these cell counts.

      You cannot prove immune boosters work even if you measured your cell counts. Ayush ministry has not yet published any scientific evidence on these boosters.

  26. It is dangerous to say just now that most Indians are immune to the Covid 19 virus. Our current death rate per million population is under 150. Elsewhere there are countries where the feath rate per million of the population is well over 1000! Let’s not count our chickens. Best to vaccinate those most at risk…

  27. Lol.. typical indian Mindset ..
    Just give up when it’s about to get real ..But then again the ‘homemade’ vaccine we are pushing has such low efficacy and have not even set forth the safety details ..
    Our mindset will primed to be anti Vax.

    We all suffered in 2020 ,Some of us died .. only for these guys to push random bogus as ‘natural immunity’ ,Sero surveys are useless when you map it only from metro cities or even towns when majority of your population lies in underdeveloped areas where no one even heard of this thing ..Moreover idk where is this 50% figure is even coming out of even if we take to lose 10 people for 1 confirmed case (assuming no reinfection)(and the state of testing is pretty ok now ) that puts us at still 17 % of the population infected .. ..India! I mean …

    Even if you double that no. To account for our “indian” attitude of slacking off ..it’s still 34% and herd immunity is achieved around 60-70% ,moreover now that the cases are Actually going down due to several prevention measures, the vaccination drive makes sense to prevent Actual deaths ,Human lives are not Statistics…
    Only those vaccine should be approved though whose safety data is sound ..by far only modrna and astrazenca comes to mind.

  28. Even in USA, covid recovered patients will be getting vaccine 3 months after recovery. Relatively less likely that it will cause any severer harm.

    • 6much better than any vaccine that has been approved at present . The Pfizer, Moderna and AstraZeneca vaccines trigger the body’s immunity to the spike protein only unlike natural immunity which is a broader immune response to the overall surface proteins of th virus. Covaxin comes closest to natural immunity but it’s data is still not available for public to understand how effective and safe it is.

    • Your friend has post Covid long haul issues – brain fog, fatigue etc. It does not matter whether it is mild or severe infection. What matters is how an individual’s immune system responds and how much the body reverts back to homeostasis. Some people’s bodies just take a long time to recover and some do not recover at all.

      Vaccinating does not mean one cannot get infected. If anyone gets infected even after vaccination they can still develop those long hauler symptoms during recovery phase. The only point of vaccination is to prevent an infection moving one’s body towards severe or life-threatening stage.

  29. The article has many factual inaccuracies. Neither US nor the UK has imposed a strict lockdown. International travel is being permitted and schools are open. Restaurants, pubs, and Christmas shopping were all kept open. Even places of worship have been kept open. This weak lockdown is considered to be one of the primary reasons for Covid having made a strong comeback. Considering that there are such gross inaccuracies in the write up it is hard to believe the rest of it including the conclusion that vaccination is pointless in India.

  30. A very very absurd opinion piece. The aunties would atleast agree to the studies on lungs if infected people. Which “flu” does that too the lungs? This is just one counter argument. The amount of mischief in this article is not even with condemning! A young completely healthy friend of mine still feels the weakness even after two months post recovery.

  31. This is a problematic view and a very serious topic. Please do another cut the clutter on this subject again. P

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