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Friday, January 28, 2022

Express Interview: ‘With Omicron variant, it is critical for India to step up vaccination’

In an interview with The Indian Express, Purnima Menon and Madhukar Pai, volunteers with India Covid SOS discuss the Omicron variant, vaccination in India and focus areas in Covid management.

By: Express News Service | Pune |
Updated: December 10, 2021 12:05:47 pm
Madhukar Pai and Purnima Menon.

Purnima Menon, a senior research fellow at the International Food Policy Research Institute in New Delhi, and Madhukar Pai, professor of epidemiology and global health in Canada’s McGill University are volunteers with India Covid SOS, an international non-profit volunteer group of scientists, clinicians, engineers, policy-makers, community organisers and industry partners. In an interview over email with The Indian Express they discuss the Omicron variant, vaccination in India and focus areas in Covid management.

Can you talk about the initiative of identifying, compiling and disseminating promising practices that emerged from the second Covid wave? The rationale and vision behind this initiative.

The idea of examining successes in public health is not uncommon or new, but in the context of Covid-19 and the fast-moving situation in India in April-June, the India Covid SOS team was hearing stories of innovation and resilience even as we came together as a network in April 2021. We realised that these stories needed to be preserved to hold and to learn from; this in turn inspired us to reach out to Exemplars in Global Health to ask for support in curating some of these case studies, now publicly available. We felt, as we came out of this traumatic period, that India and, indeed, the world would benefit from preserving the various stories of innovation, hard work and commitment. These positive case studies might come in handy if India were to see another Covid wave, especially in the context of the Omicron variant.

Omicron has emerged as a Variant of Concern now. In light of other possible variants in future 1) how can vaccination strategies be dynamic enough to keep pace with a constantly changing virus 2) a set of best practices, as you are helping to curate, may apply for one region/country but not others. How are you looking to have a more cohesive pool of best practices that any region/country can draw from?

At this point, we do not know if existing vaccines will protect fully against Omicron, but we expect them to confer at least partial protection against bad outcomes. It might be necessary to re-design existing vaccines against newer variants, and annual boosters might also be needed to keep up with new variants in future. Ongoing research will make this clearer in the next few months. For now, it is important for people in India to get vaccinated and follow basic public health measures (masking, avoiding large gatherings). Yes, some aspects of vaccination case studies may seem like they are limited only to the Indian or, indeed, the communities they are gathered from. However, if you look across them, you see that there are many connected lessons – these include the value of leadership committed to achieving a goal (in this case reaching everyone with the vaccine); paying attention to implementation detail – the missing middle, as it were; paying attention to client communities their beliefs and constraints; communicating effectively; and more. These insights are generalizable but it is important, of course, that we continue to examine successes in other countries as well as across India to explore what else surfaces as key insights.

With the country surpassing the one billion vaccination benchmark, what stands out as a positive move/practice that helped achieve this milestone?

The one billion mark is commendable. But with the new Omicron variant, it is critical for India to step up the vaccination rate. Only a third of the Indian population is fully vaccinated and that might not be sufficient to protect against new variants, especially if they are more transmissible than the Delta variant, and are more likely to cause re-infection. Millions of Indians are yet to complete their second dose and we hope the Omicron threat will nudge them to complete the vaccination schedule. Immunisation efforts have focused both on ensuring upstream supplies as well as the very local efforts to reach everyone eligible in communities – this has been a slow sweep across India. There are still challenges, including around technology, registration and so on, and some of these early issues contributed to a slower pick-up than if we had just been out there without any of the technology barriers.

Vaccine hesitancy is an issue globally and in India. In fact, it is a significantly bigger challenge in rural India. Can you share, from your experience, any unique initiative that was undertaken to address such critical issues?

Insights from the case studies curated in this initiative suggest that local leaders came together to address various hesitancy issues and other real constraints (food, water, rest) to help achieve high vaccination rates. Above all, exemplary efforts to truly understand and respect communities and then address concerns. Unlike western countries, there are no big, organised, anti-vaccination campaigns in India. So, we should be able to address hesitancy with time, effort and community engagement.

In the second wave, we witnessed various sectors uniting for Covid management. Do you think such integrated approaches will, increasingly, be the way forward for public health strategies?

One feature of the cross-sectoral responses that emerged during the second wave is that they were really solutions that came from desperation and a desire to help in an otherwise untenable situation. The sense of common purpose and the urgency of the times, in our view, really helped break down barriers that might have stood in the way in normal times. Our challenge, as we look ahead to potential future waves, is to see whether the barriers can be broken down well before we get to the sense of urgency or desperation.

How many of these promising practices have been curated as of now and what are the focus areas?

To date, we have compiled over 50 stories – not all are published yet – but we anticipate that by February 2022, many will be. Focus areas include bright spots in vaccination practices, evidence- based patient management, cross-sectoral collaborations and operational excellence. We hope these stories can inspire and support those who are interested in learning about how to deliver public health success in these challenging times. Management of public health situations is a complex task, but what we have here is both the stories and examples of success, and access to the network of individuals and organisations who delivered these successes. So we do believe this effort has potential but, as in every effort, finding ways to connect these stories (and the people behind them) to those who need the insights will need to be a continuing task. We need to make sure that the stories and individuals are not hidden from the public eye.

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