With the annual festival season around the corner, Covid infections moving up in states like Kerala (reporting 70% of India’s new cases) and Maharashtra along with the lurking danger of a third wave, Dr N K Arora, chairperson, Covid-19 Working Group, National Technical Advisory Group on Immunization, has cautioned that that only Covid-appropriate behaviour is not enough and a massive social mobilisation campaign is required at community level to stay safe.

Strongly pitching for bringing together social, cultural and religious leaders, Dr Arora said a massive social mobilisation campaign is required at community level through people with credibility and respect to exercise restrain against gatherings during festivals.      

“Simply CAB is unlikely to work. We need to proactively bring in social, cultural and religious leaders to say that another year of discipline, staying within the family and virtues of spending time together to celebrate the festivals is preferred than having social gatherings. Most new infections occur in contact with the closest friends and relatives and members of social network as you let your guard down during contact with such people. With only about two weeks left for the festival season, a massive social mobilisation campaign is required at community level.”

He was speaking to Kailashnath Adhikari, managing director, Governance Now, in a webcast as part of the Visionary Talk series held by public policy and governance analysis platform.

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In Kerala, he said, virus circulation in the population is very intense. In a sero-survey in July, 60% of Kerala’s population was negative. Though the state has only 3.5 crore population, it has disproportionately high cases and we need drastic measures like lockdown and containment at the district and sub-district levels. He said the SOPs require strict CAB at individual, community and district levels.

Reiterating community engagement for Covid mitigation, Dr Arora said with India’s huge population, community engagement is very important. “Non-adherence to CAB equals to non-compliance”.

Responding to a question about school reopening in many states though children have not been vaccinated, he said kids have not got severe disease and fatalities have been very rare. During the first and second waves, he said, symptomatic disease in children under 10 years was only 3% and for those under 18 years it was 8%.

“For children, God is kind and there are biological reasons for children to be less affected. Therefore, they are a priority after adults have been immunized and we are following that approach. Parents and teachers should be surviving to take care of children. We know that in many European countries, children are asymptomatic but they have spread the infection to teachers and their own families resulting in deaths.”

Dr Arora cautioned that schools need to open in a graded manner with local and context specific solutions and each district has to decide about attendance in schools. He noted that the hybrid teaching model has to continue for some time.
He said that with children having gone through tremendous stress over the last one and a half year, parents having lost jobs, family members hospitalised and deaths in the family, psychologists and counselors have to be involved in mainstreaming children back into school instead of merely opening the gates of schools. He also said that difference between urban, rural private and public schools and access to technology have to be considered while mainstreaming children back into schools.  

Speaking on vaccine hesitancy, the expert panel chief said instead there is eagerness in community for vaccine and as a country the community has least hesitancy. “As per the government estimates we should be able to give 100 shots per centre. We have capacity of about 100,000 immunization centers across the country. With 60,000-70,000 immunizations centres at present, each centre is processing 125-160 shots per day. With more vaccines available the speed should pick up,” he said.

He added that the private sector has been asked to participate and they can set up 20,000 immunization centres but unfortunately they have been able to set up only 3,000-4,000 centres so far.

On the world’s first DNA-based vaccine from Zydus Cadila, ‘ZyCov-D’, that can be given to 12-17-year-olds, he said initial data shows it is very safe. “For 12 crore children in this age group, the vaccine will be given on priority to those with co- morbidities. The government will come out with this list in week or so and the vaccination will start from October,” he said.

Dr Arora said with a sizeable population being immunized, the momentum should continue with more gusto. With the government now geared for a nationwide network of diagnosis through genome surveillance the sampling is done regular through hospitals and community.

Secondly, samples are being picked up from areas with upsurge and now the government is also collecting samples from sewerage, he said. Also, the government has now set up a network across the country to study samples of severe disease to preempt action.

Dr Arora further said that by end-September, all major district hospitals in the country will have their own oxygen plants. Temporary hospitals/beds created during pandemic are now being made permanent. ICU beds are being increased to double their numbers and out of that at least 100,000 beds must have ventilators.

“Every district hospital and medical college has been asked to create a special ward for children with investment by the central government and complemented by the state governments so that there is no disruption in the health system.”

“With 70% population of the country already exposed to virus, it is a blessing in disguise.  On top of that, vaccination provides solid protection and even with the [new] variant the intensity and severity becomes much less.”

Asked if India is entering the endemic stage, Dr Arora said words like ‘endemic’ and ‘herd immunity’ are “mystical” and “mythical”. While all diseases ultimately become endemic, herd immunity, he said, is very conceptual word. For polio people said, if 80% children are immunized it should go away. It did not till 99% children were immunized.

Praising resilience shown by the community, the administrative machinery and everyone involved, he said the epidemic is an example that multisectoral engagement is the key to all our activities. “The second message that the pandemic has given is that economy and health are two sides of the same coin. It is not the time to lower our guard and we must continue with the same gusto for next one to one and half year. I think we can resume completely normal lives by end of 2022 or so… there are some lingering issues of children, if booster shots are required or not…. we are generating scientific evidence if booster shots are required. Currently there is no evidence, so decisions taken so far have been on the basis of science. We are looking at locally generated as well as international evidence,” he said.
 
Dr Arora expressed confidence that the National Vaccine Tracking Platform, expected to be announced within a week or so, will show real-time vaccine effectiveness and provide answers to question regarding the need for booster shots, dose intervals, geographical variations, relationship with genomic new variants of concerns or interest, etc.