Home Moral guidelines Prevent third wave, don’t wait for it, says WHO chief scientist Soumya...

Prevent third wave, don’t wait for it, says WHO chief scientist Soumya Swaminathan

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As a researcher at the National Tuberculosis Research Institute in Chennai, she visited the homes of her poor patients and even looked after their orphaned children.

Life is essentially a quest for meaning for Dr Soumya Swaminathan, the first chief scientist of the World Health Organization. She proudly carried forward the legacy of her parents, Professor MS Swaminathan, the architect of the Green Revolution, and Mina Swaminathan, an educator.

Hopefully by the end of the year India should find itself in a situation where a large majority are immune and protected.

Each job is rewarding in a different way, says Swaminathan, who has 30 years of experience in clinical care and research. His role as chief scientist allows him to make a real difference in the world. “Being able to contribute to the pandemic response makes my life meaningful and fulfilling,” says Swaminathan, who works in Geneva, Switzerland. “It involves dealing with a new pathogen, working with scientists around the world, advancing clinical trials, developing standards and benchmarks for vaccines and diagnostics, and reviewing guidelines.”
Its ability to articulate and de-argonize scientific terms sets it apart from other scientists. Swaminathan spent his childhood surrounded by books. But they weren’t just about medicine. “I loved Gerald Durrell because I love animals,” she says. “I used to read Sherlock holmes, Jane eyre and adventure books. I have also read Agatha Christie, and many Indian authors like Rabindranath Tagore. I am a big fan of Indian literature, but after entering medicine there was less and less time to read fiction. She now enjoys listening to podcasts on environmental science, economics, philosophy and literature.
In an exclusive interview with THE WEEK, Swaminathan describes what the post-pandemic world could look like. Extracts:

What is your biggest concern about Covid-19 right now?
My biggest concern right now is that we haven’t reached the stage of the pandemic where we can feel some degree of comfort … until then.
It really concerns me that schools have been closed for over 21 months in India. A number of children, especially from lower socio-economic groups, will have great difficulty returning to school. Many of them have started to work. Young girls have been married and some have been trafficked and sold. Surveys suggest that the losses in language and numeracy learning are significant and that a concerted effort should be made to help children catch up.
There is a group of kids who were unable to take the online classes … They need some extra support over the next few months. The learning deficit will affect the future lives of hundreds of thousands of children.

You recently said that India may be entering “a certain stage of endemicity”.

Can you explain how and when a disease becomes endemic?

This is an interesting question.

This is the first time that we are faced with this kind of situation where we have a virus that is causing a pandemic and an enormous amount of suffering, death and disease in every country in the world. We now recognize that we may not be able to eliminate or eradicate this virus because the virus is seen not only in humans but also in animals. WHO is working to track down the animal reservoir of COVID-19.
It will continue to infect people. He will always find sensitive people. Among those infected, some will become ill and require hospitalization, and others will die. This is true for all respiratory infections.
One of the factors that determine endemicity is the level of immunity in the population, either due to natural infection or due to vaccination or both.

The other is the virus itself. If it turns into a whole new type of virus, the pre-existing immunity may not work. But let’s hope that doesn’t happen. We hope that the pre-existing immunity will continue to work.
As population level immunity increases and the virus continues to spread in the community, you reach a kind of plateau where there will be constant infections with occasional localized flare-ups, but you don’t. not get the kind of explosive peaks we saw in wave one and wave two.

When will India reach the endemic stage?
Hopefully by the end of the year India should find itself in a situation where a large majority – at least of the vulnerable population – are immune and protected. At this point what will happen is that we can continue to see infections but we will not see as many hospitalizations and deaths ….
About 65% of India is protected. Yet you have over 400 million people who are sensitive. If we stop all the other measures that have been put in place like masking, physical distancing, ventilation and the ban on mass gatherings, the number of infections will increase …. So it is important to continue. security measures.

Do you think children are more likely to be affected in the third wave?
There is no scientific basis for this. First of all, I don’t think we should keep talking about the third wave like it’s definitely going to happen. The idea should be to prevent the third wave and not wait for it to come.

The situation in Kerala is baffling. It represents 70% of Covid-19 cases in India.
I do not want to speak specifically of Kerala. When you have sensitive people and you allow social intermixing and mass gatherings where people do not follow precautions, you will see such an increase in cases. What happens in Kerala can also happen in other states. There is really nothing to prevent this from happening …
The major subways were all saturated by the second wave. This is why I think the risk of spreading this infection is more present in rural areas and in places where the second wave was not so severe. These are the places where people are still susceptible, if they are not vaccinated. It is therefore important to strengthen vaccination in areas where the serological prevalence was low and to strengthen rural health facilities ….
People shouldn’t think that because they are vaccinated they are protected. A lot of research on Delta shows that even if you are vaccinated, the viral load in your airways will be the same as in an unvaccinated person if you are infected. The big difference is that your chances of getting sick or dying are low compared to an unvaccinated person. But the disease could still be transmitted. That is why the other measures at the moment are very important.

What is happening on the vaccine front?
On the vaccine front, the news is good. There is still a lot of research and development going on. There are over a hundred candidates in clinical development. There are intranasal vaccines, oral vaccines, and vaccines that can be stored at room temperature. Some of them use technologies that can be scaled up quickly and therefore will be very affordable … There may be new delivery mechanisms. We already have the DNA vaccine. It is not given by injection. It uses an applicator on the skin which pushes the material into the skin. We see a lot of innovation in the delivery system.
We can also think of combinations of an injectable vaccine with an intranasal vaccine. You need both local immunity in the respiratory tract and systemic immunity. The combinations could give you that mucosal and systemic immunity advantage.

When is Covaxin likely to obtain emergency use authorization?
Hopefully in October. The company responded to all requests.

Rich countries like France have started booster doses. Your thoughts.
Whether or not to give a booster dose should be based on science. It shouldn’t be a political decision. The decision should be based on studies with different variants on different populations ….

Some countries have prematurely rushed into offering boosters to their populations. WHO tracks the data and the evidence. When it is evident that the recall is necessary, we will take appropriate action.
There is also the moral and ethical argument that large parts of the world have unvaccinated people dying while in some places booster doses are given. If the world is to control the pandemic and reduce the chances of the emergence of variants, we must vaccinate everyone. Vaccine supplies are currently limited, although the private sector says there will be 11 billion doses by the end of the year. If these doses remain only in rich countries, the pandemic problem will not be solved. We therefore urge all high income countries to share their doses now. The WHO director-general has called for a moratorium on recalls until the end of this year.
Let’s finish the primary vaccination of at least 40% of the world population before thinking about the boosters.

Why have only 3% of the African population been vaccinated?

There were no supplies for them. Covax has been deprived of supplies. High income countries bought all doses from manufacturers.

The Serum Institute of India was supposed to provide 30% of the COVAX supply. This also did not happen in 2021.

Can you tell us a little more about the gaps and challenges of vaccine deployment in Africa?

Lack of supply is a major challenge. There are planning, logistics and HR issues. In low-income countries, there are very few health workers. They may not have cold chains. But they have all made efforts to put in place what is needed.

What have you missed the most during the pandemic?

Certainly human contact. Meeting between friends and family.

How to de-stress?

I love being outdoors, especially walking, cycling, or any type of outdoor exercise has been my way of coping over the past 21 months. I also like music. I don’t have a lot of time to read. Being able to connect with friends, even from a distance, has been my biggest source of support.

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