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‘No need to worry, but we do need to prepare’ | India News

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An Israeli study rang alarm bells when it suggested that those vaccinated might be eight times as susceptible to the South Africa variant of Covid-19 as those not vaccinated. Leading virologist Dr Gagandeep Kang during an interaction with TOI explains why the implications are not as dire as they sound.
Are the findings of the Israeli study as bad as they sound? If not why not?
The study took people who were infected after vaccination (either full immunization with two doses or partly immunized, from the time the first dose is expected to kick in to until the second dose kicks in, that is from two weeks after first dose until one week after second dose) and matched them to unvaccinated people with infection. Most infections were due to B.1.1.7 (UK variant) and there was some reduced effectiveness in the partially immunized, but there were a small number with B1.351 (South Africa variant), with eight cases in fully vaccinated individuals and one in unvaccinated. This sounds worrying and looks like the vaccine is not working against B1.351. But there were no cases of B1.351 more than 14 days after the second dose.
What does this mean? It is possible that while this study design did show early reduced effectiveness against B1.351, the vaccine effect is kicking in later, enough to stop subsequent infections. We will need other studies to confirm whether this is indeed the case.
Though this study is about Pfizer vaccine specifically, would it have any implications for other vaccines?
All vaccines based on spike proteins might have similar issues and we need to conduct exactly the kind of vaccine effectiveness studies that are being rolled out across the world. The WHO has guidance on how these studies should be done, even in poorer setting without the kinds of surveillance systems available in wealthier countries.
Since we are not using the Pfizer vaccine and the South African variant is not very prevalent in India, is there any cause for worry in India?
The worry is about variants and how vaccines will perform. This study is about the Pfizer vaccine, but studies using other vaccines in other settings will also give us early warning about what we should expect with variants. I do not think we need to worry, but we do need to prepare. Without the ability to measure the extent of the problem before and after any interventions, we will be applying control measures without understanding their impact. That is not science, it is shooting in the dark.
Considering that we have identified variants in India, and much of the current surge is attributed to variants, what does that imply for our vaccination strategy?
Based on the limited sequencing data from India, we know we have the UK variant in Punjab. In the UK, there was a near vertical climb in cases with this variant, which is more transmissible and causes more severe disease. As far as we know, we have much less of the socalled South African and Brazilian variants, and they may not be spreading as much. The ‘double mutant’ or B1.617 has been found in a fair proportion of cases, but we have still not put together the pieces to figure out how much this variant is contributing to disease, and what virus biology predicts for vaccine performance. We need to establish the ability to study disease and spread at finer scale in the community and much deeper in the laboratory and then synthesize the data to predict what this might mean for our vaccination strategy. As far as I am aware, we do not have the comprehensive and integrated research approach that is really needed, that operates at the speed and scale that is needed.

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