The Third Wave and the Second Dose

The Third Wave and the Second Dose
A farmer gets his first dose of COVID-19 vaccine as he ploughs his field, on Saturday 5 June 2021. [File]Mubashir Khan for Greater Kashmir

As life limps back to normal across J&K, lockdowns and restrictions waning almost completely now, there seems to be an air of conquest and complacency around. The Government appears to be basking in glory about vaccination; the people are in a hurry to reclaim lost luxuries. And clock however is ticking, possibly towards the third wave.

The cent percent achievement

There are many myths about vaccination in J&K. The first one is a ‘figurative’ one - complete vaccination in certain districts. As per J&K Government data released everyday on social media, currently there are 12 districts in J&K which have 100 percent vaccination in the 45 plus age group. “Percentage achievement above 45 years” it says while stacking 100 against Anantnag, Kulgam, Shopian, Pulwama, Baramulla, Budgam, Bandipora, Ganderbal, Jammu, Rajouri, Poonch and Samba. The 100 percent achievement has also climbed over hoardings at many places in Srinagar and Jammu. However, it is just a misleading number. In these districts, 100 percent of the population has taken the first dose of the vaccine. The second and the decisive dose is underway, and yet to cover a substantial number.

Moreover, the population has been divided into three groups for the purpose of COVID19 vaccine – below 18 years, 18 to 44 years and 45 plus years. The 45 years plus age group has been estimated to be 23 percent of the population. In this one-fourth of the population slice, just 18 percent has received the second dose till date.

Is one dose enough?

Prof Parvaiz A Koul, ex-head of department of internal and pulmonary medicine at SKIMS Soura who is an avid researcher and Vice Chairman of Middle East, Eurasia and Africa Influenza Stakeholders Network (MENA ISN) has some bitter answers. “The beginning and the first dose is good but not good enough against the variants,” he said. The recent research, he quotes, shows that one dose of AstraZeneca vaccine (CoviShield) vaccine has 18 percent efficacy against the Delta variant while the second dose takes it up to 60 percent. Even with the Pfizer vaccine, the first dose gives 30 percent protection, the second dose boosting it up to 79 percent.

“The second dose has been recommended for most of the available vaccines and data suggested till now that we need to have a second dose of the same vaccine,” he stresses. He said that the immune response to 1 dose of the vaccine is relatively weak, as per studies, even though people who got their first dose had some protection against symptomatic COVID-19 infection. It is not known what will happen if people get only 1 dose.

There is a serious concern though. “It is possible that people who get only 1 dose will have only partial immunity to COVID-19 infection, resulting in a higher risk that vaccine-resistant variants of SARS-CoV-2, the virus that causes COVID-19, will develop.”

The more dangerous one and the one that is evident from public behavior in J&K is that people who get only 1 dose will think they have sufficient protection against COVID-19 infection and there is no need to get a second dose. Prof Koul warns that there is no evidence to make us believe that people who get only 1 dose have “adequate long-term protection against COVID-19 infection”.

Something for everyone

GoI issued instructions to functionaries across states and UTs that there should be a gap of three months between the two doses. Currently, this is the practice in vogue although it has come under criticism from many quarters. Prof Koul explains what led to the change in gap between two doses from initial 28 days to 120 days now. “Arguments have been made that because COVID-19 is such a serious disease that is rapidly spreading throughout the world and because vaccines can be made and delivered at a relatively slow rate, a first dose should be given and the second dose delayed until a large amount of the population receives the first dose,” he said.

Prof M Saleem Khan, head department of social and preventive medicine at GMC Srinagar said it is always better to give every eligible person some protection rather than giving some full protection to few and leaving the majority unprotected. “In a majority of districts in Kashmir, almost all above 45 years of age have received their first jab of vaccine, especially through door to door activity or organising special vaccination drives, camps or melas,” he said.

However, he said, what remains to be planned is that after 12 weeks, all these beneficiaries require a second jab. He said the focus needs to be on arrangements that no eligible person should miss the shot and the message is communicated well enough that “the protection provided by the first shot of vaccine is around 40-50% only and with newer variants, it might provide even lesser immunity”. “We need proactive preparedness and planning to provide second jab on time so as to enable recipients achieve considerable immunity against various circulating variants of COVID causing virus,” he said.Prof Khan said efforts need to be strengthened to vaccinate the young people, 18 years and above “the majority of this big cohort is still unvaccinated”.

Too less protection in 18-44 group

As per available data, just a little about 23 percent of the population in the 18-44 year age group has received its first dose of vaccine. The remaining 77 percent are yet to get even a single dose of the vaccine. This is the largest section of the population, the 18-44, the young, mobile, productive and vulnerable. This is over 60 lakh individuals, of which 46 lakh are out there in their life-spheres without any vaccines and believing that COVID19 is over.

Dr SaleemurRehman, Director General Health, Family Welfare and Immunization feels that the Government was doing its bit and vaccines in adequate numbers were available for both the age groups across districts. “There was a brief period when we had some supply delay but it’s an old story. We are vaccinating over 40,000 people every day in J&K now,” he said. He said on some days, over a lakh doses have also been administered across the UT. He said that vaccination for this age group started as late as just two months ago and was initially “quite low” due to only two districts having vaccines for under 45. “Now it is running full-fledged and we will soon cover ground,” he said. About 40,000 people in this age group, he said, have also received their second doses of the vaccine.

Dr NaveedNazir Shah, head department of Chest Medicine at GMC Srinagar feels worried about the vulnerability of the 18-44 year age group. “They have a higher chances of getting infection firstly due to their being the most out of home section,” he said. He said that people in this age group are students or working and mix the most with other people and get infection. “Moreover, he said, these people have the propensity to spread infection among their families and in the social circles they are in,” he said.

The Vaccine Hesitancy

In the under 18 years age group, no vaccine has been permitted yet. This 24 percent of our population, as per pediatricians, would be banking much on the immunity of the elders in the family if the Third Wave hits. Prof Koul said the best protection against the likely Third Wave is a high vaccination rate among all eligible population groups. “Unfortunately India does not figure very well there especially in the 18-44 group,” he said. He said a number of issues have contributed to this ranging from “vaccine availability, to vaccine hesitancy, to vaccine misinformation, to some genuine concerns about vaccine data and a number of myths on vaccine adverse effects ranging from infertility to a sure death in 2 yrs after vaccination”.

Prof Khan has the same advice - The rumours associated with vaccination need to be refuted with sustained efforts and various youth organizations, clubs, community leaders and influencers be roped in motivate and influence the youth to achieve the target which shall help in protecting the other vulnerable groups of children under 18 years of age for whom vaccination hasn't been started yet.

“We need to ramp up our vaccinations and maintain the behavioral practices for preventing the infection. Even though the numbers have come down, COVID is not gone and going by the global trends we could be facing another wave soon. Hope I am wrong in my prediction,” said Prof Koul.

Dr Shah adds, “We witnessed almost every family getting affected in the previous two waves and the Third Wave could be all the more devastating. We can and must ensure vaccines reach and are taken by everyone. We need to ensure that everyone has and takes two doses. This is something major that we can do to help blunt the force of the Third Wave.”

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