On March 11, Covid-19 was declared a global pandemic. Months on, in a wide-ranging interview with TOI, the World Health Organisation’s Chief Scientist, Soumya Swaminathan, discusses prevention measures, risks from cold weather and vaccine availability. Excerpts:
When will the vaccines start to arrive?
Nearly 40 clinical vaccine trials are ongoing across the world. Nine vaccine candidates are in the late stages of testing — either phase 2 or phase 3. India is currently undertaking clinical trials of three vaccines and planning more. But efficacy and safety data are key. Companies that started phase 3 trials between July and September should begin to publish results by later this year or early 2021. The first beneficiaries will be frontline workers and other high-risk groups. If we were to set a target to cover at least 60 to 70% of the population across all countries, it would likely not happen before the end of 2022.
What do we do till then?
The world is at a rather precarious stage. The winter months in the northern hemisphere will increase risk of indoor spread. People will need to use masks, practice physical distancing, wash hands and avoid crowded, poorly ventilated settings for the foreseeable future. Case fatality rates have been dipping for a number of reasons, including better management of seriously ill patients by medical staff.
What can India do to bolster emergency response?
We should focus on the implementation of the National Health Policy 2017, which prioritized strengthening of public health systems, including the need for a public health cadre. While guidelines are formulated nationally, responses to local health problems should be tackled bythe local leadership. We observed early in the pandemic that even high-income countries with excellent tertiary healthcare infrastructure struggled to cope as they became quickly overwhelmed. Others, with good primary healthcare systems, fared better then these countries.
What steps should India take in this direction?
India needs to invest in surveillance, preparedness for outbreaks; field epidemiology capacity; and in a laboratory network. We have to leverage new innovations to tackle our major health issues. Some examples are the use of contact-tracing apps, new diagnostic tools such as rapid antigen tests and the massive scale-up of molecular testing platforms, which can be leveraged to tackle other infectious diseases like tuberculosis.
What is the road ahead?
One way ahead will be to focus on three ‘R’s: Rebuild, Reimagine and Reject (systems that have not worked). There is a need to rebuild not just our healthcare delivery systems, but revisit policies and processes. There is also a need to reimagine methods of data collection — the old paper-based data collection is inefficient and slow. We need to use the digital technologies we now have. As a core principle, I would focus on equity and inclusiveness, which includes digital inclusiveness. This is most important for the health and education sectors as we need to avoid the situation of the most marginalized being left out. Along the way, we also need to work towards a sustainable and healthy future. We can start with ensuring our health facilities are run on solar energy and have adequate water and sanitation. The world needs to pay attention to climate change and deforestation, which increase the chances of zoonotic infections in the future.