No excuse for India’s slow response to Omicron
The nation should be alarmed at the slow manner in which the administration has responded to the snowballing nature of the pandemic in the light of the spread of the Omicron variant of the Sars-Cov-2 virus. In fact, it is more like a non-response, almost a carte-blanche given to the virus, if that is possible, to do its bidding. This is even more surprising given the experience that India has had and the devastation that has been seen with the first and the second waves of disease in the evolving pandemic situation.
Omicron was and is causing severe disease in other countries in lesser proportions than with Delta – but the sheer magnitude of infections was sure to cause an increase in disease cases, mostly affecting the senior citizens, those with risk-prone medical conditions, pregnant women etc.
It was more than a month ago, on 26 November, 2021, to be precise, that WHO declared Omicron to be a variant of concern in the ongoing pandemic. WHO took just two days after the announcement from South Africa about this variant to issue its warning. Scientists in South Africa provided early signals of two sinister properties – transmission efficiency higher than that of the then record-holder, the Delta variant, and Omicron’s ability to dodge immunity, whether induced by infection with other variants or the locally used vaccines, mainly mRNA, even two doses. That WHO made the right decision at the earliest is a lesson in the process and spirit of an “evidence-based decision”. Early decision was critically important and the available evidence was judged to be sufficient.
When confronting a probable problem, the decision may range from none for the time being, to deferring for more evidence, to making a conditional decision or a making a definite decision. Evidence was not the only factor in the equation, but also the adverse impact of any delay. We could disagree on whether the evidence was sufficient or not. But no one will doubt the wisdom of an early call, for such early and decisive announcement gave all countries of the world information for early action.
Are we doing this because Omicron apparently causes less disease among the young, the fit and those with means?
Japan, the country that had enjoyed two months of endemic prevalence of COVID-19 since end-September, decided to block importation of Omicron by disallowing all arrivals of travellers from any country. But the virus had already entered Japan through a twice-vaccinated Namibian diplomat. Japan abandoned the no-entry policy but is bracing for a new wave with all other well-known defences, including booster doses. India must watch the situation there.
India had been enjoying endemic state for over four months, from the second week of July till 26 November. Our stakes were high; we did not desire a third wave. Life was limping back to normal; educational institutions were open. Elections were approaching in Uttar Pradesh. Immediate intervention to block a probable third wave was the expected response, but that was not the strategy the policy-makers opted. They chose not to make any decisions for the time being.
That decision, to apply no intervention to block a wave of disease or at least to flatten the probable epidemic curve is very strange, almost as if the policy-makers were deliberately unconcerned about the risk of a third wave. Experience in other countries clearly showed that India must expect a huge rise in infections. Omicron was and is causing severe disease in other countries in lesser proportions than with Delta – but the sheer magnitude of infections was sure to cause an increase in disease cases, mostly affecting the senior citizens, those with risk-prone medical conditions, pregnant women etc. There was no reason for expecting zero-risk of a wave of disease. Why would a government defer action then and seemingly welcome a fresh wave?
The pace of vaccinations was about 1% of population covered per month, slowly increasing to 2% but no more until the second wave abated naturally. We could attribute that to traditional inefficiency, slow rollouts, mismanagement at logistics, distribution and a host of factors that come into play when such a large operation gets into the works.
The response strategies adopted against the first and second waves do not provide any clue. No vaccine was available during the first wave. Vaccines were approved for ‘emergency use’ on 3 January 2021, almost three months prior to the second wave. But significantly, no effort was visible to use vaccination as a method of mitigating disease, hospitalisations and death. That was also surprising and disappointing. The pace of vaccinations was about 1% of population covered per month, slowly increasing to 2% but no more until the second wave abated naturally. We could attribute that to traditional inefficiency, slow rollouts, mismanagement at logistics, distribution and a host of factors that come into play when such a large operation gets into the works.
But now none of these should be factors. We have enough vaccines to create a wall of population immunity to dampen the onslaught of an impending Omicron wave of disease. Yet, one full month, 26 November to 26 December, passed without any sign of using vaccinations to mitigate the size or severity of the potential third wave. Then came a decision for deferred action, minimal, more tokenism than substance. The age range of vaccination will be enlarged to cover adolescents of 15-17 years, starting on 3 January. Even if we achieve high coverage, which is very unlikely seeing no imaginative plan of action, this response is unlikely to affect the shape or mass of a third wave. In effect, our delayed response will make no impact on a possible third wave, which will come and go, if it wishes, the way it wishes, when it wishes. We have surrendered to whatever the virus does.
The lack of prompt action in increasing vaccine coverage this time cannot be condoned
Another deferred action is to offer a booster dose for those above 60 or those with medical conditions as well as for front-line workers – healthcare and others. But stipulating a minimum of a nine-month gap between the second dose and the third dose, instead of the suggested and science-based six month-gap informs us that the government is in no hurry to reduce the impact of a third wave on the lives and health of the vulnerable people.
These decisions were announced without explanations or supportive logic. They create the impression of action. But underneath that façade is also a message that the government is in no hurry to fight Omicron and reduce the misery it can bring, particularly on vulnerable sections of society. We may even ask – are we doing this because Omicron apparently causes less disease among the young, the fit and those with means. Are we not bothered about the elderly, those who are ailing or those whose immunity has been compromised?
If that is not the intention, actions would have been quicker and more goal-oriented – not merely trickling, minimalistic and ritual-like. Even if we let pass the response at the time Covid-19 first struck or during the two deadly waves, the lack of prompt action in increasing vaccine coverage this time cannot be condoned.
(Dr T Jacob John is retired Professor of Clinical Virology, Christian Medical College, Vellore, and Past President of the Indian Academy of Pediatrics)