The world is in the grip of the COVID-19 pandemic. There is no second priority for governments worldwide but to be able to save human lives. The past 10 months have gone by like a whirlwind in which we have struggled and tried our best to ensure that people learn Covid-appropriate behaviour, which is the best way to stop the progression of this deadly virus-caused disease and cut its transmission. It is not as if people have not realised that there is no magic bullet for Covid prevention. We all know that none of the new prevention methods currently being tested are likely to be 100 per cent effective, and all of them will need to be used in combination with existing prevention approaches if they are to reduce the global burden of COVID-19. Different levels of prevention have to be used. Prevention strategies include measures that prevent development of diseases or interrupt progression of a disease. Primary prevention includes reduced exposure or susceptibility, while secondary prevention means early detection and treatment, whereas tertiary prevention implies limiting disability as a result of the disease.
Like several respiratory viruses, the novel coronavirus spreads through droplets released from the nose or mouth of an infected person when they cough, sneeze or speak. These droplets can land on people, their clothing, and objects and surfaces around them. From hand hygiene to physical distancing, behavioural changes are required to reduce viral transmission. Many strategies exist to change people’s transmission-related behaviours and slow down the virus. The behaviours of various actors are crucial, including those of governments, businesses, media, and community groups.
Since there is no biological cure so far, the world has been using the “social vaccine”. Social vaccine is a primary prevention method, referring to a comprehensive package of preventive education, promotion of preventive measures and edification of communities.
Social vaccine can be defined as spreading socio-behavioural measures that are required to bring awareness among societies regarding the pandemic. In the current situation, socio-behavioural measures include wearing face masks, maintaining proper hygiene, social distancing, respiratory etiquettes, frequent hand washing etc.
There is a growing justification for social vaccine being the only way to control infectious diseases in developing and densely-populated countries like India. Of course, there are policy implications for renewed efforts towards the supply of quality education and advocacy blitzkrieg as an important strategy to promote public health. There is an urgent need for all of us to follow the norms of this social vaccine as an effective countermeasure against the emergence and accelerating expansion of Covid.
The government is working at jet speed towards induction of herd immunity by mass vaccination, which has been a successful strategy for preventing the spread of infectious diseases, hence protecting the most vulnerable population groups unable to develop immunity, for example individuals with immune deficiencies or a weakened immune system due to underlying medical or debilitating conditions. Therefore, vaccination represents one of the most promising counter-pandemic measures to COVID-19 as well. The past year, which has seen many firsts, has also seen vaccine research and development efforts at a scale and pace never seen before. Globally 50 vaccine candidates are in clinical research, with 25 in advanced clinical trials. In India, about 30 vaccines are in different stages of development with five in clinical trials. Of the four in phases two and three trials, two are in the most advanced stage of development—COVAXIN developed through ICMR-Bharat Biotech collaboration and COVISHIELD from the Serum Institute of India. Both are in Phase-III clinical trial stage.
Not just leading vaccine development efforts, India is a major vaccine manufacturing hub as well. We have 19 companies with 24 manufacturing establishments. We supply over 60 per cent vaccines to developing countries. We supply over 1.45 billion doses to over 140 countries and have developed new vaccines for rotavirus, Japanese encephalitis and typhoid. India already runs the world’s largest immunisation programme. We administer 650-million-plus doses annually to more than 100 million children. We will be utilising our rich experience to implement an effective vaccine distribution programme. We have 27,000-plus vaccine storage points covering more than 95 per cent sub-districts. We are already strengthening and augmenting this infrastructure. We have built a comprehensive Co-WIN Digital platform with provisions for real-time update of data related to health workers, stock alerts, optimal order recommendations, beneficiary tracking. COVID-19 vaccine development is being currently accelerated via fast-track programmes, and will be essential in the near future for reducing morbidity and mortality as well as inducing herd immunity, if SARS-CoV-2 becomes endemic, i.e. established in the population like the influenza virus.
The spread of infectious diseases is linked to human behaviour, so behavioural science could be used to inform effective modelling and communication strategies to reduce transmission and contain COVID-19. People can often understand the severity of a threat, but unfortunately underestimate its impact. Each person has to understand that his action affects others and their contribution is making a difference. In crises, it is also important that messages are contextualised and communicated honestly, transparently and consistently. This Covid-appropriate behaviour then becomes a cultural and social norm.
Many times in recent months, I have stated on record that the pandemic has a silver-lining to it as well. It has forced us to sit up and deploy greater resources into public health, sensitise the public towards better sanitation and hygiene, pushing us into self-reliance in the field of medical equipment and devices and has also taught us to follow an appropriate behaviour, which will serve well to break the transmission chain of not just Covid, but other infectious diseases as well. So far, TB control had not received the attention it deserved in high-burden countries, including India. COVID-19 has shown that healthcare systems can find ways to protect healthcare workers and people can change their behaviour to reduce risk, for themselves and others. Routine use of personal protection equipment (PPE) by healthcare workers, large-scale use of face masks by the public, safer disposal of respiratory secretions, and advances in research into aerosols and airborne transmission can all help interrupt TB as well as COVID-19 transmission. Massive advocacy on use of face masks has become less stigmatised during this phase, and there is wider acceptance that anyone can get a respiratory infection.
The pandemic has inspired several multilateral global collaborations and partnerships, pooling of funding for new tool development and delivery, patent pools, and other approaches to increase access to new tools. In the near future, we are planning several such partnerships for TB, where slow access to new tools has been a longstanding concern. As in the case of Covid, shared global concerns have accelerated technology collaborations and global solidarity. This has been the fastest exchange of open science, open data, open access research and pooling of technology. India has a vision of following the same path for all other global health threats like TB.
COVID-19 has firmly established the need for active action and the establishment of a robust, collaborative, scalable, and agile digital healthcare infrastructure. Even if the virus is mitigated, global health leaders and stakeholders cannot afford to sit back. Investment into public health must take a quantum jump. I reiterate that focus during 2021 must be on infectious diseases, especially making TB elimination a big societal movement. Prime Minister Narendra Modi has given a big shout-out to the citizens, exhorting them to turn Covid-appropriate behaviour into a mega Jan Andolan. My take is that while we are building infrastructure and political will to fight Covid, we must use this infrastructure to battle TB as well. Opportunity is ripe to leverage Covid innovations to turn the vision of universal health coverage into a reality. After all, health is a fundamental right for all of us.
There is yet another silver-lining to this crisis. The fast pace of life of the 21st century had driven us apart from our friends and family. I’m often reminded of a beautiful line by Gurudev Tagore
(Stray Birds, 1916): Once we dreamed we were strangers/We wake up to find that we are dear to each other…
Dr Harsh Vardhan, Union Minister for Health & Family Welfare, Science and Technology, Earth Sciences