- Mutant strains can also be triggered by mass, indiscriminate, and inadequate vaccination: Report
- ‘People who have been diagnosed with Covid-19 infection do not need to be vaccinated,’ report added.
- The report also said that young adults and children should not be vaccinated because there is no proof that it is safe or cost-effective.
A group of public health experts, including doctors from AIIMS and members of the national taskforce on COVID-19, have stated that mass, indiscriminate, and incomplete vaccination can lead to the emergence of mutant strains, and that those with documented coronavirus infection should not be inoculated.
Experts from the Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM), and Indian Association of Epidemiologists (IAE) wrote in a recent report that vaccinating the vulnerable and at risk, rather than mass population-wide inoculation including children, should be the goal at the moment.
“Given the current state of the pandemic in the country, we should prioritise vaccination based on logistical and epidemiological data rather than opening immunisation to all age groups at this time.”
“Opening all fronts at the same time will deplete human and other resources, spreading them too thin to have an impact at the population level,” the experts wrote in a report to Prime Minister Narendra Modi.
They stated that unplanned vaccination can encourage mutant strains and that vaccination of young adults and children is not supported by research and would not be cost effective.
“Mutant strains can also arise as a result of widespread, indiscriminate, and inadequate vaccination. Given the rapid spread of illness in different parts of the country, mass vaccination of all adults is unlikely to keep up with the rate of spontaneous infection among our youth,” the report said.
People who have been diagnosed with COVID-19 do not need to be vaccinated. According to the recommendations, these persons could be immunised after proving that the vaccine is effective after a natural infection.
For places or groups experiencing a surge due to certain variants, evidence-based flexibility in vaccine schedules may need to be explored, such as a shorter interval between the second and third doses of Covishield in areas experiencing a spike due to the delta variation.
“Vaccines are a potent and effective weapon in the fight against the new coronavirus. And, like other powerful weapons, it should not be kept hidden or used indiscriminately; rather, it should be utilised wisely to get the most advantage for the least amount of money, “they stated.
While it would seem logical to vaccinate all adults, the fact is that the country is currently experiencing a pandemic with limited vaccine supply, report said.
In this scenario, the focus should be on reducing mortality, which are disproportionately common among the elderly and those with co-morbidities or obesity. They claim that, given the current limits, vaccination of young adults will not be cost-effective.
The report recommended conducting repeated local level serosurveys in real time at the end of the second wave to map vulnerability at the district level in order to guide vaccination strategy, as well as long-term follow-up of the recovered COVID-19 patients to document re-infection, severity, and outcome in order to provide evidence on the duration of immunity after natural infection.
Ongoing field research on vaccine effectiveness, which involves following cohorts of vaccinated and unprotected people in various age groups, should be prioritised.
According to the experts, the current wave is mostly due to numerous variants, and India has only sequenced the genomes of less than 1% of its positive samples, and it also trails behind other high-incidence countries in another critical criterion, sequence per 1,000 cases.
They recommended that, while reaching a target of genomic sequencing of 5% positive samples appears difficult at this time, all efforts should be made to reach at least 3%, while praising the prompt formation of the Indian SARS-CoV-2 Genomics Consortium (INSACOG), which now has ten national laboratories and plans to add 17 more.
The molecular epidemiology research must be hastened, with INSACOG scientists, field epidemiologists, and clinical specialists working together to define the epidemiological characteristics of the variations, with a focus on transmissibility and mortality.
To detect virus transmission in the community and in health care settings, genetic sequences must be recorded. According to the scientists, it can detect outbreaks that would otherwise go undetected by standard approaches.
They also suggested that the syndromic management strategy be implemented in a phased way after healthcare workers have been sensitised, and that laboratory testing be used to its full potential.
In rural and peri-urban areas, testing facilities for SARS-CoV-2 are in short supply.
Because the sensitivity of RAT is so low, there’s a potential that some truly positive cases will go unnoticed, spreading the disease.
“It is impossible to test each and every symptomatic patient in a timely manner, which will place a significant load on the health system and cause isolation and treatment to be delayed. Adopting a syndromic management technique is the best solution in this case. It should concentrate on making diagnoses based on clinical symptoms and suspects with epidemiological ties “they stated.
The experts also recommended that, for both RTPCR and RAT (Rapid Antigen Test), all people tested for coronavirus have their vaccination status documented into the sample referral form in the RTPCR app.
The obtained data must be analysed on a regular basis to determine the condition of vaccinated people in terms of COVID-19 and its severity, including mortality.
According to the experts, district-level sero monitoring could be envisaged using the EPI cluster sampling methodology in the future.
“If seroprevalence is greater than 70% at the district level (due to a combination of natural illness and vaccination), there should be no lockdown and a return to normalcy should be pursued.”
According to the experts, some adverse events and deaths will be missed if a large number of people are vaccinated at once with limited facilities for monitoring adverse events following immunisation (AEFI). Furthermore, while some of these AEFI may be coincidental, they may contribute to vaccine apprehension.