There’s no doubt, number of Omicron cases will go up in India: Dr Shahid Jameel

As elsewhere, India is also under threat of an Omicron wave, says Shahid Jameel, virologist and fellow, Green Templeton College, University of Oxford. While countries like the UK and US are doubling down on booster doses, India is yet to formulate a booster policy. In an interview with ET, he warns that Covishield, which most Indians have got, will not be very effective as a third booster dose, so the government needs to approve other options quickly and increase the output of Covaxin. Edited excerpts:

Countries like the UK and France are seeing record spikes in cases – what should India learn from this?

The number of cases in India will go up, there’s no doubt. Though these are very few at the moment and the data would be very noisy, you can still see that the doubling rate of the pandemic is 2-3 days in India just like everywhere else in the world. This will get amplified very quickly, especially since India has only about 38% of the population doubly vaccinated. And we know that the vaccine effectiveness in protecting from symptomatic infection goes down. Even now, I think there will be many more cases of Omicron that are not on the radar right now. This number will definitely increase quite dramatically.

How should India move ahead about boosters?

First of all, India needs to make a booster policy – we don’t have one yet. A policy simply means you take stock of the data available, decide which vaccines you’ll use, how many doses you’ll need, all of that. Right now, you might as well give the available vaccines to those who had just one dose or no dose but eventually you’ll have to do it (give boosters). India has given 90% doses of Covishield. A third dose of Covishield is not going to boost antibodies very much so Covaxin could be used as a booster to those who got Covishield.

Why would Covishield not work well as a third dose?

Because of the nature of this vaccine. This vaccine is made using a whole chimp virus with a few genes deleted and the spike gene of Covid virus inserted in it. So this virus, besides making the Covid virus protein, it makes several of its own proteins. The immune system looks at any foreign protein to be the same so it will raise antibodies and T-cells to both the Covid protein as well as to the chimp virus proteins. Since the chimp virus proteins are many more in number compared to just one spike protein, as you give more and more of it, preferential boosting will happen of the chimp virus proteins and that’s not what you want. What you want is spike responses. That’s why we’ll have to look at other options.

But won’t the current output of Covaxin then become an issue?

Exactly. Covaxin will have to be made in bigger amounts. Another option India has is to deploy DNA vaccines as boosters in those who got Covishield. Unfortunately, after the approval in August (to ZyCov-D, the Zydus Cadila vaccine), we haven’t heard much about it. There are two other options – the protein vaccines will work as good boosters to those who got Covishield. One is from Novavax, Covovax, made by Serum Institute and the other from Dynavax Technologies, being made by Biologicals E, called Corbevax. The vaccination committee has to decide about all this.

So ideally, the government should move fast on approving these vaccines, if all the data is in.

Absolutely. My understanding is that both Corbevax and Covovax data is with the regulator. Covovax has been approved by WHO for emergency use and Serum Institute has supplied 5 crore doses to Indonesia. The WHO approval is a good move, and with SII having a large capacity for it, it would be an ideal booster for people who have received Covishield.

To insist on local data for everything… you don’t have the infrastructure for that. If you begin trials now on mixing and matching vaccines to generate local data, it will take at least three months. If you are going to make policy after that and then tell companies you want this or that vaccine, you’re taking things forward by 6-8 months. This variant is not going to give us that much time.

Is there any comfort to be derived from initial reports that Omicron may not be causing as much severe disease or is it too early?

The initial news is comforting. But as far as disease is concerned, viruses tend to behave differently in different populations and in different subsets. India still has a very large number of people who are immuno-compromised – who are on cancer therapy, who are HIV infected, who have diabetes. This should be a cause for worry.

The immuno-compromised, then, should get priority for a booster?

Absolutely.

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