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India’s top virologist, Gagandeep Kang, has said the government must prioritise second jabs for people who are aged over 60 and those with comorbidities, before vaccinating other age groups.
In a 44-minute interview to Karan Thapar for The Wire, professor Kang, who is a professor of Virology at Christian Medical College in Vellore and a member of Britain’s prestigious Royal Society, delivered several sharp wake-up calls to the government. She said the government must prioritise second jabs for people over 60 years of age as well as those with comorbidities rather than focussing equally on all age groups.
Professor Kang, who is also a member of the government’s COVID-19 Working Group, also expressed her concern that “we have no evidence on whether protection is declining with time. We have no data”. If the data is with the government it’s not been made public. She also said that we should do everything we can to open imports and bring in other vaccines available to the rest of the world.
She was referring to mRNA vaccines made by Pfizer and Moderna. She said the immunocompromised section of the population “needs them immediately”. However, she said there is no need to reduce the gap between two doses of Covishield because we do not have evidence that reducing the gap will increase the number of jabs. From an immunological perspective, a 12-16 week gap is best and we should, therefore, stick to it.
She first spoke about the need to focus on second jabs for the people aged above 60s and those with comorbidities.
Data provided to The Wire by professor Rijo John suggests that 45% of people aged above 60 haven’t had a second dose and 45% of people aged between 45-59 haven’t received the second dose. Professor Kang referred to this data and said: “It’s very worrying that such a large proportion hasn’t had a second dose.” She said this must be the government’s top priority rather than concentrating on all age groups equally. In fact, she said: “Every person over 45 must be covered because this is the age group that has comorbidities.”
She revealed that the COVID-19 Working Group and National Technical Advisory Group on Immunisation (NTAGI) have been repeatedly advising the government to ensure that people aged above 60 are fully vaccinated, but that advice doesn’t seem to have been acted upon.
On asking whether this advice is being ignored by the government, she said: “The COVID-19 Working Group is an advisory group. NTAGI is also an advisory group. Execution is in the hands of the government.”
She further said: “I’m sure the government is doing the best it can.” On pointing out to her that it seems “the best the government can do” is not good enough, she replied saying that this was the first adult immunisation programme of this scale, as if to suggest this was an explanation for the government’s best falling short of what is required.
However, professor Kang said she would “not be particularly worried if every adult does not get two doses by the end of the year”. She reiterated: “We need a laser focus on two sets of adults as soon as possible – the elderly and those with comorbidities”.
A booster shot?
She also spoke about whether “boosters” need to be given to people over the age of 60. On this issue, she analysed the difference in data available in the West and in India.
She said, “Abroad it’s quite clear that protection against hospitalisation and death declines with time.” Governments have to decide at what point of decline will they choose to give boosters. Some countries like Britain have done it when the protection from hospitalisation has fallen from 95% to 80%. Others may choose to do so at 70% or even 60%.
The problem in India, she pointed out, is “we have no evidence whether protection is declining with time. We have no data.” She further said that she assumes the government has this data but it has not been made available to her even though she’s a member of the government’s COVID-19 Working Group and widely considered the country’s foremost vaccine scientist.
“I am assuming the government has it,” she said. “We have vaccine tracker data, but it does not break down by age, location or vaccine.” More importantly, she added, “there is no .”
This means India does not have available in public data that would establish clearly the need for boosters for people over the age of 60. If such data exists with the government it’s being held in secret and has not been made public or even available to people like professor Kang.
Senior data analyst, Rukmini S., who has done excellent work on excess COVID-19 deaths, has in a recent paper established that in Kerala, Tamil Nadu and Mumbai, where the ages of COVID-19 deceased is recorded, there is an uptick in the deaths of people aged over 60. Referring to the paper, professor Kang said this is not conclusive but it’s an indication that seems to corroborate the British finding that efficacy against hospitalisation and serious disease dips after six months.
In Britain, where AstraZeneca was widely given for the first and second jabs, it’s deliberately not been given as a booster. The booster in Britain is Pfizer. So what vaccine should India use for boosters?
“This is a very important question. If based on antibody data, mRNA and protein vaccines are the best for boosters,” she said.
Two protein vaccines, Covavax, which is Serum Institute of India’s (SII) version of Novavax, and Corbevax, made by Bio E, and an mRNA vaccine being made by Gennova could be considered if only India-made vaccines are to be used for booster doses, she said. However, she added, none of these vaccines have been cleared by the Indian drug regulator, though Indonesia has cleared Covavax and is importing five million doses from SII.
“We should do everything we can to open up imports and bring in other vaccines available to the rest of the world. We have a section of the population that needs them immediately – people who are immunocompromised.” Asked if was she talking specifically about Pfizer and Moderna, she said: “Yes. It would be great to have them”.
On asking whether India should give Pfizer or Moderna as boosters rather than the third dose of Covishield – which is what Britain is doing – she said it all depends on the data as per the Indian situation. That data is being collected through small research studies but it’s likely to be partial and not complete. This is because we can assess the impact of a third Covishield jab but not a Pfizer booster jab because Pfizer is not available in India.
The above is a paraphrased precis of professor Gagandeep Kang’s interview with Karan Thapar for The Wire. Though recounted from memory it is not inaccurate. However – and I want to emphasise this – there is a lot more in the interview than has been covered by this precis. The richness and detail with which professor Kang spoke is missing as are also some of the issues and subjects which were raised. Therefore, if you want to fully understand her perspective and viewpoint you must see the full interview here.