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1.No room for complacency: On tackling Omicron
Omicron’s mild nature is more due to the protection offered by vaccines
India recorded its first death caused by Omicron in a fully vaccinated person in Rajasthan on the last day of 2021. The 73-year-old man, with co-morbidities, had tested positive on December 15. Preliminary evidence from South Africa and the U.K. suggests that unlike the Delta variant, a majority of people with Omicron, particularly in the fully vaccinated, exhibit only mild disease; hospitalisation is relatively less among the vaccinated. A huge percentage of the population in India was infected when the Delta variant raged last year. Studies from other countries have shown that such people might enjoy the same level or even better protection from severe disease than fully vaccinated people. Hybrid immunity achieved through full vaccination in people who have been previously infected offers the highest level of protection against severe disease, as several studies outside India show. With vaccination picking up speed after the second wave peaked in India, a significant percentage of the fully vaccinated might possess hybrid immunity. Even a single dose of an mRNA vaccine in previously infected people has been found to induce a high level of hybrid immunity. If vaccination coverage with at least a single dose has already crossed 90% in those above 18 years, the rollout of vaccines for adolescents will widen the protective net. But immaterial of the protection conferred, it is too early to draw any conclusions about Omicron’s virulence. For instance, in the U.S., the first Omicron-related death was in an unvaccinated person who was previously infected. The time lag between infection and hospitalisation should be another reason why it is too early to pronounce any verdict on the virulence of the variant in India. Vulnerable populations run a risk of suffering from severe disease despite their vaccination status.
The unprecedented speed at which Omicron is spreading in countries that have high levels of testing, the number of people a single infected person can spread the virus to, and a doubling time of less than three days are a loud warning that things can go out of control soon. Mild symptoms notwithstanding, its higher transmissibility can pose a severe threat to health-care settings as a high number of infections within a short time could lead to more people needing hospital care. Overwhelmed hospitals can make it harder to provide much-needed care, leading to mounting deaths. The situation can become even more challenging when health-care settings suffer from staff shortage caused by increasing infections among health-care workers — as seen in many hospitals across India. India should learn from the hard lessons of the second wave, strictly adhere to COVID-appropriate behaviour and increase vaccination coverage. Getting misled by the mild nature of the disease and throwing caution to the wind will be a dangerous gamble.
2.Exception and exemption: On Australia denying entry to Novak Djokovic
Djokovic must clarify on the exemption he got or risk being seen as wanting an exception
Novak Djokovic being denied entry into Australia in the early hours of Thursday after his visa was cancelled following a 10-hour stand-off with the Australian Border Force (ABF) at Melbourne airport is one of sport’s most sordid tales. The World No.1 and a three-time defending Australian Open champion, also a vaccine sceptic, had secured a medical exemption from the Victorian State government and Tennis Australia — the sport’s national governing body — to circumvent a mandatory vaccination requirement to play at the season’s opening Major. But in a stunning turnaround, the Serb was stopped at the border control after ABF, which operates under the Australian government, deemed the evidence supporting his medical exemption as insufficient, sparking a diplomatic row. Faced with the prospect of deportation, Djokovic has now mounted a legal challenge, the fate of which will be known by Monday. Shorn of all the drama, this month could have been momentous for the 20-time Major winner as he is on the cusp of overtaking Roger Federer and Rafael Nadal for the most Grand Slam men’s singles titles. Melbourne is his favourite hunting ground, having won an Open Era-record nine titles there. Instead, it could end in ignominy for one of the game’s bona fide greats.
This is a saga from which no one party emerges with credit. In the past, Djokovic has disapproved of vaccine mandates for travel and play and has asked for everyone’s personal choice to be respected. But in a public health crisis, the exercise of free will comes with responsibilities and reasonable restrictions, a fact Djokovic has been unmindful of all along. In the present case, the least Djokovic could have done is to explain the nature of the exemption he sought, and got. The Australian public, of which over 90% of the over-16 population is fully vaccinated, was understandably furious, for it has endured some of the harshest lockdowns, missed birthdays, marriages and funerals of loved ones to limit the death toll to among the lowest anywhere in the world — around 2,300, as on Thursday. That said, for two independent medical boards, one formed by Tennis Australia and the other by Victoria, to approve a medical exemption that cannot pass muster with its own federal authorities raises considerable doubt. For Australian Prime Minister Scott Morrison to take a hard-line stance on Djokovic’s participation, a day after leaving the decision in the hands of the State government, indicated that he was aware which way the political wind was blowing. The centre-right government has seen its popularity slump in recent months, as it has struggled to halt the unending cycle of rising cases and lockdowns. It will be sad if Djokovic becomes a political football, whether or not he pushed the envelope.
3.Up the vax game: India should consider relaxing conditions for both third dose for adults and kids’ jabs
That the precautionary dose will not be a mix and match programme resolves worries of supply constraints. Nearly 90% of vaccine recipients have been jabbed with abundantly available Covishield, and even under-performing Bharat Biotech should have enough for third doses of those double-dosed with Covaxin. Right now, there are 18.4 crore unused doses supplied to states. And SII has said it has no problems stepping up Covishield production.
However, the booster programme could have been more ambitious, instead of restricting eligibility to only those who got their second dose nine months ago. Given comfortable vaccine supply, if the gap was reduced to six months, as many global studies on immunity have suggested it should be, and if the eligible group was 45 and above, many more people would be third-dosed much faster. To take the example of January 10, when the booster programme launches, the nine-month gap makes only 1.26 crore people who received second doses by April 10, 2021 eligible. But relaxing the parameters – to a six-month gap for those 45 years and above – would make as many as 6.8 crore people eligible for the third dose on the exact same day.
GoI has cited studies pointing to immunity lasting for nine months after the second jab. A UK Health Security Agency study shows that a third shot has 88% protection from hospitalisation against the Omicron variant while this drops to 52% for those who got their second jab over six months ago. It may be worth India’s while to reassess the cutoff date and age ceiling soon. One understands the reason behind starting cautiously, but Covid often changes assumptions and priorities.
Similarly, GoI must also look at progressively relaxing the age bar for child vaccination – 1.27 crore children in the 15-18 age group have been jabbed in three days, raising the possibility of covering this cohort very quickly. Covaxin has been approved for those over 12 and trials have been conducted for children over 2. Unless there is a Covaxin production shortage, clearance for vaccinating all children above 12 must come soon. Remember, other countries have moved on to booster doses for children.
In the long run, the booster programme will have a wider bouquet if mix and match trials on BB’s intranasal vaccine and Corbevax are effective and show tolerable reactogenicity. Covovax booster trials will also be key given SII’s proven ability to ramp up production. Given how every surge is hurting economic activities, GoI must widen and deepen the vaccination coverage, and be always prepared to revise guidelines.
4.January 6 anniversary spotlights America’s gaping post-truth wounds
A telling aftereffect of last year’s January 6 riot is how seriously America now debates whether it is headed towards a civil war, not metaphorically but literally. Some of this does look like mere alarmism, especially given the way in which various national institutions have both defended the presidential election of November 3, 2020 and prosecuted the subsequent invasion of the US Capitol.
But between the continuing hold of Donald Trump on the Republican Party even as he continues to insist that “the real insurrection … took place on November 3rd”, and the fact that an extremely marginalized Liz Cheney was the only Republican lawmaker to join in a moment of silence in the House chamber to mark the first anniversary of the January 6 riot yesterday, there are abundant signs of how deep remains what President Joe Biden yesterday called “a dagger at the throat of our democracy”.
How America holds together is of course of interest not just to itself, but also the entire world. That it has been a beacon of democracy is a truism, although we must understand democracy here as a journey rather than destination. America is still rich in resources for self-correction, to heal the most gaping social and economic wounds. But no “shining city on a hill” can be built upon post-truth politics and today it is Republicans who need to take the lead in fixing this ulcer. They must step up.