Prevent third wave, don't wait for it, says WHO chief scientist Soumya Swaminathan

As a researcher at the National Institute for Research in Tuberculosis in Chennai, she would travel to the homes of her poor patients and even look after their orphaned children.

Life is essentially a quest for meaning for Dr Soumya Swaminathan, the World Health Organization’s first chief scientist. She has proudly taken forward the legacy of her parents—Prof M.S. Swaminathan, the architect of Green Revolution, and Mina Swaminathan, an educationist.

Each job is fulfilling in a different way, says Swaminathan, who has 30 years of experience in clinical care and research. Her role as chief scientist allows her to make a real difference in the world. “Being able to contribute to pandemic response makes my life meaningful and fulfilling,” says Swaminathan, who works out of Geneva, Switzerland. “It involves dealing with a new pathogen, working with scientists around the world, advancing clinical trials, developing standards and benchmarks for vaccines and diagnostics and reviewing guidelines.”
Her ability to articulate and dejargonise scientific terms sets her apart from other scientists. Swaminathan spent her childhood surrounded by books. But they were not all about medicine. “I loved Gerald Durrell because I love animals,” she says. “I used to read Sherlock Holmes, Jane Eyre and adventure books. I also read Agatha Christie, and a lot of Indian authors like Rabindranath Tagore. I am a huge fan of Indian literature, but after getting into medicine there was less and less time to read fiction.” She now enjoys listening to podcasts on environmental science, economics, philosophy and literature.
In an exclusive interview with THE WEEK, Swaminathan outlines what the post-pandemic world might look like. Excerpts:

What’s your biggest concern about Covid-19 right now?
My biggest concern right now is that we have not reached the stage of the pandemic where we can feel a degree of comfort.... One of our greatest fears is that new variants will arise, which will set back the progress that we have made so far.
It really concerns me that schools have been closed for more than 21 months in India. A number of children, especially from the lower socioeconomic group, will find it very difficult to go back to school. A lot of them have started working. Young girls have been married off, and some were trafficked and sold. Surveys suggest that learning losses in language and numeracy skills are significant and a concerted effort will have to be made to help children catch up.
There is a group of children who have not been able to keep up with online classes.... They need additional support during the next few months. The learning deficit is going to affect the future lives of lakhs of children.

You recently said India may be entering ‘’some stage of endemicity.’’ 

Could you explain how and when a disease becomes endemic? 

It’s an interesting question.

This is the first time where we are facing this sort of situation where we have a virus that is causing a pandemic and a huge amount of suffering, death and illness in all countries of the world. We now recognize that we may not be able to eliminate or eradicate this virus because the virus is seen not just in humans but in animals as well. WHO has been working to track down the animal reservoir of COVID-19.
It will continue to infect people. It will always find susceptible people. Of those people it infects, some of them will get ill and require hospitalization and some will die. This is true of all respiratory infections.
One of the factors that determine the endemicity is the level of immunity in the population, either due to natural infection or due to vaccination or both.

The other is the virus itself. If it changes itself to a completely new type of virus, then the preexisting immunity may not work. But let us hope that this may not happen. We hope preexisting immunity will continue to work.
As the population level immunity increases and the virus continues to spread in the community, you reach a sort of a plateau where there will be some constant infections happening with occasional localized surges but you don’t get the kind of explosive peaks that we saw in the first and second wave.

When will India reach the endemic stage?
Hopefully by the end of the year, India should be in a situation where a large majority—at least of the vulnerable population—are immunised and protected. At that stage, what will happen is that we may continue to see infections but we will not be seeing as many hospitalisation and deaths....
Around 65 per cent of India is protected. Still you have over 400 million people who are susceptible. If we stop all the other measures that have been put in place, like masking, physical distancing, ventilation and the banning of mass gatherings, the number of infections will increase.... So it is important to continue the safety measures.

Do you think children are more likely to be affected in the third wave?
There is no scientific basis for that. First of all, I do not think we should keep talking about the third wave as if it is definitely coming. The idea should be to prevent the third wave and not wait for it to come.

The situation in Kerala is baffling. It accounts for 70 per cent of Covid-19 cases in India.
I do not want to talk about Kerala specifically. When you have susceptible people and you allow social mixing and mass gatherings where people are not following precautions, then you will see such increase in cases. What is happening in Kerala may happen in other states as well. There is really nothing to stop that from happening....
The big metros were all saturated by the second wave. That is why I believe the risk of this infection spreading now are more in rural areas and in those places where the second wave was not so bad. Those are the places where the people are still susceptible, if they are not vaccinated. So it is important to strengthen vaccination in those areas where sero prevalence was low and strengthen the rural health facilities....
People should not think that because they are vaccinated, they are protected. A lot of research on Delta shows that even if you are vaccinated, the viral load in your respiratory tract will be the same as in an unvaccinated person if you get infected. The big difference is that your chances of getting ill or dying are low compared with an unvaccinated person. But the disease could still be transmitted. This is why the other measures for now are very important.

What’s happening on the vaccine front?
On the vaccine front, the news is good. There is still a lot of research and development going on. There are over a hundred candidates under clinical development. There are intranasal vaccines, oral vaccines and vaccines that can be stored at room temperature. Some of them use technologies that can be scaled rapidly and hence will be very affordable.... There may be new delivery mechanisms. We already have the DNA vaccine. It is not given by an injection. It uses an applicator on the skin which pushes the material into the skin. We are seeing lots of innovations in the delivery system.
We may also think of combinations of an injectable vaccine with an intranasal vaccine. You need both local immunity in the respiratory track and systemic immunity. Combinations could give you that advantage of mucosal as well as systemic immunity.

When is Covaxin likely to get emergency use authorisation?
Hopefully in October. The company has been responsive with all the queries.

Wealthy countries like France have started booster doses. Your thoughts.
Whether or not booster dose should be administered has to be based on science. It should not be a political decision. The decision should be based on studies with different variants on different population....

Some countries have prematurely jumped into giving boosters to their population. WHO follows the data and the evidence. When it is evident that the booster is needed, we will do the needful.
There is also the moral and ethical argument that large parts of the world have unvaccinated people who are dying while in some places booster doses are being given. If the world wants to control the pandemic and reduce the chances of variants emerging, we need to vaccinate everyone. Vaccine supplies right now are limited, even though the private sector claims there will be 11 billion doses by the end of the year. If those doses stay only in rich countries, the problem of pandemic is not going to be over. So we are urging all high-income countries to share their doses now. The WHO director general has called for a moratorium on boosters until the end of this year.
Let’s finish primary vaccination for at least 40 per cent of the world’s population before we think about boosters.

Why is it that only 3 per cent of the African population have been vaccinated? 

There were no supplies for them. Covax has been starved of supplies. High-income countries have bought all the doses from manufacturers. 

Serum Institute of India was supposed to supply 30% of the COVAX supply. That also did not come through in 2021 

Could you tell us a bit more about the gaps and challenges in the rollout of vaccines in Africa? 

Lack of supplies is a major challenge. There are problems in planning, logistics and HR. In low-income countries, there are very few health workers. They may not have cold chains. But they have all made efforts to put in place what is needed. 

What did you miss the most during the pandemic? 

Definitely the human contact. Meeting up with friends and family. 

How do you destress? 

I like being outdoors, particularly walking, cycling or any kind of physical exercise in the outdoors has been my mode of coping in the last 21 months. I also like music. I haven’t much time to read. Being able to connect with friends, even though it is remotely, has been my greatest source of support.