Populations where more people were previously infected and where vaccination coverage is high are expected to be less impacted by the virus
New Delhi: Stressing that the Covid virus may continue to transmit for a very long time, senior WHO official Poonam Khetrapal Singh says the level of immunity in a community, through vaccination and previous infection, will determine whether it will become endemic in the long run.
WHO's South-East Asia region regional director added that there is need to get to a situation where "we are fully in control of the virus, and not the virus in control of us".
The endemic stage is when a population learns to live with a virus, very different from the epidemic stage when the virus overwhelms a population.
Populations where more people were previously infected and where vaccination coverage is high are expected to be less impacted by the virus in the future than other populations, Singh told PTI in an interview.
"The COVID-19 virus is expected to continue to transmit for a very long time. A multitude of factors will decide whether the virus will become endemic in the long run, chief among them is the level of immunity in a community, both through vaccination and previous infection, she said.
On the granting of emergency use authorisation (EUA) for the indigenously developed Covaxin, she said Bharat Biotech's dossier seeking WHO's Emergency Use Listing (EUL) is being reviewed by technical experts and "we can expect a decision when the process is complete".
Discussing the role of booster doses to tackle waning immunity, Singh pointed out that cases and deaths in all countries are predominantly being driven by unvaccinated people. Using vaccines for booster doses constricts supply to countries where millions are still waiting for their first dose, she said. "Hence, WHO has called for a time-limited moratorium on COVID-19 booster doses until the end of 2021. This is to allow for at least 40 per cent of the population of each country - including those most at risk and health workers - to be vaccinated. We must remember that no one is safe till everyone is safe."
She said there is currently no conclusive evidence that COVID-19 vaccine efficacy against severe disease and death wanes significantly over time. The vaccines, the expert emphasised, have remained effective in preventing severe disease and death. "However, WHO has not ruled out that boosters for some population groups may be warranted in future. WHO's recommendations on boosters will be guided by the scientific evidence, which is still evolving," she said. "To make a recommendation on the use of booster doses for the general population, more data is needed on optimal timing, safety and dosage of booster doses, which may differ between vaccine products. More extensive research is needed to study the effect of booster doses in the body." According to Singh, eradication is unlikely but what we can do is to prevent or minimise deaths, hospitalisations, tragedy and social, economic and health loss due to this pandemic.
Current evidence, she said, shows that protection levels around the world remain low and most people continue to be susceptible to the virus.
"WHO continues to recommend a strong public health response based on risk assessment, and for people to continue to protect themselves by getting vaccinated, maintaining physical distance, wearing a mask, avoiding poorly ventilated spaces, cleaning hands and following respiratory hygiene." Referring to the probability of a third Covid wave, Singh said another surge and how intense it will be will depend on all of us. "If we together continue to adhere to public health and social measures and continue to vaccinate people as fast as possible, it will be hard for the virus to infect enough people to cause another wave," she said. "From experience globally, there is enough evidence that the public health and social measures work, even against the Variants of Concern that are spreading more rapidly, and these measures are critical to limiting transmission of COVID-19 and reducing deaths. For the public health and social measures to be effective, they must be implemented well and timely and must be tailored to local settings and conditions."
On India's decision to restart exporting COVID-19 vaccines, Singh said there is need for equity of vaccination administration globally to ensure that the most vulnerable such as frontline workers and the elderly are fully vaccinated. "At the moment, several low and lower-middle-income countries are lagging behind in vaccinating their vulnerable populations. An equitable vaccine distribution will also help check the emergence of variants by halting the spread of the virus." Singh also noted that the pandemic has given "once-in-a-century opportunity" to strengthen the health system to build back better.
"We must invest in strengthening health system resilience to ensure health security and achieve universal health coverage. It means allocation of more resources for health and its efficient governance," she said. Now is also the time for countries to take lessons from the pandemic to strengthen health systems in her view. "Strong health systems that are primary healthcare-oriented, and which leave no one behind, create populations that are healthier, more productive and financially secure. Resilient health systems are the bedrock of emergency preparedness and response, and ensure that when acute events occur, essential health services can be maintained," Singh said.