‘To deal with  pandemics, a global effort is important’ 

Civil Society News, New Delhi

Even as a Covid-19 variant makes news in India and some other countries with a spurt in cases, a Pandemic Agreement has been endorsed and adopted by consensus by members of the World Health Organization (WHO).

The agreement has taken all of three years to put together because of the many contentious issues that had to be navigated. The pandemic, despite the horror it brought, saw several countries working at cross-purposes on data sharing, vaccines, equipment and therapeutics.

Now, under the agreement, it is hoped that a planetary response will be possible in the event of another pandemic. Regular coordination is also needed for tracking and containing infections before they fly out of control and become major events.

The agreement addresses the inequities faced by the Global South. There is, however, some distance to go yet. There were a handful of abstentions in the WHO Assembly. And the US has cast a long shadow on the initiative by opting out as well as cutting back on its important research institutions.

India, by contrast, has been strengthening its surveillance and linking its scientific organizations into networks with both feet on the ground and capacities in high science. There has been much learning from the pandemic. Efforts that were already under way from before the pandemic have gained additional momentum.

All this is complex terrain. To understand it a little better we spoke to Dr Priya Abraham, who was the director of the National Institute of Virology in Pune and is currently back at the Christian Medical College,  Vellore.      

 

Q: How significant is the recent signing of the international agreement on pandemics?

During the Covid-19 pandemic there was considerable inequity between countries in terms of the overall response. There was vaccine nationalism, you will recall, and unequal access to therapeutics and data. The international agreement is the outcome of a three-year effort and is intended to bring nations together so as to be more participatory.

Signatories to the agreement pledge to be part of this, you know, war against potential pandemics. They’ve pledged to share data in a timely manner and share technology as well as whatever capacity-building they have. Importantly, they have also spoken on behalf of the Global South which was more affected by inequity.

Also, this pandemic agreement has sought assistance from pharmaceutical companies. Those that have signed up have pledged that they will make available 20 percent of their newly made vaccines or therapeutics for global use.

So that’s the intent of this pandemic agreement. There are potential weaknesses in it too. For instance, there is no punitive action for those who do not conform. Also, pharmaceutical companies are a little worried about the weak protection of IP (Intellectual Property) rights. The agreement is not mandatory in any way. One of the biggies, namely the US, has not actually been part of this.

 

Q: How significant is the absence of the US?

It is worrisome because the US was a big player in vaccine development as well as in the development of therapeutics during the pandemic. The US absence weakens the global effort.

 

Q: There is a vast amount of scientific work done in the US which would not be readily available.

That would not be there. And then, of course, we do know that a lot of National Institutes of Health (NIH) funding and some of the Centers for Disease Control and Prevention (CDC) efforts are somewhat trimmed now with the new powers that be in the US, which could backfire on the country itself. If we go slow on vaccines, universal vaccines for children, for instance, it could have an impact. There are already some measles outbreaks in America.

 

Q: It also cuts off the US in terms of the viruses there that could be mutating and spreading.

No one is safe until we are all safe, was the famous statement of WHO Director-General Dr Tedros Ghebreyesus during the pandemic. Whether it is a continent or a corner of a continent, it could be a source of outbreaks, which could very well spread to the rest of the world given the amount of international travel that is happening now. We all need to pull up our socks, everybody.

 

Q: What has changed in India after the pandemic in terms of sentinel services, like identifying viruses quickly?

By 2021 the Pradhan Mantri Ayushman Bharat Health Infrastructure Scheme of over `64,000 crore was announced. It was intended to prepare for future pandemics and disasters. It was actually an investment in capacity-building, starting from the primary healthcare level right up to tertiary care. One very tangible effort was to build a network of  Biosafety 3 laboratories. You know, normally labs work at biosafety one or two levels, which are for low-risk pathogens. Biosafety 3 increases a lab’s capacity to handle more risky pathogens with no risk to laboratory personnel and to the environment. And then you can scale it right up to the Biosafety 4 level.

When I was in Pune, we had the most prestigious Biosafety 4 laboratory in the National Institute of Virology. It handles deadly viruses, the likes of Ebola. That was already in place by 2012. It was not a post-pandemic effort. It was already there and of  great help to us when we were helping to make the vaccine with Bharat Biotech because we handled the virus inside Biosafety 4.

When we started working with the virus, we did not know just how risky it was. There was this, you know, gloom and doom everywhere. So, we worked at the highest risk level.

But coming back to the building of Biosafety 3 laboratories, which is a notch lower, there’s now a network of 22 laboratories across the country. We also have two mobile Biosafety 3 laboratories which, technically, can go into the back of beyond. It could be an outbreak in a far-flung corner of Kerala or West Bengal. The vehicle is well-equipped. It has a GPS and its own decontamination system to make it safe. Two of these were commissioned between 2021 and 2022.  And they have the blueprint to make many more. In fact, I think India has pledged to give them to other countries in the Global South.

In July 2022, the National One Health Mission was set up. This again recognizes the fact that most of the diseases that affect man come from the animal space, what we call zoonotic infection. In fact, 60 to 80 percent of infections come from the zoonotic space. When we talk of ‘one health’, we recognize the well-being of humans but also of animals and the environment. The three are very intricately linked.

The mission was set up on the recommendation of the Prime Minister’s Science and Technology Innovation Advisory Council. It recognized that we needed to take a holistic approach, which means you can’t just involve the ministry of health and family welfare. You need a cross-ministerial effort to coordinate, support and integrate anything that supports ‘one health’.

So many efforts were made in that direction. The first was to bring together more than, I think, 13 ministries and departments such as the Indian Council of Agricultural Research, Department of Animal Husbandry and Dairy and so on.

It brought together veterinarians, environmental scientists, NGOs and a range of professionals. The idea is to bring together people in a holistic effort for overall pandemic preparedness, focusing on priority diseases. And on developing early warning systems by carrying out surveillance of human livestock and wildlife spaces. This effort involves targeted research and development of important tools, not just for diagnosis, but also for therapeutics and vaccines.

It's an integrated response, working on genomic tools with which you can portend the appearance of a new variant as we saw with Covid-19. We look in depth at genomic signatures in a mixture of organisms that might come from an environment or from wastewater. That’s called metagenomics where you’re casting your net very wide.

 

Q: How much of this is in place?

During Covid-19 itself, one very good creation was INSACOG, an Indian consortium of premier government scientific institutions that were doing surveillance of SARS-CoV-2 to see genetic sequences. They bring out bulletins. Finally, they have a consortium of 54 laboratories. It is a hub and spoke model where premier government institutions form the hub and other government institutions, the spokes, provide the data. They monitored the SARS-CoV-2 genetic sequences that came from patients.

Also, the National Health Mission intends to look at the readiness of clinical care response which is very important as clinicians are our first responders. They also streamline whatever data we are generating, establishing information linkages across this very complex network, identifying what priority pathogens they will map.

They have a network of about 165 virus research diagnostic laboratories scattered over the length and breadth of the country. This was created in 2016.

Whenever there is an outbreak like, for instance, the Mpox virus, the best of these labs develop testing capacity. They’re given the reagents and they have to keep reporting if they have an Mpox case.

Likewise, if there is a threat of a Zika virus outbreak, all these labs will start Zika virus testing. There is a kind of drill that goes on. They come for training, and they are given reagents and funding to carry out testing. So, there is a network under the Indian Council of Medical Research (ICMR) and the Department of Health Research that comes under the Ministry of Health and Family Welfare that looks into priority agents that are either affecting or causing an outbreak. Or they are looking at broad syndromic outbreaks like acute febrile illness, which could be caused by a whole slew of organisms.

They are also developing medical countermeasures in select labs for the Nipah virus. It was first detected in West Bengal and then Kerala reported outbreaks.

Also, we have a disease, probably unique to India, known as the Kyasanur Forest Disease or KFD. It originated in the Shimoga forests of Karnataka. It’s not a concern for countries of the West and the developed world, but we have occasional outbreaks. People who are particularly affected are forest workers. It’s also known as monkey fever because it affects monkeys. Rodents actually transmit this virus via ticks.

The ICMR has also been performing surveillance of slaughterhouses, bird sanctuaries and wetlands. They undertook a mock drill in Ajmer in Rajasthan to assess how well this multi-ministerial effort works, if there is an outbreak of, say, avian influenza. You know, there is always this Damocles’ sword — whether it will affect human beings. Avian flu really exists in the veterinary space. But humans need to be equally concerned when they cull so many birds. The cullers or the workers who throw away potentially infected birds are at risk of picking up avian influenza. There is a screening that happens of the cullers. It is a multi-ministry effort of environment experts, veterinarians, those from the Ministry of Health and Family Welfare and so on.

Also, the National One Health Institute was an effort that was started before the pandemic, but now it has been formally inaugurated by the Prime Minister. It is situated in Nagpur. When I was director, we were working on the blueprint. Again, it will be a multi-ministry institute.

 

Q: How concerned should people be about the current Covid outbreak?

This virus has been morphing and mutating steadily over these past two or three years. It is now the Omicron Z. Variants will keep appearing. In fact, I was part of WHO’s technical committee on making a recommendation on the composition of the latest Covid vaccine. I left the committee since I don’t work on coronavirus anymore.

This virus has been morphing but, luckily, it’s also morphing because it is facing resistance put up by immune people. When there is an immune response, the virus  wants to still keep spreading between individuals so it will move a little, mutate a little. And that’s what is happening now.

It has now become mostly an agent that causes a mild respiratory illness. It does not really affect the lungs, but probably the upper respiratory tract, the throat, the sinuses — causing headache, a mild fever. It can potentially affect the elderly, those above 65 with comorbidities, so it’s not to be taken lightly.

 

Q: Is it possible for a virus in its weaker form to mutate into a form that makes it more difficult to manage?

That’s what genomic surveillance does. When there is a mutant, they sequence the strains from those who come to the hospital with severe respiratory disease. The patients who need ICU admission. They take those strains and see if the new mutant is incriminated in them. You might keep getting mutants, but you need to correlate those mutants with a sinister health manifestation.

 

Q: Should we be getting ready for another round of vaccination?

I’ve been telling government committees that the whole population does not need to be vaccinated but at least have it available so that people who, for instance,  want to go to a big gathering can get it at a subsidized rate.

At this point of time, the vaccine is not available. I hope the government is working towards it because we have the capacity to make vaccines and I think we should make it available for very sick people, or for those who just want to stay protected.

 

Q: Will the Covid vaccine keep changing every year depending on the strain currently going around, like the flu vaccine?

Globally, the efforts have been to update the vaccine based on the strains that are available. The WHO recommends the JN-1 lineage. You know, it's like a big family tree. Many companies are making different genres of JN-1.

This is available again in high-income countries. India has stopped vaccinating.  Though India was very good with the primary vaccine, that is, the first two doses, hardly one-third of the population took the booster.

But then, because the virus raged through the population, we have hybrid immunity, which is as a result of vaccinations  plus natural infection. So, the need was not felt and since there was no market, companies stopped making the vaccine. My opinion is let the companies make the updated vaccine and let people pay for it. ν