Dr T Jacob John, a retired professor and head of departments of clinical virology and microbiology at CMC Vellore, is known as one of India’s foremost virologists. Since the beginning of the pandemic, he has been flagging multiple issues related to India’s handling of the situation. Dr John spoke to Outlook on why India should be concerned about the new Omicron variant of Covid-19 and things need to be done.
What are the things that you think the people should know about the Omicron (B.1.1.529) variant of SARS-CoV-2?
This variant was reported to WHO by South Africa on 24 November, and on 26th WHO declared it as Variant of Concern (VOC) and named it by the Greek alphabet omicron. By then countries like Hong Kong, Israel, UK, Belgium had detected it brought in by air travellers. Many mutations of spike protein gene, high transmission efficiency (air-borne, due to very high viral load in nasal mucosa) and known spread among two-dose vaccine recipients indicating antigenic drift were the justification to assign VOC label. Now we know Germany, Denmark and Holland have got it, too. In Africa Botswana, Malawi, Mozambique and South Africa are affected .
How concerned should we be about this variant?
As mentioned above, the initial signals are a bit scary. It could spread fast to various countries, infect even immune persons and possibly displace/replace delta as the dominant variant. However, these possibilities have to be confirmed with several more days and more data. We should be very concerned since we have been alerted/warned about rapid spread and overcoming immunity. The government of India has decided to establish a system filtering air travellers from 1 December. That is unwise. We should have started filtering from Nov 26, the day we knew it was VOC.
What would be your suggestions to the common people for their own safety?
Citizens must follow Covid-appropriate behavior because that is our personal protection.. Everyone must get vaccinated in one's own personal interest and societal interest. Full vaccination must include two priming doses followed by a booster 6 months (or earliest thereafter). High immunity level will act as a defence.
What kind or degree of threat does India face from this variant? Where lies the biggest danger?
The first risk is the likelihood of importation -- entry in the country. If it enters and spreads fast, and causes many 'immunity-break-through' infections, there is a possibility that the present endemic (low daily numbers) may be interrupted by a third wave. These risks must not be ignored.
Since the first and second wave infected a vast majority of people, and since the second wave people are getting infected on a daily basis, I anticipate no big wave. However, the higher the vaccination coverage, the more confident I will be.
The most important risk is non-immune people with risk factors (older age, comorbidities, cancers/cancer treatments, organ transplants, people on treatment for autoimmune diseases etc), who might have escaped infection so far may get infected since the transmissibility is much higher than delta.
How prepared, do you think, is the government of India (and state governments) in dealing with the situation?
In terms of "skill" to respond and mitigate risks, the governments are experienced. I believe the government of India has taken the risks very seriously. I hope scientifically/technically correct and wise decisions will be made without losing even one day. I have not seen a sense of urgency in India -- other than the airport precautions to begin on 1 December.
What steps should the government immediately take?
First, prevent importation by careful management of international arrivals -- from countries known for potential widespread (e.g. countries in southern Africa), countries now known to be infected. We have already lost precious days. The xext is good genotyping coverage to monitor if omicron has entered and spreading. The government should commission necessary scientific studies to answer all questions pertaining to the behavior of the variant and ability of immunity to prevent disease and minimise infection and spread. Determining the role of a booster is an urgent need.
What should be the government’s long-term plan?
Pandemic acted as a spotlight on many deficiencies -- the government of India must enumerate them and address them all. It ranges from data collection/management, methods of verification/validation, to ability to teach the public correct information, creating trust by transparency and reliability of data to access to diagnostics and treatments by protocol, outcome monitoring of healthcare etc.
Universal healthcare cannot be postponed anymore.
Establishing a Public Health Division in the government must be a high priority. At present, India does not have one.
What would be your suggestions for the scientific community and the medical fraternity to focus on in the sphere of research?
Global watchers in India realise that India's contributions in science related to Covid is very small. Our investments in research are too small. As someone recently said, Indians are good traders but not good inventors. We are good imitators and improvisers, not innovators. Unless science is valued, scientists celebrated, scientific results demanded for policy and planning, the meagre demand will ensure poor supply. Do we have at least one PhD virologist in every medical college? Virology is highlighted since the pandemic is virus. Why does India have one of the world's highest TB burdens per unit population? The need is extremely high. The milieu is not conducive for solving our problems through research.
When we realise that in all these decades of medical research, 2020 was the very first time India had developed an indigenous vaccine from scratch, and that too not with university research, but by one motivated company owner, we realise that there is no demand for science.