India Covid-19 update - Immunity, vaccines & Remdesivir

India's surge in Covid cases is just like Brazil. There was interesting case study of Brazil's city of Manaus with 2 Million population (read 1 & 2). The region was hit hard in first wave and had high Seroprevalence last year. Then the cases went down as herd immunity got into effect. But few months later, there was another surge of Covid cases. Same thing is happening in India's resurgence of virus after we had high seroprevalence from first wave of virus. The virus had overwhelmingly spread in cities like Mumbai & Delhi in the first wave as was indicated by various Sero surveys. In Mumbai as much as 60%-75% of slum population was seropositive while in Delhi 56% of population was seropositive.  In rural villages, 69% of population was found seropositive in first ICMR survey conducted last year. I have explained in my previous articles that much of the Indian population lives in poverty and Covid control measures like social distancing, hand hygiene, sanitation etc are not possible. Anybody who has seen Indian urban slums & rural villages, in which most our population reside, understand this very well. So its not surprising that virus made its way through most of the population unrestricted.

Indian Scientists have found that 20%-30% of seropositive people lose their natural immunity within 6 months. In Initial phase of Covid Pandemic, little was known about the immunity from infection. There were various theories and one of the main theory was that there will be immunity after recovery from infection. This immunity may last for some time, possibly even years as some experts claimed. It was also said that, reinfection is very low probability, and even if it happens, it will only be mild because body will have a better defense mechanism in dealing with the virus. Now after witnessing the case of Brazil and now India, we have answers to some things. Natural Herd immunity is nonsensical concept as people can get reinfected after some months and infections from new variants can be deadlier. With emergence of various new variants like Brazilian, South African and Indian variants, people are more prone to reinfections. 

Indian Scientists found that Seropositive people have declining antibodies with period of time. Also people, even with antibodies, lose the ability for neutralization of virus. So antibodies can no longer neutralize the virus for some reason. This is not surprising given the results of British research in Convalescent Plasma therapy for Covid patients (read 1 & 2). Convalescent Plasma therapy is based on theory that patients are injected with blood plasma of recovered patients. Blood plasma is rich antibodies (extracted from recovered patients), injected into sick patients, which in theory will help neutralize the virus in infected patients. But this doesn't work in practice as was found in large scale clinical study on efficacy of Convalescent Plasma therapy by British Scientists. Americans also know the concern about duration of immunity. Pfizer says that people may need 3rd dose of their mRNA vaccine in 6 months to one year, and may possibly need annual booster doses of vaccines. 

Natural immunity against the virus was the defense of poor nations against Covid. The people don't have access to healthcare & medicines, but they will get infected & after recovery they will have immunity. A small minority of people will die from infection but rest of the population will recover & become immune. As the majority of population gets immune, the rate of virus transmission will decline due to lack of virus carriers, and ultimately virus will go away. This was the logic of Herd immunity which actually happened for some time in India & Brazil. But all that unraveled just some months later.  There is no natural immunity, certainly not for a longer period of time. How much immunity we will have from vaccination? We certainly hope that it will last much longer than immunity attained from natural infections.  Developed nations should know that success you have with present pool of vaccines may be temporary. How long the vaccines immunity will last and how much immunity will be against new variants? We need to keep a close eye on this. American vaccine makers have said that their vaccines have more than 90% efficacy against Covid-19 but this may not be entirely true. There are no large scale phase 3 trials of American vaccines against Indian variant or South African variant. Present pool of vaccines may not be sufficient, so we need to continue research & development of more vaccines & antiviral drugs. This point cannot be emphasized enough.  Do not get complacent on managing this pandemic, and think 1 year, 2 years and 5 years in advance about this pandemic. Prepare for all eventualities and continuous scientific advancement and research is the most important thing to do. We may be in for a long haul on this. Remember that the most critical mistake India & Brazil did was assuming that pandemic is over. Our Sero surveys showed that most of our population was seropositive by end of last year which made our government complacent because of herd immunity theory. Developed nations shouldn't repeat this mistake.

Recall that Dr Scott Atlas (member of US Coronavirus taskforce) convinced Trump Administration that lockdowns are useless & US should let the virus spread (read 1 & 2). Fortunately, this policy was not adopted nationwide because there were rejections from other scientists as well as Democratic party controlled states which were much more sensible in dealing with the virus. Recall how Trump wanted to lift lockdowns prematurely and even pushing state governments to do so. This would have been a monumental disaster, caused massive deaths, and ultimately achieved nothing.  Natural immunity only lasts for short time and also we have new variants which are more deadly & infectious and resistant to vaccines.

More on India's Vaccine situation

India's vaccine situation is not good. The Govt did not expect resurgence of virus, failed to expand manufacturing capacity when we had the time and hence caught in severe shortage crunch of vaccine supplies in present day.  What i find ridiculous is the blame game over shortage of vaccines among our politicians and media. I must say, i have all my complaints against the ruling Modi Govt but i am disappointed to see how ill informed our media, intellectuals & opposition politicians are about our vaccine crisis. Our experts & media blame our Government for not giving approvals to American vaccines. This claim is also propagated by our opposition politicians. The issue of shortage of vaccines has nothing to do with fast approval of vaccines.  The issue is actually about mass production, sufficient availability and most importantly, reasonable pricing of vaccines.  American companies are ready to make joint ventures with Indian Pharma companies if our Govt gives them assurance on decontrol of pricing & export restrictions.

Major issue of contention is price caps of vaccines which our experts want Govt to do away with. Basic argument made by people who have money is that they want to spend $20 or $40 for a dose of American vaccines. Why Indian Govt is restricting it? Why Indian Govt doesn't approve American vaccines and let people buy those vaccines at whatever prices companies wanna charge? But this won't solve the problem for the nation as majority of people won't be able to pay for such high prices (see the situation of poverty in India). Also now we know that two doses of vaccine may not be enough, we may need a third dose within next one year and possibly more booster doses every year to keep up with new variants of the virus.  This is enormous financial burden on poor countries. We know the incompetence and shortsightedness of our ruling Modi Govt, but even they know that we need a better approach for mass vaccination of country.  So instead of deregulation of prices and allowing American companies to sell vaccines in India on their own terms, we so far have adopted an approach of regulated pricing.  Our Govt has asked WTO to temporarily suspend patents on intellectual property of Vaccines R&D and allow unrestricted transfer of technology to developing nations. Basic idea is that Developed nations should provide the technological know how & industrial knowledge on manufacturing of their vaccines. As i explained in earlier article, the global scarcity of vaccines is artificial because we have been depending only on few companies (& their joint venture partners) to supply as vaccines. Temporarily suspending patents and open source transfer of technology for production of vaccines will massively boost our production capacity.  But this will mean that companies who created the vaccines won't be able to make big $$$ on their vaccine marketing.

Now Indian Govt is taking another approach to solve vaccine shortage problem. That's easing the process of approval of western vaccines in India & importing of vaccines (read 1 & 2). After all, this is what our media and experts have been asking our Government to do.  But how will giving an approval to particular company will solve vaccine shortage problem? Will it solve the issue of pricing of vaccines? Will fast approvals alone make companies set up factories to mass produce vaccines?  Some Indian experts have even suggested that mass production of vaccines in India is not necessary. After all, we can import vaccines from other countries and those who have money don't have any complaint about the pricing. This is the regressive and reactionary approach in dealing with pandemic. Idea that Indian Govt should give approval to all vaccines, and let the companies sell vaccines at whatever prices.  This approach solves the vaccine problems for upper class & middle class Indians who can afford higher prices vaccines & drugs but doesn't solve the problem for poor class which is 70%-80% of Indian population.

As i mentioned in my earlier article, American economist Dean Baker has written extensively on issue of vaccines and explained the reasons behind the scarcity of vaccines (read 1 & 2). Interestingly, our media and experts do not talk about these real things.  India & other poor nations are the worst affected parties in the raw deal of patent locked vaccines & monopolies of big Pharma corporations. I thought that our experts & media will be educating people about the real reasons for scarcity of vaccines but its not to be.

Lets look at scarcity of antiviral drug Remdesivir in India.  A drug originally created to fight against Ebola, this is now used to treat severe cases of Covid-19. The drug was created with financial aid of US Government but Pharma company Gilead Sciences owns the IP rights of it (read 1 & 2). In India, Gilead has licensed seven Indian Pharma companies to manufacture it.  Remdesivir has very high prices in India despite Govt trying to regulate the prices. Even so, listed (MRP) prices means little because there is no availability of it in the markets.  In black markets, people are buying the drug at 5 to 10 time the listed prices (read 1, 2 & 3). The scarcity of drug is so severe that Govt has mandated that drug to be given to people only with valid prescription along with Aadhar ID (national ID system of India with biometric national database). No person can buy the drug without furnishing his ID & prescription and even with eligibility to buy the drug. But all these restrictions means little because black markets doesn't follow them where vaccines are sold 5-10 times the listed prices. We can see the licensing alone doesn't solve much. The real issue is mass production, sufficient availability and reasonable pricing of drugs & vaccines.  Remdesivir is failing badly on all these fronts.